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Pepino C, Malerba F, Biagioli V, D’Ambrosio T, Zampatti N, Canzoneri F, Ferro J, Crocco M. SARS-CoV-2 Vaccination Coverage in Italian Children with Celiac Disease. J Clin Med 2024; 13:5851. [PMID: 39407910 PMCID: PMC11477183 DOI: 10.3390/jcm13195851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/23/2024] [Accepted: 09/24/2024] [Indexed: 10/20/2024] Open
Abstract
Background: Celiac disease (CD) is the most common multisystemic autoimmune disorder affecting the pediatric population. However, little data is available regarding SARS-CoV-2 vaccination coverage in pediatric patients with CD. This study aims to evaluate the adherence to national recommendations for SARS-CoV-2 vaccination in children and adolescents with CD and its variation over time. Methods: We retrospectively analyzed medical charts and electronic registry records of SARS-CoV-2 vaccination of patients aged 0-19 years diagnosed with CD in a tertiary center. The vaccination coverage was evaluated according to age groups (young children, children, and adolescents), considering the patients' eligibility for vaccination at different times. Results: Among the 172 patients enrolled, 44.8% received at least one dose of the SARS-CoV-2 vaccine, showing no significant differences compared to the Italian population of similar age. Vaccination coverage demonstrated a progressive reduction after an initial peak (up to 65.5% in December 2021) concomitant with a gradual extension of vaccinable eligibility and falling SARS-CoV-2 infections. Histological diagnosis and the presence of other associated autoimmune diseases were associated with higher levels of adherence to vaccination. Conclusions: Adherence to the SARS-CoV-2 vaccination in young Italian children with CD was very low, while it was better in adolescents and patients with other associated autoimmune diseases. Vaccine hesitancy remains a concern, particularly among those diagnosed using the biopsy-sparing approach. Hesitancy increased during the pandemic period, suggesting the need for ongoing efforts to improve adherence to SARS-CoV-2 vaccination recommendations.
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Affiliation(s)
- Carlotta Pepino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health, University of Genova, 16100 Genova, Italy; (C.P.); (F.M.); (V.B.); (N.Z.); (F.C.)
| | - Federica Malerba
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health, University of Genova, 16100 Genova, Italy; (C.P.); (F.M.); (V.B.); (N.Z.); (F.C.)
- Paediatric Clinic, University of Ferrara, 44124 Ferrara, Italy;
| | - Valentina Biagioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health, University of Genova, 16100 Genova, Italy; (C.P.); (F.M.); (V.B.); (N.Z.); (F.C.)
| | | | - Noemi Zampatti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health, University of Genova, 16100 Genova, Italy; (C.P.); (F.M.); (V.B.); (N.Z.); (F.C.)
| | - Francesca Canzoneri
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health, University of Genova, 16100 Genova, Italy; (C.P.); (F.M.); (V.B.); (N.Z.); (F.C.)
| | - Jacopo Ferro
- Pathology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Marco Crocco
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
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Greberman E, Kerrison EMT, Chalfin A, Hyatt JM. Understanding Vaccine Hesitancy in U.S. Prisons: Perspectives from a Statewide Survey of Incarcerated People. Vaccines (Basel) 2024; 12:600. [PMID: 38932328 PMCID: PMC11209440 DOI: 10.3390/vaccines12060600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/21/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024] Open
Abstract
Much of the American response to the COVID-19 pandemic was characterized by a divergence between general public opinion and public health policy. With little attention paid to individuals incarcerated during this time, there is limited direct evidence regarding how incarcerated people perceived efforts to mediate the harms of COVID-19. Prisons operate as a microcosm of society in many ways but they also face unique public health challenges. This study examines vaccine hesitancy-and acceptance-among a sample of individuals incarcerated within adult prisons in Pennsylvania. Using administrative records as well as rich attitudinal data from a survey of the incarcerated population, this study identifies a variety of social and historical factors that are-and are not-associated with an incarcerated person's willingness to receive the COVID-19 vaccine. Our findings highlight vaccination challenges unique to the carceral context and offer policy recommendations to improve trust in credible health messengers and health service provision for this often overlooked but vulnerable population.
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Affiliation(s)
- Emily Greberman
- School of Criminal Justice, Rutgers University, Newark, NJ 07102, USA
| | | | - Aaron Chalfin
- Department of Criminology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Jordan M. Hyatt
- Department of Criminology & Justice Studies, Center for Public Policy, Drexel University, Philadelphia, PA 19104, USA;
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Wang D, Li L, Ma X, Lin Y, Chen L, Arigonggaowa, Peng X, Shi J, Yang J, Ju R, Li Z, Cao J, Liu C, Feng Z, Li Q. Receipt of COVID-19 vaccine in preterm-born children aged 3-7 in China. Front Public Health 2023; 11:1191941. [PMID: 37546314 PMCID: PMC10400273 DOI: 10.3389/fpubh.2023.1191941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/20/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives To determine the COVID-19 vaccination rate in preterm-born children aged 3-7 in China and influential factors, identify vaccination-related adverse reactions, and clarify reasons behind parental refusal of vaccination to their children. Methods This cross-sectional study was conducted in parents of preterm-born children aged 3-7 in different regions of China through WeChat. Results Of 1,924 Chinese preterm-born children aged 3-7 included in this study, 1,552 (80.7%) had been vaccinated against COVID-19, with a higher vaccination rate in eastern China. Children older than 4 years, kids in kindergartens and primary schools, children living in eastern or western China, and children whose fathers had received at least one dose of a COVID-19 vaccine tended to be vaccinated against COVID-19 after adjusting for other covariates. Conversely, children living in urban areas, children whose annual family income was < 50,000 CNY or more than 300,000 CNY, premature children who underwent hospital transfers, and children with underlying diseases were less likely to get vaccinated. Adverse reactions occurred in 59/1,552 (3.8%) vaccinated children. Parents of 118/372 (31.7%) children expressed their concerns over adverse reactions to COVID-19 vaccination. Other reasons like the absence of information about the place where they could get vaccination were mentioned as well. Conclusions COVID-19 vaccination-related adverse reactions rarely occurred and most of them were mild among preterm-born children aged 3-7. Higher vaccination coverage can be achieved as parents are provided with more scientific data about benefits of vaccination, vaccination contraindications and precautions, and more information about vaccination sites.
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Affiliation(s)
- Dan Wang
- Newborn Intensive Care Unit, Faculty of Pediatrics, The Seventh Medical Center of Chinese People's Liberation Army (CPLA) General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Li Li
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Xiaofeng Ma
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yunfeng Lin
- Department of Neonatology, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Department of Neonatology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research (Fujian Maternity and Child Health Hospital), Fuzhou, China
| | - Liping Chen
- Newborn Intensive Care Unit, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Arigonggaowa
- Department of Neonatology, Inner Mongolia Maternal and Child Health Hospital, Hohhot, China
| | - Xianglian Peng
- Department of Neonatology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Jingyun Shi
- Department of Neonatology, Gansu Provincial Maternal and Child Hospital, Lanzhou, China
| | - Jie Yang
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rong Ju
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhankui Li
- Department of Neonatology, Northwest Women's and Children's Hospital (Maternal and Child Health Care Hospital of Shaanxi Province), Xi'an, China
| | - Jingke Cao
- Newborn Intensive Care Unit, Faculty of Pediatrics, The Seventh Medical Center of Chinese People's Liberation Army (CPLA) General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Changgen Liu
- Newborn Intensive Care Unit, Faculty of Pediatrics, The Seventh Medical Center of Chinese People's Liberation Army (CPLA) General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhichun Feng
- Newborn Intensive Care Unit, Faculty of Pediatrics, The Seventh Medical Center of Chinese People's Liberation Army (CPLA) General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Qiuping Li
- Newborn Intensive Care Unit, Faculty of Pediatrics, The Seventh Medical Center of Chinese People's Liberation Army (CPLA) General Hospital, Beijing, China
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Yoshida M, Kobashi Y, Shimazu Y, Saito H, Yamamoto C, Kawamura T, Wakui M, Takahashi K, Ito N, Nishikawa Y, Zhao T, Tsubokura M. Time course of adverse reactions following BNT162b2 vaccination in healthy and allergic disease individuals aged 5-11 years and comparison with individuals aged 12-15 years: an observational and historical cohort study. Eur J Pediatr 2023; 182:123-133. [PMID: 36224435 PMCID: PMC9556290 DOI: 10.1007/s00431-022-04643-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 01/21/2023]
Abstract
UNLABELLED We aimed to investigate the type and frequency of adverse events over 7 days following the first and second BNT162b2 vaccination. This observational and historical cohort study included patients aged 5-11 years who received two doses of BNT162b2 and provided consent along with their guardians. We collected data on sex, age, height, weight, blood type, history of Bacille Calmette-Guerin vaccination, allergic disease, medication, history of coronavirus disease 2019 (COVID-19), and adverse reactions 7 days following the first and second BNT162b2 vaccination using a questionnaire. Our results were compared with previously reported results for individuals aged 12-15 years. A total of 421 participants were eligible for this study. Among the 216 patients with allergic disease, 48 (22.2%) had experienced worsening of their chronic diseases, and the frequency of fatigue and dizziness after the second dose was higher than that of healthy individuals. The experience of systemic adverse reactions was associated with asthma. The frequency of headache, diarrhea, fatigue, muscle/joint pain, and fever after the second BNT162b2 vaccination was lower in individuals aged 5-11 years than in those aged 12-15 years. Fever was the only systemic adverse reaction that lasted longer than 5 days (1.0% of participants). CONCLUSIONS Individuals with allergic diseases, who are potentially susceptible to COVID-19, may experience worsening of their chronic diseases and more frequent adverse reactions after BNT162b2 vaccination than healthy individuals. To ensure that children with allergic diseases receive the vaccine safely, further information needs to be collected. WHAT IS KNOWN • Adverse reactions after BNT162b2 vaccination among individuals aged 5-11 years are generally nonserious, more common after second vaccination, and substantially less common compared to those observed among individuals aged 12-15 years. WHAT IS NEW • Individuals with allergic diseases experienced worsening of their chronic diseases and more frequent adverse reactions after BNT162b2 vaccination than healthy individuals. • Systemic adverse reactions were associated with asthma. Fever was the only systemic adverse reaction that lasted longer than 5 days.
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Affiliation(s)
- Makoto Yoshida
- Faculty of Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yurie Kobashi
- Department of Internal Medicine, Serireikai Group Hirata Central Hospital, Ishikawa District, Fukushima, Japan. .,Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan.
| | - Yuzo Shimazu
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Hiroaki Saito
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Chika Yamamoto
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Takeshi Kawamura
- Isotope Science Centre, The University of Tokyo, Bunkyo-ku, Tokyo, Japan ,Laboratory for Systems Biology and Medicine, Research Centre for Advanced Science and Technology (RCAST), University of Tokyo, Meguro-ku, Tokyo, Japan
| | - Masatoshi Wakui
- Department of Laboratory Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kenzo Takahashi
- Teikyo University Graduate School of Public Health, Itabashi-ku, Tokyo, Japan ,Department of Pediatrics, Jyoban Hospital, Iwaki Fukushima, Japan
| | - Naomi Ito
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Yoshitaka Nishikawa
- Department of Internal Medicine, Serireikai Group Hirata Central Hospital, Ishikawa District, Fukushima, Japan
| | - Tianchen Zhao
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Masaharu Tsubokura
- Department of Internal Medicine, Serireikai Group Hirata Central Hospital, Ishikawa District, Fukushima, Japan ,Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan ,Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima Japan
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ElSayed DA, Bou Raad E, Bekhit SA, Sallam M, Ibrahim NM, Soliman S, Abdullah R, Farag S, Ghazy RM. Validation and Cultural Adaptation of the Parent Attitudes about Childhood Vaccines (PACV) Questionnaire in Arabic Language Widely Spoken in a Region with a High Prevalence of COVID-19 Vaccine Hesitancy. Trop Med Infect Dis 2022; 7:234. [PMID: 36136645 PMCID: PMC9504773 DOI: 10.3390/tropicalmed7090234] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
The parents’ attitude toward vaccinating children and adolescents against coronavirus disease 2019 (COVID-19) remains inconsistent and needs further elucidation. The high rates of COVID-19 vaccine hesitancy in the Middle East and North Africa (MENA) region require intensive research to understand the determinants of this phenomenon. This study aimed to validate a version of the Parent Attitudes about Childhood Vaccines (PACV) tool in Arabic, the most widely spoken language in the MENA. The study objectives included the investigation of Arab-speaking parents’ views regarding COVID-19 vaccination of their children. Parents living in Egypt with at least one child aged 5−18 years were eligible to participate in the study that was conducted through an online survey with 15 PACV items. The PACV tool was translated into Arabic using forward and backward translation. To assess the psychometric properties of the Arabic version of PACV, Pearson’s correlation coefficient and exploratory and confirmatory factor analysis (EFA and CFA) were performed. A total of 223 parents participated in the study: 59.82% aged 30−39 years, 69.20% were females, 46.19% were university-educated, and 40.63% had one child. The overall Cronbach’s alpha for the Arabic version of PACV was 0.799. The EFA of the 15 items showed that three domains were most conceptually equivalent. All items had a positive significant correlation with the mean score of each subscale except for item 4 (r = 0.016, p = 0.811). Regression analyses results indicated that education, previous COVID-19 infection, vaccine status of parents, and PACV score were significantly associated with the intention of the parents to vaccinate their children against COVID-19. The CFA results showed that most of the factor loadings were statistically significant (p < 0.010) except for items 4 and 7. However, the root mean square error of approximation (RMSEA = 0.080) and the standardized root mean squared residual (SRMR = 0.080) indicated that the model had a reasonable fit, and the three factors were good in reproducing each correlation. Our study results indicated the validity and reliability of the PACV instrument in Arabic language. Consequently, the PACV can be used to assess COVID-19 vaccine hesitancy in a majority of MENA countries for better delineation of this highly prevalent phenomenon in the region.
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Affiliation(s)
- Doaa Ali ElSayed
- Family Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
| | - Etwal Bou Raad
- School of Pharmacy, Lebanese International University, Beirut 961, Lebanon
| | - Salma A. Bekhit
- Environmental Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22184 Malmö, Sweden
| | - Nada M. Ibrahim
- Nutrition Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
| | - Sarah Soliman
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
| | - Reham Abdullah
- Infectious Disease Residency Program, Egyptian Ministry of Health and Population, Cairo 71529, Egypt
| | - Shehata Farag
- Biostatistics Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
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Buonsenso D, Valentini P, Macchi M, Folino F, Pensabene C, Patria MF, Agostoni C, Castaldi S, Lecce M, Giannì ML, Marchisio P, Milani GP. Caregivers' Attitudes Toward COVID-19 Vaccination in Children and Adolescents With a History of SARS-CoV-2 Infection. Front Pediatr 2022; 10:867968. [PMID: 35463893 PMCID: PMC9021633 DOI: 10.3389/fped.2022.867968] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/03/2022] [Indexed: 12/28/2022] Open
Abstract
Background Limited data are available on the attitudes of caregivers toward COVID-19 vaccination in children and adolescents with a history of SARS-CoV-2 infection or Long Covid symptoms. The aim of this study was to investigate the vaccine hesitancy among caregivers of children and adolescents with a documented history of SARS-CoV-2 infection and to explore the possible associations between COVID-19 manifestations and the acceptance of the vaccine. Methods Caregivers of children or adolescents with a microbiologically confirmed diagnosis of SARS-CoV-2 infection evaluated in two University Hospitals were interviewed. Results We were able to contact 132 caregivers and 9 declined to participate. 68 caregivers (56%) were in favor of COVID-19 vaccination for their child. In the multiple logistic regression, child's age (OR 1.17, 95%CI 1.06-1.28) and hospitalization due to COVID-19 (OR 3.25, 95%CI 1.06-9.95) were positively associated with being in favor of COVID-19 vaccination. On the contrary, the occurrence of child's Long Covid was associated with a higher likelihood of being against the vaccination (OR 0.28, 95%CI 0.10-0.80). Conclusions This preliminary study shows that only about half of the interviewed parents of children and adolescents with a previous SARS-CoV-2 infection are willing to vaccinate them to prevent a repeated COVID-19 infection. These findings might help healthcare workers to provide tailored information to caregivers of children with a previous SARS-CoV-2 infection.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli”, Rome, Italy
- Center for Global Health Research and Studies, Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli”, Rome, Italy
- Center for Global Health Research and Studies, Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marina Macchi
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Francesco Folino
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Carola Pensabene
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Unit, Milan, Italy
| | | | - Carlo Agostoni
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Unit, Milan, Italy
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, Postgraduate School of Public Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Lecce
- Department of Biomedical Sciences for Health, Postgraduate School of Public Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Lorella Giannì
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Unit, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gregorio P. Milani
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Unit, Milan, Italy
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