Knowledge, attitudes, and practices of General Practitioners from the Province of Parma (Northern Italy) towards vaccinations in adults ≥ 65 year-old

Knowledge, attitudes and practices survey towards pneumococcal infection and vaccination among primary health care physicians, Ukraine, 2021

BACKGROUND

The Ukrainian Ministerial Order (UMO) recommends pneumococcal vaccine (PCV) in risk groups but not free-of-charge resulting in coverage <5% (crude estimation). In 2022, the vaccination calendar will include PCV for children <5years. Doctors' pneumococcal knowledge, attitudes and practices (КAP) are paramount to successful roll-out but unexplored. We surveyed doctors aiming to assess their KAP to address gaps and misconceptions and support PCV implementation.

METHODS

In March 2021, we selected and surveyed primary care doctors using simple random sampling and structured self-administered online questionnaire. We measured attitudes (importance, effectiveness, safety) and practices using 5-point Likert-type questions. We defined pneumococcal disease (PD) knowledge as low/moderate (<80%) and high (≥80%), PCV and overall knowledge as low (≤50%) and moderate/high (51-100%) and PCV attitudes and practices as negative/neutral (1.0-3.4) and positive (3.5-5.0). We calculated prevalence ratios (PRs) and 95% confidence intervals (95%CI) using Poisson regression.

RESULTS

The response rate was 46% (286/628). Females represented 85% (243/285); the median age was 47 (interquartile range: 33-59, N = 281) years. Twenty-six percent (72/277) had high PD knowledge associated with age (>47 years: PR = 0.52, 95%CI: 0.30-0.90) and child-related UMO awareness (PR = 1.78, 95%CI: 1.04-3.08); 65% (182/278) had moderate/high PCV knowledge associated with positive attitudes towards PCV effectiveness (PR = 2.08, 95%CI: 1.20-3.59). Overall knowledge was moderate/high in 69% (188/271); 83% (220/265) had positive PCV attitudes; 52% (135/258) had positive practices associated with female sex (PR = 2.11, 95%CI: 1.09-4.09), positive attitudes (PR = 3.40, 95%CI: 1.23-9.39) and perception of vaccine supply as medium/big barrier (PR = 1.66, 95%CI: 1.02-2.72).

CONCLUSION

We observed moderate pneumococcal knowledge, especially in older doctors, positive PCV attitudes and neutral practices. Females and doctors with positive attitudes recommended PCV more. For successful PCV implementation, we recommend proper planning and prior educational activities targeting patients and primary care doctors, especially older males, to improve knowledge, introduce PCV and address concerns while ensuring uninterrupted vaccine supply.

Willingness to Vaccinate Against Herpes Zoster and Its Associated Factors Across WHO Regions: Global Systematic Review and Meta-Analysis

BACKGROUND

A life-course immunization approach would enhance the quality of life across all age groups and improve societal well-being. The herpes zoster (HZ) vaccine is highly recommended for older adults to prevent HZ infection and related complications. The proportions of willingness to receive the HZ vaccine varies across countries, and various kinds of factors, including sociodemographics and individual perceptions, influence the willingness to vaccinate.

OBJECTIVE

We aim to estimate the HZ vaccination willingness rate and identify factors associated with vaccine uptake willingness across all World Health Organization (WHO) regions.

METHODS

A global systematic search was performed on PubMed, Web of Science, and the Cochrane Library for all papers related to the HZ vaccine published until June 20, 2022. Study characteristics were extracted for each included study. Using double arcsine transformation, vaccination willingness rates with 95% CIs were pooled and reported. The willingness rate and associated factors were analyzed by geographical context. Associated factors were also summarized based on Health Belief Model (HBM) constructs.

RESULTS

Of the 26,942 identified records, 13 (0.05%) papers were included, covering 14,066 individuals from 8 countries in 4 WHO regions (Eastern Mediterranean Region, European Region, Region of the Americas, and Western Pacific Region). The pooled vaccination willingness rate was 55.74% (95% CI 40.85%-70.13%). Of adults aged ≥50 years, 56.06% were willing to receive the HZ vaccine. After receiving health care workers' (HCWs) recommendations, 75.19% of individuals were willing to get the HZ vaccine; without HCWs' recommendations, the willingness rate was only 49.39%. The willingness rate was more than 70% in the Eastern Mediterranean Region and approximately 55% in the Western Pacific Region. The willingness rate was the highest in the United Arab Emirates and the lowest in China and the United Kingdom. The perception of HZ severity and susceptibility was positively associated with vaccination willingness. The perceived barriers to vaccination willingness (main reasons for unwillingness) included low trust in the effectiveness of the HZ vaccine, concerns about safety, financial concerns, and being unaware of the HZ vaccine's availability. Older individuals, those having lower education, or those having lower income levels were less likely to willing to be vaccinated.

CONCLUSIONS

Only 1 in 2 individuals showed a willingness to be vaccinated against HZ. The willingness rate was the highest in the Eastern Mediterranean Region. Our findings show the critical role HCWs play in promoting HZ vaccination. Monitoring HZ vaccination willingness is necessary to inform public health decision-making. These findings provide critical insights for designing future life-course immunization programs.

Understanding Primary Care Physician Vaccination Behaviour: A Systematic Review

BACKGROUND

Vaccine hesitancy decreases adult vaccination coverage and has been recognized by WHO as a major health threat. Primary care physicians (PCP) play a key role in vaccination by giving vaccine counselling to their patients. The aim of this systematic review is to identify the knowledge, beliefs, attitudes and barriers (KBAB) associated with own vaccination and patient recommendation in primary care physicians.

METHODS

MEDLINE/PubMed, EMBASE and Cochrane Library databases were used to search and identify relevant studies based on their title and abstract. In the next step, the full text of each previously selected article was read for eligibility. Articles were selected by two independent reviewers and data extraction was performed using tables. The following information was extracted: methodological characteristics, demographic factors, professional characteristics, and intrinsic or extrinsic factors influencing vaccination or recommendation.

RESULTS

Our search yielded 41 eligible papers, data-sources, previous practices, belief in the effectiveness or safety of the vaccine, perceived risk, and trust in health authorities were all shown to be related to own vaccination and patient recommendation.

CONCLUSION

Internet is the main source of information for PCP related to vaccine hesitancy. It is therefore essential to increase the presence and access to pro-vaccination content in this area. In addition, involving PCP in the establishment of vaccination recommendations could improve their credibility in the institutions. On the other hand, training in communication skills and establishing reminder systems could reflect higher vaccination coverage among their patients.

Vaccinating Front-Line Healthcare Workers: Results of a Pre-Pandemic Cross-Sectional Study from North-Eastern Italy on First Responders

First responders are front-line healthcare workers who are potentially exposed to different infectious agents. Characterizing their knowledge, attitudes, and practices (KAP) towards immunization, therefore, has the potential to significantly improve occupational health and safety. A cross-sectional study was performed in October 2018 using a sample of 161 first responders from the Parma Province (mean age 45.1 ± 14.1 years; seniority 10.8 ± 8.6 years). The participants were questioned on three recommended vaccinations (i.e., the seasonal influenza, measles, and pertussis vaccines) and on meningococcal vaccines (not officially recommended for first responders). The participant’s knowledge status and risk perception were assessed as percentage values through a specifically designed questionnaire. Adjusted odds ratios (aOR) for factors associated with vaccination status were calculated by means of a binary logistic regression analysis. The internal consistency result, calculated using a general knowledge test, was good (Cronbach’s alpha = 0.894), but the corresponding score was unsatisfying (46.5% ± 32.4), evidencing uncertainties surrounding the recommendations for measles and meningococcal vaccines (39.1% and 34.2% incorrect answers, respectively). While the large majority of respondents were favorable towards the meningococcal (89.4%), measles (87.5%), and pertussis vaccines (83.0%), 55.3% exhibited a favorable attitude toward the seasonal influenza vaccine, the uptake of which in 2018, was reported by 28.0% of respondents, compared to the self-reported lifetime status for meningitis (26.1%), measles (42.2%), and pertussis (34.8%). Not coincidentally, all assessed infections were associated with a low-risk perception score, particularly influenza (33.9% ± 18.4). Interestingly enough, neither knowledge status nor risk perception were associated with vaccination rates. More precisely, the main predictor for being vaccinated against seasonal influenza in 2018 was a seniority of ≥10 years (aOR 3.26, 95% confidence interval [95% CI] 1.35–7.91), while both pertussis and measles were positively associated with higher educational achievement (aOR 3.27, 95%CI 1.29–8.30; and aOR 2.69, 95%CI 1.09–6.65, respectively). The reasons for vaccination gaps among the sampled first responders, apparently, did not find their roots in inappropriate knowledge status and risk perception alone. However, the very low rates of sampled immunization lead us to recommend stronger and more appropriate information campaigns.

Healthcare Providers' Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review

Despite vaccines' effectiveness in reducing the rate of preventable diseases, vaccine hesitancy has threatened public health and economies worldwide. Healthcare providers' (HCP) communications and behavior strongly influence patient receptivity and uptake. The goal of this review was to examine HCP vaccine perceptions, knowledge, and reservations and how these attitudes affect their recommendations and vaccination practices. Primary research studies published by 16 September 2020 were searched in PubMed, Web of Science, Embase, CINAHL, and PsycINFO. A 14-item scale was developed for survey study and risk of bias appraisal (SSRBA). In total, 96 papers from 34 countries were included, covering 17 vaccines (HPV and influenza vaccines the most studied). Recommendation was positively associated with provider knowledge and experience, beliefs about disease risk, and perceptions of vaccine safety, necessity, and efficacy. HCP vaccination attitudes and practices varied across specialties, vaccines, and countries; demographic impact was inconclusive. Barriers included anticipation of patient/parental concerns or refusal, lacking clear guidelines, time constraints, and cost. For HPV, vaccines were more often recommended to older, female adolescents and by physicians who discussed sexual health. HCPs are vital advocates for patients and the public, but studies indicated a prevalence of provider hesitancy pertaining to inadequate knowledge, low vaccine confidence, and suboptimal uptake themselves. Improving HCP knowledge and assuring their access to information they deem trustworthy are essential to supporting HCPs' role as "trusted messengers" to promote vaccine acceptance.

Prevalence of Huntington Disease in Italy: a systematic review and meta-analysis

Worldwide prevalence of Huntington’s disease (HD) is quite heterogenous. As Italy is characterized by significant genetic heterogeneity, with presumptive differences between Italian regions, this review was undertaken to define available data of HD prevalence in Italy, to assess geographic heterogeneity, and reconcile possible variation in HD prevalence rates with the availability of genetic testing.

Vaccines are underused in pregnancy: what about knowledge, attitudes and practices of providers?

Introduction.

To investigate actual knowledge of official recommendations towards seasonal influenza (SID), and Tetanus-diphtheria acellular-pertussis (Tdap) vaccines in obstetrics/gynecologists (OBGYN).

Methods.

PubMed and EMBASE databases were searched. A meta-analysis was performed to calculate odds ratio (OR) and 95% confidence interval (CI) among case controls, cross-sectional studies, either questionnaire or laboratory exams based.

Results.

A total of 6 studies met inclusion criteria, including 1323 OBGYN from 5 different countries. Overall, around 99% of sampled professionals were aware that official recommendations towards SID in pregnancy do exist, compared to 92% for Tdap, with significant heterogeneity (I² > 95%, p < 0.001). Concerns about vaccine safety was reported by 10% of respondents for Tdap, and by 6.0% for SID, but again available studies were substantially heterogenous (I² = 86.7% and 86.0%, p < 0.001). Eventually, 93% of respondents actively recommended SID in pregnancy, compared to 88% for Tdap (I² 98.8% and I² 95.9%, respectively p < 0.001). The evidence of significant publication bias was initially subjectively identified from the funnel plot, and then objectively confirmed through the regression test for all analyses.

Conclusions.

These results suggest an appropriated understanding of official recommendation among sampled OBGYN, with high shares of professionals actively promoting vaccination practices among their patients. Despite the high heterogeneity and the significant publication bias we identified, our results also hint towards extensive knowledge gaps of OBGYN, and particularly regarding unmotivated concerns about vaccine safety. As a consequence, appropriate information and formation campaigns should be appropriately tailored. (www.actabiomedica.it)