Japanese Encephalitis can be devastating

Abstract

Japanese encephalitis, caused by the JE virus transmitted by mosquitoes, is the most common type of epidemic encephalitis in Asia. It is endemic in most of South and Southeast Asia, but the number of cases can vary greatly between areas. While many infections do not lead to disease, the symptomatic cases can be very severe and life-threatening. It mainly affects children, whereas adults are generally immune to the disease due to either being infected in childhood or receiving vaccination. However, individuals who are not immune, such as travelers from non-endemic countries, are susceptible to the disease when exposed to the virus for the first time, regardless of age. Without antiviral treatment options, vaccination is the only strategy to establish effective protection against Japanese encephalitis.

Perspectives in the Development of Tools to Assess Vaccine Literacy

Vaccine literacy (VL) is the ability to find, understand, and evaluate vaccination-related information to make appropriate decisions about immunization. The tools developed so far for its evaluation have produced consistent results. However, some dimensions may be underestimated due to the complexity of factors influencing VL. Moreover, the heterogeneity of methods used in studies employing these tools hinders a comprehensive understanding of its role even more. To overcome these limitations, a path has been sought to propose new instruments. This has necessitated updating earlier literature reviews on VL and related tools, exploring its relationship with vaccine hesitancy (VH), and examining associated variables like beliefs, attitudes, and behaviors towards immunization. Based on the current literature, and supported by the re-analysis of a dataset from an earlier study, we propose a theoretical framework to serve as the foundation for creating future assessment tools. These instruments should not only evaluate the psychological factors underlying the motivational aspect of VL, but also encompass knowledge and competencies. The positioning of VL in the framework at the intersection between sociodemographic antecedents and attitudes, leading to behaviors and outcomes, explains why and how VL can directly or indirectly influence vaccination decisions by countering VH and operating at personal, as well as at organizational and community levels.

COVID-19 vaccine literacy: A scoping review

To address vaccine hesitancy, specific self-rated tools have been developed to assess vaccine literacy (VL) related to COVID-19, including additional variables, such as beliefs, behavior, and willingness to be vaccinated. To explore the recent literature a search was performed selecting articles published between January 2020 and October 2022: 26 papers were identified using these tools in the context of COVID-19. Descriptive analysis showed that the levels of VL observed in the studies were generally in agreement, with functional VL score often lower than the interactive-critical dimension, as if the latter was stimulated by the COVID-19-related infodemic. Factors associated with VL included vaccination status, age, educational level, and, possibly, gender. Effective communication based on VL when promoting vaccination is critical to sustaining immunization against COVID-19 and other communicable diseases. The VL scales developed to date have shown good consistency. However, further research is needed to improve these tools and develop new ones.

Vaccine Literacy and Source of Information about Vaccination among Staff of Nursing Homes: A Cross-Sectional Survey Conducted in Tuscany (Italy)

Vaccine literacy (VL) mediates the transfer of information and facilitates vaccination acceptance. The aims of this study are to validate the HLVa-IT (Health Literacy Vaccinale degli adulti in Italiano—Vaccine health literacy for adults in Italian language) for the staff of nursing homes (NHs), to measure VL in such a peculiar target group, and to assess its relationship with the sources used to obtain information about vaccines and vaccinations. A survey has been conducted in a sample of Tuscan NHs using an online questionnaire. Eight-hundred and fifty-three questionnaires were analyzed. Two dimensions of the HLVa-IT appeared (functional and interactive/communicative/critical VL). The HLVa-IT interactive/communicative/critical subscale score was slightly higher than the functional subscale, although with no statistical significance. General practitioners (GPs) or other professionals have been reported as the main source of information by most of the respondents (66.1%). The HLVa-IT total score was significantly higher among those who have declared to use official vaccination campaigns (mean score: 3.25 ± 0.49; p < 0.001), GPs or other health professionals (3.26 ± 0.47; p < 0.001), and search engines (3.27 ± 0.48; p = 0.040) as the main sources of information. In conclusion, the HLVa-IT could be reliable test to investigate VL for staff of NHs, and also to highlight criticalities related to information sources.

A survey about the degree of information and awareness of adolescents regarding vaccination in a Province of Central Italy

BACKGROUND

Understanding the level of awareness in adolescents on the value of vaccination is kay to developing a proper culture of prevention to counter vaccine hesitancy and the decrease in vaccination coverages.

STUDY DESIGN

The aim of the survey was to evaluate awareness, attitudes, opinions, skills and knowledge about vaccines in a group of Italian adolescents through a paper-and-pencil questionnaire.

METHODS

The questionnaire was administered to adolescents who had appointments in two vaccination centers of the Public Health Authority of Latina (Latium, Italy), between August 2018 and January 2019.

RESULTS

In total, 391 forms were completed by teenagers (median age 16 years, 52% females), Results showed that 53% of participants were not aware of their vaccination status. Knowledge, assessed through questions about vaccines and preventable diseases, was generally poor. However, 89% of adolescents had a positive opinion about vaccinations. Spontaneous searches for vaccine information was low (28.7% had looked for information), despite the medium to high interest expressed. The participants usually sought information on vaccines on generic websites (52.8%) compared to getting information from paediatricians (20.4%) or other physicians (3.7%). However, participants recognized paediatricians/GPs (47%) and schools (46.2%) as the most reliable sources of information.

CONCLUSIONS

Findings are in agreement with previous published data and can be useful to school and health educators in order to teach adolescents about the value of prevention, providing them with the support necessary to improve their abilities and knowledge.

Validation of an Italian tool to assess vaccine literacy in adulthood vaccination: a pilot study

Vaccine Literacy (VL) is based on the same idea of Health Literacy (HL): it involves people's knowledge, motivation and competence to find, understand and use information to take decisions about children's and adults' vaccination. Using general measures, the association between HL and Vaccine Hesitancy has been shown to be inconsistent. HLVa-IT is a new tool, specific for the self-assessment of three VL scales, functional, interactive and critical about adults' immunization. Following a face validation process, HLVa-IT has been used to assess VL levels in a population of 50-75 years of age at the Public Health Unit of Latina (Latium, Italy). In order to validate its theoretical construct, it was administered at the same time with a Vaccine Quiz (VQ), assuming that subjects showing good knowledge about vaccination should have adequate VL. The consistent positive correlation for all three VL scales with the VQ score (Spearman's r=0.320, P=0.0004; r=0.389. P=0.0001 and r=0.306, P=0.0022, respectively), as well as with the educational degree, confirm the valid construct of HLVa-IT. A criterion validity of this tool has also been sought verifying its relation with acceptance of vaccines (VA) recommended in the adult/senior age. A positive association with VA observed only on the functional scale in the population ≥ 65 years, does not permit to accept a predictive validity, confirming that direct effect of Health Literacy is more clearly verifiable on knowledge than behavior outcomes. Nevertheless, HLVa-IT has shown suitable psychometric characteristics for the subjective measure of VL in individuals and in population studies. It is desirable that more specific tools are validated and extensively used, with the aim of assessing peoples' VL skills and defining interventions aimed at their improvement.

Italian Adults' Likelihood of Getting COVID-19 Vaccine: A Second Online Survey

Rapid online surveys are an important tool for tracking the public’s knowledge and perceptions during infectious disease outbreaks. In June 2020, during the early phases of COVID-19 vaccines development, we conducted a survey in 885 Italian adults that aimed at assessing their attitudes and opinions about vaccination, in addition to their vaccine literacy levels (i.e., skills in finding, understanding, and using information about vaccines). In January 2021, the same questionnaire was administered to a similar population (n = 160). Interactive vaccine literacy was significantly higher in January 2021 than in June 2020 (mean score 3.38 vs. 3.27 respectively, p = 0.0021). The percentage of participants willing to be vaccinated against COVID-19 assessed by either-or questions, was equally high in both surveys (>90%), which is quite reassuring, although metrics based on categorical scales cannot identify hesitant subjects.

Assessing COVID-19 vaccine literacy: a preliminary online survey

The COVID-19 infodemic can be countered by scientific evidence, clear and consistent communication, and improved health literacy of both individuals in need of information and those providing it. A rapid online survey was carried out to evaluate vaccine literacy (VL) skills in the general population and perceptions about COVID-19 vaccine candidates, along with behavior and beliefs about current vaccinations. Observed VL levels were consistent with previous observations – where comparable self-reported tools were administered face-to-face and by paper-and-pencil – the mean functional score being = 2.92, while the interactive-critical score was = 3.27, out of a maximum of 4. Perceptions regarding future COVID-19 vaccines, along with beliefs about vaccination, were mostly positive and significantly associated with functional and interactive-critical VL scales. Despite limitations, the study confirms that surveys via the web are a suitable method to evaluate and track attitudes during infectious disease outbreaks and assess health literacy skills about vaccination, which can be useful to adapt medical communication strategies, for a better understanding of the value of immunization.

Intravescical instillation of Calmette-Guérin bacillus and COVID-19 risk

It has been theorized that Calmette-Guérin bacillus may prevent or reduce the severity of COVID-19 through a nonspecific stimulation of the immune system. A preliminary assessment of SARS-CoV-2 infection rates and outcomes among 2803 individuals affected with high risk non-muscle-invasive bladder cancer and treated with intra-bladder instillation of BCG, showed no evidence of a protective effect. However, the interpretation of these data need some caution, due to the low prevalence of infection (<1%) observed within this population, along with the fact that intra-bladder administration cannot mirror the usual intradermal administration of BCG, in particular in patients partially immunocompromised. Confirmation by larger prospective studies is required.

Vaccine literacy is undervalued

Despite weak health literacy is considered a concause of vaccine hesitancy, it is rarely taken into account when discussing about this subject. The association between health literacy skills and vaccine acceptance has been shown to be uneven when using general measures, also depending on the population settings and type of vaccine considered. Vaccine literacy has been built on the same idea of health literacy, but very few specific measuring tools have been developed until now. It is desirable that more of these instruments are validated and extensively used with the objective of assessing peoples' vaccine literacy skills and defining interventions aimed at their improvement.

Assessment of health literacy skills in family doctors' patients by two brief, self-administered Italian measures

Health Literacy (HL) is an important health determinant: low HL skills result in less healthy choices, riskier behavior, poorer health, less self-management and more hospitalization. An observational study was conducted in a selected population, attending the waiting rooms of family general practitioners, with the aim of assessing HL capabilities through the administration of two HL screeners (IMETER and SILS-IT), and comparing the two measures. An anonymous questionnaire was administered, consisting of the Italian versions of the two tests on a single sheet. Demographic data, as well as concomitant chronic diseases and vaccines received, were also collected. HL skills were measured by the scores observed at both tests, and by the frequency of subjects with low HL levels according to the respective cut-off values. Overall, 305 questionnaires were collected and analyzed. Regarding IMETER, the observed frequency of subjects with low HL skills was 25.2% and the mean score and mean adjusted-score (26.3 ± 8.8 and 23.2 ± 9.4, respectively) were lower than those observed in previous studies. Similarly, at SILS-IT the percentage of subjects with low skills (49.9%) was higher than observed previously. IMETER showed high internal consistency (Cronbach's alpha > 0.9). The two measures were significantly correlated, although with a low Spearman's coefficient, and IMETER did not provide significant information about the probability to predict low HL according to SILS-IT. These results are explainable by the differences in assessment and domains between the two tests, both reliable and suitable to screen patients with low functional HL.

Health literacy, emotionality, scientific evidence: Elements of an effective communication in public health

The importance of healthcare providers' communication abilities is still underestimated. Informing the population on the basis of documented evidence is essential but not enough to induce a change in the beliefs of who is doubtful or does not accept preventive interventions, such as vaccination. Lining up the offer of prevention to the knowledge of the citizens, also improving Health Literacy skills, is a critical step toward their empowerment and behavior change. The 2017 Erice Declaration was drafted to propose to the Institutions and the scientific community the main goals to improve communication and counteract Vaccine Hesitancy, at a very critical time, when mandatory vaccination was introduced in Italy.

An Italian validation of "meter", an easy-to-use Health Literacy (hl) screener

Health Literacy (HL) is the degree to which individuals have the capability to obtain, understand and process basic health information needed to make appropriate health decisions. It affects persons' ability to access and use health care, to interact with providers, and to care for themselves. Established literacy screeners have practical limitations (such as practictioner's attendance, time to complete, etc.): to address these, a short, self-administered measure of HL, the Medical Term Recognition Test (METER) was introduced in USA. In this study an Italian version (IMETER) of this measure has been validated administering it to undergraduate students, attending Medicine, Arts and Engineering faculties. The results of this study show a high degree of reliability and validity of the test when comparing the skills of students educated in medical matters and those of non-biological faculties, indicating the potential capability of the tool to screen low HL levels in larger population. Despite the limits of this pilot study, IMETER's quick and easy administration method seems useful not only in clinical settings, but also to ease the implementation of future larger studies.

Universal varicella vaccination in the Sicilian paediatric population: rapid uptake of the vaccination programme and morbidity trends over five years

Following the licensure of the Oka/Merck varicella vaccine in Italy in January 2003, the Sicilian health authorities launched a universal vaccination programme in all nine Local Health Units. A two-cohort vaccination strategy was adopted to minimise the shift of the mean age of varicella occurrence to older age groups, with the goal of vaccinating with one dose at least 80% of children in their second year of life and 50% of susceptible adolescents in their 12th year of life. Two studies were implemented in parallel to closely monitor vaccination coverage as well as varicella incidence.

Universal varicella vaccination in the Sicilian paediatric population: rapid uptake of the vaccination programme and morbidity trends over five years

Following the licensure of the Oka/Merck varicella vaccine in Italy in January 2003, the Sicilian health authorities launched a universal vaccination programme in all nine Local Health Units. A two-cohort vaccination strategy was adopted to minimise the shift of the mean age of varicella occurrence to older age groups, with the goal of vaccinating with one dose at least 80% of children in their second year of life and 50% of susceptible adolescents in their 12th year of life. Two studies were implemented in parallel to closely monitor vaccination coverage as well as varicella incidence. Overall, the programme achieved its target, with 87.5% vaccine coverage for the birth cohort 2005 and 90.2% for adolescents born in 1995 and 1996. Varicella surveillance data obtained from a total of 28,188 children (0-14 years-old) monitored by family paediatricians showed a decline in incidence rates from 95.7 (95% confidence interval (CI): 72.2-126.8) for 1,000 person-years (PY) in 2004 to 9.0 (95% CI: 6.4-12.6) for 1,000 PY in 2007. In Europe, the only similar experience is the routine childhood varicella vaccination programme in Germany that started in 2004 with a single dose at the age of 11-14 months. The two-cohort universal vaccination programme implemented in Sicily, as well as the network for the surveillance study, can offer a model to other European countries that are considering introducing universal childhood varicella vaccination.

Comparison of the reactogenicity and immunogenicity of a split and a subunit-adjuvanted influenza vaccine in elderly subjects

A randomised, open study was carried out among an elderly population in order to compare the reactogenicity and immunogenicity of an inactivated, split virion influenza vaccine (Vaxigrip, Aventis Pasteur MSD, Lyon, France) with that of an MF59-adjuvanted, subunit vaccine (Fluad, Chiron Vaccines, Siena, Italy). Both vaccines contained the three strains: A/Sydney/5/97 (H3N2), A/Beijing/262/95 (H1N1) and B/Beijing/184/93, recommended by the WHO for the 1998-1999 influenza season. A total of 2150 subjects were vaccinated and included in the reactogenicity analysis. A total of 1076 subjects received Vaxigrip (age 73.3 +/- 5.9 years, 49.6% men) and 1074 subjects received Fluad (age 73.4 +/- 5.9 years, 52.3% men). All subjects were kept under medical observation for 30 min after vaccination, in order to check any immediate local and/or systemic reaction. A self monitoring diary card was given to all subjects to collect any local and/or systemic reaction occurring during the 3 days following the vaccination, any adverse event occurring between vaccination day and 21st day post-vaccination and any medication taken during the study period. A total of 1186 subjects were included in the immunogenicity analysis. A total of 591 subjects received Vaxigrip (age 73.4 +/- 5.6 years, 52.3% men) and 595 subjects received Fluad (age 73.8 +/- 5.9 years, 55.8% men). Blood samples were collected pre- and 21 days post-vaccination and were analysed by the haemagglutination inhibition assay. In terms of reactogenicity both vaccines were generally well tolerated. The frequency of local reactions was lower in the group that received Vaxigrip. Pain at the injection site occurring from 30 min to 3 days after vaccination was also significantly less frequent (P = 0.005) in the Vaxigrip group. Fever > or =37.5 degrees C was reported in less than 1% of all vaccinated subjects. No serious adverse event was related to vaccine administration. In terms of immunogenicity both vaccines induced an effective immune response (anti-HI titre > or =40) against A/Sydney/5/97 (H3N2) and A/Beijing/262/95 (H1N1) strains in the entire population. Vaxigrip and Fluad induced similar seroprotection and seroconversion rates against the A/Sydney/5/97 (H3N2) strain. For both vaccines a lower percentage of subjects achieved a seroprotective titre > or =40 against the B/Beijing/184/93. A lower antibody response against the influenza B strain was also observed in other studies conducted during the same season. In subjects 75 years of age or older, Fluad was more immunogenic than Vaxigrip for all three virus strains.

Safety and Immunogenicity of a Conjugate Vaccine againstHaemophilus influenzaeType b in Splenectomized and Nonsplenectomized Patients with Cooley Anemia

Patients with thalassemia are at increased risk for infections, especially after undergoing splenectomy. Vaccinations and antimicrobial prophylaxis are recommended in these patients, but the optimal immunization schedule for Haemophilus influenzae type b (Hib) vaccine is unknown. The immunogenicity of a conjugate Hib vaccine was investigated in 57 patients with thalassemia, 32 of whom had undergone splenectomy. Anti-capsular antibodies to Hib (anti-polyribosylribitol phosphate) were measured before vaccination and 2, 6, 12, 24, and 36 months after vaccination. Immunization was well tolerated. All patients achieved protective (>1 microg/mL) antibody levels. Antibody titers declined after the initial postvaccination increase, becoming undetectable in 4 patients and decreasing to concentrations of 0.15-1 microg/mL in another 2 patients when tested 2-3 years after vaccination. Hib conjugate vaccine is safe and immunogenic in patients with thalassemia major; however, additional studies are needed to assess the need and timing of booster vaccination to maintain long-term immunity.

Simultaneous influenza and pneumococcal vaccination in elderly individuals

The study was performed to evaluate the effects of influenza and pneumococcal vaccines administered alone or in combination. 124 elderly subjects living in community were vaccinated either with influenza split vaccine or with pneumococcal 23-valent or with both vaccines at the same time in different sites. Sera were tested for hemoagglutination inhibiting antibodies for influenza and for antibodies against 23-valent vaccine for streptococcus pneumoniae. No side effects were observed in the vaccinated population. Serological results indicated that influenza vaccine increased significantly antibody levels. No difference was observed between the group which received influenza vaccine alone and that which received influenza and pneumococcal vaccines associated, considering either G.M.T or the percentages of protected individuals or the percentages of subjects who seroconverted. When pneumococcal vaccine was administered at the same time with influenza vaccine, there was a not statistically significant reduction in both mean antibody concentration and mean fold increase. It is concluded that the simultaneous administration of influenza and pneumococcal vaccines to elderly individuals, including subjects at risk, is safe, effective and economically advantageous.

Immunogenicity of influenza vaccine (1993-94 winter season) in HIV-seropositive and -seronegative ex-intravenous drug users

The humoral response (haemagglutination inhibiting antibodies) to trivalent split influenza vaccine for the 1993-94 winter season (A/Beijing/32/92 (H3N2), A/Singapore/6/86 (H1N1) and B/Panama/45/90) was evaluated in a group of young HIV-seropositive ex-intravenous heroin users and compared with responses measured in HIV-seronegative individuals with a similar history. HIV-negative volunteers showed an overall positive response suggesting that previous heroin use did not influence their humoral response to influenza vaccine. Comparable results were obtained in HIV-positive subjects with CD4+ lymphocyte counts > 500 microliters-1, whereas impaired reactivity was found in HIV-positive volunteers with CD4+ counts < 500 microliters-1. Booster vaccination did not increase antibody levels in any of the groups studied, although the data did not exclude a positive influence of a second vaccine dose on persistence of antibody at 120 days after the first dose. No significant changes were observed in p24 antigenemia levels in HIV-positive individuals after vaccination.

Immune response to a booster dose of enhanced potency inactivated polio vaccine administered in association with HBV vaccine in adolescents

The immunogenicity and reactogenicity of a booster dose of enhanced potency inactivated polio vaccine (EIPV) were evaluated in 492 healthy 12 year old adolescents. The booster was administered at the same time as the HBV vaccine compulsory in Italy at this age. Blood samples and questionnaires on reactogenicity were collected over 9 months. Analysis of pre-vaccination immunity showed that 97.4% of the subjects were protected against all polio types, 1.9% were negative for two polio types and 0.6% for one. After vaccination 98.4% of the vaccinees showed a significant increase ( > or = 4 times) of antibody titre; the geometric mean titres (GMT) were markedly higher than before vaccination, particularly for poliovirus type 3. The polio booster dose did not affect HBV vaccination. An anti-HBs response > 10 mIU ml-1. (GMT = 2951 mIU ml-1) was observed in 781 (98.6%) of 792 vaccinees (492 given EIPV+HBV and 300 given only HBV) 9 months later. Only mild local and rare general reactions were noted for both the vaccines studied. These data confirm the suitability and efficacy of an EIPV booster dose and HBV vaccination in adolescents.

[Incidence of Haemophilus influenzae type b meningitis in Italy. Preliminary results]

The Authors describe the survey's results aimed at quantifying the Haemophilus influenzae type b meningitis incidence rate in Italy. The survey collected all the cases of 1994 notified per region to the Ministry of Health; furthermore, regional incidence rates are compared and integrated with other data obteined from local ad hoc studies. The results obtained show a high incidence in the age group 0-2 years and a large discrepancy in the incidence rate between regions (from 0.0 to 16.8 cases per 100,000); furthermore, in the same age group, for a large amount of meningitis cases (18% of the total) the aetiological diagnosis was not successful; this phaenomenon is certainly one of the causes for the underestimation of the disease. The integration with data collected in longitudinal studies, increases largely the regional incidence rate, showing the highest rate in the Lazio Region (18.5 cases per 100,000). The Authors conclude by stressing the need to increase the cooperation between the Regional Health Authorities and the Ministry of Health, in order to obtain more reliable figures of the national incidence rates.

Attitudes and behavior of health care personnel regarding influenza vaccination

This paper reports the results of a study conducted by the Italian Association for Immune-Prophylaxis Promotion (AIP.I) with the aim of surveying the attitudes and perceptions of Italian health care workers regarding the use and efficacy of influenza vaccine. The results clearly show that a high proportion of the questioned health care workers showed a general lack of concern about the severity of the disease. Doubts about vaccine efficacy and fear of post-vaccination side effects were also observed to have an important influence on the vaccination acceptance rates. These data underline the need for a systematic education program to provide influenza vaccination within the public and private health-care sectors in Italy.