How well does vaccine literacy predict intention to vaccinate and vaccination status? A systematic review and meta-analysis

This review quantified the association of vaccine literacy (VL) and vaccination intention and status. PubMed, Scopus, and Web of Science were searched. Any study, published until December 2022, that investigated the associations of interest were eligible. For each outcome, articles were grouped according to the vaccine administrated and results were narratively synthesized. Inverse-variance random-effect models were used to compare standardized mean values in VL domain(s) between the two groups: individuals willing vs. unwilling to get vaccinated, and individuals vaccinated vs. unvaccinated. This review of 18 studies shows that VL strongly predicts the vaccination intention while its association with vaccination status is attenuated and barely significant, suggesting that other factors influence the actual vaccination uptake. However, given the scarce evidence available, the heterogeneity in the methods applied and some limitations of the studies included, further research should be conducted to confirm the role of VL in the vaccination decision-making process.

Crohn's disease after surgery: Changes in post-operative management strategies over time and their impact on long-term re-operation rate-A retrospective multicentre real-world study

BACKGROUND

Few data are available addressing the impact of post-operative management of Crohn's disease (CD) on long-term clinical course.

AIM

To assess the evolution of post-operative management strategies over the last 40 years and their impact on the re-operation rate of CD.

METHODS

We included 657 patients with CD who had undergone their first radical ileo-caecal resection between 1980 and 2020. Three cohorts were defined according to year of surgery: cohort 1 (1980-1998; n = 198), cohort 2 (1999-2009; n = 218) and cohort 3 (2010-2020; n = 241). We estimated exposure to immunomodulators and anti-TNFα agents after surgery and rates of re-operation using Kaplan-Meier survival analyses. We used Cox proportional hazards regression to assess the association of clinical variables with time to re-operation.

RESULTS

Immunosuppressants, (IMMs) and anti-TNFα exposure within 5 years after surgery increased significantly from cohort 1 to cohort 2 and cohort 3 (IMMs: 1.6%, 38.2% and 28.0%, respectively, p < 0.001; anti-TNFα: 0.0%, 20.7% and 52.0%, respectively, p < 0.001). There was no significant difference across cohorts regarding the cumulative probability of re-operation within 5 and 10 years. Multivariate analysis identified IMMs/anti-TNFα exposure before the first surgery (HR 9.15; 95% CI 2.77-30.21) and post-operatively (HR: 0.24; 95% CI 0.07-0.74) as variables associated with the risk of re-operation. However, these associations had a time-varying effect and become non-significant after 5 and 2 years after surgery, respectively.

CONCLUSION

Despite increased post-operative use of IMMs and anti-TNFα agents in the last two decades, the impact of these strategies on the risk of long-term re-operation rate has been modest.

The Efficacy of Multivitamin, Vitamin A, Vitamin B, Vitamin C, and Vitamin D Supplements in the Prevention and Management of COVID-19 and Long-COVID: An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials

This review aims to evaluate the efficacy of any vitamin administration(s) in preventing and managing COVID-19 and/or long-COVID. Databases were searched up to May 2023 to identify randomized clinical trials comparing data on the effects of vitamin supplementation(s) versus placebo or standard of care on the two conditions of interest. Inverse-variance random-effects meta-analyses were conducted to estimate pooled risk ratios (RRs) and 95% confidence intervals (CIs) for all-cause mortality between supplemented and non-supplemented individuals. Overall, 37 articles were included: two regarded COVID-19 and long-COVID prevention and 35 records the COVID-19 management. The effects of vitamin D in preventing COVID-19 and long-COVID were contrasting. Similarly, no conclusion could be drawn on the efficacy of multivitamins, vitamin A, and vitamin B in COVID-19 management. A few positive findings were reported in some vitamin C trials but results were inconsistent in most outcomes, excluding all-cause mortality (RR = 0.84; 95% CI: 0.72-0.97). Vitamin D results were mixed in most aspects, including mortality, in which benefits were observed in regular administrations only (RR = 0.67; 95% CI: 0.49-0.91). Despite some benefits, results were mostly contradictory. Variety in recruitment and treatment protocols might explain this heterogeneity. Better-designed studies are needed to clarify these vitamins' potential effects against SARS-CoV-2.

Public health genomics research in Italy: an overview of ongoing projects

Public health genomics (PHG) aims to integrate advances in genomic sciences into healthcare for the benefit of the general population. As in many countries, there are various research initiatives in this field in Italy, but a clear picture of the national research portfolio has never been sketched. Thus, we aimed to provide an overview of current PHG research projects at the national or international level by consultation with Italian institutional and academic experts. We included 68 PHG projects: the majority were international projects in which Italian researchers participated (n = 43), mainly funded by the European Commission, while the remainder were national initiatives (N = 25), mainly funded by central government. Funding varied considerably, from € 50,000 to € 80,803,177. Three main research themes were identified: governance (N = 20); precision medicine (PM; N = 46); and precision public health (N = 2). We found that research activities are preferentially aimed at the clinical application of PM, while other efforts deal with the governance of the complex translation of genomic innovation into clinical and public health practice. To align such activities with national and international priorities, the development of an updated research agenda for PHG is needed.

Connected minds in disconnected bodies: Exploring the role of interoceptive sensibility and alexithymia in problematic use of the internet

INTRODUCTION

The ever-increasing prominence of the internet and digital technology in our society requires a deeper examination of how these developments alter perception of our bodies and emotions. One such consequence is the emergence of Problematic Use of the Internet (PUI) - an array of compulsive or addictive behaviors mediated by the web that detrimentally affect an individual's functioning. This suggests that some people may be shifting their consciousness from the physical realm to the digital world. The objective of this study was to investigate how shortcomings in interoception (the sensibility to bodily signals) and alexithymia (an inability to identify and express emotions) might contribute to PUI.

METHODS

The Internet Addiction Test (IAT), the Toronto Alexithymia Scale (TAS-20), and the Multidimensional Assessment of Interoceptive Awareness (MAIA) were used to assess a sample of 1076 adolescents and young adults aged between 16 and 26 years via an online survey. Data analysis was based on t-test, correlations and multivariate regression.

RESULTS

26.8% (n = 288) of participants met the criteria for moderate PUI. Individuals with PUI displayed higher levels of alexithymia (p < 0.001) and diminished abilities in certain aspects of interoceptive sensibility, including placing trust in their own bodily signals (p = 0.006), not responding excessively to uncomfortable sensations with worry (p < 0.001), and not denying them (p = 0.006). Multivariate modelling revealed associations between PUI and the following factors: having a boyfriend/girlfriend (aOR = 5.70), substance use (aOR = 1.78), difficulty in identifying feelings (aOR = 1.09), externally oriented thinking (aOR = 1.05), low disposition in perceiving body sensations (aOR = 0.25), tendency to become distracted (aOR = 0.82) or excessively worried (aOR = 0.11) in the face of pain. Furthermore, the analysis indicated how these aspects of body perception may be interrelated, either enhancing or reducing the risk of PUI when examined individually, collectively, or in combination.

CONCLUSIONS

This study underlines the potential connection between difficulties in the mind-body interaction and the development of PUI. It suggests a bidirectional relationship between excessive digital device use and distorted bodily interoceptive processes in PUI, reinforcing the notion that individuals struggling with emotion identification and expression may be more prone to excessive internet usage. To further comprehend the relevance of these constructs in PUI, it is necessary to conduct more targeted investigations and longitudinal studies.

Executive functions in preschool and school-age cochlear implant users: do they differ from their hearing peers? A systematic review and meta-analysis

PURPOSE

Executive functions (EF) play a fundamental role in planning and executing goal-driven behaviours. The purpose of this systematic review and meta-analysis was to investigate EF skills mastered by preschool/school-age cochlear implanted children (CIC) without morpho-functional abnormalities and to compare their outcomes with typically hearing children (THC).

METHODS

Bibliographic search for observational studies of any language/date up to 16 December 2022 was performed with the following electronic databases: PubMed, Scopus, and Web of Science. After removal of duplicates, 2442 records were subjected to a three-stage screening process and 83 potentially eligible articles were identified. A total of 15 studies was included in the final analysis: 9 articles directly meeting the eligibility criteria plus 6 more studies thanks to the authors sharing their data set, specifically for participants who met present inclusion criteria.

RESULTS

Meta-analysis showed a statistically significant difference only for verbal short-term memory, whereas group differences for visuospatial short-term memory and verbal/visuospatial working memory were not significant. For fluency skills, meta-analysis revealed statistical significance for the semantic fluency task but not for the rapid naming test. Qualitative analysis reflected group similarities in flexibility but CIC's difficulties in auditory attention/planning skills. Controversial findings for inhibitory control skills were observed.

CONCLUSIONS

EF performance comparisons between CIC and THC show inter-skill and inter-test variances. Due to the paucity of existing studies, present findings should be interpreted with caution. Future research in this domain is strongly recommended.

Magnetic resonance-guided focused ultrasound versus percutaneous thermal ablation in local control of bone oligometastases: a systematic review and meta-analysis

BACKGROUND

The percutaneous thermal ablation techniques (pTA) are radiofrequency ablation, cryoablation, and microwave ablation, suitable for the treatment of bone oligometastases. Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive ablation technique.

OBJECTIVES

To compare the effectiveness and safety of MRgFUS and pTA for treating bone oligometastases and their complications.

METHODS

Studies were selected with a PICO/PRISMA protocol: pTA or MRgFUS in patients with bone oligometastases; non-exclusive curative treatment. Exclusion criteria were: primary bone tumor; concurrent radiation therapy; palliative therapy; and absence of imaging at follow-up. PubMed, BioMed Central, and Scopus were searched. The modified Newcastle-Ottawa Scale assessed articles quality. For each treatment (pTA and MRgFUS), we conducted two separate random-effects meta-analyses to estimate the pooled effectiveness and safety. The effectiveness was assessed by combining the proportions of treated lesions achieving local tumor control (LTC); the safety by combining the complications rates of treated patients. Meta-regression analyses were performed to identify any outcome predictor.

RESULTS

A total of 24 articles were included. Pooled LTC rate for MRgFUS was 84% (N = 7, 95% CI 66-97%, I2 = 74.7%) compared to 65% of pTA (N = 17, 95% CI 51-78%, I2 = 89.3%). Pooled complications rate was similar, respectively, 13% (95% CI 1-32%, I2 = 81.0%) for MRgFUS and 12% (95% CI 8-18%, I2 = 39.9%) for pTA, but major complications were recorded with pTA only. The meta-regression analyses, including technique type, study design, tumor, and follow-up, found no significant predictors.

DISCUSSION

The effectiveness and safety of the two techniques were found comparable, even though MRgFUS is a noninvasive treatment that did not cause any major complication. Limited data availability on MRgFUS and the lack of direct comparisons with pTA may affect these findings.

CONCLUSIONS

MRgFUS can be a valid, safe, and noninvasive treatment for bone oligometastases. Direct comparison studies are needed to confirm its promising benefits.

Enhanced peripheral levels of BDNF and proBDNF: elucidating neurotrophin dynamics in cocaine use disorder

Brain-derived neurotrophic factor (BDNF) and its precursor, proBDNF, are known to significantly contribute to brain homeostasis, neuroplasticity, and neuronal remodeling. Although these neurotrophins are thought to have opposing roles, both play a critical part in shaping long-lasting behavioral changes following substance use. In this context, our study sought to explore the implications of these neurotrophins in the pathophysiology of cocaine use disorder (CUD). We conducted a case-control study, which included 28 individuals seeking treatment for CUD and 38 matched healthy participants. We measured peripheral neurotrophin concentrations via an enzyme-linked immunosorbent assay. Additionally, all participants were screened for cocaine-associated pathways (e.g., cocaine intake, craving intensity), along with associated psychopathological data. Our findings highlighted an increased concentration of BDNF and proBDNF in CUD individuals when compared to healthy controls (BDNF: 18092.80 ± 6844.62 vs. 11334.42 ± 5061.85 pg/ml, p < 0.001; proBDNF: 87.03 ± 33.23 vs. 55.70 ± 23.26 ng/ml, p < 0.001). We further corroborated the relationship between neurotrophin levels and CUD using a linear regression model. Nevertheless, there was no significant difference in the proBDNF to BDNF ratio between the two groups. Interestingly, our study also demonstrated the influence of factors like usage of psychotropic medications, history of psychiatric hospitalizations, and psychiatric diagnoses on neurotrophin dynamics. In conclusion, our study underscores the significance of neurotrophin fluctuations in CUD. The observed increase in BDNF and proBDNF levels could play a pivotal role in driving craving and relapse risk. Thus, a nuanced understanding of these neurobiological underpinnings in CUD might contribute to the development of more targeted and effective therapeutic strategies.

Impact of antibiotic exposure on antibiotic-resistant Acinetobacter baumannii isolation in intensive care unit patients: a systematic review and meta-analysis

BACKGROUND

Acinetobacter baumannii (AB) poses a significant threat to critically ill patients in intensive care units (ICUs). Although an association between antibiotic exposure and resistant AB is reported in the literature, a synthesis of evidence in ICU patients is still lacking.

AIM

To summarize the evidence on the association between prior antibiotic exposure and the occurrence of resistant AB in ICU patients.

METHODS

Online databases were searched for cohort and case-control studies providing data on the association of interest. Carbapenem/multidrug-resistant AB isolation was compared with non-isolation; carbapenem/multidrug-resistant AB was compared with carbapenem/antibiotic-susceptible AB; and extensively drug-resistant AB isolation was compared with non-isolation. Each comparison was subjected to a restricted maximum likelihood random-effects meta-analysis per antibiotic class, estimating pooled ORs. Stratified meta-analyses were performed by study design, outcome type and association-measure adjustment.

FINDINGS

Overall, 25 high-quality studies were retrieved. Meta-analyses showed that carbapenem/multidrug-resistant AB isolation was associated with previous exposure to aminoglycosides, carbapenems, third-generation cephalosporines, glycylcyclines, and nitroimidazoles. Increased risk of isolation of carbapenem/multidrug-resistant AB isolation vs carbapenem/antibiotic-susceptible AB was shown for prior exposure to aminoglycosides, antipseudomonal penicillins, carbapenems, fluoroquinolones, glycopeptides, and penicillins. Third-generation cephalosporin exposure increased the risk of extensively drug-resistant AB isolation vs non-isolation.

CONCLUSION

This systematic review clarifies the role of antibiotic use in antibiotic-resistant AB spread in ICUs, although for some antibiotic classes the evidence is still uncertain due to the small number of adjusted analyses, methodological and reporting issues, and limited number of studies. Future studies need to be carried out with standardized methods and appropriate reporting of multivariable models.

Reduced Reliability of Procalcitonin (PCT) as a Biomarker of Bacterial Superinfection: Concerns about PCT-Driven Antibiotic Stewardship in Critically Ill COVID-19 Patients-Results from a Retrospective Observational Study in Intensive Care Units

BACKGROUND

The aim of this study was to assess whether procalcitonin levels is a diagnostic tool capable of accurately identifying sepsis and ventilator-associated pneumonia (VAP) even in critically ill COVID-19 patients.

METHODS

In this retrospective, observational study, all critically ill COVID-19 patients who survived for ≥2 days in a single university hospital and had at least one serum procalcitonin (PCT) value and associated blood culture and/or culture from a lower respiratory tract specimen available were eligible for the study.

RESULTS

Over the research period, 184 patients were recruited; 67 VAP/BSI occurred, with an incidence rate of 21.82 episodes of VAP/BSI (95% CI: 17.18-27.73) per 1000 patient-days among patients who were included. At the time of a positive microbiological culture, an average PCT level of 1.25-3.2 ng/mL was found. Moreover, also in subjects without positive cultures, PCT was altered in 21.7% of determinations, with an average value of 1.04-5.5 ng/mL. Both PCT and PCT-72 h were not linked to a diagnosis of VAP/BSI in COVID-19 patients, according to the multivariable GEE models (aOR 1.13, 95% CI 0.51-2.52 for PCT; aOR 1.32, 95% CI 0.66-2.64 for PCT-72 h).

CONCLUSION

Elevated PCT levels might not always indicate bacterial superinfections or coinfections in a severe COVID-19 setting.

Adherence to SARS-CoV-2 Vaccination Recommendations among Patients with Substance Use Disorders: A Cross-Sectional Study in Rome, Italy

Adherence to vaccination recommendations is a challenge for national immunization programs. We quantified adherence to COVID-19 vaccination recommendations in people with substance use disorders (SUDs) attending an outpatient addiction center in Rome, Italy; we investigated the determinants of adherence, and also analyzed patient risk perception and compliance with preventive measures. A multivariable logistic regression model identified predictors of adherence to vaccination recommendations, with statistical validity tested by estimating adjusted odds ratios (aORs) and 95% confidence intervals (CIs). From December 2021 to January 2022, 200 SUD patients completed a questionnaire, 80% of whom reported being vaccinated against SARS-CoV-2 (minimum one dose). Negative predictors of vaccine uptake included being non-Italian (aOR: 0.36, 95% CI: 0.13-0.97), having coexisting comorbidities (aOR: 0.35, 95% CI: 0.13-0.95), and previous use of heroin (aOR: 0.24, 95% CI: 0.08-0.71). No difference was found for cocaine use, demographic characteristics, previous COVID-19 infection, methadone therapy, or compliance with preventive measures. Major reasons for non-adherence to vaccination recommendations were fear of side effects, insufficient recognition of the importance of vaccination, bureaucratic issues, and lack of trust in the authorities. Given their vulnerability, additional efforts are needed to facilitate access to vaccination for people with SUDs, and to limit disinformation around vaccines..

Compliance with hand-hygiene guidelines among healthcare workers: a cross-sectional study at the Umberto I teaching hospital of Rome, Italy

INTRODUCTION

Healthcare-associated infections are often associated with poor hand hygiene (HH) by healthcare workers (HCWs). The objective of this cross-sectional study at the Umberto I teaching hospital in Rome was to quantify compliance with HH by direct observation following a multimodal strategy devised by the World Health Organisation and to map critical areas for improvement.

METHODS

Predictors of HH compliance were identified using a multivariable logistic regression model. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.

RESULTS

Eighty-four trained observers from 50 wards collected 4,081 observations showing that overall HH compliance was 71.9%. The multivariable analysis found a positive association with the outcome for midwives compared to physicians (aOR=2.5, 95% CI: 1.5-4.1), and a negative association for healthcare assistants (aOR=0.5, 95% CI: 0.3-0.8). There was greater compliance during public holidays and weekends (aOR=1.5, 95% CI: 1.1-2.1), but compliance was lower for external staff (aOR=0.7, 95% CI: 0.5-0.9). We found a positive association with all HH indications after interaction with a patient or with patient surroundings compared with the indication "before touching a patient" (all p<0.001); the highest association was with the indication "after contact with biological fluids" (aOR=7.7, 95% CI: 4.7-12.5).

CONCLUSION

Overall, we observed reasonable compliance levels, but it is important to increase adherence to HH practice and monitor any behaviour change.

The Impact of Rotavirus Vaccination on Discharges for Pediatric Gastroenteritis in Italy: An Eleven Year (2009-2019) Nationwide Analysis

In Italy, despite the documented positive effects of rotavirus (RV) vaccination on reducing the burden of RV disease, an updated national assessment of its impact on clinical outcomes is still lacking. This study aims to analyze the implementation of RV vaccination in Italy, evaluating its impact on discharges for acute pediatric gastroenteritis (AGE). A retrospective analysis, including hospital discharge records and data on vaccination coverage for children aged 0-71 months from 2009 to 2019, was conducted. We examined trends in hospital discharge standardized incidence before and after vaccine introduction using a negative binomial mixture model with fixed effects to evaluate the impact of universal vaccination. The percentage of vaccination coverage increased over the years, from <5% between 2009 and 2013 to 26% in 2017, reaching 70% in 2019. The standardized incidence of discharges decreased over the period from 16.6/100,000 inhabitants in 2009-2013 to 9.9/100,000 inhabitants in 2018-2019. In this phase, about 15% of the estimated hospital discharges were avoided compared with those estimated in the first phase. The implementation of RV vaccination reduced AGE incidence discharges in children aged 0-71 months. Further efforts are needed to continue monitoring the vaccination effect over time and to increase vaccination coverage.

Early Warning Systems for Emerging Profiles of Antimicrobial Resistance in Italy: A National Survey

Antimicrobial resistance (AMR) national surveillance systems in Italy lack alert systems for timely detection of emerging profiles of AMR with potential relevance to public health. Furthermore, the existence of early warning systems (EWS) at subnational level is unclear. This study aims at mapping and characterizing EWS for microbiological threats available at regional level in Italy, focusing on emerging AMR, and at outlining potential barriers and facilitators to their development/implementation. To this end, a three-section, web-based survey was developed and administered to all Italian regional AMR representatives from June to August 2022. Twenty out of twenty-one regions and autonomous provinces (95.2%) responded to the survey. Among these, nine (45%) reported the implementation of EWS for microbiological threats at regional level, three (15%) reported that EWS are in the process of being developed, and eight (40%) reported that EWS are not currently available. EWS characteristics varied widely among the identified systems concerning both AMR profiles reported and data flow: the microorganisms most frequently included were extensively drug-resistant (XDR) Enterobacterales, with the lack of a dedicated regional IT platform reported in most cases. The results of this study depict a highly heterogeneous scenario and suggest that more efforts aimed at strengthening national AMR surveillance systems are needed.

Incidence of Healthcare-Associated Infections in a Neonatal Intensive Care Unit before and during the COVID-19 Pandemic: A Four-Year Retrospective Cohort Study

The COVID-19 pandemic may have had an impact on healthcare-associated infection (HAI) rates. In this study, we analyzed the occurrence of HAIs in a neonatal intensive care unit (NICU) of the Umberto I teaching hospital in Rome before and during the pandemic. All infants admitted from 1 March 2018 to 28 February 2022 were included and were divided into four groups according to their admission date: two groups before the pandemic (periods I and II) and two during the pandemic (periods III and IV). The association between risk factors and time-to-first event was analyzed using a multivariable Cox regression model. Over the four-year period, a total of 503 infants were included, and 36 infections were recorded. After adjusting for mechanical ventilation, birth weight, sex, type of delivery, respiratory distress syndrome, and previous use of netilmicin and fluconazole, the multivariable analysis confirmed that being hospitalized during the pandemic periods (III and IV) was the main risk factor for HAI acquisition. Furthermore, a change in the etiology of these infections was observed across the study periods. Together, these findings suggest that patient management during the pandemic was suboptimal and that HAI surveillance protocols should be implemented in the NICU setting promptly.

Attitudes of University Students towards Mandatory COVID-19 Vaccination Policies: A Cross-Sectional Survey in Rome, Italy

Mandatory vaccination (MV) against COVID-19 is a contentious topic. In this study, we used logistic regression models to identify attitudes among Sapienza University students towards MV for COVID-19. We considered three different scenarios: mandatory COVID-19 vaccination (MCV) for healthcare workers (HCWs) (Model 1), for all people aged ≥ 12 years (Model 2), and for admission to schools and universities (Model 3). We collected 5287 questionnaires over a six-month period and divided these into three groups (September-October 2021, November-December 2021, and January-February 2022). MCV for HCWs was the most strongly supported policy (69.8% in favour), followed by MCV for admission to schools and universities (58.3%), and MCV for the general population (54.6%). In a multivariable analysis, the models showed both similarities and differences. There was no association of socio-demographic characteristics with the outcomes, apart from being enrolled in non-healthcare courses, which negatively affected Models 2 and 3. A greater COVID-19 risk perception was generally associated with a more positive attitude towards MCV, although heterogeneously across models. Vaccination status was a predictor of being in favour of MCV for HCWs, whereas being surveyed in November-February 2022 favoured MCV for admission to schools and universities. Attitudes towards MCV were variable across policies; thus, to avoid unintended consequences, these aspects should be carefully considered by policymakers.

Killing Two Birds with One Stone: Is the COVID-19 Vaccination Campaign an Opportunity to Improve Adherence to Cancer Screening Programmes? The Challenge of a Pilot Project in a Large Local Health Authority in Rome

The COVID-19 pandemic has affected health services worldwide. The suspension of cancer screening programs during the lockdown period, coupled with the other measures taken to limit the SARS-CoV-2 spread, contributed to the idea that cancer preventive interventions are deferrable. In this opinion paper, we present some data on cancer screening coverage in one of the largest Local Health Authorities in Italy in recent years. Within this context, we introduce the benefits of a pilot project in which we took advantage of the great attention on the COVID-19 vaccination campaign to improve screening uptake. In this project, we offered men and women eligible for cancer screening the opportunity to book appointments while waiting to be vaccinated. In addition, trained healthcare personnel were available on-site to discuss any barriers to participation with the attendees. Despite the project having only just started, preliminary results are encouraging, with positive feedback from the attendees. In conclusion, we advocate for the need to adopt a comprehensive approach when it comes to population health, and we use this project as an example to discuss how it is possible to contribute to minimizing the long-term impact of the COVID-19 pandemic with resources already in place.

The Role of Pulmonary Function Testing and Lung Imaging in the Long-Term Follow-Up of Patients with COVID-19 Pneumonia

BACKGROUND

Post-COVID-19 Interstitial Lung Disease (PC-ILD) is characterized by fibrotic-like signs at high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) abnormalities after SARS-CoV-2 infection. It is still not clear how frequent these tests should be performed to rule out long-term consequences of COVID-19 pneumonia.

OBJECTIVES

The aims of our study were to evaluate the incidence and risk factors of PC-ILD and possibly to propose a long-term follow-up program.

METHOD

One-hundred patients, hospitalized in our ward for moderate to critical COVID-19, underwent two follow-up visits at three and 15 months in which PFTs and HRCT were performed.

RESULTS

At the 15-month follow-up, 8% of patients showed residual radiological and functional signs consistent with PC-ILD. All but one of these patients had already demonstrated PFTs and HRCT alterations at first follow-up visit, and the last 1 patient showed worsening of lung function during follow-up. These findings highlight the negative predictive value of PFTs at 3-month follow-up for the development of PC-ILD. Aging, severity of COVID-19, and degree of pulmonary involvement during acute infection proved to be significant risk factors for developing PC-ILD.

CONCLUSIONS

Our study highlights the importance of PFTs in the long-term follow-up of patients affected by moderate to critical COVID-19 pneumonia. Further studies are needed to confirm our hypothesis that HRCT should be performed only in patients with PFTs abnormalities.

The other side of COVID-19: A cross-sectional study on mental health in a sample of Italian nurses during the second wave

Introduction

The COVID-19 pandemic has led to a drastic increase in the workload of healthcare professionals, particularly nurses, with serious consequences for their psychological well-being. Our study aimed to identify demographic and work-related factors, as well as clinical predictors of post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD), in nurses employed during the COVID-19 pandemic.

Methods

We carried out a cross-sectional study between December 2020 and April 2021 on nurses employed during the COVID-19 second wave (October - December 2020). We evaluated PTSD and GAD using two validated questionnaires: i) the Impact of Event Scale - Revised (IES-R); and ii) General Anxiety Disorder -7 (GAD-7).

Results

Overall, 400 nurses, whose mean age was 34.3 years (SD ± 11.7), were included in the study. Most were female (78.5%), unmarried (58.5%) and employed in the central (61.5%) regions of Italy. A total of 56.8% of all participants had clinical predictors of PTSD, recording a median IES-R score (IQR) of 37.0 (22.0, 51.0) (range 1-84; cut-off >33 for PTSD). Furthermore, 50% of respondents reported moderate-to-severe symptoms consistent with GAD, recording a median GAD-7 score (IQR) of 9.5 (6.0,14.0) (range 0-21; cut-off >10 for GAD). Multivariable analysis showed that moderate-to-severe GAD (aOR = 4.54, 95% CI: 2.93 - 7.05), being employed in the critical care area (aOR = 1.74, 95% CI: 1.01 - 3.00) and being female (aOR= 1.88, 95% CI: 1.09 - 3.22) were significantly associated with the presence of clinical predictors of PTSD.

Discussion

The levels of PTSD symptoms and anxiety among nurses were high during the pandemic. PTSD and GAD represent a public health problem that should be addressed in the post-pandemic period. Healthcare organizations need to activate specific support and rehabilitation networks and programs for healthcare professionals employed during the COVID-19 pandemic.

Conservative oxygen supplementation during Helmet CPAP therapy in patients with COVID-19 and respiratory failure: A pilot study

Background

Respiratory failure is a severe complication in COVID-19 pneumonia that, in addition to oxygen therapy, may require CPAP support. It has been postulated that COVID-19 lung injury may share some features with those observed in HALI. Thus, a correct target PaO2during oxygen supplementation may be crucial to protect the lung from further tissue damage. Aims of the study were: 1) to evaluate the effects of conservative oxygen supplementation during Helmet CPAP therapy on mortality and ICU admission in patients with COVID-19 and respiratory failure; 2) to evaluate the effect of conservative oxygen supplementation on new-onset organ failure and secondary pulmonary infections.

Methods

This was a single-center, historically controlled study of patients with severe respiratory failure due to COVID-19 pneumonia, receiving either conservative or non-conservative oxygen supplementation during Helmet CPAP. A cohort receiving conservative oxygen supplementation was studied prospectively in which oxygen supplementation was administered with a target PaO2<100 mmHg. Results of this cohort were compared with those of a cohort who had received liberal oxygen supplementation.

Results

Seventy-one patients were included in the conservative cohort and 75 in the non-conservative cohort. Mortality rate was lower in the conservative cohort (22.5%versus62.7%, p<0.001). Rates of ICU admission and new-onset rate organ failure were lower in conservative cohort (14.1%versus37.3%, p=0.001, and 9.9%versus45.3% p<0.001, respectively).

Conclusions

In patients with COVID-19 and severe respiratory failure, conservative oxygen supplementation during Helmet CPAP was associated to improved survival, lower ICU admission rate and less new-onset organ failure.

COVID-19 vaccines reduce the risk of SARS-CoV-2 reinfection and hospitalization: Meta-analysis

The addictive protection against SARS-CoV-2 reinfection conferred by vaccination, as compared to natural immunity alone, remains to be quantified. We thus carried out a meta-analysis to summarize the existing evidence on the association between SARS-CoV-2 vaccination and the risk of reinfection and disease. We searched MedLine, Scopus and preprint repositories up to July 31, 2022, to retrieve cohort or case-control studies comparing the risk of SARS-CoV-2 reinfection or severe/critical COVID-19 among vaccinated vs. unvaccinated subjects, recovered from a primary episode. Data were combined using a generic inverse-variance approach. Eighteen studies, enrolling 18,132,192 individuals, were included. As compared to the unvaccinated, vaccinated subjects showed a significantly lower likelihood of reinfection (summary Odds Ratio-OR: 0.47; 95% CI: 0.42-0.54). Notably, the results did not change up to 12 months of follow-up, by number of vaccine doses, in studies that adjusted for potential confounders, adopting different reinfection definitions, and with different predominant strains. Once reinfected, vaccinated subjects were also significantly less likely to develop a severe disease (OR: 0.45; 95% CI: 0.38-0.54). Although further studies on the long-term persistence of protection, under the challenge of the new circulating variants, are clearly needed, the present meta-analysis provides solid evidence of a stronger protection of hybrid vs. natural immunity, which may persist during Omicron waves and up to 12 months.

Predictors of SARS-CoV-2 Infection in University Students: A Case-Control Study

Closure of Higher Education Institutions in the early phase of the SARS-CoV-2 pandemic was largely diffused. With their reopening, numerous preventive measures have been enacted, but limited evidence exists on students' behavior that could influence their infection risk. We conducted a case-control study at the Sapienza University of Rome to identify protective and risk factors for SARS-CoV-2 infection. Students attending the campus within 48 h of SARS-CoV-2 infection were considered cases. Controls were students who come in contact with a confirmed case within the campus. Demographic features and activities carried out before positivity or contact were investigated. Multivariable logistic regression models were built to identify factors associated with SARS-CoV-2 infection, estimating adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). The analysis showed an increased risk of SARS-CoV-2 infection for attending the second year or above of university (aOR 17.7, 95% CI 2.21-142.82) and participating in private parties or ceremonies (aOR 15.9, 95% CI 2.30-109.67) while living outside the family (aOR 0.08, 95% CI 0.01-0.54) and attending practical activities or libraries on campus (aOR 0.29, 95% CI 0.08-0.97) reduced the risk. Data strongly suggests that it may be safe to participate in activities organized under strict infection prevention guidelines. Tailored prevention measures might reduce the risk of infection in university students.

The Association of Health Literacy with Intention to Vaccinate and Vaccination Status: A Systematic Review

Despite health literacy (HL) being recognized as a driver of health-promoting behavior, its influence on the vaccination decision-making process remains unclear. This study summarized current evidence on the association between HL and both intention to vaccinate and vaccination status. We searched PubMed, Scopus, and Web of Science, retrieving observational studies published until January 2022 that used HL-validated tools to investigate the above associations for any vaccine. Quality was assessed using the Newcastle-Ottawa scale. Twenty-one articles were included; of these, six investigated the intention to vaccinate and the remainder vaccination status. Articles on intention looked at SARS-CoV-2 vaccination using heterogeneous HL tools and were of high/fair quality. Vaccination status, mainly for influenza or pneumococcal vaccines, was explored using various HL tools; the quality was generally high. We found inconsistent results across and within vaccine types, with no clear conclusion for either vaccination intention or status. A weak but positive association was reported between a high HL level and influenza vaccination uptake for individuals aged more than 65 years. HL did not seem to significantly influence behavior towards vaccination. Differences in the methods used might explain these results. Further research is needed to investigate the role of HL in the vaccination decision-making process.

Covid-19 vaccination adherence and correlated factors in patients with substance use disorders

Background

Analyzing trends and patterns of vaccination during COVID-19 pandemic is important to understand how current policies are working. Evidence regarding the general population is already available, but hard-to-reach populations as migrants or minorities, but also people suffering from a Substance Use Disorder (SUD), have not been fully explored. To understand the extent of vaccine adherence and evaluate associated factors in this population subgroup, we conducted a cross-sectional study in collaboration with Villa Marini Foundation, national agency of the Italian Red Cross for pathological addictions.

Methods

We developed a questionnaire regarding COVID-19 vaccination, adherence to prevention measures, concerns about COVID-19 and questions relating to drug use that we administered to each participant. Only people aged over 18 with a diagnosis of SUD were included in the study. A multivariable logistic regression model was built to identify the predictors associated with anti-SARS-CoV-2 vaccination, estimating adjusted odds ratios (aOR) and 95% confidence intervals (CIs).

Results

We recruited 200 participants between December 2021 and January 2022. Most respondents were male (84.5%), Italian (72%), aged 44 years on average. A total of 40 patients (20%) reported they haven't received any dose of COVID-19 vaccine; the most common motivations were lack of trust in the vaccine and fear of side effects. At multivariable analysis, the use of heroin appears to be negatively associated with vaccination acceptance (aOR=0.31 CI 95%: 0.11-0.81) as well as not being Italian (aOR=0.27 CI 95%: 0.12-0.63).

Conclusions

The vaccination rate in our sample was consistent with the one of the general Italian population in the same period, whereas the reasons behind the lower adherence to vaccination in the heroin group need to be further investigated. It’s also important to reduce possible bureaucratic obstacles that could explain the lower number of vaccinated foreign citizens.

Key messages

• People with Substance Use Disorder are a fragile and often overlooked population that needs to be considered during Public Health intervention and vaccination campaigns.

• The access to vaccination for foreigners should be made more simple and easier to increase accessibility and participation.

Attitudes of university students towards mandatory COVID-19 vaccination: a cross-sectional survey

Background

Vaccination is an effective public health measure to control the COVID-19 pandemic. In Italy, vaccination against SARS-CoV-2 was made compulsory by law for some job categories, such as healthcare and education workers. Although students required a valid COVID-19 certificate to access university, they were never subjected to mandatory vaccination. In this context, we investigated their attitudes towards mandating COVID-19 vaccination to be able to access schools and universities.

Methods

We conducted a cross-sectional survey from September 2021 to February 2022. A multivariable logistic regression model was built to identify predictors of positive attitudes towards the outcome. Adjusted odds ratio (aOR) and 95% confidence intervals (CIs) were calculated.

Results

We collected 5287 questionnaires, grouped into three periods (September-October 2021, November-December 2021 and January-February 2022). The highest proportion of students supporting COVID-19 mandatory vaccination (62.5%) was found between November and December 2021. Multivariable analysis showed that November-December and January-February participants had higher odds of having a positive attitude towards the vaccine mandate than September-October respondents (aOR=1.26, 95% CI:1.09-1-48; and aOR=1.22, 95% CI:1.01-1.48). Other positive predictors were age (aOR=1.01, 95% CI:1.01-1.03), higher levels of perceived COVID-19 severity (aOR=1.09, 95% CI:1.05-1.14), concern for the emergency (aOR=1.09, 95% CI:1.05-1.14), getting vaccinated for fear of infecting other people or being infected (aOR=1.08, 95% CI:1.04-1.12; and aOR=1.07, 95% CI:1.03-1.10) and believing that vaccines could end the pandemic (aOR=1.49, 95% CI:1.41-1.56).

Conclusions

Attitudes towards COVID-19 mandatory vaccination changed over time, probably in relation to the pandemic trends. Moreover, feeling involved in the pandemic situation seems to be related with a positive attitude.

Key messages

• Pandemic trends may affect the attitude towards vaccine mandates. Mandating vaccines to access universities could be taken into account in emergency situations to ensure a safer learning environment.

• Involvement in the pandemic situation seems related with a supportive attitude towards vaccine mandates, suggesting that awareness is a key factor to be addressed to implement mandatory vaccination.

Attitudes and experiences towards the IMMUNI App among Sapienza university students: a pilot study

Background

IMMUNI is an app that was created to help fight epidemics, starting with COVID-19. The app has a contact tracing feature but its diffusion in Italy was low. In this pilot study, we investigated university students’ attitudes and experience towards the IMMUNI app.

Methods

This cross-sectional study was conducted at Sapienza University of Rome between 14 April and 19 April 2021. An online survey was administrated to university students of medical area. A multivariable logistic regression model was built to identify app download's predictors. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated.

Results

We collected 247 questionnaires (response rate: 78.2%). More than half of the students (65.0%) didn't download IMMUNI app mostly because of the belief that it was useless (30.0%). By contrast, the main reason for downloading was sense of duty (40.0%). Experience with the app was limited but the process was judged as lacking for the technical difficulties. As for hypothetical incentives, feedback on how the download could help against the pandemic was considered as the most effective (3.5 out of 5). In the multivariable analysis, higher likelihood of download was associated with higher fear of contagion for family and acquaintances (aOR:1.50, 95% CI: 1.01-2.23) and higher rating to the health management of the emergency (aOR: 1.33, 95% CI:1.00-1.76). The highest odds of download were found for participants who have been advised to download the app (aOR: 3.21, 95% CI:1.80-5.73). On the other hand, greater belief that the virus came from a laboratory was negatively associated with the download (aOR: 0.75, 95% CI: 0.60-0.93).

Conclusions

Strategies aimed at raising students’ awareness on the importance of health technologies, restoring confidence in health authorities, and limiting disinformation around SARS-Cov-2 should be devised. In addition, the app could be enriched with positive feedbacks for users, and some technical issues should be fixed.

Key messages

• The spread of digital technologies for public health purposes is fostered by trust in health institutions and improving health literacy and user engagement.

• An efficient and user-friendly technology is recommended.

The role of health literacy in vaccination behaviours: a systematic review

Background

Health literacy (HL) is recognized as a driver of health-promoting behaviors, including preventive actions. However the influence of HL on vaccines uptake remains unclear. This study aimed at summarize the evidence on the role of HL in vaccination behaviors.

Methods

PubMed, Scopus, and Web of Science were searched. Observational studies of any design conducted worldwide, published through June 2021 and investigated the association between HL and vaccination intention or status using HL validated tools were included. Any vaccine was considered. An adapted Newcastle-Ottawa Scale was used to assess quality.

Results

Twenty-one articles were included, 6 investigated intention to vaccinate and 15 explored vaccination status. Studies of the first group had a cross-sectional design, considered anti-COVID-19 vaccination and were judged of high or fair quality. Population investigated was heterogeneous as well as the tool used to assess HL. Five analysis provided adjusted estimates. HL seemed not influence the vaccination intention in 3 studies whereas adequate HL was associated with positive attitude to get vaccinated in the remained 3 ones. The majority of articles assessed vaccine status, had a cross sectional design (N = 11) and were of high quality (N = 8). The HL tool more frequently used was TOFHLA (N = 5), sample investigated was heterogeneous included parents of children who received vaccinations (N = 5). Four articles considered multiple vaccinations, thus providing a total of 19 analysis. Vaccine against influenza was the most investigated (N = 11) and 15 studies provided adjusted estimates. No association was found between HL and the receipt of vaccination in 11 analysis, whereas HL levels significantly influenced vaccination uptake in 8 studies.

Conclusions

Health literacy did not seem to strongly influence people decision on vaccinations. Difference in population and vaccines considered, but also in tool used to measure HL might explain the heterogeneity of the results.

Key messages

• The impact of HL on vaccination behaviours remains controversial.

• Efforts to extend the studies on targeted populations applying a comprehensive HL measurement tool should be devised.

Risk factors for SARS-CoV-2 infection: a case-control study in college students after vaccination

Background

Within the SARS-CoV-2 screening campaign offered through RT-PCR test by Sapienza University of Rome, we conducted a case-control study to identify the risk factors for the acquisition of SARS-CoV-2 infection among university students.

Methods

Positive students identified through the SARS-CoV-2 screening campaign (September 2021 - February 2022) were enrolled as cases and matched to two randomly selected students who tested negative on the same day. The interview questionnaire consisted of 39 questions investigating exposure to modifiable and nonmodifiable risk factors for SARS-CoV-2 in the two weeks before testing. A multivariable conditional logistic regression model was constructed to identify predictors of SARS-CoV-2 infection. Adjusted odds ratio (aOR) and 95% CI were calculated.

Results

Out of 8.730 tests for SARS-CoV-2, 173 students tested positive (2.0%), of which 122 were included in the case-control study (response rate: 70.5%). Most students were female (73.2%), with a mean age of 23.3 years (SD ± 3.6), vaccinated for SARS-CoV-2 (97.8%) and enrolled in non-health faculty (56.8%). At the multivariable analysis, significant positive associations were found with having had contact with a person who tested positive for SARS-CoV-2 (aOR: 3.04, 95% CI: 1.59-5.82) or having been to a disco/nightclub (aOR: 5.37, 95% CI: 2.00-14.38). Instead, being vaccinated against SARS-CoV-2 (aOR: 0.13, 95% CI: 0.01-0.93), having a valid EU COVID digital certificate (aOR: 0.06, 95% CI: 0.01-0.30) and attending lectures in-person (aOR: 0.35, 95% CI: 0.17-0.70) were negatively predictors. No association was found for sex, age, health faculty students, use of public transportation, attendance at restaurants or gyms.

Conclusions

The results highlight how anti-COVID-19 vaccinations and the reasons for students to obtain an EU COVID digital certificate may prevent students from getting infected. In addition, university environment seems to be safe for students.

Key messages

• Promoting SARS-CoV-2 vaccination adherence in the college-age population is crucial to limiting the SARS-CoV-2 spread.

• Attending in-person educational activities in regulated settings (e.g., low occupancy, mask use) may not be a risk factor for COVID-19 infection.

Prevalence of SARS-CoV-2 infection and associated risk factors: A testing program and nested case-control study conducted at Sapienza University of Rome between March and June 2021

Background

To safely resume in-person activities during the COVID-19 pandemic, Sapienza University of Rome implemented rigorous infection prevention and control measures, a successful communication campaign and a free SARS-CoV-2 testing program. In this study, we describe the University's experience in carrying out such a program in the context of the COVID-19 response and identify risk factors for infection.

Methods

Having identified resources, space, supplies and staff, from March to June 2021 Sapienza offered to all its enrollees a molecular test service (8.30 AM to 4 PM, Monday to Thursday). A test-negative case-control study was conducted within the program. Participants underwent structured interviews that investigated activity-related exposures in the 2 weeks before testing. Multivariable conditional logistic regression analyses were performed. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were calculated.

Results

A total of 8,959 tests were administered, of which 56 were positive. The detection trend followed regional tendencies. Among 40 cases and 80 controls, multivariable analysis showed that a known exposure to a COVID-19 case increased the likelihood of infection (aOR: 8.39, 95% CI: 2.38-29.54), while having a job decreased it (aOR: 0.23, 95% CI: 0.06-0.88). Of factors that almost reached statistical significance, participation in activities in the university tended to reduce the risk (aOR: 0.32, 95% CI: 0.09-1.06), while attendance at private gatherings showed an increasing risk trend (aOR: 3.48, 95% CI: 0.95-12.79). Age, gender, activities in the community, visiting bars or restaurants, and use of public transportation were not relevant risk factors. When those students regularly attending the university campus were excluded from the analysis, the results were comparable, except that attending activities in the community came close to having a statistically significant effect (aOR: 8.13, 95% CI: 0.91-72.84).

Conclusions

The testing program helped create a safe university environment. Furthermore, promoting preventive behavior and implementing rigorous measures in public places, as was the case in the university setting, contributed to limit the virus transmission.

Risk of reinfection and disease after SARS-CoV-2 primary infection: Meta-analysis

INTRODUCTION

A precise estimate of the frequency and severity of SARS-CoV-2 reinfections would be critical to optimize restriction and vaccination policies for the hundreds of millions previously infected subjects. We performed a meta-analysis to evaluate the risk of reinfection and COVID-19 following primary infection.

METHODS

We searched MedLine, Scopus and preprint repositories for cohort studies evaluating the onset of new infections among baseline SARS-CoV-2-positive subjects. Random-effect meta-analyses of proportions were stratified by gender, exposure risk, vaccination status, viral strain, time between episodes, and reinfection definition.

RESULTS

Ninety-one studies, enrolling 15,034,624 subjects, were included. Overall, 158,478 reinfections were recorded, corresponding to a pooled rate of 0.97% (95% CI: 0.71%-1.27%), with no substantial differences by definition criteria, exposure risk or gender. Reinfection rates were still 0.66% after ≥12 months from first infection, and the risk was substantially lower among vaccinated subjects (0.32% vs. 0.74% for unvaccinated individuals). During the first 3 months of Omicron wave, the reinfection rates reached 3.31%. Overall rates of severe/lethal COVID-19 were very low (2-7 per 10,000 subjects according to definition criteria) and were not affected by strain predominance.

CONCLUSIONS

A strong natural immunity follows the primary infection and may last for more than one year, suggesting that the risk and health care needs of recovered subjects might be limited. Although the reinfection rates considerably increased during the Omicron wave, the risk of a secondary severe or lethal disease remained very low. The risk-benefit profile of multiple vaccine doses for this subset of population needs to be carefully evaluated.

What Are the Effects of Vitamin A Oral Supplementation in the Prevention and Management of Viral Infections? A Systematic Review of Randomized Clinical Trials

Vitamin A (VA) deficiency is associated with increased host susceptibility to infections, but evidence on its role in the prevention and management of viral infections is still lacking. This review aimed at summarizing the effects of VA supplementation against viral infections to support clinicians in evaluating supplemental treatments. PubMed, Scopus, and Web of Science were searched. Randomized clinical trials comparing the direct effects of VA oral supplementation in any form vs. placebo or standard of care in the prevention and/or management of confirmed viral infections in people of any age were included. A narrative synthesis of the results was performed. The revised Cochrane Risk-Of-Bias tool was used to assess quality. Overall, 40 articles of heterogeneous quality were included. We found data on infections sustained by Retroviridae (n = 17), Caliciviradae (n = 2), Flaviviridae (n = 1), Papillomaviridae (n = 3), Pneumoviridae (n = 4), and Paramyxoviridae (n = 13). Studies were published between 1987 and 2017 and mostly conducted in Africa. The findings were heterogeneous across and within viral families regarding virological, immunological, and biological response, and no meaningful results were found in the prevention of viral infections. For a few diseases, VA-supplemented individuals had a better prognosis and improved outcomes, including clearance of HPV lesions or reduction in some measles-related complications. The effects of VA oral supplementation seem encouraging in relation to the management of a few viral infections. Difference in populations considered, variety in recruitment and treatment protocols might explain the heterogeneity of the results. Further investigations are needed to better identify the benefits of VA administration.

Mapping the Prevalence of COVID-19 Vaccine Acceptance at the Global and Regional Level: A Systematic Review and Meta-Analysis

Despite the availability of effective and safe vaccines, the acceptance of COVID-19 vaccination is suboptimal. In this meta-analysis we quantified the prevalence estimates of COVID-19 vaccine acceptance with a specific focus on worldwide geographical differences. We searched PubMed, Scopus, Web of Science and PsycInfo up to April 2021 (PROSPERO ID: CRD42021235328). Generalized random-effects linear models with a logit link were used to calculate the pooled estimated rate of vaccine acceptance at both the global and regional level. A meta-regression analysis was performed to assess the association between COVID-19 vaccine acceptance and various characteristics of the studies. Overall, 71 articles yielding 128 prevalence estimates were included. The pooled prevalence of COVID-19 vaccination acceptance rate was 66% (95% CI: 61-71%). This varied by geographic area, ranging from 36% (95% CI: 18-60%) in Africa to 83% (95% CI: 82-84%) in Oceania, and there was high variability between countries (15.4% Cameroon-100% Bhutan). Meta-regression analysis showed that studies that investigated COVID-19 vaccination intentions using multiple choice/scoring gave a vaccine acceptance prevalence lower than studies with only two possible answers (yes/no) (ß: -1.02 95% CI: -1.41 to -0.63). Despite some variation in the estimates, the results showed that one in three people may refuse/delay COVID-19 vaccination.

The Impact of eHealth Interventions on the Improvement of Self-Care in Chronic Patients: An Overview of Systematic Reviews

Promoting self-care is one of the most promising strategies for managing chronic conditions. This overview aimed to investigate the effectiveness of eHealth interventions at improving self-care in patients with type-2 diabetes mellitus, cardiovascular disease, and chronic obstructive pulmonary disease when compared to standard care. We carried out a review of systematic reviews on PubMed, Scopus, Cochrane, PsychInfo, and CINAHL. AMSTAR-2 was used for quality appraisal. Eight systematic reviews (six with meta-analysis) were included, involving a total of 41,579 participants. eHealth interventions were categorized into three subgroups: (i) reminders via messaging apps, emails, and apps; (ii) telemonitoring and online operator support; (iii) internet and web-based educational programs. Six systematic reviews showed an improvement in self-care measurements through eHealth interventions, which also led to a better quality of life and clinical outcomes (HbA1C, blood pressure, hospitalization, cholesterol, body weight). This overview provided some implications for practice and research: eHealth is effective in increasing self-care in chronic patients; however, it is required to designate the type of eHealth intervention based on the needed outcome (e.g., implementing telemonitoring to increase self-monitoring of blood pressure). In addition, there is a need to standardize self-care measures through increased use of validated assessment tools.

Managing the introduction of genomic applications into the National Health Service: A special challenge for health technology assessment in Italy

In recent years, the rapid proliferation of genomic tests for use in clinical practice has prompted healthcare systems to use a health technology assessment (HTA) approach to distinguish valuable from unwarranted applications. In this study, we narratively review the Italian HTA mechanisms for medical devices (MDs), both at the national and regional levels, and discuss the opportunity and benefits of extending them to genomic technologies, for which a dedicated assessment path was advocated by the National Plan for Public Health Genomics in 2017. We found that the National Health Technology Assessment Program for MDs, completed in 2019, had developed a structured pathway for the HTA of MDs; it established a hub-and-spoke structure, run by a governmental institution, and put in place transparent methodological procedures to cover all four HTA phases (i.e., proposal and prioritization, assessment, appraisal, and dissemination). However, several factors have hindered its adoption, and the regions are at different stages of its implementation. For these reasons, efforts should be made to ensure its effective deployment, both at national and regional levels. In addition, we argue that to harmonize the institutional roles and methodological procedures adopted, the time has come to concentrate resources on a single pathway for the assessment of all technologies that include both MDs and genomic applications.

What Went Wrong with the IMMUNI Contact-Tracing App in Italy? A Cross-Sectional Survey on the Attitudes and Experiences among Healthcare University Students

The adoption of digital contact-tracing apps to limit the spread of SARS-CoV-2 has been sup-optimal, but studies that clearly identify factors associated with the app uptake are still limited. In April 2021, we administered a questionnaire to healthcare university students to investigate their attitudes towards and experiences of the IMMUNI app. A multivariable logistic regression model was built to identify app download predictors. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. We surveyed 247 students. Most respondents (65.6%) had not downloaded IMMUNI, reporting as the main reason the perceived app uselessness (32.7%). In the multivariable analysis, being advised to use the app (aOR: 3.21, 95%CI: 1.80-5.73), greater fear of infecting others (aOR: 1.50, 95%CI: 1.01-2.23), and greater trust in the institutional response to the emergency (aOR: 1.33, 95%CI: 1.00-1.76) were positively associated with the outcome, whereas greater belief in the "lab-leak theory" of COVID-19 was a negative predictor (aOR: 0.75, 95%CI: 0.60-0.93). Major technical issues were reported by app users. Targeted strategies aimed at improving awareness of digital health applications should be devised. Furthermore, institutions should invest in the development of these technologies, to minimize technical issues and make them accessible to the entire population.

Effectiveness of ustekinumab in patients with refractory Crohn's disease: a multicentre real-life study in Italy

BACKGROUND

The effectiveness of ustekinumab in patients with refractory Crohn's disease (CD) has been investigated in several real-world studies. However, very few data concerning the real-life experience in Italy have been reported. Therefore, this study assessed the effectiveness of ustekinumab in a large cohort of Italian patients with refractory CD.

METHODS

All patients who had started on ustekinumab after failure of or intolerance to antitumour necrosis factor-α (TNF-α) treatment at five tertiary centres between November 2018 and February 2020 were retrospectively enrolled. The coprimary outcome was corticosteroid-free clinical remission, defined as a Harvey-Bradshaw Index (HBI) score of ⩽4, at weeks 26 and 52. The secondary outcomes were changes in the HBI and C-reactive protein (CRP) values at weeks 8, 26, and 52 from baseline and the normalization of CRP in patients with initially abnormal values.

RESULTS

Totally, 140 patients who had previously received at least one anti-TNF-α agent were enrolled; 40.0% received two anti-TNF-α agents and 20.0% received vedolizumab. At baseline, 108 patients (77.1%) had HBI scores of >4; of these, 56.5% and 58.3% achieved corticosteroid-free clinical remission at weeks 26 and 52, respectively. Significant decreases in HBI and CRP values were observed at weeks 8, 26, and 52 in the entire study cohort (all p < 0.0001). The CRP values were normalized in 34.9%, 37.8%, and 49.3% of the patients by weeks 8, 26, and 52, respectively. The baseline HBI score of ⩾8 was a negative predictor of corticosteroid-free clinical remission at week 52 (odds ratio: 0.21, 95% confidence interval: 0.08-0.56, p = 0.002). The probability of remaining on ustekinumab after 52 weeks was 92.1%. Eleven (7.9%) patients discontinued ustekinumab (three for adverse events).

CONCLUSION

Our study findings confirm the effectiveness and safety of ustekinumab in patients with CD after failure of or intolerance to anti-TNF-α therapy.

The association between adherence to cancer screening programs and health literacy: A systematic review and meta-analysis

The effectiveness of a cancer screening program relies on its adherence rate. Health literacy (HL) has been investigated among the factors that could influence such participation, but the findings are not always consistent. The aim of this meta-analysis was to summarize the evidence between having an adequate level of HL (AHL) and adherence to cancer screening programs. PubMed, Scopus, and Web of Science were searched. Cross-sectional studies, conducted in any country, that provided raw data, unadjusted or adjusted odds ratio (OR) on the associations of interest were included. The quality of the studies was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled ORs and their associated confidence interval (CI) stratified by time interval (e.g., undergoing screening in the last period, or at least once during lifetime) for each cancer type, considering unadjusted and adjusted estimates separately. A sensitivity analysis was performed for those studies providing more estimates. Overall, 15 articles of average-to-good quality were pooled. We found a significant association between AHL and higher screening participation for breast, cervical and colorectal cancer, independently of other factors, both overall (N = 7, aOR = 1.73; 95% CI: 1.27-2.36; N = 3, aOR = 1.64; 95% CI: 1.30-2.09; and N = 5, aOR = 1.25, 95% CI: 1.12-1.39, respectively) and in most time-stratified analyses. The sensitivity analyses confirmed these results. Health literacy seems to be critical for an effective cancer prevention. Given the high prevalence of illiterate people across the world, a long-term action plan is needed.

Time to Align: A Call for Consensus on the Assessment of Genetic Testing

In this paper, we updated our 2018 systematic review aimed to identify and compare ad hoc designed frameworks for genetic testing evaluation. Overall, we identified 30 frameworks (29 in the first systematic review and one in the update): they were mainly based on the ACCE model, whereas a minority were adjustments of the more traditional Health Technology Assessment (HTA) approach. After discussing the strengths and weaknesses of the retrieved frameworks, this perspective calls for consensus on the assessment of genetic testing. In line with the recent European recommendations that encouraged the generation of comparable evidence across Member States, we believe that the time has come to align all the ideas that have emerged over the last few decades and find a sustainable and sharable tool for the evaluation of genetic and genomic applications. Therefore, we suggest stopping the evaluation of such technologies using ad hoc strategies-affected by validation, implementation, and adoption issues-and we propose to use a general HTA approach, particularly the European reference tool for the assessment of health technologies, the EUnetHTA HTA core model, that is built on solid theoretical and methodological principles and provides a comprehensive assessment of the technologies value.

Benefits of Parent Training in the Rehabilitation of Deaf or Hard of Hearing Children of Hearing Parents: A Systematic Review

The present study is a systematic review on the effectiveness of Parent Training (PT) and coaching in deaf and hard of hearing (DHH) rehabilitation programs which reviews and synthesizes the existing body of evidence to assess the benefits of these programs in enhancing parents' sensitivity, responsivity and promoting language development in DHH children during the first years after HA fitting or CI activation. Five published studies met the Population, Intervention, Comparison and Outcomes (PICO) inclusion criteria and were eligible to be included, but heterogeneity in terms of the study design, interventions and outcomes did not allow for performing a meta-analysis. All included studies shared the view that a parent's learning is a circular (rather than frontal) process, and the results appear promising in terms of enhancing parents' responsiveness and promoting DHH child language development. Nevertheless, the available evidence was judged to not be robust enough due to limitations in the studies' designs. Further high-quality evidence is needed to evaluate the true degree of clinical value and the cost effectiveness of PT programs aimed at increasing parents' responsiveness to their DHH children.

Job Satisfaction Among Employees After a Merger: A Cross-Sectional Survey in the Local Health Unit of Sardinia Region, Italy

Job satisfaction plays an important role in healthcare organization and management; it is critical for maintaining and improving staff efficiency and consequently the quality of care provided. Organizational restructuring processes, including mergers, are likely to affect job satisfaction levels, but evidence of the impact they have is surprisingly scarce. The aim of the study was to describe a methodology used to measure job satisfaction of the employees at a Local Health Unit (LHU) in Italy immediately after a merger and to assess the determinants associated with any reduction in worker satisfaction. The study was conducted among employees of the LHU of the Sardinia Region in July 2018, after a merger of eight subregional LHUs had taken place. The entire staff was enrolled, of which a total of 1,737 employees were surveyed. We used a questionnaire exploring socio-demographic and working characteristics of the employees, the various areas related to job satisfaction and interviewee opinions on the merger process. Multivariable stepwise backward logistic regression models were built to identify factors independently associated with lower job satisfaction. The results of a multivariable analysis showed that lower job satisfaction was more likely in employees with an administrative role (aOR: 2.34, 95% CI: 1.37-4.00) or a career demotion (aOR: 1.84, 95%CI: 1.11-3.03). High levels of mental stress were strongly associated with lower job satisfaction (aOR: 5.64, 95%CI: 4.16-7.64). "More equity of employee rewards" was the only example of a set of responder suggestions found to be associated with lower job satisfaction (aOR: 2.30, 95%CI: 1.51-3.47). Generally, responders showed a good level of job satisfaction-and this was also the case following the merger-but some job profile determinants were strongly associated with low employee satisfaction. The results of the study highlighted several challenging areas and critical issues relating to working conditions. Further surveys are required to confirm these results and to monitor their evolution over time.

Molecular characterization of A. baumanni isolates causing co-infections in SARS-COV-2 patients

Background

Respiratory viral infections, such as COVID-19, predispose patients to co-infections leading to increased morbidity and mortality. A. baumannii poses as a serious threat to hospital facilities because of its ability to persist in the environment and acquire multi-drug resistance. The aim of this study was to quantify the extent of A. baumannii cross-infection and identify any gene clonality between isolates in SARS-CoV-2 patients.

Methods

Bacterial isolates of A. baumannii found in patients with SARS-CoV-2 admitted to the main Intensive Care Unit (ICU) of the Umberto I Teaching Hospital of Rome were collected between March 2020 and February 2021. Isolates were typed by pulsed-field electrophoresis to analyse their homology relationships.

Results

Overall, 196 SARS-CoV-2 patients were admitted to the ICU. They were mainly male (N = 138) and aged 63 years on average. Of these, 122 died, and 74 were discharged. A total of 157 strains of A. baumannii were isolated from 74 patients (38%), who had a higher mean hospital stay than patients in whom the bacterial strain had not been isolated (24.6 vs. 12.2 days). The genotypic analysis of 120 isolates revealed two main patterns (A and F) and a few subtypes, especially A8 (43%), A4 (29%), and A11 (10%). Clone A8 was found mainly between October 2020 and February 2021, clone A4 in April-December 2020 and January-February 2021, and A11 in December 2020 and January 2021. The strains were susceptible to colistin only, were isolated mostly from tracheobronchial aspirates (41%) or rectal swabs (35%) and accounted for 56 healthcare-associated infections (33% of which sustained by A4, 38% by A8, and 9% by A11).

Conclusions

The isolation of A. baumannii from patients with COVID-19 highlighted the importance of monitoring co-infections caused by this pathogen, which frequently shows a multi-drug resistant profile that may lengthen the hospital stay. It is essential to implement preventive measures to contain these infections.

Key messages

A. baumanni is a pathogen that needs to be monitored because it may lengthen the hospital stay of SARS-CoV-2 patients. In critically ill patients, the continued growth of multidrug-resistant organisms shows the importance of preventing these infections.

Incidence rate of Healthcare Associated Infections in a COVID-19 Intensive Care Unit

Background

Intensive Care Units (ICU) faced a high pressure under the COVID-19 pandemic. It is recognized that patients admitted in these wards are more susceptible to Healthcare Associated Infections (HAIs). This study aims at comparing the incidence of HAIs in a COVID-19 ICU to a No-COVID ward.

Methods

A retrospective cohort study including patients admitted to the ICU of the Teaching Hospital Policlinico Umberto I in Rome from April 2020 to March 2021 was performed. Data on age, gender, hospitalization, different types of devices (ventilation, central venous and urinary catheter), number and type of device-related HAI were collected. Statistical analyses were performed with Episheet and STATA 13.

Results

Out of 347 patients admitted in the ICUs, 329 were included in the study (217 had COVID-19 and 112 had not). In the COVID-19 group, patients were mainly male (69.58%) with a mean age of 62.5±13.5 years, whereas the other group was slightly older (63.2±16.2 years) and more balanced between the two sexes (52.68% male). A total of 133 patients developed at least one HAI, 94 of which were SARS-CoV-2 positive. Globally, 246 HAIs were diagnosed: 163 occurred in the COVID group and 83 in the No-COVID one. The cumulative days of hospitalization were 3233 for the COVID group and 2134 for the No-COVID. The incidence of HAI considered for 1000 days of hospitalization among COVID patients was 50.42 (IC 95%: 42.97-58.78), compared to 38.89 (IC 95%: 30.98-48.22) for the No-COVID one, for an incidence rate ratio of 1.30 (IC 95%: 0.99-1.71).

Conclusions

Even though the confidence interval contains the value 1, the results point out that there is an increase in the incidence rate of HAI among COVID-19 patients. Further investigations are needed to better understand the reasons behind the present findings.

Key messages

Patients admitted to Intensive Care Units are more susceptible to Healthcare Associated Infections. Our study aims at describing the impact of COVID-19 on the risk of developing such conditions.

Being infected with COVID-19 leads to an increase in the incidence rate of Healthcare Associated Infections. Further studies are needed to understand the underlying reasons.

COVID-19 vaccine hesitancy among university students: how worrying is it? An Italian survey

Background

With the availability of COVID-19 vaccines, vaccine hesitancy (VH) poses a great challenge to achieving herd immunity. Since young adults are usually asymptomatic, they may be less inclined to follow social distancing and mask-wearing guidelines. This study aimed at (i) quantifying VH among university students and (ii) investigating its determinants to identify barriers and predisposing factors to COVID-19 vaccination.

Methods

Students physically attending Sapienza University of Rome during April 2021 were invited to take part in an online survey. The questionnaire explored sociodemographic variables, COVID-19 experience, attitude towards preventive measures, and COVID-19 vaccination. Hesitancy was measured as the complement to 10 of students' intention to get vaccinated and was modeled through zero-inflated negative binomial regression analysis.

Results

Overall, 1949 students were surveyed. Most were females (59.9%) and aged 23.8±4.9 years on average. A great proportion reported no (76.8%) or slight hesitancy (15.7%). At multivariable analysis, in the count part, being more scared for the pandemic (IRR=0.94, 95%CI: 0.89-0.98), rating COVID-19 as more severe (IRR=0.93, 95%CI: 0.89-0.98) and being Italian rather than non-Italian (IRR=0.68, 95%CI: 0.54-0.85) were associated with lower VH, but no influence was found for age, sex, self-perceived risk of infection, and being a medical student. In the logit part, rating the vaccines as safe (b: 0.92, 95%CI: 0.75-1.10) or effective (b: 0.30, 95%CI: 0.14-0.45) decreased the likelihood of being hesitant.

Conclusions

A few factors seemed to influence the intention to get vaccinated against COVID-19, including vaccine safety and effectiveness. Hence, attention should be given to planning effective communication about the vaccine profile in order to maintain and improve the public's confidence. Also, partnerships should be established among the stakeholders to ensure coordinated information sharing and dissemination.

Key messages

Almost one-quarter of the surveyed students reported VH to some extent, and a few factors seemed to play a role in the vaccination decision-making process. Among others, the perceived vaccine safety and effectiveness seemed to influence VH. Attention should be given to planning effective communication about the vaccines’ profile.

The other side of COVID-19: a cross-sectional study on mental health in a sample of Italian nurses

Background

The COVID-19 pandemic and the resulting drastic increase in the workload for healthcare professionals, particularly nurses, has had serious consequences on the psychological well-being of these professionals. Our study aimed at (i) identifying demographic, work-related factors, and clinical predictors of Post-traumatic stress disorder (PTSD) and Generalized Anxiety Disorder (GAD) in nurses employed during COVID-19 pandemic and (ii) assessing problem-focused coping strategies implemented by nurses.

Methods

We carried out a cross-sectional study between December 2020 and April 2021, addressed to nurses employed during the COVID-19 second wave (October - December 2020). PTSD and GAD were assessed by Social Readjustment Rating Scale, Impact of Event Scale - Revised (IES-R) and General Anxiety Disorder -7 scale.

Results

Overall, 359 nurses were included in the study, whose mean age was 31.75 years (SD ± 9.77). Most were female (80.8%), unmarried (53.2%) and employed in the central (52.5%) and northern (36.4%) regions of Italy. A total of 59.7% of all participants had clinical predictors of PTSD, recording a mean score of IES-R of 38.2, SD ± 19.2, range 1- 84 (cut-off >33 for PTSD). Furthermore, 45.6% of respondents reported moderate - severe symptoms consistent with generalized anxiety disorder. Statistical significance was found between GAD and nurses being employed on the front line (Intensive care unit and emergency department) during the COVID-19 second wave (p = 0.016), and between GAD and clinical predictors of PTSD (p = 0.001). Furthermore, we found a statistically significant association between PTSD and nurses who were employed in hospitals or institutions dedicated to COVID-19 (p = 0.028).

Conclusions

PTSD and GAD represent a public health problem to be addressed in the post-pandemic period. Healthcare organizations need to activate specific support and rehabilitation networks and programs for healthcare professionals employed during the COVID-19 pandemic.

Key messages

The levels of PTSD symptoms and anxiety among nurses were high during the pandemic.

It is necessary for health systems to differentiate between temporary and long-term mental disorders in order to provide the health workforce with appropriate rehabilitation.

Impact of the Covid-19 pandemic on health services utilization: a cross-sectional study

Background

Health services disruption during the COVID-19 pandemic has forced to postpone or cancel most scheduled health visits. Within this context, disadvantaged people may have been suffered the most from the indirect consequences of the emergency. The aim of the study was to quantify the pandemic impact on health services utilization in the Roman population based on the economic, sociodemographic and cultural characteristics.

Methods

In January 2021, an online survey was administrated to 640 patients attending a Roman general practitioner. The questionnaire investigated sociodemographic characteristics, working and living conditions, COVID-19 experience, consequences of lockdown or policy responses, and health literacy. A multiple logistic regression model was built to investigate factor associated with a reduction in the healthcare use.

Results

Overall, 451 respondents were surveyed. More than 60% were women and mean age was 55 years. In total, 211 patients referred to have cancelled one or more scheduled health visits (14 vaccinations, 60 screening exams, 168 medical examinations and 23 surgeries). At multivariable logistic regression analysis, the loss of at least one visit seemed to be associated with lower perceived wealth (aOR=1.60, 95%CI: 1.07-2.39), pre-existing comorbidities (aOR=1.60, 95%CI: 1.04-2.45), and older age (aOR=1.03, 95%CI: 1.01-1.04). No association was found for sex, education, or health literacy.

Conclusions

A few socio-demographic characteristics seemed to identify people that may have suffered the most from the health services disruption during the COVID-19 pandemic, contributing to worsen the existing health inequalities. Future research is needed to devise strategies aimed at containing the negative effects of the pandemic on vulnerable populations.

Key messages

The COVID-19 pandemic seemed to have a greater impact on health service utilization among disadvantaged people. The COVID-19 pandemic may have exacerbated health inequalities.

Mapping levels of COVID-19 vaccine hesitancy worldwide: preliminary results of a systematic review

Background

Several factors can determine the success of a vaccination campaign, regardless of the availability of an effective and safe vaccine. Among these, vaccine hesitancy (VH) has long represented one of the main barriers to achieving vaccination coverage goals in many countries. The aim of this systematic review was to summarize the global levels of COVID-19 VH and to identify their determinants.

Methods

A systematic review of the literature was carried out following the PRISMA guideline and searching on PubMed, Web of Science, Scopus and PsycINFO for observational studies published up to April 2021 in English or Italian language. Levels of hesitancy and data on determinants, according to the SAGE working group matrix of determinants, were extracted. The systematic review protocol was registered on Prospero (ID: CRD42021235328).

Results

Of the 5447 articles initially retrieved, 89 were included in the qualitative synthesis. The included studies investigated COVID-19 VH on 1.954.331 individuals from 68 different countries (North America 19; South America 23; Africa 3; Asia 18; Europe 55; Oceania 4) between March 2020 and January 2021. Rates of hesitancy, before to the worldwide availability of vaccinations (82 studies), ranged from 84.6% (Cameroon, May-August 2020) to 10.37% (China, March-June 2020). Studies carried out on January 2021 (N = 7) showed rates ranging from 42.8% (Turkey) to 5.3% (UK). A subgroup analysis of data referring to healthcare workers showed the highest hesitancy rates in Honk Kong (60%) and Turkey (26.6%), before and after vaccine availability, respectively.

Conclusions

Preliminary results confirm the wide variability of VH across the world. The ongoing quantitative synthesis on prevalence of VH and the analysis on determinants will allow to update intervention strategies to address VH, both in general population and healthcare workers, orienting public health policies.

Key messages

Vaccine Hesitancy continues to be one of the greatest threats to global health and, in the long term, one of the potential barriers to the success of the global COVID-19 vaccination campaign. Identifying and synthesizing the specific determinants of COVID-19 vaccine hesitancy is essential to guide intervention strategies to promote vaccine confidence and, finally, vaccine acceptance.

Effect of the mandatory vaccination law on measles and rubella incidence and vaccination coverage in Italy (2013-2019)

Despite the introduction of the trivalent vaccine (measles, mumps, rubella) more than 20 years ago, measles outbreaks have occurred in Europe, including Italy, due to its underutilization. In Italy mandatory vaccination was established in 2017 (Decree Law 119/2017). This study aimed at evaluating the impact of mandatory vaccination and determining the trend in vaccination coverage for measles and rubella in Italy. We retrieved data from the Annual Status Update, a form sent annually by the Italian National Verification Committee to the Regional Verification Committee for Europe, from 1^st January 2013 to 31^st December 2019. Since the beginning of 2013, 14,788 cases of measles have been reported, ranging from 256 (3.9 x 1,000,000) to 5,397 (88.4 x 1,000,000) compared to 259 rubella cases for the same period. From 2013 to 2015, vaccination coverage decreased for the first dose of measles (90.4% to 85.3%) and rubella vaccine (90.3% to 85.2%), but then it increased significantly, reinforced by the Italian Decree Law, reaching 94.4% in 2019. The trend for the second dose showed a decrease from 2013 to 2016 (84.1% to 82.2% for measles and 83.7% to 82.0% for rubella), but then increased significantly and reached 90.2% in 2019 for measles and 90.0% for rubella. The mandatory vaccination law has resulted in a significant increase in vaccination coverage for measles and rubella in Italy, and demonstrates encouraging progress toward the 95% target and the restriction of measles transmission. Special attention should be paid to maintaining and further improving vaccination coverage.