Public health strategies adopted to manage the increase of accesses to vaccination services, as a result of the application of the law 119/2017.

BACKGROUND AND AIM OF THE WORK: In response to the alarming reduction of vaccination coverage rates, Italian Ministry of Health approved the law number 119/2017, which has extended the number of mandatory vaccinations, for school attendance, from four to ten. The present study aims to evaluate accesses to the vaccination services of the Palermo Local Health Unit (LHU) and the variation of the vaccination coverage rates for hexavalent and measles, mumps, rubella and varicella (MMRV) vaccines, after the implementation of the law 119/2017. METHODS: An extent of opening hours and an involvement of other health-care professionals in the vaccination services of the Palermo LHU have been adopted to manage the excess of accesses after the introduction of 119/2017 law and to limit the discomfort of general population. Vaccination accesses and coverage rates were calculated from the electronic immunization registers. RESULTS: An overall increase of about 15% of single vaccination accesses was observed in the three semester after the introduction of the law in the LHU of Palermo. A peak of 35,516 accesses was observed during the second semester of 2017 (+ 30% compared to the same semesters of 2016 and 2018). From 2016 to 2018, coverage rates for full hexavalent cycle and first dose of MMRV, at 24 and 36 months, and for full MMRV cycle and fourth dose of diphtheria, tetanus, pertussis, poliomyelitis (DTPa+IPV), among 6 years old children, showed considerable increases. CONCLUSIONS: Law 199/2017 demonstrated a high efficacy in increase vaccination coverage rates also in Sicily. The synergy established between the LHU and the University of Palermo allowed an excellent management of the accesses to vaccination services, making it possible to respond to the public health needs of the general population.

Knowledge and attitudes of parents after the implementation of mandatory vaccination in kindergartens of Palermo, Italy.

BACKGROUND AND AIM OF THE WORK: Even though vaccination is easy to access in Europe, it has been facing several outbreaks caused by vaccine preventable diseases. Trying to balance the right to health of the community with individual self-determination, in Italy was mandate vaccination for ten vaccine preventable diseases in 2017. The project "Sportello Vaccinale" provided a counseling service to parents in kindergarten of Palermo. The main objective of the study was to investigate knowledge and compliance on vaccination by children's parents after the implementation of mandatory vaccination. METHODS: A cross sectional study was conducted among parents accessing to the "Sportello Vaccinale" using a questionnaire.  The questionnaire consisted of 34 items divided into three sections: socio-demographic data; knowledge and attitude on mandatory vaccination using Health Belief Model (HBM); Health Literacy (HL) level. RESULTS: A total of 95 questionnaires were garnered in the kindergartens from respondents with a mean age of 36 (±SD=6) years. The respondents who delayed hexavalent or Measles, Mumps, Rubella and Varicella (MMRV) vaccinations were 8 (8%) and the more frequent cause was fear of adverse reaction (87%). The sample had more often high level of health literacy (37%), and 55% had higher HBM score. The factor significantly associated with higher HBM score was the age of respondents (OR= 1.14, p=0.006) after controlling for other variables. CONCLUSIONS: Consent to vaccination practice was widely represented, but the results of the study highlighted the need for parents to have more information and more time devoted to the practice of vaccination counseling. Implementing counseling activities at school or at the vaccination service, could support an aware decision process of the parents on vaccination topic.