Indoor air pollution: an Italian Knowledge, Attitude and Practice (KAP) study among the general population.

Background: Indoor air pollution negatively affects population health and the national health services in terms of socio-economic costs. The presence of indoor pollutants depends a lot on lifestyles. Study design: The aim of this work is to evaluate knowledge, daily habits and the preventive behaviors in order to contrast the effects on health caused by indoor pollutants. Methods: The study was conducted through the administration of questionnaires to the population resident in the metropolitan city of Messina (Italy), asking about sociodemographic characteristics, knowledge, daily habits and preventive behaviors. Results: The questionnaire was filled by 894 subjects (46.8% M; 53.2% F). Regarding knowledge, 66.8% had heard of indoor air pollution and 94.9% knew what the most common indoor pollutants are; regarding daily habits they often aired out the house (91.9% in the morning and 71.4% after cleaning), 24.8% were smokers and 36.7 of them smoked indoors; regarding preventive behaviors, 41.6% chose the cleaning products based on habit and only 32.9% bought plants able to purify environments. Conclusions: Although the analyzed population had adequate knowledge of indoor air pollution, this did not strongly impact on the adoption of healthy lifestyles. Therefore, it becomes necessary to intervene on a social level with environmental education activities, starting from school age.

Quali sono la conoscenza, l'attitudine e la percezione dei rischi alimentari nei giovani adulti? Un'indagine effettuata in Italia.

BACKGROUND: in recent years, food safety has become increasingly important and a public health priority, especially in developed and rich countries. OBJECTIVES: to investigate knowledge and perception of food risk among young adults and the related behaviours. DESIGN: observational study conducted from March to October 2022 through the administration of an anonymous questionnaire based on multiple-choice questions spread online through social networks. SETTING AND PARTICIPANTS: 317 men and women with a mean age of 23.6 ± 6.7 (71% F, 29% M), mainly students, who filled the questionnaire and gave their consent to the use of personal data for the purpose of scientific research. MAIN OUTCOMES MEASURES: knowledge, attitudes, and perception of food risk in the target population. RESULTS: the majority think that food safety is very important to their health. The most perceived food risks are the presence of pesticides, bacterial and viral contamination, residuals of antibiotics and/or hormones, and microplastics. More than half believes to be poorly informed about the risk associated with food consumption. There is a high level of trust in data from scientific evidence and physicians and a low level of trust in data from European institutions and the Italian government. Almost everyone thinks that public authorities should provide more information. CONCLUSIONS: these data show a good knowledge of the importance of food safety for health; nevertheless, the majority does not feel well informed. The evaluation of the risk perception and of the factors influencing it is important for the success of the information/communication about food safety and for the consumer empowerment.

Rethinking the Healthcare Facilities: The Role of the Buffer Space.

OBJECTIVES: A working group conducted a survey on the use of the principle of buffer space (BS), which in case of emergencies, could benefit healthcare settings. The aim of the preliminary investigation is to define new research lines in hospitals' functional design. BACKGROUND: The global experience of the COVID-19 pandemic highlighted challenges faced by hospitals when responding promptly to emergencies, including spatial reorganization and suspension of ordinary medical activities for ensuring adequate management of the emergency surge of patients. METHODS: The group designed questionnaires to be administered to healthcare staff and healthcare designers aimed at understanding varied conceptions and features of BSs. Content across the two surveys overlapped significantly, allowing for direct comparisons of responses, while also including tailored questions in relation to the respective experience and skills of the two groups of respondents. RESULTS: 102 healthcare professionals and 56 designers took part to the survey. Analysis of the responses permitted for initial recommendations regarding BS typology including (a) proximity to the emergency department (ED), intensive care units (ICUs), and inpatient wards (IWs); (b) location within hospitals but separate from other medical areas; (c) need for independent access; (d) organizational and spatial features similar to ED, ICUs, and IWs; (e) existing as a fully flexible operational space; and (f) BS bed capacity to be approximately 12% of ED beds. CONCLUSIONS: Although the analysis is related to the Italian context, the expansion of this preliminary research to alternate healthcare facilities and geographic areas is necessary for reaching a wide consensus by different professionals on this field. It serves as a starting point for future investigations regarding the implementation of BS in hospital settings.

Rates of Primary and Secondary Prevention of Cervical Cancer: A Study in a Province in the South of Italy.

In Italy, cervical cancer represents the fifth most prevalent cancer in women under 50 years of age and is one of the most commonly detected lesions globally. Given the developing burden of the disease and the availability of both primary and secondary prevention measures, their accurate surveillance is of paramount importance. The aim of this study was to evaluate the trends in cervical cancer screening adherence in the period between 2020 and 2022, as well as to evaluate positive tests, identifying the most frequently associated genotypes and the vaccination coverage. The study sample was made up of 6880 women from the health district of Messina. We highlighted that there was a high proportion of positive results in the investigated period, with a high prevalence of HSIL. Moreover, HPV vaccination coverage was clearly inadequate, as was adherence to screening, both far away from WHO goals. This finding is probably linked to inadequate communication and awareness of the issue in the population and to the lack of data relating to tests carried out privately. In accordance with existing data in the literature, the introduction of the HPV-DNA test in Sicily made it possible to identify women positive for the genotypes most frequently involved in the etiopathogenesis of neoplastic lesions (genotypes 16 and 18), as well as for those in the "others" category, which should be investigated because some of them could have an impact on carcinogenicity and, for this reason, a future vaccine including them could represent a new prevention weapon.

Between mandatory vaccination and the COVID-19 pandemic: effects on the vaccination coverage trend in a province of Southern Italy.

BACKGROUND AND AIM: Although vaccination is considered an extraordinarily effective and safe tool for the prevention of infectious diseases, from 2013 to 2016 CVs at national level showed a downward trend, falling well below the 95% threshold recommended by the WHO to limit the circulation of viruses and bacteria in the community and to obtain the so-called herd effect in addition to the protection of individual vaccinated individuals. The aim of the study was to assess vaccination coverage data following the introduction of Law 119/2017 and in like to COVID-19 pandemic the impact on vaccination coverage. METHODS: The study was conducted from 1 October 2019 to 1 October 2022, using the OnVac programme. RESULTS: The analysis of the coverage rates of hexavalent vaccination during the entire study period shows that there was an increase in vaccinations during the two-year period 2020-2021, followed by a drastic decrease down to values below 95%. where variable coverage was noted between the two genders with higher percentages in the female sex. Contrary to expectations, 2021 did not allow the recovery of the defaulting cohorts, with a drop in coverage much higher than in previous years (with values approaching the values of 2008), not only for polio, diphtheria and tetanus, but also for measles, mumps, rubella, chicken pox and HPV, effectively getting worse over the previous decade. CONCLUSIONS: immunization challenges need to be addressed to ensure that every child, adolescent or patient at risk is immunized, especially but not only for COVID-19.

The Importance of COVID-19/Influenza Vaccines Co-Administration: An Essential Public Health Tool.

Vaccine co-administration is an important tool with several advantages for public health, among which is the increase of vaccination coverage, as well as economic and logistical benefits. The purpose of this study was to assess and compare the immune response to the COVID-19 first booster dose in healthcare workers (HCWs) who chose co-administration and in HCWs who received only COVID-19 vaccination and to investigate personal opinions about the experience of co-administration. We carried out a retrospective analysis involving two groups of HCWs, both vaccinated with the complete primary cycle and the first booster dose of the COVID-19 vaccine, but one of them was also vaccinated, at the same time as the first booster dose, with the influenza vaccine. Active phone calls were also performed, and specific questions about the onset of side effects and general opinions were asked. A good immune response was found in both two groups without any statistically significant difference in the immune response. No severe reactions occurred in either group. A greater part of the sample was completely satisfied, and they would do it again. Our findings are totally in favor of the co-administration, considering the many positive aspects provided by administering, at the same time, more vaccines.

Insight into Prevention of Neisseria Gonorrhoeae: A Short Review.

Neisseria gonorrhoeae (gonococcus) and Neisseria meningitidis (meningococcus) are important global pathogens which cause the sexually transmitted diseases gonorrhea and meningitis, respectively, as well as sepsis. We prepared a review according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA), with the aims of (a) evaluating the data on the MenB vaccination as protection against sexually transmitted infections by N. gonorrhoeae and (b) to briefly comment on the data of ongoing studies of new vaccines. We evaluated existing evidence on the effect of 4CMenB, a multi-component vaccine, on invasive diseases caused by different meningococcal serogroups and on gonorrhea. Non-B meningococcal serogroups showed that the 4CMenB vaccine could potentially offer some level of protection against non-B meningococcal serogroups and N. gonorrhoeae. The assessment of the potential protection conferred by 4CMenB is further challenged by the fact that further studies are still needed to fully understand natural immune responses against gonococcal infections. A further limitation could be the potential differences between the protection mechanisms against N. gonorrhoeae, which causes local infections, and the protection mechanisms against N. meningitidis, which causes systemic infections.

Reactogenicity and Humoral Immune Response after Heterologous Vaxzevria/Comirnaty Vaccination in a Group of Individuals Vaccinated in the AOU Policlinic "G. Martino" (Messina, Italy): A Retrospective Cohort Study.

On 11 June 2021, the Italian Ministry of Health authorized the heterologous vaccination schedule. The goals of our retrospective study were to (a) evaluate the undesirable effects after the administration of Vaxzevria and Comirnaty vaccines; (b) evaluate the antibody response after 28 days from the administration of the second dose; and (c) compare the antibody responses after the homologous and heterologous vaccination regimens. The undesirable effects were collected using a survey; IgG Spike was quantified using the electrochemiluminescence method; the comparison between the antibody responses was carried out using the sample of a homologous vaccine schedule previously analyzed. Pain at the injection site is the most common undesirable effect after the administration of both vaccines (62.1% after Vaxzevria vs. 82.75% after Comirnaty); swelling at the injection site is more frequent after the administration of Vaxzevria than after the administration of Comirnaty: (15.52% vs. 5.17%); headache is more frequent in women than in men for both the vaccination types (p < 0.05); 49.09% of the sample reported IgG Spike ≥ 12,500 U/mL; the antibody titer of the heterologous schedule is higher than that of the homologous vaccination. Our study demonstrated that the undesirable effects after the administration of the second dose are less frequent and less severe than after the administration of the first dose, and that the immunogenicity of the heterologous vaccinations is higher than that of the homologous ones.

COVID-19: opinions and behavior of Italian general population during the first epidemic phase.

BACKGROUND AND AIM: On January 9, 2020, the World Health Organization (WHO) declared that Chinese health authorities had identified a new coronavirus strain never before isolated in humans, the 2019-nCoV later redefined SARS-CoV-2, that still today represent a public health problem. The present survey started on 10 February 2020 with the aim of a) assessing the risk perception in healthcare workers and young students, following the evolution of attitudes, perception and knowledge over time, b) provide useful information to the general population during survey. RESULTS: A study sample consisting of 4116 Italian individuals of both sexes was enrolled. High levels of risk perception, low perception of self-efficacy and low levels of knowledge scores (24.55 ± 5.76 SD) were obtained indicating the need for continuous population monitoring as well as further communication strategies carried out at institution levels. CONCLUSION: The results of the present study could help public health authorities in carrying out informative campaigns for general population and could be an important tool in evaluating public knowledge and misperceptions during the management of the COVID-19. (www.actabiomedica.it).

A Knowledge, Attitude, and Perception Study on Flu and COVID-19 Vaccination during the COVID-19 Pandemic: Multicentric Italian Survey Insights.

In January 2020, Chinese health authorities identified a novel coronavirus strain never before isolated in humans. It quickly spread across the world, and was eventually declared a pandemic, leading to about 310 million confirmed cases and to 5,497,113 deaths (data as of 11 January 2022). Influenza viruses affect millions of people during cold seasons, with high impacts, in terms of mortality and morbidity. Patients with comorbidities are at a higher risk of acquiring severe problems due to COVID-19 and the flu-infections that could impact their underlying clinical conditions. In the present study, knowledge, attitudes, and opinions of the general population regarding COVID-19 and influenza immunization were evaluated. A multicenter, web-based, cross-sectional study was conducted between 10 February and 12 July 2020, during the first wave of SARS-CoV-2 infections among the general population in Italy. A sample of 4116 questionnaires was collected at the end of the study period. Overall, 17.5% of respondents stated that it was unlikely that they would accept a future COVID-19 vaccine (n = 720). Reasons behind vaccine refusal/indecision were mainly a lack of trust in the vaccine (41.1%), the fear of side effects (23.4%), or a lack of perception of susceptibility to the disease (17.1%). More than 50% (53.8%; n = 2214) of the sample participants were willing to receive flu vaccinations in the forthcoming vaccination campaign, but only 28.2% of cases had received it at least once in the previous five seasons. A higher knowledge score about SARS-CoV-2/COVID-19 and at least one flu vaccination during previous influenza seasons were significantly associated with the intention to be vaccinated against COVID-19 and influenza. The continuous study of factors, determining vaccination acceptance and hesitancy, is fundamental in the current context, in regard to improve vaccination confidence and adherence rates against vaccine preventable diseases.

COVID-19 serological evaluation in a cohort of Vaccinated and Seropositive healthcare workers.

INTRODUCTION: Severe Acquired Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) infection represents an unprecedented public health problem and, at present, vaccination is the only weapon available to combat the infection. The simplest and most immediate method to quantify the response of the subject's immune system to vaccination and / or infection is the serological assessment of the antibody titer. The objective of our study was 1) to evaluate the presence of antibody responses in a sample of healthcare workers subjected to a complete vaccination course as per ministerial provisions (double dose for negatives and single dose for ex-SARS-CoV subjects -2 positive) with Comirnaty vaccine (Pfizer / BioNTech) 2) evaluate the presence of statistically significant associations for sex, age and previous positive swab. MATERIALS AND METHODS: the antibody levels of both nucleocapsid antibodies and anti-Sars-CoV2 Spike antibodies of the study subjects were examined with the electrochemiluminescent immunoassay (ECLIA) method developed by Roche®. The cut-off value, as suggested by the manufacturer, for anti-nucleocapsid antibodies was 1 COI, while the Ig Spike value was 0.8 I / mL. The study sample was stratified by age (≤45 years, 46-55, ≥56 years old), previous positive molecular swab, gender and IgG S1 / S2 values ​​at the completed vaccination course (≤200, ≥200 AU / mL ). Statistical analyzes were carried out with the R software. RESULTS: almost all of the sample (89.45%) showed IgG Spike values> 200 AU / mL with statistically significant associations in relation to sex (greater in females, p≤0.05), to previous swab positivity in the presence of a vaccine dose (n = 44; p <0.001) and at age (with greater antibody response in subjects under 45; p <0.001). DISCUSSION AND CONCLUSIONS: The current study confirms what is reported in the literature. In the light of the results obtained, it could be interesting to promote studies that evaluate the antibody titers trend over time a) in women of childbearing age and postmenopausal age b) in particular categories of subjects with chronic degenerative diseases to assess the actual need for doses booster, it being understood that the immune system response is guaranteed by both cellular and humoral immunity and that the antibody titer does not faithfully reflect the protection obtained.

Management care improvement of people living with HIV: definition of a targeted clinical pathway in a University Hospital of South Italy.

BACKGROUND AND AIM: In the world 37,9 billions live with Human Immunodeficiency Virus and, despite the availability of retroviral therapy, they have an higher risk to acquire other infectious diseases and to develop severe complications. According to several guidelines their immunization is crucial but only some center have developed a specific scheduled pathway and vaccination coverage is very low.  Aim of this study is: a)incentivize the active and free of charge offer of vaccines and increase of immunization coverage; b) application and implementation of a shared clinical pathway avoiding reluctance, embarrassment or shame by patients for their condition; d) instauration of an empathic relationship between doctor and patient; e) evaluation of side effects. METHODS: A prospective study was conducted from October 2019 to February 2020 at the University Hospital G. Martino of Messina. Inclusion criteria were: age over 18; absence of other diseases; absence of immunization against HBV or HAV; CD4 count for live attenuated viral vaccines of 350/uL and for other vaccine 200/uL. A specific scheduled pathway was adopted for every patient. Statistical analysis was performed with Excel software. RESULTS: 86 patients were enrolled (74.4% were males, 79.1% were Italian; mean age=4013.3 SD).  An increase in administration was observed between 2018 and 2019 (+164.3% for flu and for other vaccines +370%).  The higher increase was observed for HPV one. No-one received DTpa, MMRV or Zoster vaccine. CONCLUSIONS: The undertook clinical pathway showed the relevance of specific management of these patients and the need to increase the vaccination offer.

Attitudes and Perception of Healthcare Workers Concerning Influenza Vaccination during the 2019/2020 Season: A Survey of Sicilian University Hospitals.

Influenza is an infectious disease with a high impact on the population in terms of morbidity and mortality, but despite International and European guidelines, vaccination coverage rates among healthcare workers (HCWs) remain very low. The aim of the present study was to evaluate influenza vaccination adherence in the three Sicilian University Hospitals of Catania, Messina, and Palermo and to understand the attitudes and perceptions of vaccinated healthcare workers and the main reasons for vaccination refusal. A cross-sectional survey through a self-administered questionnaire was conducted during the 2019/2020 influenza season. Overall, 2356 vaccinated healthcare workers answered the questionnaire. The main reason reported for influenza vaccination adherence during the 2019/2020 season was to protect patients. Higher self-perceived risk of contracting influenza and a positive attitude to recommending vaccination to patients were significantly associated with influenza vaccination adherence during the last five seasons via multivariable analysis. Fear of an adverse reaction was the main reason for influenza vaccine refusal. In accordance with these findings, Public Health institutions should develop and tailor formative and informative campaigns to reduce principal barriers to the immunization process and promote influenza vaccination adherence among HCWs.

Predicting needlestick and sharps injuries in nursing students: Development of the SNNIP scale.

Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018-January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50-1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of "personal exposure" (4.06, SD 3.78) were reported by third-year students. Higher scores for "perceived benefits" of preventive behaviours (13.6, SD 1.46) were reported by second-year students.

Correct management and low rate of contagiousness of healthcare workers in a University Hospital in Southern Italy: from contact tracing to serological investigation.

The COVID-19 epidemic, which began in Wuhan in December 2019, quickly spread all over the world, leading in a few months to a high number of deaths also in healthcare workers. The purpose of the study is to a) describe the importance of a correct management of SARS-CoV-2 infections; b) report the number of positive healthcare workers after the epidemic phase and to describe their socio-characteristics data, the main methods of transmission and the symptoms; c) to report the seroconversion rate of healthcare workers  (HCWs). The study was conducted from March 9, 2020 to June 19, 2020 in three phases:1) in a first phase, we implemented the guidelines to be followed for patient care in our hospital; 2) in a second phase, we provided the epidemiological investigation/contact tracing of HCWs; 3)  we collected swabs on all healthcare workers and we also performed serological investigation. The number of healthcare workers under surveillance is of 2611 subjects and, of these, only 0.65% contracted COVID-19. In particular, 70.6% of these have been infected in the healthcare setting, 11, 8% in the family and 17.6% returning from high risk areas. Ultimately, only 0.1% of HCWs dedicated to the treatment of COVID-19 patients contracted the infection (one was asymptomatic). Only 2% of HCWS were positive for serological investigation.

Molecular epidemiology of antimicrobial resistant microorganisms in the 21th century: a review of the literature.

Healthcare-associated infections (HAIs) are the most frequent and severe complication acquired in healthcare settings with high impact in terms of morbidity, mortality and costs. Many bacteria could be implicated in these infections, but, expecially multidrug resistance bacteria could play an important role. Many microbial typing technologies have been developed until to the the bacterial whole-genome sequencing and the choice of a molecular typing method therefore will depend on the skill level and resources of the laboratory and the aim and scale of the investigation. In several studies the molecular investigation of pathogens involved in HAIs was performed with many microorganisms identified as causative agents such as Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Clostridium difficile, Acinetobacter spp., Enterobacter spp., Enterococcus spp., Staphylococcus aureus and several more minor species. Here, we will describe the most and least frequently reported clonal complex, sequence types and ribotypes with their worldwide geographic distribution for the most important species involved in HAIs.

Immunogenicity and antibody persistence of diphteria-tetanus-acellular pertussis vaccination in adolescents and adults: a systematic review of the literature showed different responses to the available vaccines.

INTRODUCTION: In industrialized countries, the routine use of Bordetella pertussis vaccines has shifted the burden of Bordetella pertussis disease from children to infants, adolescents and adults, leading to the necessity for booster doses. MATERIALS AND METHODS: We prepared a review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) with the aims of: a) describing the immunogenicity of the main available vaccines for adolescents and adults; b) describing antibody persistence after immunization with the main vaccines available in childhood and adults and, also, possible co-administration; and c) identifying the gold standard for adolescent and adult immunizations. RESULTS: We identified 6906 records. After removing duplicate records, we included 12 RCT (Randomized Controlled Trial) (people aged 11-73): 7 of these studies had only 1 control group, 4 had 2 control groups and 1 had 5 control groups; moreover, of the 12 studies included, only 2 regarded co-administration, while all concerned immunogenicity. Nine of the 12 studies had a Jadad score above 3 points, and 10 out of 12 met the criteria of Cochrane Back Review Group Criteria List for Methodological Quality Assessment. DISCUSSION AND CONCLUSION: We found a limited number of good-quality RCTs investigating our object. The 5-component vaccines, although containing a lower dose of antigen, proved more effective than the 1-component vaccine. Evidence supports the use of 5-component vaccines for booster sessions in adolescence and adulthood.

The 'Dangerous Cocktail': an epidemiological survey on the attitude of a population of pregnant women towards some pregnancy risk factors.

Many investigations have shown the important role played by risk factors such as tobacco and alcohol and infectious agents (especially Rubella) in the development of congenital anomalies (CAs). Through the administration of a questionnaire, we evaluated the attitude of a population of pregnant women towards some risk factors in pregnancy (smoking and alcohol habit and risk of contracting one of TORCH agents). 14% of the women continued to smoke despite pregnancy; the majority of these were 34-35 years old, divorced, workers and with a high educational level. The 4.3% who identified as moderate drinkers; were mainly younger and married. Concerning the TORCH agents, it a high percentage were negative to the Rubella antibodies (62.8%). In order to improve the awareness of pregnant women on these risk factors, health education campaigns represent a public health cornerstone. Impact statementWhat is already known on this subject? Several investigations have shown an association between congenital anomalies (CAs) and various exogenous factors such as air pollutants, pesticides, metals, radiations and others present in the environmental matrices. Moreover, an important role is played by some risk factors linked to the lifestyles (i.e. tobacco and alcohol).What do the results of this study add? Our study shows that the awareness of the women about the importance of these risk factors is still rather poor, especially concerning the avoidable risks associated with smoke and alcohol and the preventable risk associated with rubella infection.What are the implications of these findings for clinical practice and/or further research? Our results highlight the importance of continuous health education both about the risk to smoke and drink during pregnancy and about the risk not to have had contract the rubella infection before the pregnancy. Particularly, about the latter issue, it appears necessary to increase the pre-conceptional diagnosis and, eventually, to vaccinate the women resulted negative in order to eliminate congenital rubella.

Immunization Status against Measles of Health-Care Workers Operating at Three Sicilian University Hospitals: An Observational Study.

Measles is a highly contagious vaccine-preventable disease (VPD) that also commonly affects health-care workers (HCWs). Measles immunization of HCWs was strongly recommended by international health authorities, in order to limit the spreading of the illness to susceptible patients and colleagues. An observational study, evaluating the immunization and vaccination status against measles of HCWs working at three Sicilian university hospitals, was conducted. All subjects not completely immune (vaccinated with only one dose in their lifetime), not immune (not vaccinated or not naturally immunized), and with an unknown immunization status were considered not immunized. Among HCWs operating in the three Sicilian university hospitals, 54.6% were not immune against measles. The average age of not immune HCWs was 51.3 (SD ± 9.8), ranging between 25 and 71 years old. In particular, 46.9% of HCWs not immunized worked in "at-risk" hospital units, based on medical conditions of patients which increases the probability of contracting an infection. Vaccination coverage rates observed against measles are considerably lower than other European countries and inadequate. It is therefore crucial to tackle vaccine hesitancy among HCWs, promoting strategies targeted to evaluate immunization status against VPDs and to significantly increase vaccine coverages, such as tailored training and vaccination offer or compulsory vaccination programs.

Healthcare workers' vaccination at European and Italian level: a narrative review.

Today some vaccine-preventable diseases remain an important cause of morbidity and mortality worldwide despite the availability of new vaccines. Healthcare workers are particularly at risk to acquire an infection disease, playing a fundamental role in nosocomial transmission, which makes them an important target group for vaccination. The vaccination recommendations of HCWs, as well as the general population, differ from country to country. Furthermore, coverage rates vary widely a lot over the world, making HCWs vulnerable to disease and so healthcare settings to outbreaks.  The motivations of vaccine hesitancy are many and maybe other studies would help policymakers and stake-holders to shape programs to improve vaccination coverage and the control of infectious diseases through the correct application of guidelines on prevention.