Time lapses between distribution of influenza vaccines to health authorities and their administration by General Practitioners (GPs) to older adults: a retrospective study over five influenza seasons in Italy.

BACKGROUND: Delays in influenza vaccine delivery and administration can hinder vaccine coverage and protection. This study examines the differentials in distributing and administering adjuvanted trivalent (aTIV) and quadrivalent influenza vaccines (aQIV) to older adults in Italy's primary care setting and its potential impact on hospitalization risk over 5 epidemic seasons. METHODS: Using a primary care database, individuals aged ≥ 65 years were selected. The proportion of vaccine distribution to regional authorities and subsequent administration by GPs was estimated using census data. Using quantile (median) regression, we examined the relationship between velocities of vaccine distribution and administration (doses/week) and the incidence of hospitalizations. RESULTS: Over the 5 influenza seasons, the velocity of distribution and administration of aTIV/aQIV ranged 341-833 and 152-270 median doses/week; no trend was yielded for the difference between these velocities (p = 0.189) or vaccine coverage (p = 0.142). An association was observed for each differential dose/week between distributed and administered vaccines and all-cause hospitalizations with a 10% increase in 2017-2018, 54% in 2018-2019, and 12% in 2020-2021 season. CONCLUSIONS: These findings highlight the importance of minimizing the time lapse between vaccine distribution and administration to mitigate the impact of influenza and address factors that contribute to vaccination barriers.

Increasing Influenza Vaccination Uptake by Sending Reminders: A Representative Cross-Sectional Study on the Preferences of Italian Adults.

Evidence from countries that achieved a high seasonal influenza vaccination (SIV) coverage suggests that reminders to get vaccinated may increase SIV uptake. The goal of this study was to explore the experience and attitudes of Italian adults toward an active invitation to receive SIV, triggered by different sources and delivered via different communication channels, and to assess the projected benefits of this strategy. A cross-sectional survey on a representative sample of Italian adults was conducted by using computer-assisted web interviewing. Responses from 2513 subjects were analyzed. A total of 52.2% of individuals previously received invitations to undergo SIV and compared with people who did not receive any reminder were three times more likely (68.2% vs. 22.2%) to be vaccinated in the last season. Compared with other sources, reminders sent by general practitioners (GPs) were perceived as the most attractive. As for communication channels, most participants preferred text/instant messaging (24.6%) or email (27.2%), suggesting an acceleration in the Italian digital transformation triggered by the COVID-19 pandemic. Conversely, traditional postal letters or phone calls were preferred by only 17.0% and 8.6% of respondents, respectively. Reminders sent by GPs via text/instant messages or email are a valuable option for increasing SIV uptake among Italian adults.

The burden of influenza and the role of influenza vaccination in adults aged 50-64 years: A summary of available evidence.

Influenza is a vaccine-preventable disease and a global public health problem. Although most national influenza vaccination recommendations focus on subjects aged ≥65 years, an extensive burden of influenza has also been reported in those aged ≥50 years and is exacerbated by immune system aging. The main purpose of this review is to provide an overview of the burden of influenza and its potential prevention within the 50-64 age-group. These subjects account for a large proportion of the workforce, and play a central economic and social role. Individuals aged 50-64 years had a 3-times higher rate of hospitalization and a 9-fold higher mortality rate attributable to influenza than those aged 18-49-years, generating higher influenza-related hospitalization costs. Available data suggest that including healthy subjects aged 50-64 years in influenza vaccination recommendations would allow a broader population to be reached, reducing the economic and social burden of influenza.

Influenza Vaccination Assessment according to a Value-Based Health Care Approach.

BACKGROUND: Seasonal influenza has a considerable public health impact, and vaccination is the key to preventing its consequences. Our aim was to describe how the value of influenza vaccination is addressed in the scientific literature considering a new value framework based on four pillars (personal, allocative, technical, and societal value). METHODS: A systematic review was conducted by querying three databases. The analysis was performed on international studies focused on influenza vaccination value, and the four value pillars were taken into consideration for their description. RESULTS: Overall, 40 studies were considered. Most of them focused on influenza vaccination in the general population (27.5%), emphasizing its value for all age groups. Most studies addressed technical value (70.4%), especially in terms of economic models and cost drivers to be considered for the economic evaluations of influenza vaccines, and societal value (63%), whereas few dealt with personal (37%) and allocative values (22.2%). CONCLUSIONS: The whole value of influenza vaccination is still not completely recognized. Knowledge and communication of the whole value of influenza vaccination is essential to guide value-based health policies. To achieve this goal, it is necessary to implement initiatives that involve all relevant stakeholders.

The Economic and Fiscal Impact of Influenza Vaccination for Health Care Workers in Italy.

Influenza has a significant impact on the health care system and also on production and economic systems. Vaccinated health care workers (HCWs) are more likely to have improved productivity compared to unvaccinated workers. The study aim was to estimate the economic and fiscal impact of an influenza vaccination program for HCWs in Italy. We performed a cost analysis aimed to estimate the indirect costs (productivity losses due to working days lost) and the increase in tax revenues derived from the increase in vaccination coverage among HCWs. Assuming an incremental increase in vaccination coverage of 10% per year over a period of 5 years, total savings could be obtained in terms of a reduction in productivity losses equal to -€4,475,497.16 and an increase in tax revenues of €327,158.84. This revenue could be used to finance other health interventions. Our results are fundamental in view of the sustainability of health systems and of a value-based allocation of health resources. Therefore, a complete social perspective, including the fiscal impact of flu vaccination, should be adopted to assess the economic value of influenza vaccines. Currently, health policies based on the whole value of flu vaccination are needed.

Acceptance of COVID-19 and Influenza Vaccine Co-Administration: Insights from a Representative Italian Survey.

Co-administration of coronavirus disease 2019 (COVID-19) and seasonal influenza vaccines has several advantages, has been advocated by various public health authorities and should be seen as an opportunity to increase the uptake of both vaccines. The objective of this survey was to quantify the acceptance of concomitant COVID-19/influenza vaccination and to identify its correlates in a representative sample of Italian adults. Of 2463 participants, a total of 22.9% were favorable to vaccine co-administration, while 16.6% declared their firm unwillingness to receive both vaccines simultaneously. The remaining 60.5% of subjects could be dubbed hesitant to some degree. Compliance with the primary COVID-19 vaccination schedule (adjusted proportional odds ratio (aOR) = 7.78), previous influenza vaccination (aOR = 1.89) and trust in public health institutions (aOR = 1.22) were the main determinants of positive attitudes toward vaccine co-administration. Other significant correlates included age, sex, perceived disease severity and vaccination risk-benefit, being offered a more personalized influenza vaccine and recent seeking for influenza-related information. In Italy, hesitancy toward COVID-19/influenza vaccine co-administration is common and appears to be higher than hesitancy toward either vaccine administered alone. This pattern is multifaceted and requires specific and tailored strategies, with public health institutions playing the central role.

Off-Label Use of Hydroxychloroquine in COVID-19: Analysis of Reports of Suspected Adverse Reactions From the Italian National Network of Pharmacovigilance.

This study aimed to characterize adverse drug reactions (ADRs) to hydroxychloroquine in the setting of COVID-19, occurring in Italy in the period March to May 2020. The analysis of the combination therapy with azithromycin or/and lopinavir/ritonavir as well as a comparison with ADRs reported throughout 2019 was performed. ADRs collected by the Italian National Network of Pharmacovigilance were analyzed for their incidence, seriousness, outcome, coadministered drugs, and Medical Dictionary for Regulatory Activities classification. A total of 306 reports were gathered for the quarter of 2020: 54% nonserious and 46% serious, and half of the latter required either the hospitalization or its prolongation. However, most of them were either completely recovered (26%) or in the process of recovery (45%), except for 9 fatal cases. Throughout 2019, 38 reports were collected, 53% nonserious and 47% serious, but no deaths had been reported. Diarrhea, prolonged QT interval, and hypertransaminasemia were the most frequently ADRs reported in 2020, significantly higher than 2019 and specific for COVID-19 subjects treated with hydroxychloroquine. The logistic regression analyses demonstrated that the likelihood of serious ADRs, QT prolongation, and diarrhea significantly increased with hydroxychloroquine dosage. Coadministration of lopinavir/ritonavir and hydroxychloroquine showed a positive correlation with diarrhea and hypertransaminasemia and a negative relationship with the ADR seriousness. The combination therapy with azithromycin was another independent predictor of a serious ADR. Off-label use of hydroxychloroquine for COVID-19, alone or in combination regimens, was associated with increased incidence and/or seriousness of specific ADRs in patients with additional risk factors caused by the infection.

An exploratory study to assess patterns of influenza- and pneumonia-related mortality among the Italian elderly.

Older adults are at disproportionately high risk of severe influenza-related outcomes and represent the main target of the annual influenza vaccination. The protective effect of seasonal influenza vaccination on the observed mortality indicators is controversial. In this ecological study, spatiotemporal patterns of pneumonia- and influenza-related mortality registered in the Italian elderly over seven (2011-2017) consecutive seasons were explored and the epidemiological association between the observed local pneumonia- and influenza-related mortality and influenza vaccination campaign features were modeled by using both fixed- and random-effects panel regression models. The descriptive spatiotemporal analysis showed a clear North-South gradient, where northern regions tended to report more pneumonia- and influenza-related deaths. After adjustment for potential confounders, it was found that each 1% increase in influenza vaccination coverage rate would be associated (P < .001) with a 1.6-1.9% decrease in pneumonia- and influenza-related mortality. Moreover, each 1% increase in the use of MF59®-adjuvanted trivalent influenza vaccine would be associated (P < .05) with a further 0.4% decrease in pneumonia- and influenza-related mortality. This study supports the increase in annual influenza vaccination in Italy and suggests that a higher level of use of the adjuvanted influenza vaccine in the elderly may be beneficial.

Changes in Attitudes and Beliefs Concerning Vaccination and Influenza Vaccines between the First and Second COVID-19 Pandemic Waves: A Longitudinal Study.

Perceptions of the risks of vaccine-preventable diseases and preventive behaviors change over time. The ongoing COVID-19 pandemic may have modified laypeople's attitudes towards routine vaccinations. In this longitudinal study, we aimed to assess changes in attitudes and beliefs concerning (influenza) vaccines between the first and second COVID-19 pandemic waves. A total of 1979 participants completed both 2020 and 2021 surveys. After one year, more interviewees agreed that vaccines were fundamental and should be mandatory (77.3% vs. 75.0%). Analogously, willingness to undergo influenza vaccination increased (p < 0.001) from 44.1% to 48.6%. This increase was seen in subjects aged ≥35 years. Previous influenza vaccinations, receipt of a COVID-19 vaccine, positive attitudes towards (influenza) vaccination, male sex, and older age were the main correlates of willingness to receive the 2021/22 influenza vaccine. Totals of 12.6% and 11.8% had no intention to receive the next seasonal influenza and COVID-19 vaccines, respectively. Most respondents favored a hypothetical combined influenza/COVID-19 vaccine (73.7%) or influenza and COVID-19 vaccine co-administration (67.5%). In Italy, influenza and COVID-19 vaccination hesitancy and refusal are common. Effective public health strategies to pursue higher uptake of both vaccines are urgently needed.