Influenza and Covid-19 Vaccination in 2023: a descriptive analysis in two Italian Research and Teaching Hospitals. Is the On-Site strategy effective?
Keywords:
Influenza vaccine, COVID 19 vaccine, healthcare workersAbstract
Background. Vaccinations represent an extremely effective tool for the prevention of certain infectious diseases - such as influenza and COVID-19 -, particularly for those categories at risk due to both their frail condition or professional exposure, such as healthcare workers. The aim of this study is to describe the course of the anti-influenza and anti-COVID-19 vaccination campaign at two Research Hospitals in Milan, Italy.
Study design. Multicentre, cross-sectional study.
Methods. For the 2023-24 vaccination campaign, the two facilities opted for two different approaches. At the Hospital A, two different strategies for vaccinating healthcare workers were implemented: a fixed-site vaccination clinic and two mobile vaccination groups run by Public Health residents of the University of Milan. At the Hospital B, on the other hand, a single fixed-site outpatient clinic run by Public Health residents of the University of Milan was used. On the occasion of the campaign, a survey was also carried out using anonymous online questionnaires to investigate healthcare workers attitudes towards vaccination.
Results. A total of 1,937 healthcare workers were vaccinated: 756 were immunized against influenza only, 99 against COVID-19 only, and 1,082 against both. The results show a substantial difference in vaccination adherence among medical and nursing staff compared to other professional categories. In particular, the category with the highest vaccination adhesion turned out to be that of medical doctors with 55.7% adhesion while, on the contrary, the category with the lowest adhesion turned out to be that of auxiliary personnel characterized by 7.4% adhesion. At the same time, the comparison between the two hospital facilities showed a double adherence rate by the staff of Hospital A as regards both the flu vaccine (40.6% and 20.1%) and the anti-COVID-19 vaccine (26.4% and 12.3%). Finally, the survey showed that the attitude towards influenza vaccination is lower among auxiliary staff in terms of both knowledge and vaccination attitude.
Conclusions. The results of the study show a vaccination adherence in line with that of previous years, although lower than the values recommended by the principal national and international Organizations. The analysis of the differences between the two facilities and the surveys carried out will allow for the implementation of targeted interventions to increase adherence in future campaigns.
References
1. Dangi T, Jain A. Influenza Virus: A Brief Overview. Proc Natl Acad Sci India Sect B Biol Sci. 2012;82(1):111-121. doi: 10.1007/s40011-011-0009-6. Epub 2012 Jan 18.
2. Iuliano AD, Roguski KM, Chang HH, Muscatello DJ, Palekar R, Tempia S, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet. 2018 Mar 31;391(10127):1285-1300. doi: 10.1016/S0140-6736(17)33293-2. Epub 2017 Dec 14. Erratum in: Lancet. 2018 Jan 19.
3. Krammer F, Smith GJD, Fouchier RAM, Peiris M, Kedzierska K, Doherty PC, et al. Influenza. Nat Rev Dis Primers. 2018 Jun 28;4(1):3. doi: 10.1038/s41572-018-0002-y.
4. European Centre for Disease Prevention and Control (ECDC). Factsheet about seasonal influenza [Internet]. 2022. Available from: https://www.ecdc.europa.eu/en/seasonal-influenza/facts/factsheet [Last Accessed: 2023 Oct 5].
5. Istituto Superiore Sanità (ISS). Rapporto Epidemiologico Influnet 2023. 2023. Available from: https://www.salute.gov.it/portale/temi/documenti/epidemiologica/Influnet_2023_17.pdf [Last Accessed: 2023 Dec 10].
6. Baldo V, Bertoncello C, Cocchio S, Fonzo M, Pillon P, Buja A, et al. The new pandemic influenza A/(H1N1)pdm09 virus: is it really “new”? J Prev Med Hyg. 2016;57(1):E19-22.
7. Keech M, Beardsworth P. The impact of influenza on working days lost: a review of the literature. Pharmacoeconomics. 2008;26(11):911-24. doi: 10.2165/00019053-200826110-00004.
8. Postma MJ, Jansema P, Scheijbeler HW, van Genugten ML. Scenarios on costs and savings of influenza treatment and prevention for Dutch healthy working adults. Vaccine. 2005 Nov 16;23(46-47):5365-71. doi: 10.1016/j.vaccine.2005.06.007.
9. Molinari NA, Ortega-Sanchez IR, Messonnier ML, Thompson WW, Wortley PM, Weintraub E, et al. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine. 2007 Jun 28;25(27):5086-96. doi: 10.1016/j.vaccine.2007.03.046.
10. Sisto F, Maraschini A, Fabio G, Serafino S, Zago M, Scaltrito MM, et al. Isolation and characterization of a new Clostridium difficile ribotype during a prospective study in a hospital in Italy. Curr Microbiol. 2015 Feb;70(2):151-3. doi: 10.1007/s00284-014-0697-2.
11. Fabiani M, Volpe E, Faraone M, Bella A, Pezzotti P, Chini F. Effectiveness of influenza vaccine in reducing influenza-associated hospitalizations and deaths among the elderly population; Lazio region, Italy, season 2016-2017. Expert Rev Vaccines. 2020 May;19(5):479-489. doi: 10.1080/14760584.2020.1750380.
12. Marano G, Boracchi P, Luconi E, Pariani E, Pellegrinelli L, Galli C, et al. Evaluation of influenza vaccination efficacy in reducing influenza-related complications and excess mortality in Northern Italy (2014-2017). Expert Rev Vaccines. 2021 Jan;20(1):73-81. doi: 10.1080/14760584.2021.1874927.
13. Ludolph R, Nobile M, Hartung U, Castaldi S, Schulz PJ. H1N1 Influenza Pandemic in Italy Revisited: Has the Willingness to Get Vaccinated Suffered in the Long Run? J Public Health Res. 2015 Sep 4;4(2):559. doi: 10.4081/jphr.2015.559.
14. Esposito S, Bruno C, Berardinelli A, Filosto M, Mongini T, Morandi L, et al. Vaccination recommendations for patients with neuromuscular disease. Vaccine. 2014 Oct 14;32(45):5893-900. doi: 10.1016/j.vaccine.2014.09.003.
15. Esposito S, Marchisio P, Droghetti R, Lambertini L, Faelli N, Bosis S, et al. Influenza vaccination coverage among children with high-risk medical conditions. Vaccine. 2006 Jun 12;24(24):5251-5. doi: 10.1016/j.vaccine.2006.03.059.
16. Panatto D, Domnich A, Chironna M, Loconsole D, Napoli C, Torsello A, et al; On Behalf Of The It-Bive-Hosp Network Study Group. Surveillance of Severe Acute Respiratory Infection and Influenza Vaccine Effectiveness among Hospitalized Italian Adults, 2021/22 Season. Vaccines (Basel). 2022 Dec 30;11(1):83. doi: 10.3390/vaccines11010083.
17. Panatto D, Lai PL, Mosca S, Lecini E, Orsi A, Signori A, et al. Influenza Vaccination in Italian Healthcare Workers (2018-2019 Season): Strengths and Weaknesses. Results of a Cohort Study in Two Large Italian Hospitals. Vaccines (Basel). 2020 Mar 5;8(1):119. doi: 10.3390/vaccines8010119.
18. Lecce M, Perrone PM, Castaldi S. Tdap Booster Vaccination for Adults: Real-World Adherence to Current Recommendations in Italy and Evaluation of Two Alternative Strategies. Int J Environ Res Public Health. 2022 Mar 29;19(7):4066. doi: 10.3390/ijerph19074066.
19. Leone Roberti Maggiore U, Scala C, Toletone A, Debarbieri N, Perria M, D’Amico B, et al. Susceptibility to vaccine-preventable diseases and vaccination adherence among healthcare workers in Italy: A cross-sectional survey at a regional acute-care university hospital and a systematic review. Hum Vaccin Immunother. 2017 Feb;13(2):470-476. doi: 10.1080/21645515.2017.1264746.
20. Squeri R, Di Pietro A, La Fauci V, Genovese C. Healthcare workers’ vaccination at European and Italian level: a narrative review. Acta Biomed. 2019 Sep 13;90(9-S):45-53. doi: 10.23750/abm.v90i9-S.8703.
21. European Centre for Disease Prevention and Control (ECDC). Seasonal influenza vaccination recommendations and coverage rates in EU/EEA Member States. 2023; Available from: www.ecdc.europa.eu
22. Direzione Generale della Prevenzione Sanitaria del Ministero della Salute, Gruppo di lavoro interistituzionale “Strategie Vaccinali, Gruppo interregionale di Sanità Pubblica e Screening del Coordinamento interregionale della Prevenzione della Conferenza delle Regioni e delle Province Autonome, Società Scientifiche: SItI FFS. Piano Nazionale Prevenzione Vaccinale. 2017 Jan.
23. Barbara A, La Milia DI, Di Pumpo M, Tognetto A, Tamburrano A, Vallone D, et al. Strategies to Increase Flu Vaccination Coverage among Healthcare Workers: A 4 Years Study in a Large Italian Teaching Hospital. Vaccines (Basel). 2020 Feb 13;8(1):85. doi: 10.3390/vaccines8010085.
24. Albanesi B, Clari M, Gonella S, Chiarini D, Aimasso C, Mansour I, et al. The impact of COVID-19 on hospital-based workers influenza vaccination uptake: A two-year retrospective cohort study. J Occup Health. 2022 Jan;64(1):e12376. doi: 10.1002/1348-9585.12376. Erratum in: J Occup Health. 2023 Jan;65(1):e12394.
25. Ogliastro M, Borghesi R, Costa E, Fiorano A, Massaro E, Sticchi L, et al. Monitoring influenza vaccination coverage among healthcare workers during the COVID-19 pandemic: a three-year survey in a large university hospital in North-Western Italy. J Prev Med Hyg. 2022 Oct 27;63(3):E405-E414. doi: 10.15167/2421-4248/jpmh2022.63.3.2700.
26. Bianchi FP, Stefanizzi P, Cuscianna E, Di Lorenzo A, Martinelli A, Tafuri S. Effectiveness of on-site influenza vaccination strategy in Italian healthcare workers: a systematic review and statistical analysis. Expert Rev Vaccines. 2023 Jan-Dec;22(1):17-24. doi: 10.1080/14760584.2023.2149500.
27. Mancarella M, Natarelli F, Bertolini C, Zagari A, Enrica Bettinelli M, Castaldi S. Catch-up vaccination campaign in children between 6 and 8 years old during COVID-19 pandemic: The experience in a COVID hub in Milan, Italy. Vaccine. 2022 Jun 9;40(26):3664-3669. doi: 10.1016/j.vaccine.2022.05.005.
28. Castaldi S, Auxilia F, Piga MA, Gandolfi CE, Franchini AF, Porro A, et al. The first major vaccination campaign against smallpox in Lombardy: the mass vaccination campaign against coronavirus… nothing new… only terminology. Acta Biomed. 2022 Mar 14;93(1):e2022101. doi: 10.23750/abm.v93i1.11910.
29. Oliani F, Savoia A, Gallo G, Tiwana N, Letzgus M, Gentiloni F, et al. Italy’s rollout of COVID-19 vaccinations: The crucial contribution of the first experimental mass vaccination site in Lombardy. Vaccine. 2022 Mar 1;40(10):1397-1403. doi: 10.1016/j.vaccine.2022.01.059.
30. Pennisi F, Mastrangelo M, De Ponti E, Cuciniello R, Mandelli A, Vaia F, et al. The role of pharmacies in the implementation of vaccination coverage in Italy. Insights from the preliminary data of the Lombardy Region. Ann Ig. 2024 Feb 22. doi: 10.7416/ai.2024.2611. Epub ahead of print. PMID: 38386026.
31. Astorri E, Mazziotta F, Macrelli C, Tiwana N, Letzgus M, Bisesti A, et al. Anti-Sars-CoV-2 vaccination campaign in children aged 5-11 years: the experience of a mass vaccination center in the city of Milan. Acta Biomed. 2023 Feb 13;94(1):e2023036. doi: 10.23750/abm.v94i1.13348.
32. Signorelli C, De Ponti E, Mastrangelo M, Pennisi F, Cereda D, Corti F, et al. The contribution of the private healthcare sector during the COVID-19 pandemic: the experience of the Lombardy Region in Northern Italy. Ann Ig. 2024 Mar-Apr;36(2):250-255. doi: 10.7416/ai.2024.2609. Epub 2024 Feb 1. PMID: 38303641.
33. Regulation (EU) 2016/679. General Data Protection Regulation. Art 110-bis, comma 4.
34. Consonni D, Bordini L, Nava C, Todaro A, Lunghi G, Lombardi A, et al. COVID-19: What happened to the healthcare workers of a research and teaching hospital in Milan, Italy? Acta Biomed. 2020 Sep 7;91(3):e2020016. doi: 10.23750/abm.v91i3.10361.
35. Lombardi A, Consonni D, Oggioni M, Bono P, Uceda Renteria S, Piatti A, et al. SARS-CoV-2 anti-spike antibody titres after vaccination with BNT162b2 in naïve and previously infected individuals. J Infect Public Health. 2021 Aug;14(8):1120-1122. doi: 10.1016/j.jiph.2021.07.005.
36. Lombardi A, Renisi G, Consonni D, Oggioni M, Bono P, Uceda Renteria S, et al. Clinical characteristics of healthcare workers with SARS-CoV-2 infection after vaccination with BNT162b2 vaccine. BMC Infect Dis. 2022 Jan 28;22(1):97. doi: 10.1186/s12879-022-07083-1.
37. Borroni E, Consonni D, Cugno M, Lombardi A, Mangioni D, Bono P, et al. Side effects among healthcare workers from a large Milan university hospital after second dose of BNT162b2 mRNA COVID-19 vaccine. Med Lav. 2021 Dec 23;112(6):477-485. doi: 10.23749/mdl.v112i6.12507.
38. Consonni D, Lombardi A, Mangioni D, Bono P, Oggioni M, Uceda Renteria S, et al. Immunogenicity and effectiveness of BNT162b2 COVID-19 vaccine in a cohort of healthcare workers in Milan (Lombardy Region, Northern Italy). Epidemiol Prev. 2022 Jul-Aug;46(4):250-258. English. doi: 10.19191/EP22.4.A513.065.
39. Perrone PM, Biganzoli G, Lecce M, Campagnoli EM, Castrofino A, Cinnirella A, et al. Influenza Vaccination Campaign during the COVID-19 Pandemic: The Experience of a Research and Teaching Hospital in Milan. Int J Environ Res Public Health. 2021 May 30;18(11):5874. doi: 10.3390/ijerph18115874.
40. Maffeo M, Luconi E, Castrofino A, Campagnoli EM, Cinnirella A, Fornaro F, et al. 2019 Influenza Vaccination Campaign in an Italian Research and Teaching Hospital: Analysis of the Reasons for Its Failure. Int J Environ Res Public Health. 2020 May 30;17(11):3881. doi: 10.3390/ijerph17113881.
41. Godoy P, Castilla J, Mayoral JM, Martín V, Astray J, Torner N, et al. Influenza vaccination of primary healthcare physicians may be associated with vaccination in their patients: a vaccination coverage study. BMC Fam Pract. 2015 Mar 31;16:44. doi: 10.1186/s12875-015-0259-0.
42. Butler R, Monsalve M, Thomas GW, Herman T, Segre AM, Polgreen PM, Suneja M. Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network. Am J Med. 2018 Aug;131(8):972.e9-972.e15. doi: 10.1016/j.amjmed.2018.03.015.
43. Paoli S, Lorini C, Puggelli F, Sala A, Grazzini M, Paolini D, Bonanni P, et al. Assessing Vaccine Hesitancy among Healthcare Workers: A Cross-Sectional Study at an Italian Paediatric Hospital and the Development of a Healthcare Worker’s Vaccination Compliance Index. Vaccines (Basel). 2019 Nov 29;7(4):201. doi: 10.3390/vaccines7040201.
44. Rhudy LM, Tucker SJ, Ofstead CL, Poland GA. Personal choice or evidence-based nursing intervention: nurses’ decision-making about influenza vaccination. Worldviews Evid Based Nurs. 2010 Jun 1;7(2):111-20. doi: 10.1111/j.1741-6787.2010.00190.x.
45. Prematunge C, Corace K, McCarthy A, Nair RC, Roth V, Suh KN, et al. Qualitative motivators and barriers to pandemic vs. seasonal influenza vaccination among healthcare workers: a content analysis. Vaccine. 2014 Dec 12;32(52):7128-34. doi: 10.1016/j.vaccine.2014.10.023.
46. Genovese C, Costantino C, Odone A, Trimarchi G, La Fauci V, Mazzitelli F, et al. A Knowledge, Attitude, and Perception Study on Flu and COVID-19 Vaccination during the COVID-19 Pandemic: Multicentric Italian Survey Insights. Vaccines (Basel). 2022 Jan 19;10(2):142. doi: 10.3390/vaccines10020142.
47. Bert F, Olivero E, Rossello P, Gualano MR, Castaldi S, Damiani G, D’Errico MM, et al. Knowledge and beliefs on vaccines among a sample of Italian pregnant women: results from the NAVIDAD study. Eur J Public Health. 2020 Apr 1;30(2):286-292. doi: 10.1093/eurpub/ckz209.
48. Gualano MR, Bert F, Voglino G, Buttinelli E, D’Errico MM, De Waure C, et al. Attitudes towards compulsory vaccination in Italy: Results from the NAVIDAD multicentre study. Vaccine. 2018 May 31;36(23):3368-3374. doi: 10.1016/j.vaccine.2018.04.029.
49. Gianfredi V, Stefanizzi P, Berti A, D’Amico M, De Lorenzo V, Lorenzo AD, et al. A Systematic Review of Population-Based Studies Assessing Knowledge, Attitudes, Acceptance, and Hesitancy of Pregnant and Breastfeeding Women towards the COVID-19 Vaccine. Vaccines (Basel). 2023 Jul 27;11(8):1289. doi: 10.3390/vaccines11081289.
50. Marano G, Pariani E, Luconi E, Pellegrinelli L, Galli C, Magoni M, et al. Elderly people: propensity to be vaccinated for seasonal influenza in Italy. Hum Vaccin Immunother. 2020 Aug 2;16(8):1772-1781. doi: 10.1080/21645515.2019.1706931.
51. Buonsenso D, Valentini P, Macchi M, Folino F, Pensabene C, Patria MF, et al. Caregivers’ Attitudes Toward COVID-19 Vaccination in Children and Adolescents With a History of SARS-CoV-2 Infection. Front Pediatr. 2022 Apr 7;10:867968. doi: 10.3389/fped.2022.867968.
52. Lecce M, Biganzoli G, Agnello L, Belisario I, Cicconi G, D’Amico M, et al. COVID-19 and Influenza Vaccination Campaign in a Research and University Hospital in Milan, Italy. Int J Environ Res Public Health. 2022 May 26;19(11):6500. doi: 10.3390/ijerph19116500.
53. Lecce M, Perrone PM, Bonalumi F, Castaldi S, Cremonesi M. 2020-21 Influenza vaccination campaign strategy as a model for the third COVID-19 vaccine dose? Acta Biomed. 2021 Oct 19;92(S6):e2021447. doi: 10.23750/abm.v92iS6.12230.
54. Ministero della Salute. Influenza, coperture vaccinali stagione 2020-2021. 2021. Available from: https://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=dalministero&id=5548 [Last Accessed: 2023 Oct 9].
55. Chen C, Liu X, Yan D, Zhou Y, Ding C, Chen L, et al. Global influenza vaccination rates and factors associated with influenza vaccination. Int J Infect Dis. 2022 Dec;125:153-163. doi: 10.1016/j.ijid.2022.10.038.
56. La Torre G, Mannocci A, Ursillo P, Bontempi C, Firenze A, Panico MG, et al. Prevalence of influenza vaccination among nurses and ancillary workers in Italy: systematic review and meta analysis. Hum Vaccin. 2011 Jul;7(7):728-33. doi: 10.4161/hv.7.7.15413.
57. Pless A, McLennan SR, Nicca D, Shaw DM, Elger BS. Reasons why nurses decline influenza vaccination: a qualitative study. BMC Nurs. 2017 Apr 28;16:20. doi: 10.1186/s12912-017-0215-5.
Downloads
Published
Issue
Section
License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.