Knowledge, attitudes and adherence towards influenza and other vaccinations among healthcare workers at the University Hospital of Palermo, Italy, during the first COVID-19 pandemic season (2020/2021)

Knowledge, attitudes and adherence towards influenza and other vaccinations among healthcare workers at the University Hospital of Palermo, Italy, during the first COVID-19 pandemic season (2020/2021)

Authors

  • C. Costantino
  • N. Bonaccorso
  • F. Balsamo
  • M. Belluzzo
  • A. Carubia
  • L. D'Azzo
  • F. Grimaldi
  • M. Sciortino
  • T. Vitello
  • L. Zagra
  • G. Graziano
  • C. M. Maida
  • A. Pieri
  • W. Mazzucco
  • F. Tramuto
  • F. Vitale
  • V. Restivo

Keywords:

Influenza vaccination, health care workers, vaccination coverage, communication campaigns, informative strategies

Abstract

Background. Increasing adherence to influenza vaccination among healthcare workers is a public health priority, stated that actually remains far below than international recommendations. During the 2020/2021 pandemic season, COVID-19 vaccines were not yet available until the end of December 2020, and influenza vaccines were the only one available to protect against seasonal respiratory diseases. The main objective of the present study was to assess knowledge, attitudes and adherence to influenza and other vaccinations recommended by the National Immunization Plan 2017-2021 for healthcare workers.

Methods. Enrollment lasted from October and December 2020 at the vaccination unit of the University Hospital of Palermo. Data were collected through an anonymous and self-administered questionnaire, divided into 5 sections and 31 items.

Results. Among 734 healthcare professionals that completed the survey, a significantly higher adherence to influenza vaccination was observed among healthcare workers that were more prone to receive COVID-19 vaccination (OR=4.02; 95% CI: 1.63-9.91). Moreover, higher influenza vaccination rates were observed among healthcare professionals that received influenza vaccination during previous 2019/2020 season

(OR=15.3; 95% CI: 5.17-45.1) and that were favorable to the possible impact on increasing adherence of influenza mandatory vaccination (OR=4.88; 95% CI: 2.43-9.80).

Conclusions. Propensity of healthcare workers to undergo vaccinations recommended in the National Immunization Plan increased during the first pandemic season. At the end of the vaccination season, flu vaccination coverage reached highest rates ever at the University Hospital of Palermo (around 60%), remaining anyway below the recommended minimum value of 75%. During next seasonal flu vaccination campaigns, it becomes essential to promote communication and information strategies to increase flu vaccination among healthcare workers, also focusing on co-administration with the anti-COVID-19 booster/seasonal doses.

References

1. Dionne B, Brett M, Culbreath K, Mercier R-C. Potential ceiling effect of healthcare worker influenza vaccination on the incidence of nosocomial influenza infection. Infect Control Hosp Epidemiol. 2016 Jul; 37(7): 840-4. doi: 10.1017/ ice.2016.77. Epub 2016 Apr 21.

2. Ministry of Health, Italy. National Immunization Plan 2017-2021. [cited 2023 Feb 23]. Available on: https://www.salute.gov.it/imgs/ C_17_pubblicazioni_2571_allegato.pdf [Last accessed: 2023 Feb 28].

3. Ministry of Health, Italy. Circolare Prevenzione e controllo dell’influenza: raccomandazioni per la stagione 2021-2022. [cited 2023 Feb 23]. Available on: https://www.trovanorme.salute. gov.it/norme/renderNormsanPdf?anno=2021& codLeg=79647&parte=1%20&serie=null [Last accessed: 2023 Feb 28].

4. Costantino C, Vitale F. Influenza vaccination in high-risk groups: a revision of existing guidelines and rationale for an evidence-based preventive strategy. J Prev Med Hyg. 2016; 57(1): E13-8.

5. Bridges CB, Kuehnert MJ, Hall CB. Transmission of influenza: implications for control in health care settings. Clin Infect Dis. 2003 Oct 15; 37(8): 1094-101. doi: 10.1086/378292. Epub 2003 Sep 19.

6. Restivo V, Costantino C, Mammina C, Vitale

F. Influenza like illness among medical residents anticipates influenza diffusion in general population: Data from a national survey among Italian medical residents. PLoS One. 2016 Dec 20; 11(12): e0168546. doi: 10.1371/journal.

pone.0168546.

7. Voirin N, Barret B, Metzger M-H, Vanhems P. Hospital-acquired influenza: a synthesis using the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) statement. J Hosp Infect. 2009 Jan; 71(1): 1-14. doi: 10.1016/j.jhin.2008.08.013. Epub 2008 Oct 25.

8. Sartor C, Zandotti C, Romain F, et al. Disruption of services in an internal medicine unit due to a nosocomial influenza outbreak. Infect Control Hosp Epidemiol [Internet]. 2002 Oct; 23(10): 615-9. doi: 10.1086/501981.

9. Pearson ML, Bridges CB, Harper SA; Healthcare Infection Control Practices Advisory Committee (HICPAC); Advisory Committee on Immunization Practices (ACIP). Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006 Feb 24; 55(RR-2): 1-16.

10. Burls A, Jordan R, Barton P, et al. Vaccinating healthcare workers against influenza to protect the vulnerable—Is it a good use of healthcare resources?A systematic review of the evidence and an economic evaluation. Vaccine. 2006 May 8; 24(19): 4212-21. doi: 10.1016/j.

vaccine.2005.12.043. Epub 2006 Jan 9.

11. InfluNet, Italy. Rete italiana sorveglianza influenza. Rapporto epidemiologico InfluNet, stagione influenzale 2021-2022. Rapporto n. 26 dell’8 maggio 2022. [cited 2023 Feb 23]. Available on: https://www.salute.gov.it/portale/temi/ documenti/epidemiologica/Influnet_2022_17. pdf [Last accessed: 2023 Feb 28).

12. Maggi S, Veronese N, Burgio M, et al. Rate of hospitalizations and mortality of respiratory Syncytial Virus infection compared to influenza in older people: A systematic review and metaanalysis. Vaccines (Basel). 2022 Dec 7; 10(12): 2092. doi: 10.3390/vaccines10122092.

13. Tramuto F, Mazzucco W, Maida CM, et al. Emergence of COVID-19 in Sicily and the intersection with the 2019-2020 influenza epidemic. J Prev Med Hyg. 2021 Apr 29; 62(1): E10-12. doi:

10.15167/2421-4248/jpmh2021.62.1.1870.

14. Montalti M, Di Valerio Z, Rallo F, et al. Attitudes toward the SARS-CoV-2 and influenza vaccination in the metropolitan cities of Bologna and Palermo, Italy. Vaccines (Basel). 2021 Oct 18; 9(10): 1200. doi: 10.3390/vaccines9101200.

15. Costantino C, Fiacchini D. The Rationale of the WHO Document on Risk communication and community engagement (RCCE) readiness and response to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and of the Italian Decalogue for Prevention Departments. J Prev Med Hyg. 2020 Apr 2; 61(1): E1-E2. doi:

10.15167/2421-4248/jpmh2020.61.1.1502.

16. Costantino C, Rizzo C, Rosselli R, et al. Ten actions to counteract vaccine hesitancy suggested by the Italian Society of Hygiene, Preventive Medicine, and Public Health. Vaccines (Basel). 2022 Jun 27; 10(7): 1030. doi: 10.3390/vaccines10071030.

17. WHO Sage Working Group dealing with vaccine hesitancy. Strategies for addressing vaccine hesitancy - A systematic review. October 2014. [cited 2023 Feb 23]. Available on: https://cdn.who.int/media/docs/default-source/ immunization/sage/2014/october/3-sage-wgstrategies-addressing-vaccine-hesitancy-2014. pdf?sfvrsn=b632b81e_4.

18. Gilardi F, Castelli Gattinara G, et al. Seasonal influenza vaccination in health care workers. A pre-post intervention study in an Italian paediatric hospital. Int J Environ Res Public Health. 2018 Apr 24; 15(5): 841. doi: 10.3390/ ijerph15050841.

19. Marotta C, Raia DD, Ventura G, et al. Improvement in vaccination knowledge among health students following an integrated extra curricular intervention, an explorative study in the University of Palermo. J Prev Med Hyg. 2017 Jun; 58(2): 5-10.

20. Looijmans-van den Akker I, van Delden JJ, Verheij TJ, et al. Effects of a multi-faceted program to increase influenza vaccine uptake among health care workers in nursing homes: A cluster randomised controlled trial. Vaccine.

2010 Jul 12; 28(31): 5086-92. doi: 10.1016/j.

vaccine.2010.05.003. Epub 2010 May 23.

21. Bonaccorsi G, Lorini C, Santomauro F, et al. Predictive factors associated with the acceptance of pandemic and seasonal influenza vaccination in health care workers and students in Tuscany, Central Italy. Hum Vaccin Immunother. 2013

Dec; 9(12): 2603-12. doi: 10.4161/hv.26036. Epub 2013 Aug 16.

22. Lehmann BA, Chapman GB, Franssen FM, Kok G, Ruiter RA. Changing the default to promote influenza vaccination among health care workers. Vaccine. 2016 Mar 8; 34(11): 1389-92. doi: 10.1016/j.vaccine.2016.01.046. Epub 2016 Feb 3.

23. Bonaccorsi G, Santomauro F, Porchia BR, et al. Beliefs and Opinions of Health Care Workers and Students Regarding Influenza and Influenza Vaccination in Tuscany, Central Italy. Vaccines (Basel). 2015 Feb 26; 3(1): 137-47. doi: 10.3390/ vaccines3010137.

24. Costantino C, Casuccio A, Caracci F, et al. Impact of communicative and informative strategies on influenza vaccination adherence and absenteeism from work of health care professionals working at the University Hospital of Palermo, Italy: A quasi-experimental field trial on twelve influenza seasons. Vaccines (Basel). 2019 Dec 24; 8(1): 5. doi: 10.3390/vaccines8010005.

25. Costantino C, Ledda C, Squeri R, et al. Attitudes and Perception of Healthcare Workers Concerning Influenza Vaccination during the 2019/2020 Season: A Survey of Sicilian University Hospitals. Vaccines (Basel). 2020 Nov 16; 8(4): 686. doi: 10.3390/vaccines8040686.

26. Costantino C, Restivo V, Amodio E, Colomba GME, Vitale F, Tramuto F. A mid-term estimate of 2018/2019 vaccine effectiveness to prevent laboratory confirmed A(H1N1)pdm09 and

A(H3N2) influenza cases in Sicily (Italy). Vaccine. 2019 Sep 16; 37(39): 5812-6. doi: 10.1016/j.

vaccine.2019.08.014. Epub 2019 Aug 16.

27. Costantino C, Graziano G, Bonaccorso N, et al. Knowledges, Attitudes, Perceptions and Vaccination Acceptance/Hesitancy among the Community Pharmacists of Palermo’s Province, Italy: From Influenza to COVID-19. Vaccines (Basel). 2022 Mar 18; 10 (3): 475. doi: 10.3390/ vaccines10030475.

28. Costantino C, Restivo V, Tramuto F, Casuccio A, Vitale F. Influenza vaccination of healthcare workers in Italy: could mandatory vaccination be a solution to protect patients? Future Microbiol. 2019 Jun; 14(9S): 45-9. doi: 10.2217/fmb-20180238. Epub 2019 Jun 18.

29. Scarpitta F, Restivo V, Bono CM, et al. The role of the Community Pharmacist in promoting vaccinations among general population according to the National Vaccination Plan 2017-2019: results from a survey in Sicily, Italy. Ann Ig [Internet]. 2019 Mar-Apr; 31(2 Suppl 1): 25-35. doi: 10.7416/ai.2019.2274.

30. Betsch C. Overcoming healthcare workers vaccine refusal--competition between egoism and altruism. Euro Surveill [Internet]. 2014 Dec 4; 19(48): 20979. doi: 10.2807/1560-7917. es2014.19.48.20979.

31. Khorramdelazad H, Kazemi MH, Najafi A, Keykhaee M, Zolfaghari Emameh R, Falak

R. Immunopathological similarities between COVID-19 and influenza: Investigating the consequences of Co-infection. Microb Pathog [Internet]. 2021 Mar; 152: 104554. doi: 10.1016/j. micpath.2020.104554.

32. Ministry of Health, Italy. Circolare 2 ottobre 2021. Intervallo temporale tra la somministrazione dei vaccini anti-SARS-CoV-2/COVID-19 e altri vaccini. [cited 2023 Feb 21]. Available on: https://www.trovanorme.salute.gov.it/norme/ren derNormsanPdf?anno=2021&codLeg=83013& parte=1%20&serie=null [Last accessed: 28 Feb 2023].

33. Ministry of Health, Italy. Circolare 6 luglio 2022. Prevenzione e controllo dell’influenza: raccomandazioni per la stagione 2022-2023. [cited 2022 Dec 15]. Available on: https://www. trovanorme.salute.gov.it/norme/renderNormsan Pdf?anno=2022&codLeg=87997&parte=1%20 &serie=null [Last accessed: 2023 Feb 23].

34. Dubé E. Addressing vaccine hesitancy: the crucial role of healthcare providers. Clin Microbiol Infect. 2017 May; 23(5): 279-80. doi: 10.1016/j.

cmi.2016.11.007. Epub 2016 Nov 13.

35. Larson HJ, de Figueiredo A, Xiahong Z, et al. The state of vaccine confidence 2016: Global insights through a 67-country survey. EBioMedicine [Internet]. 2016 Oct; 12: 295-301. doi: 10.1016/j.ebiom.2016.08.042. Epub 2016 Sep 13.

36. Istituto Superiore di Sanità (ISS) – Epicentro, Italy. L’epidemiologia per la sanità pubblica Istituto Superiore di Sanità. Influenza, vaccini disponibili. [cited 2022 Dec 15]. Available on: https://www.epicentro.iss.it/influenza/vaccinidisponibili [Last accessed: 2023 Feb 28].

37. Vecchia L, Negri C, Alicandro E, Scarpino G. Attitudes towards influenza vaccine and a potential COVID-19 vaccine in Italy and differences across occupational groups. Med Lav 2020 Nov 17; 111(6): 445-8. doi: 10.23749/mdl. v111i6.10813.

38. Ministry of Health, Italy. Vaccinazione antinfluenzale - Coperture vaccinali medie. Aggiornamento 7 luglio 2022 [cited 2022 Dec 15]. Available on: https://www.salute.gov.it/portale/documentazione/p6_2_8_3_1.jsp?lingua=italiano&id=19 [Last accessed: 2023 Feb 23].

39. Domnich A, Cambiaggi M, Vasco A, et al. Attitudes and beliefs on influenza vaccination during the COVID-19 pandemic: Results from a representative Italian survey. Vaccines (Basel) [Internet]. 2020 Nov 30; 8(4): 711. doi: 10.3390/ vaccines8040711.

40. Mereckiene J, Cotter S, Nicoll A, et al. Seasonal influenza immunisation in europe. Overview of recommendations and vaccination coverage for three seasons: pre-pandemic (2008/09), pandemic (2009/10) and post-pandemic (2010/11). Euro Surveill. 2014 Apr 24; 19(16): 20780. doi: 10.2807/1560-7917.es2014.19.16.20780.

41. Maltezou HC, Poland GA. Vaccination policies for healthcare workers in Europe. Vaccine [Internet].

2014; Aug 27; 32(38): 4876-80. doi: 10.1016/j.

vaccine.2013.10.046. Epub 2013 Oct 23.

42. Pryluka D, Lopardo G, Daciuk L, Stecher D, Bonvehi P; Working group for the study of H1N1 infections in health-care workers, Argentine Society of Infectious Diseases (SADI), Buenos Aires, Argentina. Severe acute respiratory disease in health-care workers during the influenza H1N1 pandemic in Argentina. J Infect Dev Ctries [Internet]. 2013 Jan 15; 7(1): 36-40. doi:

10.3855/jidc.2368.

Downloads

Published

2025-08-04

Issue

Section

Original research

How to Cite

1.
Costantino C, Bonaccorso N, Balsamo F, et al. Knowledge, attitudes and adherence towards influenza and other vaccinations among healthcare workers at the University Hospital of Palermo, Italy, during the first COVID-19 pandemic season (2020/2021). Ann Ig. 2025;35(5):560-571. doi:10.7416/ai.2023.2568