Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors, the study could be interesting if improved, but it requires major revisions. Here are some suggestions. Please respond point by point.

1) The title should better specify where the study was conducted, who conducted it, when it was conducted, and the types of interventions. It would be appropriate to change it, for example: "HPV Prevention Strategies in 2024: An Approach by the University of Milan."
2) The materials and methods section in the abstract is inadequate. Specify when the study was conducted, the study setting, and improve the statistical analysis.
3) Only the descriptive analysis is reported in the abstract section; this is not enough.
4) For keywords: enter at least 5, preferably MeshTerms; one of these could be "Italy."
5) In the Introduction, the authors refer to STDs; it would be more correct to refer to STIs (sexually transmitted infections).
6) The National Vaccination Prevention Plan (PNPV 2023-2025) is cited in the Introduction; it should be cited and included in the bibliography.
7) In the Introduction, from lines 71 to 86, no bibliographical sources are used to justify what is written; it would be appropriate to include one.
8) In general, the introduction should be rewritten, further justifying why this study should be considered important.
9) In the Materials and Methods section, include the type of study.
10) In the Materials and Methods section, specify the days the clinic was open for the first intervention strategy. Were there any differences between weekday and weekend openings?
11) Regarding the communication campaign, how was it structured? Was a well-defined protocol used, or was it conducted in a nonspecific manner? Furthermore, it would be appropriate to upload all the completed material as supplementary materials.
12) Line 100 "The administration of the first doses of the HPV vaccine ended on January 13", what year?
13) Why were two regional databases (SIAVR and ARVAX) used to collect the data? Please specify the reason.
14) In materials and methods, why were the age data aggregated and according to what criteria?
15) How many categories are included in the sex data extraction category? Only male and female, or does it also include other gender identities? Could this be a limitation of the study?
16) The authors report that the university students' demographic data were obtained in an anonymized file through the university office. How did you cross-reference the data? Were the data truly anonymized or pseudonymized?
17) The catch-up strategy discussed later in materials and methods is unclear. Please describe it further.
18) In the materials and methods section, the statistical analysis is poor, for example, the CI for use or how the p-value was set is missing. Please improve this section.
19) The authors state that these studies do not require ethics committee approval, which seems strange given that the users signed an informed consent form. The referenced footnote 18 refers to an article, not the law.
20) In the results section, a table describing the sample characteristics would be appropriate; it is not currently present; please add one.
21) The results section should highlight how the intervention strategies influenced the outcome; none of this is evident.
22) The conclusions should be expanded to indicate how these findings can be useful to policymakers to improve the situation.

23) Please check English.

Kind regards.

Author Response

Dear reviewer, 

Many thanks for having carefully read the paper and for your suggestions. We revised our work according to your observations as follows (highlighted in the manuscript). 

  

Q1. The title should better specify where the study was conducted, who conducted it, when it was conducted, and the types of interventions. It would be appropriate to change it, for example: "HPV Prevention Strategies in 2024: An Approach by the University of Milan." 

  

A1. The title was changed into “HPV Prevention Strategies in 2024: an Approach by the University of Milan." 

  

Q2. The materials and methods section in the abstract is inadequate. Specify when the study was conducted, the study setting, and improve the statistical analysis. 
   

A2. Abstract was improved in its material and metods section. “”  

  

Q3. Only the descriptive analysis is reported in the abstract section; this is not enough. 
   

We have included the requested information 

  

Q4. For keywords: enter at least 5, preferably MeshTerms; one of these could be "Italy." 
   

A4. Keywords where improved, adding “Italy” and “catch-up”. 

  

Q5. In the Introduction, the authors refer to STDs; it would be more correct to refer to STIs (sexually transmitted infections). 
   

A5. STDs was changed into STIs. 

  

Q6. The National Vaccination Prevention Plan (PNPV 2023-2025) is cited in the Introduction; it should be cited and included in the bibliography. 
 
A6. We have added the citation 

  

Q7. In the Introduction, from lines 71 to 86, no bibliographical sources are used to justify what is written; it would be appropriate to include one.  
 

A7. We have changed this section according to n° 8 suggestion, rewriting the section and adding new reference 

  

Q8. In general, the introduction should be rewritten, further justifying why this study should be considered important. 
 

A8. We have extensively revised the introduction, aiming to make it more comprehensive and exhaustive in order to emphasise the importance of these studies. This includes describing their potential organisational implications for future vaccination campaigns. 

  

Q9. In the Materials and Methods section, include the type of study. 
  

A9. “ Alongside it,  and an descriptive observational study was conducted to collect relevant covariates to better understand its impact was added in the Materials and Methods section. 

 

Q10. In the Materials and Methods section, specify the days the clinic was open for the first  intervention strategy. Were there any differences between weekday and weekend openings? 

 

A10. We specified that the clinic was open on weekdays. 

  

Q11. Regarding the communication campaign, how was it structured? Was a well-defined protocol used, or was it conducted in a nonspecific manner? Furthermore, it would be appropriate to upload all the completed material as supplementary materials. 
  

A11.  A detailed description of the campaign is currently the subject of another article that is in the process of being published. Therefore, at this time, it is not possible to provide a specific description or add a reference. 

 

Q12. Line 100 "The administration of the first doses of the HPV vaccine ended on January 13", what year? 
   

A12. 2025 was added in the sentence to clarify the end date 

 

Q13. Why were two regional databases (SIAVR and ARVAX) used to collect the data? Please specify the reason. 
   

A13. Written informed consent form for each vaccination was obtained and medical history was collected. Vaccinations were recorded in the digital regional platform SIAVR 4.45.4.0 (until end of 2024, when it was migrated to a more advanced one), and on Arvax (from 2025, which is currently in use after the software update) 

  

Q14. In materials and methods, why were the age data aggregated and according to what criteria? 
 

A14. The data concerning age are presented in aggregated form because they were received in aggregated mode due to the anonymization processes applied to the database generated by the vaccination application. According to the eligibility criteria for the vaccination, 27 was the tresholds. Chunks were then created in 3-year chunks, and the expanded to cover outliers 

  

Q15. How many categories are included in the sex data extraction category? Only male and female, or does it also include other gender identities? Could this be a limitation of the study? 
  

A15. Partecipants only declared a binary identity (male and female); we inserted this point among the limitations of the study. “Lastly, gender categories only describe binary identities, with no futher investigation on non-binary ones,  

  

Q16. The authors report that the university students' demographic data were obtained in an anonymized file through the university office. How did you cross-reference the data? Were the data truly anonymized or pseudonymized? 
  

A16. The data were provided in an aggregated format that cannot be traced back to individual persons. The cross‑referencing of the data was carried out by requesting the competent university office to extract information disaggregated by gender, nationality, and age, in a way that complemented the age data obtainable from the vaccination applications in use. 

  

Q17. The catch-up strategy discussed later in materials and methods is unclear. Please describe it further. 
   

A17. We have expanded the paragraph describing the catch‑up vaccination component to make it more detailed and better integrated within the Discussion section. 

  

Q18. In the materials and methods section, the statistical analysis is poor, for example, the CI for use or how the p-value was set is missing. Please improve this section. 
   

A18. Given the characteristics of the variables analyzed in the study, the only applicable hypothesis tests were those based on the chi-square distribution or frequency tests such as Fisher’s exact test. We have included a more detailed description of the p-value considered significant within the statatistical paragraphanalysis. 

  

Q19. The authors state that these studies do not require ethics committee approval, which seems strange given that the users signed an informed consent form. The referenced footnote 18 refers to an article, not the law. 
   

A19. Written informed consent form was signed to get vaccinated, this was specified in the text. Reference regarding the Law (ex num. 18, now num.) was modified. The correct reference is “Regulation (EU) 2016/679. General Data Protection Regulation. Art. 110-bis, comma 4. https://eur-lex.europa.eu/legal-content/EN-IT/TXT/?uri=CELEX:32016R0679 (accessed on 12 February 2026)”. This European regulation was implemented in Italy through Decreto Legislativo n. 101 del 10 agosto 2018.   

  

Q20. In the results section, a table describing the sample characteristics would be appropriate; it is not currently present; please add one. 
   

A20. We kindly ask for clarification on what you mean by “table describing the sample characteristics.” The tables provided describe the characteristics indicated for the different groups (partially vaccinated and fully vaccinated). Due to the anonymization procedures applied to the data extracted from the systems in use, it is not possible to further detail the individuals included in the study.We have included a separate descriptive table for university population and for the vaccinated cohort to describe its characteristics 

  

Q21. The results section should highlight how the intervention strategies influenced the outcome; none of this is evident. 
  

A21. The outcome of this pilot study was to test the implementation model in the University setting, in order to improve the vaccination offer in University settings. This topic was specified in the Discussion section (we only reported statistical data in the Result section, with no discussion of them). A sentence was added in the Discussion section: “This pilot study actually showed to represent the first step towards the implementation of an annual HPV University vaccination campaign in Italy, with the objective of increasing attention on overall vaccination coverage among young adult students.” 

  

Q22. The conclusions should be expanded to indicate how these findings can be useful to policymakers to improve the situation.  

  

A22. A sentence was improved in this direction. “This pilot study, regarding only 2.5% of the total University population, could represent the first step towards the implementation of an annual HPV University vac-cination campaign in Italy, with the objective of increasing attention from policymak-ers regarding overall vaccination coverage among young adult students, as a potential hard-to-reach population.” 

Reviewer 2 Report

Comments and Suggestions for Authors

This study evaluated a multifaceted HPV vaccination campaign at the University of Milan (November 2024-July 2025) combining online education with on-campus vaccination services. Of 1,805 students booking appointments, 1,667 received first doses (92.5% uptake). The cohort was predominantly aged 23-26 years (47%), with Italian (58.4%) and Iranian (26.5%) students highly represented. Among initiators, 82.5% completed the three-dose series. University locations proved most effective, administering 64.7% of doses. Follow-up visits enabled catch-up vaccinations. Authors conclude integrated educational campaigns with convenient on-campus services effectively increase HPV awareness and coverage among young adults, potentially serving as a model for annual Italian university programs.

This manuscript describes a well-intentioned public health intervention. The topic is timely and relevant, and the implementation of an on-campus vaccination program with integrated catch-up vaccinations is commendable. However, the manuscript contains some inconsistencies that undermine its scientific rigor and readability.

1. The authors' stated objective was to "evaluate the impact of an advertising and vaccination campaign." However, the study design is observational and does not include data on the reach or effectiveness of the advertising component (e.g., how many students saw the ads, a survey on what prompted them to book). How do you propose to address this disconnect between your objective and your methodology?

2. In the discussion section, the author states that the campaign shows "a higher prevalence of male students (50.9%)." However, Table 1 and the results text (line 109) clearly show that 49.1% of the vaccinated cohort was male. This is a direct contradiction. Which number is correct, and can you please correct this error throughout the manuscript?

3. The authors report high appointment utilization (92%) and good series completion (82.5%). However, the actual coverage of the entire student body appears to be low (1667/66357 ≈ 2.5%). Was the goal of this campaign to achieve a specific population coverage rate, or was it primarily to provide a convenient service and test the implementation model? Please clarify the campaign's intended scope and discuss this 2.5% figure in the context of your conclusions.

4. The catch-up vaccination data presented in Figure 3 is a valuable and distinctive aspect of your study. To help readers better contextualize its public health impact, could you please provide additional details on eligibility and uptake? Specifically, of the students returning for their second or third HPV dose, how many were eligible for each catch-up vaccine (e.g., dTpa), and what proportion of those eligible accepted it? Providing this context would strengthen the analysis by moving beyond simple description toward a more meaningful evaluation of the catch-up strategy's effectiveness.

Author Response

Dear reviewer, 

Many thanks for having carefully read the paper and for your suggestions. We revised our work according to your observations as follows (highlighted in the manuscript). 

  

Q1. The authors' stated objective was to "evaluate the impact of an advertising and vaccination campaign." However, the study design is observational and does not include data on the reach or effectiveness of the advertising component (e.g., how many students saw the ads, a survey on what prompted them to book). How do you propose to address this disconnect between your objective and your methodology? 

  

A1. The whole intervention was composed of an advertising and a vaccination campaign. The former will be discussed in a separate paper,  currently in the process of being published, and no reference can be provided at the moment. However, the sentence in the abstract was corrected to align with the aim stated also at the end of introduction, which is "to describe the implementation of a vaccination campaign against HPV, targeting students attending the University of Milan, and its results 

  

Q2. In the discussion section, the author states that the campaign shows "a higher prevalence of male students (50.9%)." However, Table 1 and the results text (line 109) clearly show that 49.1% of the vaccinated cohort was male. This is a direct contradiction. Which number is correct, and can you please correct this error throughout the manuscript? 

 

A2. It was a typographical error, as we intended to refer to a higher prevalence of female students. The correct result is the one displayed on the table, discussion has been adjusted accordingly 

  

Q3. The authors report high appointment utilization (92%) and good series completion (82.5%). However, the actual coverage of the entire student body appears to be low (1667/66357 ≈ 2.5%). Was the goal of this campaign to achieve a specific population coverage rate, or was it primarily to provide a convenient service and test the implementation model? Please clarify the campaign's intended scope and discuss this 2.5% figure in the context of your conclusions. 

  

A3. This was a pilot study aimed at testing the implementation model in the University setting with a catch-up strategy to protect from HPV those who, for various reasons, did not take part in it yet. HPV vaccination is already part of National and Regional Vaccination Prevention Plans, and other targeted regional initiatives. Thus, even if the university does not have routine access to individual vaccination status of its students, vaccinating the 2.5% of enrolled students represent a net increase on the existing coverage. In the Conclusion section, sentences were rephrased to reflect this explanation. 

  

Q4. The catch-up vaccination data presented in Figure 3 is a valuable and distinctive aspect of your study. To help readers better contextualize its public health impact, could you please provide additional details on eligibility and uptake? Specifically, of the students returning for their second or third HPV dose, how many were eligible for each catch-up vaccine (e.g., dTpa), and what proportion of those eligible accepted it? Providing this context would strengthen the analysis by moving beyond simple description toward a more meaningful evaluation of the catch-up strategy's effectiveness. 

  

A4 The Discussion section was improved as follows. “Starting from the analysis of partecipants’ vaccination certificates in the occasion of second and third HPV doses implementation, other crucial vaccinations have been proposed and administered, thus improving vaccination coverage against infections recognized worldwide as epidemic outbreaks risk factors in community environments. As regards other subjects with no certificate available, through medical history we identified students missing some vaccinations (e.g. not having received the dTpa one for more than 10 years). Students showed great interest in being adequately vaccinated and no one refused the proposal for other vaccinations.” 

 

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

the manuscript has been implemented but is not scientifically rigorous enough: the sample is insufficient, and adequate sampling was not used; the reviewer's requests were not fully met; and it adds nothing to the existing literature. Therefore, it is not suitable for publication in this journal.

Good luck!

Reviewer 2 Report

Comments and Suggestions for Authors

I am OK with the revised version of the manuscript and have no further comments.