Tick-Borne Encephalitis Virus Vaccination among Tourists in a High-Prevalence Area (Italy, 2023): A Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Sample Size
2.2. Inclusion Criteria
- (1)
- being aged 18 years or older;
- (2)
- having any previous knowledge of TBE;
- (3)
- having traveled to the Dolomite Mountains as a tourist in the 5 years before the inception of the questionnaire.
2.3. Instruments
2.3.1. Demographic Characteristics of the Participants
2.3.2. Knowledge Test
2.3.3. Risk Perception
2.3.4. Attitudes toward the TBE Vaccine
2.3.5. Preventive Practices
2.4. Ethical Considerations
2.5. Data Analysis
3. Results
3.1. Demographic Characteristics of the Participants
3.2. Knowledge Test
3.3. Risk Perception
3.4. Attitudes toward the TBE Vaccine
3.5. Practices
3.6. Univariate Analysis
3.7. Multivariable Analysis
4. Discussion
4.1. Key Results
4.2. Interpretation
4.3. Limitations and Generalizability
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Statement | Correct Answer | |
---|---|---|
Content | N./942, % | |
Q01. Ticks feeding on cats and dogs may cause human disease. | TRUE | 402, 35.5% |
Q02. Ticks prefer to live in damp, shady areas. | TRUE | 555, 49.1% |
Q03. The majority of ticks that are found in Italy may spread severe human diseases. | FALSE | 330, 29.2% |
Q04. Tick-borne human diseases are more frequently diagnosed between May and September. | TRUE | 746, 79.1% |
Q05. The available vaccines protect against all tick-borne human diseases. | FALSE | 517, 45.7% |
Q06. Ticks removed within 24 hours from their first bite do not require any treatment. | FALSE | 492, 43.5% |
Q07. All tick-borne human diseases manifest themselves within 2 days of the first bite. | FALSE | 660, 58.4% |
Q08. Tick-borne human diseases may always be treated with antibiotics. | FALSE | 498, 44.0% |
Q09. Tick bites are frequently complicated by local infections. | TRUE | 684, 60.5% |
Q10. Local treatment with alcohol on the bite site is appropriate for tick removal. | FALSE | 714, 63.1% |
Q11. After tick removal, the bite site should be checked for the tick head. | TRUE | 873, 77.2% |
Q12. The milk of animals affected by tick-borne disease may harbor pathogens. | TRUE | 105, 9.3% |
Almost Zero (N, %) | Low or Rather Low (N, %) | Moderate (N, %) | High or Rather High (N, %) | Very High (N, %) | |
---|---|---|---|---|---|
Einf | 33, 3.5% | 120, 12.7% | 303, 32.2% | 357, 37.9% | 129, 13.7% |
Cinf | 3, 0.3% | 36, 3.8% | 150, 15.9% | 426, 45.2% | 327, 34.7% |
Evac | 504, 53.5% | 204, 21.7% | 180, 19.1% | 42, 4.5% | 12, 1.3% |
Cvac | 516, 54.8% | 189, 20.1% | 183, 19.4% | 45, 4.8% | 9, 1.0% |
Cumulative Score | GKS | SKS | RPSinf | RPSvac |
---|---|---|---|---|
GKS | - | ρ = 0.334 p < 0.001 | ρ = 0.085 p = 0.009 | ρ = −0.281 p < 0.001 |
SKS | ρ = 0.334 p < 0.001 | - | ρ = 0.262 p < 0.001 | ρ = −0.123 p < 0.001 |
RPSinf | ρ = 0.085 p = 0.009 | ρ = 0.262 p < 0.001 | - | ρ = −0.078 p = 0.017 |
RPSvac | ρ = −0.281 p < 0.001 | ρ = −0.123 p < 0.001 | ρ = −0.078 p = 0.017 | - |
Cumulative Score | Age Group | ||
---|---|---|---|
<40 Years | 40 to 59 Years | 60 Years or Over | |
General Knowledge Score (%) | 61.79 ± 17.59 (p = 0.001) | 56.12 ± 16.03 (p = 0.972) | 56.39 ± 16.74 (REFERENCE GROUP) |
Symptom Knowledge Score (%) | 59.98 ± 16.51 (p < 0.001) | 58.29 ± 16.51 (p < 0.001) | 51.93 ± 19.50 (REFERENCE GROUP) |
Risk Perception Score, Tick-borne Infections (%) | 51.62 ± 23.00 (p = 0.877) | 53.27 ± 24.03 (p = 0.367) | 50.73 ± 27.03 (REFERENCE GROUP) |
Risk Perception Score, TBE Vaccine (%) | 13.74 ± 18.79 (p = 0.001) | 11.27 ± 13.62 (p = 0.088) | 8.62 ± 11.54 (REFERENCE GROUP) |
Year | Total Population | Cases of TBEV (Crude Incidence per 100,000 People) | Delivered Doses (Doses per 100 People) | Total Vaccine Doses (% TBE) |
---|---|---|---|---|
2016 | 539,513 | 20 (3.7) | 0 (-) | 164,095 (-) |
2017 | 540,280 | 21 (3.9) | 673 (0.1) | 216,053 (0.3%) |
2018 | 541,966 | 8 (1.5) | 16,525 (3.0) | 243,733 (6.8%) |
2019 | 543,721 | 13 (2.4) | 21,473 (3.9) | 244,555 (8.8%) |
2020 | 545,425 | 11 (2.0) | 13,351 (2.5) | 265,184 (5.0%) |
2021 | 542,166 | 5 (0.9) | 6,354 (1.2) | 199,215 (3.2%) |
RSV on Tick-Borne Encephalitis | ||
---|---|---|
Spearman’s Rho (95%CI) | p-Value | |
Einf | −0.020 (95%CI −0.131 to 0.092) | 0.722 |
Cinf | −0.107 (95%CI −0.217 to 0.004) | 0.054 |
Evac | 0.021 (95%CI −0.091 to 0.133) | 0.709 |
Cvac | −0.066 (95%CI −0.176 to 0.047) | 0.239 |
RPSinf | −0.066 (95%CI −0.176 to 0.047) | 0.239 |
RPSvac | 0.027 (95%CI −0.086 to 0.138) | 0.633 |
What did you want do address in this study? |
Tick-borne encephalitis (TBE) is a human viral infectious disease transmitted by the bite of infected ticks and affecting the central nervous system. Climate changes and increased human interactions in at-risk areas (mostly woodlands in Central Europe and alpine ranges), including the Dolomite Mountains, have stressed the importance of vaccination campaigns as a reliable instrument for achieving TBE control in countries in the European Union/European Economic Areas. We wanted to investigate the TBE vaccination rates and individual preventive measures for tick bites among tourists to the Dolomite Mountains and ascertain which individual factors were associated with TBE vaccination uptake. |
What have we learned from this study? |
Vaccination rates in the tourist population were low (<30% for the sample as a whole), even in individuals from Italian regions considered at high risk for TBE (i.e., the Autonomous Provinces of Trento and Bolzano and the regions of Veneto and Friuli Venezia Giulia, <40%). Participants exhibited an unsatisfactory level of knowledge of TBE and tick-borne disorders, which was associated with a similarly inappropriate risk perception about its occurrence. The main effectors of vaccination status were identified as age, living in high-risk areas, having previously been bitten by a tick, knowledge status, and risk perception, which, in turn, was well-correlated with knowledge status. |
What are the implications of your findings for public health? |
Information campaigns aimed at improving disease awareness among tourists traveling to high-risk areas can improve their risk perception regarding TBE and more in general regarding tick-borne diseases. By improving vaccination status in individuals potentially at high risk of contracting TBE and other tick-borne diseases, properly designed interventions, including appropriate pre-travel counseling, could contribute to the better control of TBE in northeastern Italy. |
References
- Johnson, N.; Migné, C.V.; Gonzalez, G. Tick-Borne Encephalitis. Curr. Opin. Infect. Dis. 2023, 36, 198–202. [Google Scholar] [CrossRef] [PubMed]
- Nygren, T.M.; Pilic, A.; Böhmer, M.M.; Wagner-Wiening, C.; Went, S.B.; Wichmann, O.; Hellenbrand, W. Tick-Borne Encephalitis: Acute Clinical Manifestations and Severity in 581 Cases from Germany, 2018–2020. J. Infect. 2023, 86, 369–375. [Google Scholar] [CrossRef] [PubMed]
- ECDC. Tick-Borne Encephalitis Annual Epidemiological Report for 2020 Key Facts; ECDC: Solna, Sweden, 2020. [Google Scholar]
- European Centre for Disease Prevention and Control. Tick-Borne Encephalitis Annual Epidemiological Report for 2018 Key Facts; European Centre for Disease Prevention and Control: Solna, Sweden, 2019. [Google Scholar]
- Martello, E.; Gillingham, E.L.; Phalkey, R.; Vardavas, C.; Nikitara, K.; Bakonyi, T.; Gossner, C.M.; Leonardi-Bee, J. Systematic Review on the Non-Vectorial Transmission of Tick-Borne Encephalitis Virus (TBEv). Ticks Tick-Borne Dis. 2022, 13, 102028. [Google Scholar] [CrossRef] [PubMed]
- Chiffi, G.; Grandgirard, D.; Leib, S.L.; Chrdle, A.; Růžek, D. Tick-borne Encephalitis: A Comprehensive Review of the Epidemiology, Virology, and Clinical Picture. Rev. Med. Virol. 2023, 33, e2470. [Google Scholar] [CrossRef]
- Ricco, M.; Peruzzi, S.; Balzarini, F. Epidemiology of West Nile Virus Infections in Humans, Italy, 2012–2020: A Summary of Available Evidences. Trop. Med. Infect. Dis. 2021, 6, 61. [Google Scholar] [CrossRef]
- Riccò, M.; Peruzzi, S.; Balzarini, F.; Zaniboni, A.; Ranzieri, S. Dengue Fever in Italy: The “Eternal Return” of an Emerging Arboviral Disease. Trop. Med. Infect. Dis. 2022, 7, 10. [Google Scholar] [CrossRef]
- van Leur, S.W.; Heunis, T.; Munnur, D.; Sanyal, S. Pathogenesis and Virulence of Flavivirus Infections. Virulence 2021, 12, 2814–2838. [Google Scholar] [CrossRef]
- ECDC. Epidemiological Situation of Tick-Borne Encephalitis in the European Union and European Free Trade Association Countries; ECDC: Solna, Sweden, 2012; ISBN 9789291933846. [Google Scholar]
- Xing, Y.; Schmitt, H.J.; Arguedas, A.; Yang, J. Tick-Borne Encephalitis in China: A Review of Epidemiology and Vaccines. Vaccine 2017, 35, 1227–1237. [Google Scholar] [CrossRef]
- Ruzek, D.; Avšič Županc, T.; Borde, J.; Chrdle, A.; Eyer, L.; Karganova, G.; Kholodilov, I.; Knap, N.; Kozlovskaya, L.; Matveev, A.; et al. Tick-Borne Encephalitis in Europe and Russia: Review of Pathogenesis, Clinical Features, Therapy, and Vaccines. Antivir. Res. 2019, 164, 23–51. [Google Scholar] [CrossRef]
- Caputo, M.; Stumpe, V.; Rübsamen, N.; Mikolajczyk, R.T.; Karch, A. Implementation of Preventive Measures against Tick-Borne Infections in a Non-Endemic Area for Tick-Borne Encephalitis—Results from a Population-Based Survey in Lower Saxony, Germany. Ticks Tick-Borne Dis. 2019, 10, 614–620. [Google Scholar] [CrossRef]
- Charrel, R.N.; Attoui, H.; Butenko, A.M.; Clegg, J.C.; Deubel, V.; Frolova, T.V.; Gould, E.A.; Gritsun, T.S.; Heinz, F.X.; Labuda, M.; et al. Tick-Borne Virus Diseases of Human Interest in Europe. Clin. Microbiol. Infect. 2004, 10, 1040–1055. [Google Scholar] [CrossRef] [PubMed]
- Kohlmaier, B.; Schweintzger, N.A.; Sagmeister, M.G.; Švendová, V.; Kohlfürst, D.S.; Sonnleitner, A.; Leitner, M.; Berghold, A.; Schmiedberger, E.; Fazekas, F.; et al. Clinical Characteristics of Patients with Tick-Borne Encephalitis (Tbe): A European Multicentre Study from 2010 to 2017. Microorganisms 2021, 9, 1420. [Google Scholar] [CrossRef] [PubMed]
- Panatto, D.; Domnich, A.; Amicizia, D.; Reggio, P.; Iantomasi, R. Vaccination against Tick-Borne Encephalitis (TBE) in Italy: Still a Long Way to Go. Microorganisms 2022, 10, 464. [Google Scholar] [CrossRef] [PubMed]
- Haglund, M.; Günther, G. Tick-Borne Encephalitis—Pathogenesis, Clinical Course and Long-Term Follow-Up. Vaccine 2003, 21, S11–S18. [Google Scholar] [CrossRef]
- Coyer, L.; Sogan-Ekinci, A.; Greutélaers, B.; Kuhn, J.; Saller, F.S.; Hailer, J.; Böhm, S.; Brosch, R.; Wagner-Wiening, C.; Böhmer, M.M. Knowledge, Attitudes and Behaviors Regarding Tick-Borne Encephalitis Vaccination and Prevention of Tick-Borne Diseases among Primary Care Physicians in Bavaria and Baden-Wuerttemberg, Germany, May–September 2022. Microorganisms 2023, 11, 961. [Google Scholar] [CrossRef]
- Vonesch, N.; D’Ovidio, M.C.; Melis, P.; Remoli, M.E.; Ciufolini, M.G.; Tomao, P. Climate Change, Vector-Borne Diseases and Working Population. Ann. Ist. Super. Sanità 2016, 52, 397–405. [Google Scholar] [CrossRef]
- Alkishe, A.A.; Peterson, A.T.; Samy, A.M. Climate Change Influences on the Potential Geographic Distribution of the Disease Vector Tick Ixodes Ricinus Climate Change Influences on the Potential Geographic Distribution of the Disease Vector Tick Ixodes Ricinus. PLoS ONE 2017, 12, e0189092. [Google Scholar] [CrossRef]
- Riccò, M.; Bragazzi, N.L.; Vezzosi, L.; Balzarini, F.; Colucci, M.E.; Veronesi, L. Knowledge, Attitudes, and Practices on Tick-Borne Human Diseases and Tick-Borne Encephalitis Vaccine among Farmers from North-Eastern Italy (2017). J. Agromedicine 2020, 25, 73–85. [Google Scholar] [CrossRef]
- Riccò, M.; Gualerzi, G.; Ranzieri, S.; Ferraro, P.; Bragazzi, N.L. Knowledge, Attitudes, Practices (KAP) of Italian Occupational Physicians towards Tick Borne Encephalitis. Trop. Med. Infect. Dis. 2020, 5, 117. [Google Scholar] [CrossRef]
- Bojkiewicz, E.; Toczylowski, K.; Grygorczuk, S.; Zelazowska-Rutkowska, B.; Dunaj, J.; Zebrowska, A.; Czupryna, P.; Moniuszko-Malinowska, A.; Sulik, A. The Prevalence of Asymptomatic Infections with Tick-Borne Encephalitis Virus and Attitude towards Tick-Borne Encephalitis Vaccine in the Endemic Area of Northeastern Poland. Vaccines 2022, 10, 1294. [Google Scholar] [CrossRef]
- Pilz, A.; Erber, W.; Schmitt, H.J. Vaccine Uptake in 20 Countries in Europe 2020: Focus on Tick-Borne Encephalitis (TBE). Ticks Tick-Borne Dis. 2023, 14, 102059. [Google Scholar] [CrossRef] [PubMed]
- Rezza, G.; Farchi, F.; Pezzotti, P.; Ruscio, M.; lo Presti, A.; Ciccozzi, M.; Mondardini, V.; Paternoster, C.; Bassetti, M.; Merelli, M.; et al. Tick-Borne Encephalitis in North-East Italy: A 14-Year Retrospective Study, January 2000 to December 2013. Eurosurveillance 2015, 20, 30034. [Google Scholar] [CrossRef] [PubMed]
- Cocchio, S.; Bertoncello, C.; Napoletano, G.; Claus, M.; Furlan, P.; Fonzo, M.; Gagliani, A.; Saia, M.; Russo, F.; Baldovin, T.; et al. Do We Know the True Burden of Tick-Borne Encephalitis? A Cross-Sectional Study. Neuroepidemiology 2019, 54, 227–234. [Google Scholar] [CrossRef] [PubMed]
- Amicizia, D.; Domnich, A.; Panatto, D.; Lai, P.L.; Cristina, M.L.; Avio, U.; Gasparini, R. Epidemiology of Tick-Borne Encephalitis (TBE) in Europe and Its Prevention by Available Vaccines. Hum. Vaccin. Immunother. 2013, 9, 1163–1171. [Google Scholar] [CrossRef]
- Erber, W.; Schmitt, H.J. Self-Reported Tick-Borne Encephalitis (TBE) Vaccination Coverage in Europe: Results from a Cross-Sectional Study. Ticks Tick-Borne Dis. 2018, 9, 768–777. [Google Scholar] [CrossRef]
- Vonesch, N.; Binazzi, A.; Bonafede, M.; Melis, P.; Ruggieri, A.; Iavicoli, S.; Tomao, P. Emerging Zoonotic Viral Infections of Occupational Health Importance. Pathog. Dis. 2019, 77, ftz018. [Google Scholar] [CrossRef]
- Riccò, M. Epidemiology of Tick-Borne Encephalitis in North-Eastern Italy (2017–2020): International Insights from National Notification Reports. Acta Biomed. 2021, 92, e2021229. [Google Scholar]
- Alfano, N.; Tagliapietra, V.; Rosso, F.; Ziegler, U.; Arnoldi, D.; Rizzoli, A. Tick-Borne Encephalitis Foci in Northeast Italy Revealed by Combined Virus Detection in Ticks, Serosurvey on Goats and Human Cases. Emerg. Microbes Infect. 2020, 9, 474–484. [Google Scholar] [CrossRef]
- Kunze, U.; Kunze, M. The Austrian Vaccination Paradox: Tick-Borne Encephalitis Vaccination Versus Influenza Vaccination. Cent. Eur. J. Public Health 2015, 23, 223. [Google Scholar] [CrossRef]
- Zingg, A.; Siegrist, M. Measuring People’s Knowledge about Vaccination: Developing a One-Dimensional Scale. Vaccine 2012, 30, 3771–3777. [Google Scholar] [CrossRef]
- Gaube, S.; Lermer, E.; Fischer, P. The Concept of Risk Perception in Health-Related Behavior Theory and Behavior Change. In Perceived Safety. Risk Engineering; Raue, M., Streicher, B., Lermer, E., Eds.; Springer: Cham, Switzerland, 2019; pp. 101–118. ISBN 9783030114565. [Google Scholar]
- Yates, F.J.; Stone, E.R. The Risk Construct. In Risk-Taking Behaviour; John Wiley & Sons.: Chichester, UK, 1992; pp. 1–25. ISBN 0471922501. [Google Scholar]
- Betsch, C.; Wicker, S. Personal Attitudes and Misconceptions, Not Official Recommendations Guide Occupational Physicians’ Vaccination Decisions. Vaccine 2014, 32, 4478–4484. [Google Scholar] [CrossRef] [PubMed]
- Haddock, G.; Maio, G.R. 6 Attitudes: Content, Structure and Functions. In An Introduction to Social Psychology; Hewstone, M., Stroebe, W., Jonas, K., Eds.; BPS Blackwell: Chichester, UK, 2012; pp. 112–133. [Google Scholar]
- Arghittu, A.; Dettori, M.; Azara, A.; Gentili, D.; Serra, A.; Contu, B.; Castiglia, P. Flu Vaccination Attitudes, Behaviours, and Knowledge among Health Workers. Int. J. Environ. Res. Public. Health 2020, 17, 3185. [Google Scholar] [CrossRef] [PubMed]
- European Union; European Council; European Parliament. Europea Union (EU) Regulation N. 2016/679 on the Protection of Natural Persons with Regard to the Processing of Personal Data and on the Free Movement of Such Data, and Repealing Directive 95/46/EC (General Data Protection Regulation); European Union: Strasbourg, France, 2016. [Google Scholar]
- R Development Core Team. R a Language and Environment for Statistical Computing: Reference Index; R Foundation for Statistical Computing: Vienna, Austria, 2010; ISBN 3900051070. [Google Scholar]
- Province of Belluno; Autonomous Province of Bolzano; Autonomous Province of Trento; Province of Udine; Autonomous Region of Friuli Venezia Giulia. THE DOLOMITES THE WORLD NATURAL HERITAGE LIST UNESCO Nomination of the Dolomites for Inscription on the World Natural Heritage List UNESCO; Autonomous Province of Bolzano: Bolzano, Italy, 2009. [Google Scholar]
- Belobo, J.T.E.; Kenmoe, S.; Kengne-Nde, C.; Emoh, C.P.D.; Bowo-Ngandji, A.; Tchatchouang, S.; Wobessi, J.N.S.; Mikangue, C.A.M.; Tazokong, H.R.; Bebey, S.R.K.; et al. Worldwide Epidemiology of Crimean-Congo Hemorrhagic Fever Virus in Humans, Ticks and Other Animal Species, a Systematic Review and Meta-Analysis. PLoS Negl. Trop. Dis. 2021, 15, e0009299. [Google Scholar] [CrossRef] [PubMed]
- Maioli, G.; Pistone, D.; Bonilauri, P.; Pajoro, M.; Barbieri, I.; Patrizia, M.; Vicari, N.; Dottori, M. Ethiological Agents of Rickettsiosis and Anaplasmosis in Ticks Collected in Emilia-Romagna Region (Italy) during 2008 and 2009. Exp. Appl. Acarol. 2012, 57, 199–208. [Google Scholar] [CrossRef]
- Riccò, M.; Baldassarre, A.; Corrado, S.; Bottazzoli, M.; Marchesi, F. Seroprevalence of Crimean Congo Hemorrhagic Fever Virus in Occupational Settings: Systematic Review and Meta-Analysis. Trop. Med. Infect. Dis. 2023, 8, 452. [Google Scholar] [CrossRef]
- Zöldi, V.; Turunen, T.; Lyytikäinen, O.; Sane, J. Knowledge, Attitudes, and Practices Regarding Ticks and Tick-Borne Diseases, Finland. Ticks Tick-Borne Dis. 2017, 8, 872–877. [Google Scholar] [CrossRef]
- Slunge, D.; Boman, A. Learning to Live with Ticks? The Role of Exposure and Risk Perceptions in Protective Behaviour against Tick-Borne Diseases. PLoS ONE 2018, 13, e0198286. [Google Scholar] [CrossRef]
- Pugh, S.J.; Moïsi, J.C.; Kundi, M.; Santonja, I.; Erber, W.; Angulo, F.J.; Jodar, L. Effectiveness of Two Doses of Tick-Borne Encephalitis (TBE) Vaccine. J. Travel. Med. 2022, 29, taab193. [Google Scholar] [CrossRef]
- Riccò, M.; Razio, B.; Poletti, L.; Panato, C. Knowledge, Attitudes, and Sun-Safety Practices among Agricultural Workers in the Autonomous Province of Trento, North-Eastern Italy (2016). G. Ital. Dermatol. Venereol. 2020, 155, 31–40. [Google Scholar] [CrossRef]
- Angelo, K.M.; Kozarsky, P.E.; Ryan, E.T.; Chen, L.H.; Sotir, M.J. What Proportion of International Travellers Acquire a Travel-Related Illness? A Review of the Literature. J. Travel. Med. 2017, 24, tax046. [Google Scholar] [CrossRef]
- Stefanati, A.; Pierobon, A.; Baccello, V.; DeStefani, E.; Gamberoni, D.; Furlan, P.; Sandri, F.; Stano, A.; Coin, P.; Baldo, V.; et al. Travellers’ Risk Behaviors and Health Problems: Post-Travel Follow up in Two Travel Medicine Centers in Italy. Med. Mal. Infect. 2020, 51, 279–284. [Google Scholar] [CrossRef]
- Khan, N.M.; Jentes, E.S.; Brown, C.; Han, P.; Rao, S.R.; Kozarsky, P.; Hagmann, S.H.F.; LaRocque, R.C.; Ryan, E.T. Pre-Travel Medical Preparation of Business and Occupational Travelers. J. Occup. Environ. Med. 2016, 58, 76–82. [Google Scholar] [CrossRef] [PubMed]
- Poulos, C.; Boeri, M.; Coulter, J.; Huang, L.; Schley, K.; Pugh, S.J. Travelers’ Preferences for Tick-Borne Encephalitis Vaccination. Expert. Rev. Vaccines 2022, 21, 1495–1504. [Google Scholar] [CrossRef] [PubMed]
- Marano, C.; Moodley, M.; Melander, E.; De Moerlooze, L.; Nothdurft, H.D. Perceptions of Tick-Borne Encephalitis Risk: A Survey of Travellers and Travel Clinics from Canada, Germany, Sweden and the UK. J. Travel. Med. 2018, 26, S10–S16. [Google Scholar] [CrossRef]
- MacDonald, N.E.; Eskola, J.; Liang, X.; Chaudhuri, M.; Dube, E.; Gellin, B.; Goldstein, S.; Larson, H.; Manzo, M.L.; Reingold, A.; et al. Vaccine Hesitancy: Definition, Scope and Determinants. Vaccine 2015, 33, 4161–4164. [Google Scholar] [CrossRef]
- Slunge, D. The Willingness to Pay for Vaccination against Tick-Borne Encephalitis and Implications for Public Health Policy: Evidence from Sweden. PLoS ONE 2015, 10, e143875. [Google Scholar] [CrossRef] [PubMed]
- Paradowska-Stankiewicz, I.; Pancer, K.; Poznańska, A.; Hordowicz, M.; Skibicka, M.; Słowiński, M.; Motak, G.; Falkiewicz, B. Tick-Borne Encephalitis Epidemiology and Surveillance in Poland, and Comparison with Selected European Countries before and during the COVID-19 Pandemic, 2008 to 2020. Eurosurveillance 2023, 28, 2200452. [Google Scholar] [CrossRef]
- Wendt, S.; Beier, D.; Paquet, D.; Trawinski, H.; Fuchs, A.; Lübbert, C. Medical Advice for Travelers. Dtsch. Arztebl. Int. 2021, 118, 349–356. [Google Scholar] [CrossRef]
- Kogelman, L.; Barnett, E.D.; Chen, L.H.; Quinn, E.; Yanni, E.; Wilson, M.E.; Benoit, C.; Karchmer, A.W.; Ooi, W.W.; Jentes, E.S.; et al. Knowledge, Attitudes, and Practices of US Practitioners Who Provide Pre-Travel Advice. J. Travel. Med. 2014, 21, 104–114. [Google Scholar] [CrossRef]
- Italian Health Ministry. Italian National Plan for the Prevention, Surveillance, and Response to Arboviroses (PNA) 2020–2025; Italian Health Ministry: Rome, Italy, 2019.
- Italian Health Ministry. Piano Nazionale Di Prevenzione Vaccinale (PNPV) 2023–2025; Italian Health Ministry: Rome, Italy, 2023.
- Tostrud, L.; Thelen, J.; Palatnik, A. Models of Determinants of COVID-19 Vaccine Hesitancy in Non-Pregnant and Pregnant Population: Review of Current Literature. Hum. Vaccin. Immunother. 2022, 18, 2138047. [Google Scholar] [CrossRef]
- Lipschitz, J.M.; Fernandez, A.C.; Elsa Larson, H.; Blaney, C.L.; Meier, K.S.; Redding, C.A.; Prochaska, J.O.; Paiva, A.L. Validation of Decisional Balance and Self-Efficacy Measures for HPV Vaccination in College Women. Am. J. Health Promot. 2013, 27, 299–307. [Google Scholar] [CrossRef]
- Arnett, D.K.; Claas, S.A. Introduction to Epidemiology. In Clinical and Translational Science: Principles of Human Research: Second Edition; Elsevier Inc.: Amsterdam, The Netherlands, 2017; pp. 53–69. ISBN 9780128021019. [Google Scholar]
- Heiervang, E.; Goodman, R. Advantages and Limitations of Web-Based Surveys: Evidence from a Child Mental Health Survey. Soc. Psychiat Epidemiol. 2011, 46, 69–76. [Google Scholar] [CrossRef]
- Riccò, M.; Vezzosi, L.; Marchesi, F. Vaccinating Front-Line Healthcare Workers: Results of a Pre-Pandemic Cross-Sectional Study from North-Eastern Italy on First Responders. Vaccines 2022, 10, 1492. [Google Scholar] [CrossRef] [PubMed]
- Morrone, T.; Napolitano, F.; Albano, L.; Di, G. Meningococcal Serogroup B Vaccine: Knowledge and Acceptability among Parents in Italy Meningococcal Serogroup B Vaccine: Knowledge and Acceptability among Parents in Italy. Hum. Vaccines Immunother. 2017, 13, 1921–1927. [Google Scholar] [CrossRef]
- MacDougall, D.M.; Langley, J.M.; Li, L.; Ye, L.; MacKinnon-Cameron, D.; Top, K.A.; McNeil, S.A.; Halperin, B.A.; Swain, A.; Bettinger, J.A.; et al. Knowledge, Attitudes, Beliefs, and Behaviors of University Students, Faculty, and Staff during a Meningococcal Serogroup B Outbreak Vaccination Program. Vaccine 2017, 35, 2520–2530. [Google Scholar] [CrossRef]
- Riccò, M.; Peruzzi, S. Tetanus Vaccination Status and Vaccine Hesitancy in Amateur Basketball Players (Italy, 2020). Vaccines 2022, 10, 131. [Google Scholar] [CrossRef] [PubMed]
- Gualano, M.R.; Bert, F.; Voglino, G.; Buttinelli, E.; D’Errico, M.M.; De Waure, C.; Di Giovanni, P.; Fantini, M.P.; Giuliani, A.R.; Marranzano, M.; et al. Attitudes towards Compulsory Vaccination in Italy: Results from the NAVIDAD Multicentre Study. Vaccine 2018, 36, 3368–3374. [Google Scholar] [CrossRef] [PubMed]
- Riccò, M.; Cattani, S.; Veronesi, L.; Colucci, M.E. Knowledge, Attitudes, Beliefs and Practices of Construction Workers towards Tetanus Vaccine in Northern Italy. Ind. Health 2016, 54, 554–563. [Google Scholar] [CrossRef] [PubMed]
- Bonaccorsi, G.; Lorini, C.; Santomauro, F.; Guarducci, S.; Pellegrino, E.; Puggelli, F.; Balli, M.; Bonanni, P. 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, 9, 2603–2612. [Google Scholar] [CrossRef]
- Baig, S.A.; Hassan, M.; Ahmed, S.M.; Moazzam, W.; Inayat, A. A Cross-Sectional Study to Investigate Pneumococcal Vaccination in the Elderly in a Low Income County: Patient Knowledge, Awareness, and Attitudes of Vaccination and Prevalence Rates by Socioeconomic Status. Hum. Vaccin. Immunother. 2014, 10, 1024–1027. [Google Scholar] [CrossRef]
- Mckeirnan, K.; Colorafi, K.; Sun, Z.; Daratha, K.; Potyk, D.; Mccarthy, J. Improving Pneumococcal Vaccination Rates among Rural Older Adults through Academic Detailing: Medicine, Nursing and Pharmacy Partnership. Vaccines 2021, 9, 317. [Google Scholar] [CrossRef] [PubMed]
- Riccò, M.; Vezzosi, L.; Cella, C.; Pecoraro, M.; Novembre, G.; Moreo, A.; Ognibeni, E.M.; Schellenberg, G.; Maranelli, G. Tetanus Vaccination Status in Construction Workers: Results from an Institutional Surveillance Campaign. Acta Biomed. 2019, 90, 269. [Google Scholar] [CrossRef]
- Marano, C.; Moodley, M.; Melander, E.; De Moerlooze, L.; Nothdurft, H.D. Multinational Survey Shows Low Awareness of Tick-Borne Encephalitis and Rabies among Travellers to Endemic Regions. J. Travel. Med. 2018, 26, S1–S2. [Google Scholar] [CrossRef]
- Steffen, R. Epidemiology of Tick-Borne Encephalitis (TBE) in International Travellers to Western/Central Europe and Conclusions on Vaccination Recommendations. J. Travel. Med. 2016, 23, taw018. [Google Scholar] [CrossRef]
- Steffen, R. Tick-Borne Encephalitis (TBE) in Children in Europe: Epidemiology, Clinical Outcome and Comparison of Vaccination Recommendations. Ticks Tick-Borne Dis. 2019, 10, 100–110. [Google Scholar] [CrossRef]
- Parfut, A.; Laugel, E.; Baer, S.; Gonzalez, G.; Hansmann, Y.; Wendling, M.J.; Fafi-Kremer, S.; Velay, A. Tick-Borne Encephalitis in Pediatrics: An Often Overlooked Diagnosis. Infect. Dis. Now. 2023, 53, 104645. [Google Scholar] [CrossRef] [PubMed]
- Mahroum, N.; Watad, A.; Rosselli, R.; Brigo, F.; Chiesa, V.; Siri, A.; Ben-Ami Shor, D.; Martini, M.; Bragazzi, N.L.; Adawi, M. An Infodemiological Investigation of the So-Called “Fluad Effect” during the 2014/2015 Influenza Vaccination Campaign in Italy: Ethical and Historical Implications. Hum. Vaccin. Immunother. 2018, 14, 712–718. [Google Scholar] [CrossRef] [PubMed]
- Kow, R.Y.; Mohamad Rafiai, N.; Ahmad Alwi, A.A.; Low, C.L.; Ahmad, M.W.; Zakaria, Z.; Zulkifly, A.H. COVID-19 Infodemiology: Association Between Google Search and Vaccination in Malaysian Population. Cureus 2022, 14, e29515. [Google Scholar] [CrossRef]
- Riccò, M.; Baldassarre, A.; Provenzano, S.; Corrado, S.; Cerviere, M.P.; Parisi, S.; Marchesi, F.; Bottazzoli, M. Infodemiology of RSV in Italy (2017–2022): An Alternative Option for the Surveillance of Incident Cases in Pediatric Age? Children 2022, 9, 1984. [Google Scholar] [CrossRef]
- Rota, F.; Casazza, G.; Genova, G.; Midolo, G.; Prosser, F.; Bertolli, A.; Wilhalm, T.; Nascimbene, J.; Wellstein, C. Topography of the Dolomites Modulates Range Dynamics of Narrow Endemic Plants under Climate Change. Sci. Rep. 2022, 12, 1398. [Google Scholar] [CrossRef]
- Bosellini, A.; Gianolla, P.; Stefani, M. Geology of the Dolomites. Episodes 2003, 26, 181–185. [Google Scholar] [CrossRef] [PubMed]
- Baráková, I.; Derdáková, M.; Selyemová, D.; Chvostáč, M.; Špitalská, E.; Rosso, F.; Collini, M.; Rosà, R.; Tagliapietra, V.; Girardi, M.; et al. Tick-Borne Pathogens and Their Reservoir Hosts in Northern Italy. Ticks Tick-Borne Dis. 2017, 9, 164–170. [Google Scholar] [CrossRef] [PubMed]
- Nazzi, F.; Martinelli, E.; Del Fabbro, S.; Bernardinelli, I.; Milani, N.; Iob, A.; Pischiutti, P.; Campello, C.; D’Agaro, P. Ticks and Lyme Borreliosis in an Alpine Area in Northeast Italy. Med. Vet. Entomol. 2010, 24, 220–226. [Google Scholar] [CrossRef] [PubMed]
Variables | N/942, % |
---|---|
Age (years) | |
<20 | 3, 0.3% |
20–29 | 57, 6.1% |
30–39 | 273, 29.0% |
40–49 | 234, 24.8% |
50–59 | 195, 20.7% |
60–69 | 141, 15.0% |
≥70 | 39, 4.1% |
Male gender | 369, 39.2% |
Region of Origin | |
High-risk Areas for TBEV 1 | 561, 59.6% |
Northern Italy 2 | 351, 37.3% |
Central Italy 3 | 15, 1.6% |
Southern Italy 4 | 12, 1.3% |
Major Island 5 | 3, 0.3% |
Any occupational background in healthcare settings | 291, 30.9% |
Any occupational background in agricultural settings | 15, 1.6% |
Educational achievement | |
University (≥14 years of formal education) | 651, 69.1% |
High school (9–13 years of formal education) | 267, 28.3% |
Primary/Secondary school (≤8 years of formal education) | 24, 2.5% |
Any pet in the household | 414, 43.9% |
GKS > median value (58.33%) | 396, 42.0%% |
Symptom score > median value (57.89%) | 441, 46.8% |
RPS for tick-borne infections > median value (49.00%) | 465, 49.4% |
RPS for TBE vaccine > median value (6.00%) | 405, 43.0% |
Tick bite in the previous season | 156, 16.6% |
Attitudes Toward Vaccines | |
In general, somehow favorable | 840, 74.3% |
Previously vaccinated against TBEV | 267, 28.3% |
TBEV was recommended by any healthcare professional | 291, 30.9% |
General Practitioner | 57, 6.1% |
Medical Officer from Vaccination Services of the Local Health Unit | 102, 10.8% |
Emergency Department | 9, 1.0% |
Occupational physician | 9, 1.0% |
Other non-medical HCWs | 114, 12.1% |
Cumulative Score | Average ± SD | Median (Range; Min–Max) | K2 (p-Value) |
---|---|---|---|
General Knowledge Score | 58.17 ± 16.93 | 58.33 (1.00; 100) | K2 = 63.71, p < 0.001 |
Symptom Knowledge Score | 57.67 ± 17.70 | 57.89 (15.79; 100) | K2 = 37.55, p < 0.001 |
Risk Perception Score, Tick-borne Infections | 52.20 ± 24.28 | 49.00 (1.00; 100) | K2 = 30.11, p < 0.001 |
Risk Perception Score, TBE Vaccine | 11.63 ± 15.42 | 6.00 (1.00; 100) | K2 = 569.1, p < 0.001 |
Variable | N/156, % |
---|---|
Tick Removed by: | |
Any HCW | 12, 7.7% |
Friends/Relatives | 33, 21.1% |
Him-/Herself | 111, 71.2% |
Antibiotic treatment | 18, 11.5% |
Laboratory follow-up | 30, 19.2% |
Diagnosis of Lyme disease | 8, 5.1% |
Diagnosis of TBEV infection | 0, - |
Diagnosis of skin infection on tick bite | 8, 5.1% |
Preventive Measures (Often/Always) | |
Use of Repellent | 39, 25.0% |
Wear light-colored clothing | 12, 7.7% |
Wear long sleeves and pants | 21, 13.5% |
Tuck pants into socks or boots | 66, 42.3% |
Perform body check | 0, - |
Wear a hat | 18, 11.5% |
Avoid typical tick habitats | 18, 11.5% |
Any | 105, 67.3% |
1 preventive measure | 54, 34.6% |
2 preventive measures | 39, 25.0% |
3 preventive measures or more | 12, 7.7% |
All Respondents | Previously Vaccinated Against TBEV | ||
---|---|---|---|
Yes (N/267, %) | No (N/675, %) | p-Value | |
General Knowledge Score (%, average ± SD) | 62.09 ± 13.19 | 56.38 ± 18.17 | <0.001 |
Symptoms Score (%, average ± SD) | 59.63 ± 17.32 | 57.06 ± 17.85 | 0.023 |
Risk Perception Score, Tick-Borne infection (%, average ± SD) | 62.88 ± 26.41 | 47.95 ± 22.13 | <0.001 |
Risk Perception Score, TBE vaccine (%, average ± SD) | 6.79 ± 10.45 | 47.95 ± 22.13 | <0.001 |
Age < 50 years | 135, 50.6% | 414, 61.3% | <0.001 |
Male gender | 105, 39.3% | 255, 37.8% | 0.925 |
Resident in high-risk areas | 216, 80.9% | 342, 50.7% | <0.001 |
Any occupational background in healthcare settings | 93, 34.8% | 198, 29.3% | 0.177 |
Any occupational background in agricultural settings | 6, 2.2% | 6, 0.9% | 0.106 |
High educational achievement | 174, 65.2% | 459, 68.0% | 0.136 |
Any pet in the household | 126, 47.2% | 285, 42.2% | 0.345 |
Higher general knowledge score | 135, 50.6% | 249, 36.9% | <0.001 |
Higher knowledge of symptoms score | 147, 55.1% | 288, 42.7% | 0.002 |
High risk perception regarding tick-borne infections | 183, 68.5% | 273, 40.4% | <0.001 |
High risk perception regarding TBE vaccine | 69, 25.8% | 318, 47.1% | <0.001 |
Attitude toward vaccines (favorable) | 258, 96.6% | 564, 83.6% | <0.001 |
Tick bite in the previous season | 90, 33.7% | 63, 9.3% | <0.001 |
All Respondents | Previously Vaccinated Against TBEV | |
---|---|---|
aOR | 95% Confidence Interval | |
Age < 50 years | 0.646 | 0.458; 0.913 |
Living in high-risk areas | 3.010 | 2.062; 4.394 |
Higher general knowledge score | 1.515 | 1.071; 2.142 |
Higher knowledge of symptoms score | 1.009 | 0.714; 1.427 |
High risk perception regarding tick-borne infections | 2.566 | 1.806; 3.646 |
High risk perception regarding TBE vaccine | 0.541 | 0.379; 0.772 |
Attitude toward vaccines (favorable) | 3.824 | 1.774; 8.244 |
Tick bite in the previous season | 5.479 | 3.582; 8.382 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Riccò, M.; Corrado, S.; Marchesi, F.; Bottazzoli, M. Tick-Borne Encephalitis Virus Vaccination among Tourists in a High-Prevalence Area (Italy, 2023): A Cross-Sectional Study. Trop. Med. Infect. Dis. 2023, 8, 491. https://doi.org/10.3390/tropicalmed8110491
Riccò M, Corrado S, Marchesi F, Bottazzoli M. Tick-Borne Encephalitis Virus Vaccination among Tourists in a High-Prevalence Area (Italy, 2023): A Cross-Sectional Study. Tropical Medicine and Infectious Disease. 2023; 8(11):491. https://doi.org/10.3390/tropicalmed8110491
Chicago/Turabian StyleRiccò, Matteo, Silvia Corrado, Federico Marchesi, and Marco Bottazzoli. 2023. "Tick-Borne Encephalitis Virus Vaccination among Tourists in a High-Prevalence Area (Italy, 2023): A Cross-Sectional Study" Tropical Medicine and Infectious Disease 8, no. 11: 491. https://doi.org/10.3390/tropicalmed8110491