Immunization strategies targeting newly arrived migrants in Non-EU countries of the mediterranean basin and black sea

Background: The World Health Organization recommends that host countries ensure appropriate vaccinations to refugees, asylum seekers and migrants. However, information on vaccination strategies targeting migrants in host countries is limited. Methods: In 2015-2016 we carried out a survey among national experts from governmental bodies of 15 non-EU countries of the Mediterranean and Black Sea in order to document and share national vaccination strategies targeting newly arrived migrants. Results: Four countries reported having regulations/procedures supporting the immunization of migrants at national level, one at sub-national level and three only targeting specific population groups. Eight countries offer migrant children all the vaccinations included in their national immunization schedule; three provide only selected vaccinations, mainly measles and polio vaccines. Ten and eight countries also offer selected vaccinations to adolescents and adults respectively. Eight countries provide vaccinations at the community level; seven give priority vaccines in holding centres or at entry sites. Data on administered vaccines are recorded in immunization registries in nine countries. Conclusions: Although differing among countries, indications for immunizing migrants are in place in most of them. However, we cannot infer from our findings whether those strategies are currently functioning and whether barriers to their implementation are being faced. Further studies focusing on these aspects are needed to develop concrete and targeted recommendations for action. Since migrants are moving across countries, development of on-line registries and cooperation between countries could allow keeping track of administered vaccines in order to appropriately plan immunization series and avoid unnecessary vaccinations

Key dimensions for the prevention and control of communicable diseases in institutional settings. a scoping review to guide the development of a tool to strengthen preparedness at migrant holding centres in the EU/EEA

Migrant centres, as other institutions hosting closed or semi-open communities, may face specific challenges in preventing and controlling communicable disease transmission, particularly during times of large sudden influx. However, there is dearth of evidence on how to prioritise investments in aspects such as human resources, medicines and vaccines, sanitation and disinfection, and physical infrastructures to prevent/control communicable disease outbreaks. We analysed frequent drivers of communicable disease transmission/issues for outbreak management in institutions hosting closed or semi-open communities, including migrant centres, and reviewed existing assessment tools to guide the development of a European Centre for Disease Prevention and Control (ECDC) checklist tool to strengthen preparedness against communicable disease outbreaks in migrant centres. Among articles/reports focusing specifically on migrant centres, outbreaks through multiple types of disease transmission were described as possible/occurred. Human resources and physical infrastructure were the dimensions most frequently identified as crucial for preventing and mitigating outbreaks. This review also recognised a lack of common agreed standards to guide and assess preparedness activities in migrant centres, thereby underscoring the need for a capacity-oriented ECDC preparedness checklist tool

National immunization strategies targeting migrants in six European countries

Over the last three years an unprecedented flow of migrants arrived in Europe. There is evidence that vaccine preventable diseases have caused outbreaks in migrant holding centres. These outbreaks can be favored by a combination of factors including low immunization coverage, bad conditions that migrants face during their exhausting journey and overcrowding within holding facilities. In 2017, we conducted an online survey in Croatia, Greece, Italy, Malta, Portugal and Slovenia to explore the national immunization strategies targeting irregular migrants, refugees and asylum seekers. All countries stated that a national regulation supporting vaccination offer to migrants is available. Croatia, Italy, Portugal and Slovenia offer to migrant children and adolescents all vaccinations included in the National Immunization Plan; Greece and Malta offer only certain vaccinations, including those against diphtheria-tetanus-pertussis, poliomyelitis and measles-mumps-rubella. Croatia, Italy, Malta and Portugal also extend the vaccination offer to adults. All countries deliver vaccinations in holding centres and/or community health services, no one delivers vaccinations at entry site. Operating procedures that guarantee the migrants' access to vaccination at the community level are available only in Portugal. Data on administered vaccines is available at the national level in four countries: individual data in Malta and Croatia, aggregated data in Greece and Portugal. Data on vaccination uptake among migrants is available at national level only in Malta. Concluding, although diversified, strategies for migrant vaccination are in place in all the surveyed countries and generally in line with WHO and ECDC indications. Development of procedures to keep track of migrants' immunization data across countries, development of strategies to facilitate and monitor migrants' access to vaccinations at the community level and collection of data on vaccination uptake among migrants should be promoted to meet existing gaps. The study was conducted in the framework of the CARE (''Common Approach for REfugees and other migrants' health") project (717217/CARE) that received funding from the EU health Programme (2014–2020). info:eu-repo/semantics/publishedVersio

Immunisation of migrants in EU/EEA countries: Policies and practices

In recent years various EU/EEA countries have experienced an influx of migrants from low and middle-income countries. In 2018, the “Vaccine European New Integrated Collaboration Effort (VENICE)” survey group conducted a survey among 30 EU/EEA countries to investigate immunisation policies and practices targeting irregular migrants, refugees and asylum seekers (later called “migrants” in this report). Twenty-nine countries participated in the survey. Twenty-eight countries reported having national policies targeting children/adolescent and adult migrants, however vaccinations offered to adult migrants are limited to specific conditions in seven countries. All the vaccinations included in the National Immunisation Programme (NIP) are offered to children/adolescents in 27/28 countries and to adults in 13/28 countries. In the 15 countries offering only certain vaccinations to adults, priority is given to diphtheria-tetanus, measles-mumps-rubella and polio vaccinations. Information about the vaccines given to child/adolescent migrants is recorded in 22 countries and to adult migrants in 19 countries with a large variation in recording methods found across countries. Individual and aggregated data are reportedly not shared with other centres/institutions in 13 and 15 countries, respectively. Twenty countries reported not collecting data on vaccination uptake among migrants; only three countries have these data at the national level. Procedures to guarantee migrants’ access to vaccinations at the community level are available in 13 countries. In conclusion, although diversified, strategies for migrant vaccination are in place in all countries except for one, and the strategies are generally in line with international recommendations. Efforts are needed to strengthen partnerships and implement initiatives across countries of origin, transit and destination to develop and better share documentation in order to guarantee a completion of vaccination series and to avoid unnecessary re-vaccination. Development of migrant-friendly strategies to facilitate migrants' access to vaccination and collection of vaccination uptake data among migrants is needed to meet existing gaps

A cohort study to evaluate persistence of hepatitis B immunogenicity after administration of hexavalent vaccines

<p>Abstract</p> <p>Background</p> <p>In 2001, two hexavalent vaccines were licensed in Italy (Hexavac^®, Infanrix Hexa^®), and since 2002 were extensively used for primary immunization in the first year of life (at 3, 5, 11/12 months of age). In 2005, the market authorization of Hexavac^®was precautionary suspended by EMEA, because of doubts on long-term protection against hepatitis B virus. The objectives of this study were to evaluate the persistence of antibodies to anti-HBs, in children in the third year of life, and to investigate the response to a booster dose of hepatitis B vaccine.</p> <p>Methods</p> <p>Participant children were enrolled concomitantly with the offering of anti-polio booster dose, in the third year of life. Anti-HBs titers were determined on capillary blood samples. A booster dose of hepatitis B vaccine was administered to children with anti-HBs titers < 10 mIU/ml, with the monovalent precursor product of the previously received hexavalent vaccine. HBsAb titers were tested again one month after the booster.</p> <p>Results</p> <p>Sera from 113 children previously vaccinated with Hexavac^®, and from 124 vaccinated with Infanrix Hexa^®were tested for anti-HBs. Titers were ≥ 10 mIU/ml in 69% and 96% (p < 0,0001) respectively. The proportion of children with titers ≥ 100 mIU/ml did also significantly differ among groups (27% and 78%; p < 0,0001).</p> <p>Post-booster, 93% of children achieved titers ≥ 10 mIU/ml, with no significant difference by vaccine group.</p> <p>Discussion</p> <p>Fifteen months after third dose administration, a significant difference in anti-HBs titers was noted in the two vaccine groups considered. Monovalent hepatitis B vaccine administration in 3-year old children induced a proper booster response, confirming that immunologic memory persists in children with anti-HBs titers < 10 mIU/ml. However, long-term persistence of HBV protection after hexavalent vaccines administration should be further evaluated over time.</p

Migrant and refugee populations: a public health and policy perspective on a continuing global crisis.

The 2015-2017 global migratory crisis saw unprecedented numbers of people on the move and tremendous diversity in terms of age, gender and medical requirements. This article focuses on key emerging public health issues around migrant populations and their interactions with host populations. Basic needs and rights of migrants and refugees are not always respected in regard to article 25 of the Universal Declaration of Human Rights and article 23 of the Refugee Convention. These are populations with varying degrees of vulnerability and needs in terms of protection, security, rights, and access to healthcare. Their health status, initially conditioned by the situation at the point of origin, is often jeopardised by adverse conditions along migratory paths and in intermediate and final destination countries. Due to their condition, forcibly displaced migrants and refugees face a triple burden of non-communicable diseases, infectious diseases, and mental health issues. There are specific challenges regarding chronic infectious and neglected tropical diseases, for which awareness in host countries is imperative. Health risks in terms of susceptibility to, and dissemination of, infectious diseases are not unidirectional. The response, including the humanitarian effort, whose aim is to guarantee access to basic needs (food, water and sanitation, healthcare), is gripped with numerous challenges. Evaluation of current policy shows insufficiency regarding the provision of basic needs to migrant populations, even in the countries that do the most. Governments around the world need to rise to the occasion and adopt policies that guarantee universal health coverage, for migrants and refugees, as well as host populations, in accordance with the UN Sustainable Development Goals. An expert consultation was carried out in the form of a pre-conference workshop during the 4th International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland, on 20 June 2017, the United Nations World Refugee Day

Progetto nazionale per la PREvenzione del carcinoma della cervice uterina nelle GIOvani donne (PREGIO): indagine conoscitiva, prevalenza dell’infezione da papilloma virus umano (HPV) e fattibilità dell’offerta della vaccinazione anti-HPV

In Italia si registrano annualmente circa 3500 nuovi casi e 1000 morti per carcinoma invasivo della cervice uterina (CC), la prima neoplasia ad essere riconosciuta dall’OMS come totalmente riconducibile all’infezione da tipi oncogeni di Papilloma virus umano (HPV). Attualmente la prevenzione del CC si basa su programmi di screening mediante Pap-test; la recente disponibilità dei vaccini contro l’HPV ha aperto la strada alla prevenzione primaria di questo tumore. Il Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute dell’Istituto Superiore di Sanità (ISS) ha condotto il progetto nazionale “PreGio” (PREvenzione GIOvani) in collaborazione con 10 ASL di sei Regioni italiane. Gli obiettivi di questo progetto erano: 1) descrivere la prevalenza delle infezione da tipi oncogeni di HPV; 2) realizzare un’indagine su conoscenza, attitudine e pratica (CAP) su HPV e prevenzione del cervicocarcinoma; 3) valutare la fattibilità dell’offerta vaccinale in donne di 18-26 anni. Metodi Il protocollo dello studio prevedeva l’arruolamento di 2000 donne di 18-26 anni, campionate dalle liste anagrafiche di popolazione e stratificate per 2 fasce d’età: 18-24 e 25-26 anni. Le donne campionate sono state randomizzate in quattro gruppi con un diverso percorso nell’ambito del progetto. A tutte le donne è stato offerto un colloquio sulla prevenzione del CC, un Pap-test, un test HPV (utilizzando il test Hybrid Capture 2); i campioni positivi sono stati tipizzati con PCR. A 1000 donne è stato somministrato un questionario su HPV e prevenzione del carcinoma della cervice uterina e ad altre 1000 è stata offerta la vaccinazione contro l’HPV. I dati sono stati inseriti localmente su una piattaforma web dedicata. L’analisi descrittiva univariata e multivariata è stata effettuata in ISS utilizzando il Package statistico STATA 9.2. Risultati Il tasso di partecipazione al progetto è stato del 58% con un ampio range tra le ASL (34-84%). Il test HPV ha rilevato la presenza di infezione nel 19% dei campioni, senza differenze per area geografica e fascia di età. Il tipo più frequente è risultato HPV 16 seguito da 31, 66, 51, 18. La proporzione di donne positive è risultata maggiore nelle donne nubili; in chi non convive con il proprio partner; nelle nullipare ed aumenta con l’aumentare del numero di partner. Complessivamente il 50% del campione è stato vaccinato. L’adesione è stata inferiore al Sud, nelle ragazze più grandi (25-26 anni), nelle coniugate e nelle donne con titolo di studio basso. Sono state intervistate 667 donne per l’indagine CAP. Il 92% delle intervistate ha riferito di aver sentito parlare del Pap-test, il 59% del papillomavirus e il 52% del vaccino contro l’HPV. Amici e parenti rappresentano la principale fonte di informazioni sul Pap-test; i mass-media su HPV e vaccino. Il 31, 13 e 8% delle donne ha ricevuto informazioni dai ginecologi su Pap-test, HPV e vaccino rispettivamente e il 12, 7 e 8% le ha ricevute dai medici di base. Il 63% sa che il Pap-test serve a prevenire il cervicocarcinoma, ma solo il 28% ritiene che vada ripetuto ogni tre anni. Il 63% sa che le infezioni da HPV sono frequenti, ma solo il 21% sa che gran parte delle infezioni regredisce spontaneamente e il 26% che l’HPV può provocare questo tumore. Il livello di conoscenza sulla prevenzione del CC è maggiore nelle donne con titolo di studio elevato (OR=1.53 95%CI 0.98-2.41) e in quelle che non hanno ancora effettuato un Pap-test preventivo (OR= 1.40 95%CI 0.97-2.02) mentre è minore in chi ha già avuto figli (OR=0.40 95%CI 0.22-0.74). Il 73% è propenso a vaccinarsi e nell’81% dei casi il consiglio di un medico di fiducia influirebbe molto/abbastanza su questa decisione. Le donne con uno score di conoscenza alto (OR=2,95 95%CI 1,86-4,71) e quelle con 5 o più partner (OR=2,41 95%CI 1,17-4,95) sono più propense a vaccinarsi, mentre le donne di 25-26 anni (OR=0,491 95%CI 0,32-0,76) rispetto alle più giovani e quelle che riferiscono di usare sempre/spesso il profilattico (OR=0,66 95%CI 0,43-1,01) hanno una probabilità maggiore di non accettare l’offerta vaccinale. Conclusioni Lo studio PreGio ha permesso di raccogliere dati di prevalenza su un campione consistente di donne giovani del Nord, Centro e Sud Italia prima dell’introduzione della vaccinazione contro l’HPV. La fascia di età 18-26 anni si è dimostrata difficile da raggiungere, infatti, nonostante il setting protetto dello studio, è stato vaccinato soltanto il 50% del campione. In un’ottica di salute pubblica l’organizzazione di una campagna vaccinale attiva deve tener conto, oltre alle caratteristiche epidemiologiche della malattia da prevenire, anche di altri fattori quali le priorità a livello locale, le risorse umane e finanziarie e i livelli di copertura vaccinale da raggiungere perché la campagna sia costo/efficace. I risultati dell’indagine CAP confermano l’urgente bisogno di una comunicazione evidence-based rivolta alla popolazione target da parte di professionisti sanitari opportunamente formati. Alla luce delle richieste del Consiglio Superiore di Sanità che ha raccomandato di raccogliere maggiori evidenze prima di procedere con un’eventuale offerta attiva della vaccinazione a fasce di età diverse dalle dodicenni, PreGio ha raccolto informazioni utili per la programmazione di eventuali programmi vaccinali di catch up e per il miglioramento dei contenuti della comunicazione che gli operatori sanitari si trovano ad affrontare con l’introduzione dei vaccini contro l’HPV.National project for the prevention of cervical cancer in young women (PREGIO): knowledge, attitudes and practices survey, prevalence of human papillomavirus infection (HPV) and feasibility of HPV vaccination offer. Introduction Each year in Italy 3500 cases and 1000 deaths attributable to cervical cancer (CC) are reported. The causal role of certain human papillomavirus (HPV) types in all cervical cancers is well established. Currently, CC prevention is based on pap smear cervical screening programmes; recent availability of vaccines against HPV has opened the way for primary prevention of this neoplasm. The National Center for Epidemiology, Surveillance and Health Promotion of the Italian Health Institute (ISS) carried out a National project “PreGio” in collaboration with 10 Local Health Units (LHU) of six Italian Regions. The objectives of this project were to: 1) describe the prevalence of oncogenic types HPV infections, 2) perform a knowledge, attitudes and practices (KAP) survey on HPV and CC prevention, and 3) evaluate the feasibility of the HPV vaccine offer in women aged 18-26 years. Methods The study protocol planned to recruit 2000 women aged 18-26 years, sampled from the anagraphic population lists and stratified for two age groups (18-24 and 25-26 years old), and randomize them into four groups with a different path within the project. All women were offered an informative conversation on CC prevention, a cervical smear for Papanicolaou and HPV test (using the Hybrid Capture 2 test); positive samples were genotyped by PCR. A sample of 1000 women were also submitted to a questionnaire on HPV and CC prevention and other 1000 women were offered HPV vaccination. Collected data were uploaded on a web platform by LHU’s operators. Data analysis was performed at ISS using the STATA 9.2 statistical package. Results The project participation rate was 58% with a wide range among LHUs (34-84%). The infection rate was 19%, without differences by geographical area and age. The most frequent viral type was HPV 16, followed by 31, 66, 51, 18. HPV prevalence was higher in never married women, in women not living with their partner, in nulliparous and increased with increasing number of sexual partners. Overall, half of the women were vaccinated. The vaccination rate was lower in the South, in women aged 25-26 years (compared with 18-24 years), married girls and women with a low educational level. Among the 667 women interviewed (KAP survey), 92% had already heard about pap smear cervical screening, 59% about the papillomavirus and 52% about the HPV vaccine. Friends and relatives represented the main source of information on pap smear; media on HPV and vaccine. In total 31, 13 and 8% of women had received information from gynecologists on Pap-test, HPV and vaccine respectively and 12, 7 and 8% from primary care physicians. For 63% of respondents the main purpose of the pap smear was preventing cervical cancer, but only for 28% the cervical smear had to be carried out every three years; 63% of women thought that HPV infections are frequent, but only 21% that most HPV infections regress spontaneously and 26% that HPV can cause this neoplasm. Knowledge level about CC prevention was lower in parous compared with nulliparous (OR=0.40 95%CI 0.22-0.74) while higher in women with a high educational level (OR=1.53 95%CI 0.98-2.41) and in women who had never benefit from a preventive pap smear (OR= 1.40 95%CI 0.97-2.02). Overall, 73% of women intended to be vaccinated and the support of a physician was quite/very influent on the decisional process for 81% of respondents. The intent to receive the vaccine was significantly greater among women who reported ≥ 5 partners (OR=2,41 95%CI 1,17-4,95) and with a high knowledge score (OR=2,95 95%CI 1,86-4,71), while women aged 25-26 years (OR=0,491 95%CI 0,32-0,76) and women who reported to use always/often the condom (OR=0,66 95%CI 0,43-1,01) were less likely to be vaccinated. Conclusions This project allowed to collect prevalence data on a large sample of young women in Northern, Central and Southern Italy before the introduction of the HPV vaccination. In regards to vaccination, women aged 18-26 years proved to be a difficult target, in fact, though the protected setting of the project, only half of the sample was vaccinated. From a public health perspective the organization of an active vaccination campaign should take into consideration, besides the epidemiological features of the preventable disease, also the local priorities, human and financial resources and vaccination coverage levels to be achieved so that the campaign is cost/effective. The results of the KAP survey strengthen the urgent need of evidence-based educational activities addressed to the target population from opportunely trained healthcare professionals. In conclusion, also considering that the Superior Council of the Italian Ministry of Health recommended to collect more evidences before extending the active offer of HPV vaccination to age groups older than 11 years, the project “PreGio” collected useful information for planning catch up vaccination campaigns and improving the communication contents which many health operators have to face since the introduction of the HPV vaccines

Progetto nazionale per la PREvenzione del carcinoma della cervice uterina nelle GIOvani donne (PREGIO): indagine conoscitiva, prevalenza dell’infezione da papilloma virus umano (HPV) e fattibilità dell’offerta della vaccinazione anti-HPV

In Italia si registrano annualmente circa 3500 nuovi casi e 1000 morti per carcinoma invasivo della cervice uterina (CC), la prima neoplasia ad essere riconosciuta dall’OMS come totalmente riconducibile all’infezione da tipi oncogeni di Papilloma virus umano (HPV). Attualmente la prevenzione del CC si basa su programmi di screening mediante Pap-test; la recente disponibilità dei vaccini contro l’HPV ha aperto la strada alla prevenzione primaria di questo tumore. Il Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute dell’Istituto Superiore di Sanità (ISS) ha condotto il progetto nazionale “PreGio” (PREvenzione GIOvani) in collaborazione con 10 ASL di sei Regioni italiane. Gli obiettivi di questo progetto erano: 1) descrivere la prevalenza delle infezione da tipi oncogeni di HPV; 2) realizzare un’indagine su conoscenza, attitudine e pratica (CAP) su HPV e prevenzione del cervicocarcinoma; 3) valutare la fattibilità dell’offerta vaccinale in donne di 18-26 anni. Metodi Il protocollo dello studio prevedeva l’arruolamento di 2000 donne di 18-26 anni, campionate dalle liste anagrafiche di popolazione e stratificate per 2 fasce d’età: 18-24 e 25-26 anni. Le donne campionate sono state randomizzate in quattro gruppi con un diverso percorso nell’ambito del progetto. A tutte le donne è stato offerto un colloquio sulla prevenzione del CC, un Pap-test, un test HPV (utilizzando il test Hybrid Capture 2); i campioni positivi sono stati tipizzati con PCR. A 1000 donne è stato somministrato un questionario su HPV e prevenzione del carcinoma della cervice uterina e ad altre 1000 è stata offerta la vaccinazione contro l’HPV. I dati sono stati inseriti localmente su una piattaforma web dedicata. L’analisi descrittiva univariata e multivariata è stata effettuata in ISS utilizzando il Package statistico STATA 9.2. Risultati Il tasso di partecipazione al progetto è stato del 58% con un ampio range tra le ASL (34-84%). Il test HPV ha rilevato la presenza di infezione nel 19% dei campioni, senza differenze per area geografica e fascia di età. Il tipo più frequente è risultato HPV 16 seguito da 31, 66, 51, 18. La proporzione di donne positive è risultata maggiore nelle donne nubili; in chi non convive con il proprio partner; nelle nullipare ed aumenta con l’aumentare del numero di partner. Complessivamente il 50% del campione è stato vaccinato. L’adesione è stata inferiore al Sud, nelle ragazze più grandi (25-26 anni), nelle coniugate e nelle donne con titolo di studio basso. Sono state intervistate 667 donne per l’indagine CAP. Il 92% delle intervistate ha riferito di aver sentito parlare del Pap-test, il 59% del papillomavirus e il 52% del vaccino contro l’HPV. Amici e parenti rappresentano la principale fonte di informazioni sul Pap-test; i mass-media su HPV e vaccino. Il 31, 13 e 8% delle donne ha ricevuto informazioni dai ginecologi su Pap-test, HPV e vaccino rispettivamente e il 12, 7 e 8% le ha ricevute dai medici di base. Il 63% sa che il Pap-test serve a prevenire il cervicocarcinoma, ma solo il 28% ritiene che vada ripetuto ogni tre anni. Il 63% sa che le infezioni da HPV sono frequenti, ma solo il 21% sa che gran parte delle infezioni regredisce spontaneamente e il 26% che l’HPV può provocare questo tumore. Il livello di conoscenza sulla prevenzione del CC è maggiore nelle donne con titolo di studio elevato (OR=1.53 95%CI 0.98-2.41) e in quelle che non hanno ancora effettuato un Pap-test preventivo (OR= 1.40 95%CI 0.97-2.02) mentre è minore in chi ha già avuto figli (OR=0.40 95%CI 0.22-0.74). Il 73% è propenso a vaccinarsi e nell’81% dei casi il consiglio di un medico di fiducia influirebbe molto/abbastanza su questa decisione. Le donne con uno score di conoscenza alto (OR=2,95 95%CI 1,86-4,71) e quelle con 5 o più partner (OR=2,41 95%CI 1,17-4,95) sono più propense a vaccinarsi, mentre le donne di 25-26 anni (OR=0,491 95%CI 0,32-0,76) rispetto alle più giovani e quelle che riferiscono di usare sempre/spesso il profilattico (OR=0,66 95%CI 0,43-1,01) hanno una probabilità maggiore di non accettare l’offerta vaccinale. Conclusioni Lo studio PreGio ha permesso di raccogliere dati di prevalenza su un campione consistente di donne giovani del Nord, Centro e Sud Italia prima dell’introduzione della vaccinazione contro l’HPV. La fascia di età 18-26 anni si è dimostrata difficile da raggiungere, infatti, nonostante il setting protetto dello studio, è stato vaccinato soltanto il 50% del campione. In un’ottica di salute pubblica l’organizzazione di una campagna vaccinale attiva deve tener conto, oltre alle caratteristiche epidemiologiche della malattia da prevenire, anche di altri fattori quali le priorità a livello locale, le risorse umane e finanziarie e i livelli di copertura vaccinale da raggiungere perché la campagna sia costo/efficace. I risultati dell’indagine CAP confermano l’urgente bisogno di una comunicazione evidence-based rivolta alla popolazione target da parte di professionisti sanitari opportunamente formati. Alla luce delle richieste del Consiglio Superiore di Sanità che ha raccomandato di raccogliere maggiori evidenze prima di procedere con un’eventuale offerta attiva della vaccinazione a fasce di età diverse dalle dodicenni, PreGio ha raccolto informazioni utili per la programmazione di eventuali programmi vaccinali di catch up e per il miglioramento dei contenuti della comunicazione che gli operatori sanitari si trovano ad affrontare con l’introduzione dei vaccini contro l’HPV.National project for the prevention of cervical cancer in young women (PREGIO): knowledge, attitudes and practices survey, prevalence of human papillomavirus infection (HPV) and feasibility of HPV vaccination offer. Introduction Each year in Italy 3500 cases and 1000 deaths attributable to cervical cancer (CC) are reported. The causal role of certain human papillomavirus (HPV) types in all cervical cancers is well established. Currently, CC prevention is based on pap smear cervical screening programmes; recent availability of vaccines against HPV has opened the way for primary prevention of this neoplasm. The National Center for Epidemiology, Surveillance and Health Promotion of the Italian Health Institute (ISS) carried out a National project “PreGio” in collaboration with 10 Local Health Units (LHU) of six Italian Regions. The objectives of this project were to: 1) describe the prevalence of oncogenic types HPV infections, 2) perform a knowledge, attitudes and practices (KAP) survey on HPV and CC prevention, and 3) evaluate the feasibility of the HPV vaccine offer in women aged 18-26 years. Methods The study protocol planned to recruit 2000 women aged 18-26 years, sampled from the anagraphic population lists and stratified for two age groups (18-24 and 25-26 years old), and randomize them into four groups with a different path within the project. All women were offered an informative conversation on CC prevention, a cervical smear for Papanicolaou and HPV test (using the Hybrid Capture 2 test); positive samples were genotyped by PCR. A sample of 1000 women were also submitted to a questionnaire on HPV and CC prevention and other 1000 women were offered HPV vaccination. Collected data were uploaded on a web platform by LHU’s operators. Data analysis was performed at ISS using the STATA 9.2 statistical package. Results The project participation rate was 58% with a wide range among LHUs (34-84%). The infection rate was 19%, without differences by geographical area and age. The most frequent viral type was HPV 16, followed by 31, 66, 51, 18. HPV prevalence was higher in never married women, in women not living with their partner, in nulliparous and increased with increasing number of sexual partners. Overall, half of the women were vaccinated. The vaccination rate was lower in the South, in women aged 25-26 years (compared with 18-24 years), married girls and women with a low educational level. Among the 667 women interviewed (KAP survey), 92% had already heard about pap smear cervical screening, 59% about the papillomavirus and 52% about the HPV vaccine. Friends and relatives represented the main source of information on pap smear; media on HPV and vaccine. In total 31, 13 and 8% of women had received information from gynecologists on Pap-test, HPV and vaccine respectively and 12, 7 and 8% from primary care physicians. For 63% of respondents the main purpose of the pap smear was preventing cervical cancer, but only for 28% the cervical smear had to be carried out every three years; 63% of women thought that HPV infections are frequent, but only 21% that most HPV infections regress spontaneously and 26% that HPV can cause this neoplasm. Knowledge level about CC prevention was lower in parous compared with nulliparous (OR=0.40 95%CI 0.22-0.74) while higher in women with a high educational level (OR=1.53 95%CI 0.98-2.41) and in women who had never benefit from a preventive pap smear (OR= 1.40 95%CI 0.97-2.02). Overall, 73% of women intended to be vaccinated and the support of a physician was quite/very influent on the decisional process for 81% of respondents. The intent to receive the vaccine was significantly greater among women who reported ≥ 5 partners (OR=2,41 95%CI 1,17-4,95) and with a high knowledge score (OR=2,95 95%CI 1,86-4,71), while women aged 25-26 years (OR=0,491 95%CI 0,32-0,76) and women who reported to use always/often the condom (OR=0,66 95%CI 0,43-1,01) were less likely to be vaccinated. Conclusions This project allowed to collect prevalence data on a large sample of young women in Northern, Central and Southern Italy before the introduction of the HPV vaccination. In regards to vaccination, women aged 18-26 years proved to be a difficult target, in fact, though the protected setting of the project, only half of the sample was vaccinated. From a public health perspective the organization of an active vaccination campaign should take into consideration, besides the epidemiological features of the preventable disease, also the local priorities, human and financial resources and vaccination coverage levels to be achieved so that the campaign is cost/effective. The results of the KAP survey strengthen the urgent need of evidence-based educational activities addressed to the target population from opportunely trained healthcare professionals. In conclusion, also considering that the Superior Council of the Italian Ministry of Health recommended to collect more evidences before extending the active offer of HPV vaccination to age groups older than 11 years, the project “PreGio” collected useful information for planning catch up vaccination campaigns and improving the communication contents which many health operators have to face since the introduction of the HPV vaccines