Vaccination coverage in healthcare workers: a multicenter cross-sectional study in Italy


healthcare workers
vaccination coverage



In recent years, a phenomenon known as "vaccine hesitancy" has spread throughout the world, even among health workers, determining a reduction in vaccination coverage (VC). 

A study aimed at evaluating VC among healthcare workers (HCWs) in 10 Italian cities (L'Aquila, Genoa, Milan, Palermo, Sassari, Catanzaro, Ferrara, Catania, Naples, Messina) was performed.

Materials and methods

Annex 3 of the Presidential Decree n. 445 of 28 December 2000 was used to collect information on the vaccination status of HCWs. The mean and standard deviation (SD) were calculated with regard to the quantitative variable (age), while absolute and relative frequencies were obtained for categorical data (sex, professional profile, working sector, vaccination status). The connection between VC and the categorical variables was evaluated by chi-square method (statistical significance at p<0.05). The statistical analyses were performed by SPSS and Stata software.


A total of 3,454 HCWs participated in the project: 1,236 males and 2,218 females. 

The sample comprised: physicians (26.9%), trainee physicians (16.1%), nurses (17.2%) and other professional categories (9.8%). Low VC was generally recorded. Higher VC was found with regard to polio, hepatitis B, tetanus and diphtheria, while coverage was very low for measles, mumps, rubella, pertussis, chickenpox and influenza (20-30%). 


This study revealed low VC rates among HCWs for all the vaccinations. Measures to increase VC are therefore necessary in order to prevent HCWs from becoming a source of transmission of infections with high morbidity and/or mortality both within hospitals and outside.


World Health Organization (WHO). Addressing Vaccine Hesitancy. Available at: [Accessed on 15 December 2018].

World Health Organization (WHO). Report of the sage working group on vaccine hesitancy, 12 November 2014. Available at: [Accessed on 15 December 2018].

Karafillakis E, Dinca I, Apfel F, Cecconi S, Wűrz A, Takacs J ,Suk J, Celentano LP, Kramarz P, Larson HJ. Vaccine hesitancy among healthcare workers in Europe: A qualitative study. Vaccine. 2016;34(41):5013-5020. doi: 10.1016/j.vaccine.2016.08.029.

Dubé E, Laberge C, Guay M, Bramadat P,Roy R, Bettinger JA. Vaccine hesitancy. An overview. Hum Vaccin Immunother. 2013; 9(8): 1763–1773. doi: 10.4161/hv.24657.

Feldstein LR, Mariat S, Gacic-Dobo M, Diallo MS, Conklin LM, Wallace AS. Global Routine Vaccination Coverage, 2016. MMWR Morb Mortal Wkly Rep. 2017;66(45):1252-1255. doi: 10.15585/mmwr.mm6645a3.

Signorelli C, Odone A, Cella P, Iannazzo S, D'Ancona F, Guerra R. Infant immunization coverage in Italy (2000-2016). Ann Ist Super Sanita. 2017;53(3):231-237. doi: 10.4415/ANN_17_03_09.

Squeri R. , Genovese C., Trimarchi G., Palamara M.A.R., La Fauci V. An evaluation of attitude toward vaccines among healthcare workers of a University Hospital in Southern Italy R. Ann Ig 2017; 29: 595-606. doi:10.7416/ai.2017.2188.

Di Gregori V, Franchino G, Marcantoni C, Simone B, Costantino C. Logistic regression of attitudes and coverage for influenza vaccination among Italian Public Health medical residents. J Prev Med Hyg. 2014;55(4):152-7.

Mereckiene J. European Centre for Disease Prevention and Control. Seasonal influenza vaccination in Europe: overview of vaccination recommendations and coverage rates in the EU Member States for the 2012–13 influenza season. Stockholm: ECDC. 2015.

Ahmed F, Lindley MC, Allred N, Weinbaum CM, Grohskopf L. Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: systematic review and grading of evidence. Clin Infect Dis. 2014;58(1):50-7. doi: 10.1093/cid/cit580.

Gianino MM, Politano G, Scarmozzino A, Charrier L, Testa M, Giacomelli S, Benso A, Zotti CM. Estimation of sickness absenteeism among Italian healthcare workers during seasonal influenza epidemics. PLoS One. 2017;12(8):e0182510.

Haviari S, Bénet T, Saadatian-Elahi M, André P, Loulergue P, Vanhems P. Vaccination of healthcare workers: A review. Hum Vaccin Immunother. 2015;11(11):2522-37. doi: 10.1080/21645515.2015.1082014.

World Health Organization (WHO). Occupational health. Health workers. Health worker occupational health. Available at: [Accessed on 15 December 2018].

Piano Nazionale Prevenzione Vaccinale (PNPV) 2017-2019. Available at: [Accessed on 15 December 2018].

Maggiore LRU, Scala C, Toletone A, Debarbieri N, Perria M, D'Amico B, Montecucco A, Martini M, Dini G, Durando P. Susceptibility to vaccine-preventable diseases and vaccination adherence among healthcare workers in Italy: A cross-sectional survey at a regional acute-care university hospital and a systematic review. Hum Vaccin Immunother. 2017;13(2):470-476. doi: 10.1080/21645515.2017.1264746.

Fortunato F, Tafuri S, Cozza V, Martinelli D, Prato R. Low vaccination coverage among Italian healthcare workers in 2013. Contributing to the voluntary vs. mandatory vaccination debate. Hum Vaccin Immunother. 2015; 11(1): 133–139. doi: 10.4161/hv.34415.

Alicino C, Iudici R, Barberis I, Paganino C, Cacciani R, Zacconi M, Battistini A, Bellina D, Di Bella AM, Talamini A, Sticchi L, Morando A, Ansaldi F, Durando P. Influenza vaccination among healthcare workers in Italy. Hum Vaccin Immunother. 2015;11(1):95-100. doi: 10.4161/hv.34362.

Gruppo di Studio Conferenza Nazionale “Medice cura te ipsum”. La Carta di Pisa delle vaccinazioni negli operatori sanitari. GImPIOS 2017; 7(4):155-7.

L. 31 luglio 2017, n. 119. Conversione in legge, con modificazioni, del decreto-legge 7 giugno 2017, n. 73, recante disposizioni urgenti in materia di prevenzione vaccinale. (G.U. 5 agosto 2017, n. 182).

Law 81/2008. Testo unico sulla salute e sicurezza sul lavoro. Available at:

Law 8 March 2017, n. 24. Disposizioni in materia di sicurezza delle cure e della persona assistita, nonchè in materia di responsabilità professionale degli esercenti le professioni sanitarie (GU Serie Generale n.64 del 17-03-2017). Available at:

Law Decree 28 December 2000, No. 445, published in the Official Gazette No. 42 of 20 February 2001.

Palamara MA, Visalli G, Picerno I, DI Pietro A, Puglisi G, Marano F, D'Andrea G, Facciolà. Measles outbreak from February to August 2017 in Messina, Italy. J Prev Med Hyg 2018; 59(1): E8-E13. doi: 10.15167/2421-4248/jpmh2018.59.1.853.

Report n° 37 January 2018. Available on: Last access: 30 October 2018.

La Fauci V, Riso R, Facciolà A, Ceccio C, Lo Giudice D, Calimeri S, Squeri R. Response to anti-HBV vaccine and 10-year follow-up of antibody levels in healthcare workers. Public Health. 2016;139:198-202. doi: 10.1016/j.puhe.2016.08.007.

Gabutti G, Bergamini M, Bonanni P, Guido M, Fenoglio D, Giammanco A, Sindoni L, Zotti C, Boddi V, Bamfi F, Severini R, Bechini A, Boccalini S, Crovari P; Collaborative Group for the Study of Pertussis. Assessment of humoral and cell-mediated immunity against Bordetella pertussis in adolescent, adult, and senior subjects in Italy. Epidemiol Infect 2008;136(11):1576-84. doi: 10.1017/S0950268807000192.

Swamy GK, Heine RP. Vaccinations for pregnant women. Obstet Gynecol. 2015;125(1):212-26. doi: 10.1097/AOG.0000000000000581.

Lo Giudice D, Cannavò G, Capua A, Grillo OC, La Fauci V, Puliafito A, Sindoni D, Squeri R, Calimeri S. Eliminating congenital rubella: a seroepidemiological study on women of childbearing age and MMR vaccine coverage in newborns. J Prev Med Hyg 2009; 50(4): 236-40.

Ferrera G, Squeri R, Genovese C. The evolution of vaccines for early childhood: the MMRV. Ann Ig. 2018;30(4 Suppl 1):33-37. doi: 10.7416/ai.2018.2232.

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;11(12):e0168546. doi: 10.1371/journal.pone.0168546.

Costantino C, Amodio E, Calamusa G, Vitale F, Mazzucco W. Could university training and a proactive attitude of coworkers be associated with influenza vaccination compliance? A multicentre survey among Italian medical residents. BMC Med Educ. 2016;16:38. doi: 10.1186/s12909-016-0558-8.

Costantino C, Amodio E, Vitale F, Maida C, Maringhini G, Asciutto R, Tramuto F, Calamusa G. Attitudes, behaviours and perceptions of Italian General Practitioner trainees towards influenza vaccination in Western Sicily (Italy). Ital J Public Health 2012;9:33-9.

Riphagen-Dalhuisen J, Gefenaite G, Hak E. Predictors of seasonal influenza vaccination among healthcare workers in hospitals: a descriptive meta-analysis. Occup Environ Med (2012); 69:230-5; PMID:22172951;

Castilla J, Martínez-Baz I, Godoy P, Toledo D, Astray J, García S, Mayoral JM, Martín V, González-Candelas F, Guevara M, et al., CIBERESP Working Group for the Survey on Influenza Vaccination in Primary Healthcare Professionals. Trends in influenza vaccine coverage among primary healthcare workers in Spain:2008-2011. Prev Med (2013); 57:206-11.

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;9:2603-12.

Gilardi F, Castelli Gattinara G, Vinci MR, Ciofi Degli Atti M, Santilli V, Brugaletta R, Santoro A, Montanaro R, Lavorato L, Raponi M, Zaffina S. Seasonal Influenza Vaccination in Health Care Workers. A Pre-Post Intervention Study in an Italian Paediatric Hospital. Int J Environ Res Public Health. 2018;15(5). pii: E841. doi: 10.3390/ijerph15050841.

Orr P. Influenza vaccination for health care workers: A duty of care. Can J Infect Dis. 2000;11(5):225-6.

Squeri R, Riso R, Facciolà A, Genovese C, Palamara MA, Ceccio C, La Fauci V. Management of two influenza vaccination campaign in health care workers of a university hospital in the south Italy. Ann Ig 2017; 29(3): 223-31. doi: 10.7416/ai.2017.2150.

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.

Restivo V, Costantino C, Bono S, Maniglia M, Marchese V, Ventura G, Casuccio A, Tramuto F, Vitale F. Influenza vaccine effectiveness among high-risk groups: A systematic literature review and meta-analysis of case-control and cohort studies. Hum Vaccin Immunother. 2018;14(3):724-735.

Guthmann JP, Fonteneau L, Ciotti C, Bouvet E, Pellissier G, Lévy-Bruhl D, Abiteboul D.. Vaccination coverage of health care personnel working in health care facilities in France: results of a national survey, 2009. Vaccine (2012); 30:4648-54; PMID:22579863; .

Aaron D, Nagu TJ, Rwegasha J, Komba E. Hepatitis B vaccination coverage among healthcare workers at national hospital in Tanzania: how much, who and why? BMC Infect Dis. 2017 Dec 20;17(1):786. doi: 10.1186/s12879-017-2893-8.

La Torre G, Scalingi S, Garruto V, Siclari M, Chiarini M, Mannocci A. Knowledge, Attitude and Behaviours towards Recommended Vaccinations among Healthcare Workers. Healthcare (Basel). 2017;5(1). pii: E13. doi: 10.3390/healthcare5010013.

Gasparini R, Panatto D, Lai PL, Amicizia D. The "urban myth" of the association between neurological disorders and vaccinations. J Prev Med Hyg. 2015 Jun 10;56(1):E1-8.

Genovese C., La Fauci V., Squeri A., Trimarchi G., Squeri R. HPV vaccine and autoimmune diseases: systematic review and meta-analysis of the literature. J Prev Med Hyg 2018; 59: E194-E199.

Gasparini R, Amicizia D, Lai PL, Panatto D. Influenza vaccination: from epidemiological aspects and advances in research to dissent and vaccination policies. J Prev Med Hyg. 2016;57(1):E1-4.

Yaqub O, Castle-Clarke S, Sevdalis N, Chataway J. Attitudes to vaccination: a critical review. Soc Sci Med. 2014;112:1-11. doi: 10.1016/j.socscimed.2014.04.018.

Stahl JP, Cohen R, Denis F, Gaudelus J, Martinot A, Lery T, Lepetit H. The impact of the web and social networks on vaccination. New challenges and opportunities offered to fight against vaccine hesitancy. Med Mal Infect. 2016 May;46(3):117-22. doi: 10.1016/j.medmal.2016.02.002. Epub 2016 Mar 14.

Signorelli C, Odone A, Cella P, Iannazzo S, D'Ancona F, Guerra R. Infant immunization coverage in Italy (2000-2016). Ann Ist Super Sanita. 2017 Jul-Sep;53(3):231-237. doi: 10.4415/ANN_17_03_09..

Legge regionale “Disposizioni per l’esecuzione degli obblighi di vaccinazione degli operatori sanitari”. Avaible on:

Delibera G.R. Emilia Romagna 351 del 12/3/2018.

DDG 613 del 26/10/17 Regione Marche. Avaible on:

Gualano MR, Bert F, Voglino G, Buttinelli E, D'Errico MM, De Waure C, Di Giovanni P, Fantini MP, Giuliani AR, Marranzano M, Masanotti G, Massimi A, Nante N, Pennino F, Squeri R, Stefanati A, Signorelli C, Siliquini R; Collaborating Group. Attitudes towards compulsory vaccination in Italy: Results from the NAVIDAD multicentre study. 2018;36(23):3368-3374. doi: 10.1016/j.vaccine.2018.04.029.

Montagna MT, Mascipinto S, Pousis C, Bianchi FP, Caggiano G, Carpagnano LF, De Giglio O, Barbuti G, Auxilia F, Destrebecq A, Castaldi S, Baldovin T, Bargellini A, Righi E, Boccia G, Santoro E, Casini B, Baggiani A, Novati R, Oriani R, Odone A, Mezzoiuso AG, Orsi GB, Napoli C, Pasquarella C, Veronesi L, Ripabelli G, Sammarco ML, Rossini A, Squeri R, Laganà P, Antonuccio GM, Genovese C, Tardivo S, Torre I, Alfano R, Pennino F, Torregrossa MV, Barchitta M, Agodi A. Knowledge, experiences, and attitudes toward Mantoux test among medical and health professional students in Italy: a cross-sectional study. Ann Ig. 2018;30(5 Supple 2):86-98. doi: 10.7416/ai.2018.2253.