Pertussis immunization in healthcare workers: knowledge, attitudes and practices (KAP) of Occupational Physicians. Preliminary results from a web-based survey (2017).


Healthcare workers
Pertussis vaccine
Diptheria-Tetanus-acellular Pertussis Vaccines
Occupational Physicians


Introduction: The present study aims to characterize knowledge, attitudes and practices in a sample of occupational physicians (OPh) towards pertussis immunization in healthcare workers (HCWs).


Material and Methods: A total of 148 OPh (45.9% males, mean age of 40.3±13.2 years) compiled a web questionnaire including a knowledge test on Italian recommendations for HCWs, epidemiology and pathology of pertussis infection, being then investigated about risk perceptions and vaccination practices. A General Knowledge Score (GKS) and a Risk Perception Score (RPS) were calculated. Multivariate odds ratios (OR) for predictors of vaccine propensity were calculated through regression analysis.


Results: 78 participants regularly recalled pertussis vaccination status and/or performed pertussis vaccination in HCWs (52.7%). Proactive status was correlated with the aim to avoid pertussis infection in HCWs and its diffusion to other adults (p < 0.001, both statements). GKS was satisfying (72.4%±14.9), but participants underestimated the clinical issues of pertussis infection (RPS 60.8%±9.5) when confronted with influenza (73.9%±10.9) and HBV infection (68.1%±10.1). GKS and RPS were well correlated (r = 0.244, p = 0.003). Eventually, a better GKS and the aim to avoid pertussis infection in HCWs were predictive of a proactive status for pertussis vaccination (OR 4.186 95%CI 1.809–9.685 and OR 11.459, 95%CI 3.312–39.651, respectively).


Conclusions: Adherence of OPh to HCWs pertussis vaccination was unsatisfying. As knowledge status was predictive for vaccine propensity, information programs for OPh should be more appropriately designed, stressing that HCWs may represent a significant reservoir for pertussis infection in high risk groups (e.g. children/newborns, frail elderly).


O’Brien JA, Caro JJ. Hospitalization for pertussis: Profiles and case costs by age. BMC Infect Dis. 2005;5:57. doi: 10.1186/1471-2334-5-57

Di Mattia G, Nicolai A, Frassanito A, Petrarca L, Nenna R, Midulla F. Pertussis: New preventive strategies for an old disease. Paediatr Respir Rev. 2018; pii: S1526-0542(18)30077-0. doi: 10.1016/j.prrv.2018.03.011. [Epub ahead of print]

Frassanito A, Nenna R, Nicolai A, Pierangeli A, Tozzi AE, Stefanelli P, Carsetti R, Concato C, Schiavoni I, Midulla F; Pertussis study group. Infants hospitalized for Bordetella pertussis infection commonly have respiratory viral coinfections. BMC Infect Dis. 2017;17(1):492. doi: 10.1186/s12879-017-2567-6

Luthy KE, Bainum JL, Beckstrand RL, MacIntosh JLB, Eden LM, Saunders B. Promoting adult pertussis vaccination in the workplace. Work Heal Saf. 2016;64(6):269–78. doi: 10.1177/2165079916628883

Sabbe M, Vandermeulen C. The resurgence of mumps and pertussis. Hum Vaccines Immunother. 2016;12(4):955–9. doi: 10.1080/21645515.2015.1113357

Wiley KE, Zuo Y, Macartney KK, McIntyre PB. Sources of pertussis infection in young infants: A review of key evidence informing targeting of the cocoon strategy. Vaccine 2013;31(4):618–25. doi: 10.1016/j.vaccine.2012.11.052

Visser O, Hulscher MEJL, Antonise-Kamp L, Akkermans R, van der Velden K, Ruiter RAC, Hautvast JLA. Assessing determinants of the intention to accept a pertussis cocooning vaccination: A survey among healthcare workers in maternity and paediatric care. Vaccine. 2018;36:736–43. doi: 10.1016/j.vaccine.2017.12.021

Esposito S, Franco E, Gavazzi G, de Miguel AG, Hardt R, Kassianos G, Bertrand I, Levant MC, Soubeyrand B, López Trigo JA. The public health value of vaccination for seniors in Europe. Vaccine. 2018;36(19):2523–8. doi: 10.1016/j.vaccine.2018.03.053

Esposito S, Principi N, European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Vaccine Study Group (EVASG). Immunization against pertussis in adolescents and adults. Clin Microbiol Infect 2016;22(S5):S89–95. doi: 10.1016/j.cmi.2016.01.003

Esposito S, Principi N. Prevention of Pertussis: An unresolved problem. Hum Vaccin Immunother. 2018;5515:1–27. doi: 10.1080/21645515.2018.1480298

Ward A, Bassinet L, Housset B, O’Brien JA, Guiso N. Health and Economic Consequences of an Outbreak of Pertussis Among Healthcare Workers in a Hospital in France. Infect Control Hosp Epidemiol. 2005;26:288–92. doi: 10.1086/502541

Guiso N, Liese J, Plotkin S. The global pertussis initiative: Meeting report from the fourth regional roundtable meeting, France, April 14-15, 2010 - Commentary. Hum Vaccin. 2011;7(4):481-488. doi: 10/4161/hv.7.4.14528

Tuckerman JL, Collins JE, Marshall HS. Factors affecting uptake of recommended immunizations among health care workers in South Australia. Hum Vaccin Immunother. 2015;11(3):704–12. doi: 10.1080/21645515.2015.1008886

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(31):4648–54. doi: 10.1016/j.vaccine.2012.04.098

Manzoli L, Sotgiu G, Magnavita N, Durando P, National Working Group on Occupational Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI). Evidence-based approach for continuous improvement of occupational health. Epidemiol Prev. 2015;39(4S1):81-5

Riccò M, Cattani S, Casagranda F, Gualerzi G, Signorelli C. Knowledge, attitudes, beliefs and practices of occupational physicians towards vaccinations of health care workers: A cross sectional pilot study in North-Eastern Italy. Int J Occup Med Environ Health. 2017;30(5):775–90. doi: 10.13075/ijomeh.1896.00895

Riccò M, Cattani S, Casagranda F, Gualerzi G, Signorelli C. Knowledge, attitudes, beliefs and practices of occupational physicians towards seasonal influenza vaccination: A cross-sectional study from North-Eastern Italy. J Prev Med Hyg. 2017; 58(2):E141-E154. doi: 10.15167/2421-4248/jpmh2017.58.2.559

Betsch C, Wicker S. Personal attitudes and misconceptions, not official recommendations guide occupational physicians’ vaccination decisions. Vaccine. 2014;32(35):4478–84. Doi: 10.1016/j.vaccine.2014.06.046

Maggiore ULR, 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 Vaccines Immunother. 2017;13(2):470–6. doi: 10.1080/21645515.2017.1264746

Esposito S, Durando P, Bosis S, Ansaldi F, Tagliabue C, Icardi G. Vaccine-preventable diseases: From paediatric to adult targets. Eur J Intern Med. 2014;25(3):203–12. Doi: 10.1016/j.ejim.2013.12.004

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: The experience of a large tertiary acute-care teaching hospital. Hum Vaccines Immunother. 2015;11(1):95–100. doi: 10.4161/hv.34362

Vasilevska M, Ku J, Fisman DN. Factors Associated with Healthcare Worker Acceptance of Vaccination: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol. 2014;35(06):699–708. doi: 10.1086/676427

Burgess A, Shah K, Hough O, Hynynen K. Tetanus, diphtheria and acellular pertussis (Tdap) vaccination among healthcare personnel–United States, 2011. Vaccine 2014;32(5):572–8. doi: 10.1016/j.vaccine.2013.11.077

Graves MC, Harris JR, Kohn M, Hannon PA, Lichiello PA, Martin, Ahmed F. Employers’ Views on Influenza and Tetanus-Diphtheria-Pertussis Vaccination in the Workplace. J Occup Environ Med. 2016;58(4):e157–8. doi: 10.1097/JOM.0000000000000693

Palazzo R, Carollo M, Fedele G, Rizzo C, Rota MC, Giammanco A, Iannazzo S, Ausiello CM, Sero-Epidemiology Working Group. Evidence of increased circulation of Bordetella pertussis in the Italian adult population from seroprevalence data (2012-2013). J Med Microbiol. 2016;65(7):649–57. 10.1099/jmm.0.000264

Fedele G, Carollo M, Palazzo R, Stefanelli P, Pandolfi E, Gesualdo F, Tozzi AE, Carsetti R, Villani A, Nicolai A, Midulla F, Ausiello CM; Pertussis Study Group. Parents as source of pertussis transmission in hospitalized young infants. Infection. 2017;45(2):171–8. doi: 10.1007/s15010-016-0943-6.

Kuncio DE, Middleton M, Cooney MG, Ramos M, Coffin SE, Feemster KA. Health Care Worker Exposures to Pertussis: Missed Opportunities for Prevention. Pediatrics. 2014;133(1):15–21. doi: 10.1542/peds.2013-0745

Ausiello CM, Cassone A. Acellular Pertussis Vaccines and Pertussis Resurgence : Revise or Replace. MBio 2014;5(3):e01339-14. doi: 10.1128/mBio.01339-14.

Gonfantini M V., Carloni E, Gesualdo F, Pandolfi E, Agricola E, Rizzuto E, Iannazzo S, Ciofi Degli Atti ML, Villani A, Tozzi AE. Epidemiology of pertussis in Italy: Disease trends over the last century. Eurosurveillance. 2014;19(40):pii=20921. doi: 10.2807/1560-7917.ES2014.19.40.20921

Taddei C, Ceccherini V, Niccolai G, Porchia BR, Boccalini S, Levi M, Tiscione E, Santini MG, Baretti S, Bonanni P, Bechini A. Attitude toward immunization and risk perception of measles, rubella, mumps, varicella, and pertussis in health care workers working in 6 hospitals of Florence, Italy 2011. Hum Vaccines Immunother. 2014;10(9):2612–22. doi: 10.4161/21645515.2014.970879

Yates FJ, Stone ER. The Risk Construct. In: Yates FJ, editor. Risk-Taking Behaviour. 1st Editio. Chichester; 1992. p. 1–25.

Wicker S, Rose MA. Health care workers and pertussis: An underestimated issue. Med Klin. 2010;105(12):882–6. doi: 10.1007/s00063-010-1153-0

Wicker S, Zielen S, Rose MA. Obstacles in the Motivation of Health Care Workers for Pertussis vaccination. Proc Vaccinol. 2010;1(1):174-176. 10.1016/j.provac.2009.07.029

Wicker S, Zielen S, Rose MA. Attitudes of healthcare workers toward pertussis vaccination. Expert Rev Vaccines. 2008;7(9):1325–8. doi: 10.1586/14760584.7.9.1325

Power ML, Leddy MA, Anderson BL, Gall SA, Gonik B, Schulkin J. Obstetrician-Gynecologists’ Practices and Perceived Knowledge Regarding Immunization. Am J Prev Med. 2009;37(3):231–4. doi: 10.1016/j.amepre.2009.05.019

Bonville CA, Cibula DA, Domachowske JB, Suryadevara M. Vaccine attitudes and practices among obstetric providers in New York State following the recommendation for pertussis vaccination during pregnancy. Hum Vaccines Immunother. 2015;11(3):713–8. doi: 10.1080/21645515.2015.1011999.

Naleway AL, Smith WJ, Mullooly JP. Delivering influenza vaccine to pregnant women. Epidemiol Rev. 2006;28(1):47–53. doi: 10.1093/epirev/mxj002

Becker-Dreps S, Butler AM, McGrath LJ, Boggess KA, Weber DJ, Li D, Hudgens MG, Layton JB. Effectiveness of Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination in the Prevention of Infant Pertussis in the U.S. Am J Prev Med. 2018;55(2):159–166. doi: 10.1016/j.amepre.2018.04.013

Layton JB, Butler AM, Li D, Boggess KA, Weber DJ, McGrath LJ, Becker-Dreps S. Prenatal Tdap immunization and the risk of maternal and newborn adverse events. Vaccine. 2017;35(33):4072–8. doi: 10.1016/j.vaccine.2017.06.071.

Maltezou HC, Wicker S, Borg M, Heininger U, Puro V, Theodoridou M, Poland GA. Vaccination policies for health-care workers in acute health-care facilities in Europe. Vaccine. 2011;29(51):9557–62. doi: 10.1016/j.vaccine.2011.09.076

Maltezou HC, Poland GA. Vaccination policies for healthcare workers in Europe. Vaccine. 2014;32(38):4876–80. doi: 10.1016/j.vaccine.2013.10.046

Maltezou HC, Gargalianos P, Nikolaidis P, Katerelos P, Tedoma N, Maltezos E, Lazanas M. Attitudes towards mandatory vaccination and vaccination coverage against vaccine-preventable diseases among health-care workers in tertiary-care hospitals. J Infect. 2012;64(3):319–24. doi: 10.1016/j.jinf.2011.12.004

Killian M, Detoc M, Berthelot P, Charles R, Gagneux-Brunon A, Lucht F, Pulcini C, Barbois S, Botelho-Nevers E. Vaccine hesitancy among general practitioners: evaluation and comparison of their immunisation practice for themselves, their patients and their children. Eur J Clin Microbiol Infect Dis. 2016;35(11):1837–43. doi: 10.1007/s10096-016-2735-4

Bouhour D, Gavazzi G, Gaillat J, Gajdos V, Loulergue P, Paccalin M, Ploy MC, de Pontual L, Pulcini C, Rogeaux O, Sana C, Caulin E; group “Avancées Vaccinales”. Survey of vaccination policies in French healthcare institutions. Med Mal Infect 2012;42(4):161–6. doi: 10.1016/j.medmal.2011.11.003

Sheikh S, Biundo E, Courcier S, Damm O, Launay O, Maes E, Marcos C, Matthews S, Meijer C, Poscia A, Postma M, Saka O, Szucs T, Begg N. A report on the status of vaccination in Europe. Vaccine. 2018;36(33):4979-92

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

Pulcini C, Massin S, Launay O, Verger P. Factors associated with vaccination for hepatitis B, pertussis, seasonal and pandemic influenza among French general practitioners: A 2010 survey. Vaccine. 2013;31(37):3943–9. doi: 10.1016/j.vaccine.2013.06.039

Pulcini C, Massin S, Launay O, Verger P. Knowledge, attitudes, beliefs and practices of general practitioners towards measles and MMR vaccination in southeastern France in 2012. Clin Microbiol Infect. 2014;20(1):38-43. doi: 10.1111/1469-0691.12194

Hollmeyer HG, Hayden F, Poland G, Buchholz U. Influenza vaccination of health care workers in hospitals-A review of studies on attitudes and predictors. Vaccine. 2009;27(30):3935–44. doi: 10.1016/j.vaccine.2009.03.056

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. 2017;Epub ahead of print. doi: 10.23736/S0392-0488.17.05672-3

Awali RA, Samuel PS, Marwaha B, Ahmad N, Gupta P, Kumar V, Ellsworth J, Flanagan E, Upfal M, Russell J, Kaplan C, Kaye KS, Chopra T. Understanding health care personnel’s attitudes toward mandatory influenza vaccination. Am J Infect Control. 2014;42(6):649–52. doi: 10.1016/j.ajic.2014.02.025

Riccò M, Vezzosi L, Gualerzi G, Signorelli C. Knowledge, attitudes and practices (KAP) towards vaccinations in the school settings: an explorative survey. J Prev Med Hyg. 2017;58:266–78. doi: 10.15167/2421-4248/jpmh2017.58.4.673

Klett-Tammen CJ, Krause G, Seefeld L, Ott JJ. Determinants of tetanus, pneumococcal and influenza vaccination in the elderly: a representative cross-sectional study on knowledge, attitude and practice (KAP). BMC Public Health [Internet]. 2015;16(1):121. doi: 10.1186/s12889-016-2784-8.

Zingg A, Siegrist M. Measuring people’s knowledge about vaccination: Developing a one-dimensional scale. Vaccine. 2012;30(25):3771–7. doi: 10.1016/j.vaccine.2012.03.014

Signorelli C, Guerra R, Siliquini R, Ricciardi W. Italy’s response to vaccine hesitancy: An innovative and cost effective National Immunization Plan based on scientific evidence. Vaccine. 2017;35(33):4057–9. doi: 10.1016/j.vaccine.2017.06.011

Betsch C, Wicker S. E-health use, vaccination knowledge and perception of own risk: Drivers of vaccination uptake in medical students. Vaccine. 2012;30(6):1143–8. doi: 10.1016/j.vaccine.2011.12.021

Huang Y, Xu S, Wang L, Zhao Y, Liu H, Yao D, Xu Y, Lv Q, Hao G, Xu Y, Wu Q. Knowledge, Attitudes, and Practices Regarding Zika : Paper- and Internet-Based Survey in Zhejiang, China. JMIR Public Heal Surveill 2017;3(4):e81. 10.2196/publichealth.7663

Heiervang E, Goodman R. Advantages and limitations of web-based surveys : evidence from a child mental health survey. Soc Psychiat Epidemiol. 2011;46(1):69-76. doi: 10.1007/s00127-009-0171-9.

Bonanni P, Ferrero A, Guerra R, Iannazzo S, Odone A, Pompa M, Rizzuto E, Signorelli C. Vaccine coverage in Italy and assessment of the 2012-2014 National Immunization Prevention Plan. Epidemiol Prev. 2015;39(4S1):146–58.

Riccò M, Razio B, Panato C, Poletti L, Signorelli C. Knowledge, Attitudes and Practices of Agricultural Workers towards Tetanus Vaccine: a Field Report. Ann Ig 2017;29(4):239–55. doi: 10.7416/ai.2017.2156

Riccò M, Cattani S, Veronesi L, Colucci ME. Knowledge, attitudes, beliefs and practices of construction workers towards tetanus vaccine in northern Italy. Ind Health 2016;54(6):554-563 doi: 10.2486/indhealth.2015-0249