Improvement in vaccination knowledge among biomedical students following an integrated extra curricular intervention


medical education
educational intervention
medical students



Vaccination coverages threaten to decrease because of false beliefs in their unsafety and inefficacy. Therefore formation of future health-care workers on this topic is fundamental to deal with any doubt and to promote active immunization among general population.


In order to assess health-care students knowledge about vaccination before an integrated seminar on this topic, and to evaluate their improvement after the educational intervention, an integrated educational intervention was held by a multidisciplinary team. Before and after the seminar, 118 students of medicine and biology schools at Palermo University were asked to answer 10 multiple-choice questions regarding vaccine history, mechanism of action, side effects, composition, use and nowadays issues (hesitancy). Two more questions investigating possible changes on students’ attitudes towards vaccination and the usefulness of the formative intervention,  were added at the post-test phase of the survey.


Eighty-one out of 118 students (68.6%) answered to both pre- and post-test questions. 97.6% and 81.5% of the participating group also completed the two additional questions about their improvement in knowledge (question 11) and attitudes (question 12) towards vaccinations. The post-test results showed a significant improvement for all questions administered, except for number 3, with a overall percentage of correct answers increasing from 38.8% to 77.6%  (p<0.001).


The present study highlights the importance of educating health-care professions students by means of integrated extra-curricular intervention to be held early in their degree curricula in order to improve knowledge and attitudes towards vaccinations and to prepare them to promote vaccines among the general population.



Centers for Disease Control and Prevention. Achievements in public health, 1900–1999 impact of vaccines universally recommended for children – United States, 1990–1998. Morb Mortal Wkly Rep 1999;48(12):243–8.

Kata A. Anti-vaccine activists, Web 2.0, and the postmodern paradigm – An overview of tactics and tropes used online by the anti-vaccination movement.

Vaccine. 2012 May 28;30(25):3778-89.

Report of the SAGE Working Groupon Vaccine Hesitancy 2014 vaccine_hesitancy_final.pdf (last accessed 21/04/2016)

Signorelli C, Odone A, Conversano M, Bonanni P. Deaths after Fluad flu vaccine and the epidemic of panic in Italy. BMJ 2015; 350 :h116

Ministero della Salute. Vaccino e autismo, nessuna correlazione. I giudici ribaltano in appello la sentenza del 2012; Available from: ministero&id=1960 (last accessed 21/04/2016)

Kembabanova G, Askarova J, Ivanova R, Deshevoi S, Vitek C, McNabb SJ. Epidemic investigation of diphtheria, Republic of Kazakhstan, 1990-1996. J Infect Dis. 2000 Feb;181 Suppl 1:S94-7.

Filia A, Bella A, Rota MC, Tavilla A, Magurano F, Baggieri M, Nicoletti L, Iannazzo S, Pompa MG, Declich S. Analysis of national measles surveillance data in Italy from October 2010 to December 2011 and priorities for reaching the 2015 measles elimination goal. Euro Surveill. 2013;18(20):pii=20480.

Afonso N, Kavanagh M, Swanberg S. Improvement in attitudes toward influenza vaccination in medical students following an integrated curricular intervention. Vaccine 2014 32 (2014) 502– 506

Costantino C, Mazzucco W, Azzolini E, Baldini C, Bergomi M, Biafiore AD. Influenza vaccination coverage among medical residents: An Italian multicenter survey. Hum Vaccin Immunother. 2014;10: 1204-10

Babcock HM, Gemeinhart N, Jones M, Dunagan WC, Woeltje KF. Mandatory influenza vaccination of health care workers: translating policy to practice.

Clin Infect Dis 2010; 50:459-64

Isaacs D, Leask J. Should influenza immunization be mandatory for health care workers? No. BMJ 2008; 337:a2140

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

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 Jan 29;16(1):38.

Wheeler M, Buttenheim AM. Parental vaccine concerns, information source, and choice of alternative immunization schedules. Hum Vaccin Immunother. 2013 Aug;9(8):1782-9.

Avelino-Silva VI, Avelino-Silva TJ, Miraglia JL, Miyaji KT, Jacob-Filho W, Lopes MH. Campaign, counseling and compliance with influenza vaccine among older persons. Clinics (Sao Paulo). 2011;66(12):2031-5.

Rath B, Muhlhans S, Gaedicke G. Teaching vaccine safety communication to medical students and health professionals. Curr Drug Saf. 2015;10(1):23-6

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 Dec;55(4):152-7.

Burgess A, Oates K, Goulston K. Role modelling in medical education: the importance of teaching skills. Clin Teach. 2015.

Mena G, Llupià A, García-Basteiro AL, Sequera VG, Aldea M, Bayas JM. Educating on professional habits: attitudes of medical students towards diverse strategies for promoting influenza vaccination and factors associated with the intention to get vaccinated. BMC Med Educ. 2013;13:99.