Journal of Preventive Medicine and Hygiene
The Journal of Preventive Medicine and Hygiene (JPMH) is an international, multidisciplinary, open-access, peer-reviewed journal published on a three-monthly basis and covers the fields of Hygiene, Preventive Medicine and Public Health. The Journal has been publishing original articles, reviews, editorials, letters and proceedings of symposia and conferences since 1960. Systematic reviews of topics relevant to the journal’s aim are highly welcome. Scientific validity, methodological soundness, originality and advances in the field of Hygiene, Preventive Medicine and Public Health are a key acceptance criterion. For further information, please check our Section Policies. The JPMH is currently abstracted and indexed in PubMed, PubMed Central, Scopus, Web of Science, and Google Scholar. The JPMH currently has no article-processing charges.
Department of Health Science - University of Genoa
Mapping the social networks of key actors in the development of health technology assessment in Iran
Background: Health Technology Assessment (HTA) plays a crucial role in informing health policy and ensuring the effective allocation of resources. In Iran, the development and implementation of HTA involve various key actors with differing levels of influence, interest, and support. Understanding the social networks and power dynamics among these actors is essential for optimizing HTA processes. Methods: This study employed Social Network Analysis (SNA) to map the relationships and interactions among 27 identified stakeholders involved in HTA development in Iran. Data were collected through an online questionnaire distributed to 83 participants, assessing five dimensions: power, position, interest, influence, and support. Network metrics, including degree centrality, closeness centrality, betweenness centrality, and eigenvector centrality, were calculated to evaluate the roles and connections of each actor. Results: The analysis revealed that the Ministry of Health and Medical Education, Food and Drug Administration, Insurance Organizations, and the Islamic Consultative Assembly (Parliament) are the most influential actors in the HTA network. The Plan and Budget Organization and National Institute of Health Research emerged as key connectors with high centrality metrics. Despite this, the network exhibited limited connectivity and sparse interactions among some actors, notably the Chamber of Commerce. Conclusion: The study highlights the central roles of key institutions in HTA development while identifying gaps in stakeholder communication and connectivity. Enhancing collaboration and addressing these gaps are critical for improving HTA processes in Iran. Strengthening central coordination and stakeholder engagement will facilitate more effective HTA implementation and informed health policy decisions.
Copyright (c) 2025 Journal of Preventive Medicine and Hygiene
Impact of an Educational Intervention Video in HPV Prevention among Tunisian Female Students: A before-and-after Study
Background: Cervical cancer is the second most common gynecological cancer in Tunisia. The HPV vaccine is a crucial tool for preventing and controlling this disease. Training healthcare providers and equipping them with adequate knowledge is essential. This study aimed to evaluate the effectiveness of an educational intervention video (EIV) on the knowledge and perceptions of HPV, cervical cancer, and the HPV vaccine among Tunisian female students. Methods: A quasi-experimental study involving a single interventional group was conducted among 158 female students. Participants were interviewed before and after watching the EIV. The chi-square test using McNemar's method assessed variations between pre- and post-intervention responses. A p-value <0.05 was considered statistically significant. Results: The average age of participants was 19.74±1.7 years. The EIV had a positive impact on the scores for knowledge and perceptions related to HPV and cervical cancer. A significant association was observed between the intention to receive the HPV vaccine and perceived severity of HPV, perceived benefits of vaccination, and perceived barriers. Notably, 50.6% of female students believed the HPV vaccine should be available upon request and covered by health insurance, while 46.2% thought it should be included in the Tunisian vaccination schedule. Conclusion: The EIV improved students’ knowledge and perceptions about HPV, cervical cancer, and the HPV vaccine. Tailored educational strategies may enhance vaccine acceptance, especially when integrated early in academic training.
Psychometric Evaluation of Iranian Version of Beliefs about Third-Hand Smoke Scale (BATHS-T) in Pregnant Women
Introduction: Exposure to third-hand smoke (THS) is hazardous for human health, especially for pregnant women. This study aimed at psychometric evaluation of the Iranian version of “Beliefs about Third-Hand Smoke Scale”(BATHS-T) in pregnant women. Aims & Methods: The data collected from 364 pregnant women referring to Yazd health centers. The BATHS scale was translated into Persian, and the stages of adaptation of the BATHS scale in Persian were evaluated with CVR=0.87 and CVI=0.88. Confirmatory factor analysis (CFA) was performed to analyze the construct validity of the scale. Besides, the correlation test was used to evaluate the correlation of categories and subcategories of the scale. Results: The BATHS structural equation model showed a favorable fit as RMSEA value was less than 0.05 and X2/df varied between 2 to 5. Moreover, other indices such as CFI and NFI were more than 90%, indicating the optimal fit of the present model. The correlation between the overall scale of BATHS and its two subcategories was 0.843 (P<0.001) and the correlation between health and stability subcategories was 0.886 (P<0.001). Since there was a positive and highly significant correlation, the fitted BATHS scale was considered to be structurally consistent with its subcategories. The reliability of the whole scale was 0.86 using Cronbach's α coefficient. Conclusion: The Iranian version of the BATHS scale is reliable and valid. This scale provides the required prerequisites for further research and education on third hand smoke exposure. It can also be possibly used in similar studies.
What strategic actions may be implemented to reach high immunisation coverage for clinically vulnerable individuals? A process for achieving regional consensus using World Cafè methods
Background and Study Design: Clinically vulnerable individuals, including the elderly, are at increased risk of adverse health outcomes following infections, due to immunosenescence, chronic inflammation, or underlying medical conditions. Despite measures such as the National Immunisation Prevention Plan and Regional Laws, immunisation coverage for herpes zoster, pneumococcus, and COVID-19 in the Apulia Region has declined in recent years. This study outlines strategic actions to improve vaccination coverage for clinically vulnerable individuals s in the region, using methods like the World Café (WoCa) to achieve regional consensus. Methods: On 31st May 2023, a working group of Apulian researchers and healthcare workers, supported by the Regional Immunisation Committee, conducted a workshop. The WoCa method facilitated structured discussions across five thematic domains to generate innovative solutions for enhancing immunisation rates. Results: Key actions included active vaccination reminders in all formats of informed consent and during healthcare visits; improved training for healthcare workers conducting outreach; involving pharmacies in patient guidance alongside general practicioners (GPs) and SHPH operators; establishing vaccination clinics near specialist centres and employing mobile units; launching media campaigns to counteract misinformation using authoritative voices; providing vaccinology and scientific communication training for professionals; implementing a hub-and-spoke logistics system under the governance by the Department of Prevention (DP); and ensuring seamless communication between digital platforms for vaccine data reporting and monitoring. Conclusions: The findings demonstrate the value of WoCa in achieving regional consensus to enhance immunisation for frail individuals . Collaboration among healthcare professionals, institutions, and the public is vital to raise awareness, improve accessibility, and address logistical challenges, ensuring equitable access to vaccination for vulnerable populations.
Comparison of Photoprotection Knowledge, Attitudes, and Practices among Medical and Non-Medical Students at a Peruvian University
Introduction. Skin cancer is one of the most prevalent malignancies worldwide, particularly in countries with high ultraviolet (UV) radiation exposure. Thus, to reduce sun exposure, the early adoption of protection behaviours is essential. In this task, future medical professionals must demonstrate competencies in skin cancer prevention. This study aimed to describe and compare sun protection knowledge, attitudes, and practices (KAP) among medical and non-medical students. Methods. A cross-sectional study was conducted at a private university in Lima, Peru, involving 624 students from five programs: medicine, industrial and systems engineering, law, psychology, and business administration. Participants were divided into two groups: medical and non-medical students. The Questionnaire on Habits, Attitudes, and Knowledge about Sun Exposure in Adolescence and Adulthood (CHACES), a validated tool to assess sun exposure and protection KAP, was used. Group comparisons were performed using Chi-squared and Mann-Whitney U tests. Results. Participants' average age was 21.09 years old, with 56.1% being female. Medical students scored higher in photoprotection knowledge (U = 35,853.5; p = 0.003) and reported lower sun exposure (U = 37,263.5; p = 0.028) than non-medical students. However, no significant differences were observed in sun protection practices (p = 0.807) or photoprotection attitudes (p = 0.238). Conclusions. Medical students demonstrated greater knowledge and fewer sun exposure habits, however, their sun protection practices did not differ significantly from non-medical students. These findings highlight the need for enhanced educational strategies for skin cancer prevention across all university programs.
Challenges of using artificial intelligence in Iran's health system: a qualitative study
Background: Artificial intelligence (AI) is rapidly transforming healthcare by improving diagnostic accuracy, treatment planning, and operational efficiency. While AI adoption is advancing in high-income countries, low- and middle-income countries (LMICs), including Iran, face significant challenges that limit its integration. Iran’s health system is increasingly strained by an aging population, rising non-communicable diseases, and resource limitations. AI offers potential solutions to these issues by enabling data-driven, patient-centered care, yet its implementation remains in early stages within the country. Understanding the barriers to AI adoption in Iran’s health system is essential for guiding effective integration. Methods: This qualitative study employed semi-structured interviews with 15 purposively selected stakeholders involved in healthcare management, policy-making, and AI application in Iran. Participants represented diverse sectors such as government, academia, healthcare provision, and technology development. Interviews were conducted between January 2025 and April 2025, both virtually and face-to-face. Data were analyzed thematically using Braun and Clarke’s framework to identify key challenges. Methodological rigor was ensured through member checking, triangulation, and adherence to qualitative research standards. Results: Five major themes emerged as barriers to AI integration in Iran’s healthcare system: organizational and structural barriers, legal and policy constraints, data-related issues, skill and human resource challenges, and difficulties embedding AI within existing policymaking processes. Participants reported inadequate infrastructure, fragmented governance, and resistance to technological change. Legal ambiguities and lack of regulatory frameworks fostered ethical and accountability concerns. Data quality, security, and standardization were significant obstacles. The shortage of skilled professionals and insufficient training limited AI utilization. Additionally, integrating AI into traditional policymaking raised concerns about preserving human oversight and ethical decision-making. Conclusion: The study reveals multifaceted challenges to AI adoption in Iran’s healthcare system, emphasizing the need for a coordinated strategy encompassing legal reforms, infrastructure investment, capacity building, and cultural change. Balancing AI’s technological benefits with ethical and human-centered care is critical for sustainable integration. These findings provide valuable insights to inform policy and practice, supporting responsible AI implementation in Iran’s healthcare system.
Final Heights in Patients with Congenital Adrenal Hyperplasia: A Retrospective Cohort Study
Introduction Congenital adrenal hyperplasia (CAH) attributed to 21-OHD is one of the most common genetic endocrine disorders that occurs due to the disruption and defects in the steroidogenic enzymes involved in the production of cortisol. The current study aims to assess the final height of patients with classic CAH forms in Iran. Methods The retrospective cohort study was conducted on 30 patients with classic type CAH who were followed up and treated in the endocrinology clinic of Ali Asghar Hospital during the 2000-2022 years. The history of the patients at the time of diagnosis was extracted from the patient's files and recorded in the checklist. All data was analyzed using IBM SPSS Statistics version 22 software. Results In the SV group, the target and final height for females was 162 and 159.2 cm, and for males was 173 and 171 cm. In the SW group, the target and final height for females was 164 and 163.2 cm, and for males was 171.7 and 173.1 cm. There was a significant and reverse correlation between the mean age at the time of diagnosis and the Final Height percentile among all cases (r: -0.55, p: 0.02) and the SW group (r: -0.75, p: 0.002). A positive and significant correlation was seen between the bone age advanced and final height percentile in the SV group (r: 0.04, p: 0.03). The final height percentile increased significantly with an increase in the Duration of treatment regardless of CAH type (r: -0.67, p: 0.009). Also, there was a positive and significant correlation between hydrocortisone dose and final height percentile in the SV group (r: 0.24, p: 0.04). Conclusion The results of the present study showed that early diagnosis of the disease at a young age, lower bone age of patients, preventing the increase of obesity in children with CAH, and receiving appropriate drugs with standard doses can play an effective role in increasing the final height of CAH patients.
Assessment of “Quality of Life” of Parents and Siblings of Intellectually Disabled Children residing at one of Metropolitan cities at Western India
Introduction: Intellectual disability is a permanent disability and raising such a child may lead to varied physical, social, emotional response from caregivers. Data of Quality of life of family members of such children is underexplored. Objectives: To measure quality of life of family members of intellectually disabled children. Methodology: A total of 253 parents and 195 siblings eligible and giving consent to participate in the study were interviewed from 382 students enrolled across multiple schools located at one of the Metropolitan cities in Western India. Result: Areas like Social aspect, Physical care, Embarrassment & Sibling effect were more affected unfavorably amongst Parents. However Positive impact was seen amongst 62.8% Parents. Functional impairment was observed in 80% of siblings. Conclusion: Quality of life of Parents was affected but more functional impairment was observed amongst siblings of intellectually disabled children.
Attitude and Practices Towards Breast Cancer Among Undergraduate Female Pharmacy Students in Pakistan
Background: Lack of knowledge, attitude and perception towards breast cancer still a major public health issue disease in many developed and under-developed countries including Pakistan. In 2024 in Pakistan, one in every 8 females is affected by Breast Cancer. Objective: To determine the awareness, attitude, and practices of Pharmacy (Pharm-D) students towards Breast Cancer (BC) and their correlation with participants’ age and level of study. Methodology: A cross-sectional study was conducted on 401 female students of Pharmacy from December 2023 to March 2024, using a self-administered questionnaire assessing awareness, attitude, and practices towards BC. For sample size calculation, Raosoft® online sample size calculator with a 5.0% margin of error and a 95.0% confidence interval was used. The respondents were sampled via convenience sampling. Results: Our sample included 401 participants. The majority gained knowledge about BC from the media (69.8%). About 73.4% of participants did not participate in breast self-examination (BSE), and about 41.3% of them believed they were not at risk. About 92.6% of participants didn’t undergo clinical breast examination (CBE). Nearly half of the participants (44.9%) agreed that BC is more common in older women. About four-fifths of the respondents (79.3%) agreed that regular examination can reduce the risk of BC. Conclusion: The practice of BSE by the Pharm.D students is lagging. There were notable gaps in CBE by pharmacy students due to the belief that breast cancer predominantly affects older women. Therefore, it is important to make future pharmacists aware of practicing BSE and CBE regularly.
Hebatallah Ahmed Mohamed Moustafa Moustafa
Why Do Middle-Aged Adults Use Or Avoid Health Services? A Study Of Social And Demographic Determinants
Introduction: Middle-aged adults experience distinctive health issues, yet underutilize preventive care despite Iran’s strong primary healthcare (PHC) system. This research investigates social and demographic determinants of healthcare services utilization among middle-aged adults in Qom, Iran, to support evidence-based focused interventions. Methods: A cross-sectional study was conducted in underprivileged suburbs of Qom (June–September 2024) among 697 adults aged 30–59, randomly sampled by cluster sampling. Awareness about available health services, utilization, and satisfaction with PHC service information were collected via phone interviews. Multivariate logistic regression identified predictors of service utilization. Results: Only 11.8% of the participants were aware of middle-aged health services, and 24.2% had utilized them in the past year. Women used services 2.5 times more than men (35.3% vs. 13.9%, p<0.001), and utilization increased with age (31.1% among 50–59-year-olds vs. 19.6% in 30–39-year-olds, p=0.023).The strongest predictor was awareness: aware adults had 22.4-fold higher odds of use (95% CI: 11.60–43.29, *p*<0.001). Dissatisfaction (by 7.7% of users) was linked to gaps in staff communication (38%), overcrowding (38%), and perceived incompetence (30%). Work and education lost significance in multivariate analysis, suggesting indirect impacts. Conclusions: PHC utilization among middle-aged population is handicapped by low awareness and gender/age disparities. Interventions should prioritize health literacy programs, staff training to improve patient-provider communication, and systemic modifications to reduce overcrowding. Increased outreach to men and younger adults are necessary to ensure equitable preventive care.
Social and Behavioral Determinants of Dental Care Utilization among Homeless Pregnant Women in the United States
Introduction: Despite modest research on oral health care during pregnancy, there is a dearth of evidence describing dental care among pregnant women experiencing homelessness. The purpose of this study was to examine associations between dental care utilization and social and behavioral determinants of health among United States (US) pregnant women who experienced homelessness relative to those who did not. Methods: This was a cross-sectional study that used data from the 2012-2018 Pregnancy Risk Assessment Monitoring System (PRAMS). The sample consisted of 5,939 homeless and 209,942 non-homeless women. Bivariable and multivariable analyses were conducted to determine associations between dental health-related measures and social, medical, and behavioral determinants of health based on whether a woman experienced homelessness 12 months prior to birth. Results: In this sample, 41.2% of homeless women saw a dentist for a problem while this was true for only 19.1% of women who were not homeless. Approximately 36.4% of women who experienced homelessness did not have their teeth cleaned before pregnancy compared to 25.7% of women who were not homeless. Lack of preventive care, smoking, older age, and experiencing multiple stressors during pregnancy were positively associated with seeing a dentist during pregnancy for both groups of women. Conclusions: The results indicate the need for healthcare providers and policy officials to develop targeted interventions and policies to ensure that dental care is readily accessible for all pregnant women and especially those who are homeless.
1985: Forty years ago, the world opened its eyes to AIDS. History of the early years of the HIV epidemic
At the end of 1980, Michael Gottlieb, a researcher at the University of California, was conducting a clinical study on deficiencies of the immune system when he heard of the case of a young man with a rare form of pneumonia due to Pneumocystis carinii (now known as Pneumocystis jirovecii), a protozoon that usually affects only people with a weakened immune system. In the following months, Gottlieb discovered further cases of patients with Pneumocystis carinii pneumonia, oral candidiasis and a very low level of T lymphocytes. All were male and active homosexuals. In reality the infection had already manifested itself in previous years but had always been mistaken for something else. HIV probably originated from a virus found in chimpanzees and began infecting humans in the first half of the 20th century. It probably emerged when members of the Bantu tribe, who lived in the forests of central Africa, consumed chimpanzee meat infected with a virus called simian immunodeficiency virus (SIV). This may have caused a so-called spillover from chimpanzees to humans.
Breaking the Stalemate: How Italy's Non-Medical Health Professions Are Trapped by Redundant Roles and Ineffective Degrees
This letter addresses the critical issues affecting non-medical health professions in Italy, highlighting the inefficacy of master's degrees and the proliferation of redundant professional roles. Despite advanced training, these professionals often experience stagnant career progression and limited autonomy due to overlapping roles and resistance from the medical community. The letter also underscores the lack of European harmonization in educational standards, which exacerbates these challenges. To improve the system, the letter advocates for reducing role overlaps, reforming advanced education, and promoting greater autonomy for non-medical health professionals to ensure patient-centered care.
Response to the letter “Breaking the Stalemate: How Italy's Non-Medical Health Professions Are Trapped by Redundant Roles and Ineffective Degrees”
A Field Report from War-Torn Remote Villages in South-Eastern Ukraine: Enhancing Healthcare Access Through a Community-Oriented Primary Care Model
The ongoing conflict in Ukraine has severely disrupted healthcare infrastructure, displaced medical personnel and restricted access to care, prompting an unprecedented international support. Since October 2023, the non-governmental organization EMERGENCY has conducted a field assessment to identify critical barriers to healthcare delivery in remote villages of Donetsk to inform an effective intervention. The assessment revealed that many health needs, particularly those related to chronic diseases and mental health, were pre-existing but had been exacerbated by the war, resulting in a secondary surge of unmet needs in rural communities facing growing barriers to basic care. In response, a Community Health Worker (CHW)-led intervention was developed to bridge gaps between communities and health services. Locally recruited CHWs conduct door-to-door assessments, monitor treatment adherence for chronic diseases, address mental health needs, arrange home-based care for bedridden individuals, deliver health education sessions, and facilitate timely referrals in close collaboration with nurse-led clinics. To strengthen resilience, CHWs are trained in basic emergency and disaster preparedness, including life support skills, improving community-level readiness for health emergencies. To address sustainability challenges, the intervention is integrated into Ukraine’s primary care network, and provides CHWs with ongoing training and compensation through regular contracts. Aligned with national health priorities and the Health Cluster’s strategy, the model targets marginalized groups, engages communities, and strengthens local health systems, ensuring efficient use of resources and continuity of care. This report outlines a scalable, context-sensitive approach to enhancing healthcare access in conflict settings, with relevance for other humanitarian contexts.
Achieving Health Equity in Decentralized Healthcare: An Innovative Approach to Preventive Care in Southern Italy
Introduction: This report evaluates the Italian Ministry of Health’s Decree No. 77 of 23 May 2022, aimed at standardizing preventive healthcare nationwide. It highlights regional disparities in healthcare access and explores innovative approaches, including Regulation 13/2023 of the Apulia Region (Southern Italy), to improve health outcomes. Methods: The report compares the healthcare management systems of northern and southern Italy, focusing on vaccination rates, chronic disease management, and the integration of environmental health. It examines the Apulian regulatory model, emphasizing environmental determinants such as air quality monitoring and predictive analytics to mitigate climate-related health risks. Additionally, comparisons are made with decentralized healthcare systems in Spain, Germany, Canada, and the United Kingdom. Results: The Apulia model led to significant health improvements, including a 25% reduction in waterborne diseases and a 12% reduction in heatwave-related hospitalizations. Multidisciplinary collaboration and community engagement enhanced policy effectiveness and public confidence. Conclusions: This report underscores the importance of balancing national health guidelines with regional autonomy to address health inequalities. The Apulia model demonstrates the need for integrating environmental health factors and offers a replicable framework to improve health equity and resilience. Recommendations include strengthening administrative capacity, fostering inter-regional collaboration, and promoting innovative regional healthcare approaches.
Monitoring Surgical Site Infections: Insights from an Italian Teaching Hospital
Background: Surgical Site Infections (SSIs) represent one of the most frequent and costly healthcare-associated infections, leading to increased morbidity, prolonged hospital stays, and higher healthcare costs. Surveillance programs are essential for monitoring and preventing SSIs, yet there is variability in their implementation and effectiveness across healthcare facilities. This study aims to assess the trends of SSIs at Ferrara Teaching Hospital for providing useful data to improve surveillance systems. Materials and methods: A retrospective study was conducted on data from 2020 to 2023, of SIChER surveillance system and Hospital Discharge Cards of Ferrara Teaching Hospital. The study examined infection rates across various surgical procedures, applying two key indicators: SSIs Percentage by Category and Incidence Density of Hospital-Onset SSIs. Statistical analysis was performed using STATA software. Results: During the study period, an average of 5,158 surgical procedures were performed annually, with a steady increase in SIChER-monitored procedures, reaching 80.7% coverage in 2023. The highest infection rates were observed in colon surgery, while cardiac surgery consistently recorded no infections. The overall incidence density of hospital-onset SSIs was 0.18 per 1,000 follow-up days, with significant variations across surgical categories. The accuracy of HDCs in documenting SSIs improved over time, reaching 97.2% match in 2023. Conclusions: The study highlights an increasing trend in SSI surveillance coverage and accuracy, demonstrating the effectiveness of SIChER in monitoring infections. However, variations in infection rates across procedures suggest the need for targeted interventions, particularly for high-risk surgeries such as colorectal and orthopaedic procedures.
Combating Infectious Diseases in Low-Resource Communities: Socioeconomic, Environmental, Climate Change and Gender-Based Strategies
Infectious diseases continue to pose a significant challenge to global health, particularly within resource-limited communities, where socioeconomic and environmental health determinants amplify their prevalence and impact. This letter to editor examines comprehensive strategies aimed at alleviating the burden of communicable diseases by addressing essential factors such as water, sanitation, and hygiene (WASH), housing conditions, climate change, gender equity, sociocultural influences, and poverty. Key interventions, including enhancing access to clean water, promoting sufficient sanitation, improving housing quality, and fostering climate resilience, are identified as vital measures to prevent disease transmission. Moreover, empowering women through equitable healthcare and education, implementing culturally responsive health campaigns, and engaging community members in preventive actions are distinctly highlighted. Strategies for poverty alleviation, encompassing economic development and social protection initiatives, play a crucial role in breaking the cycle of disease and poverty. The letter emphasizes the importance of a multidisciplinary approach and collaborative efforts across sectors to address the intricate relationships between these determinants, ultimately advancing health equity and well-being for at-risk populations.
Pneumococcal Vaccination of Adults in Italy: What Strategies?
S. pneumoniae has been classified by the World Health Organization (WHO) as one of the 12 priority pathogens with the greatest global health impact. Although many individuals (approximately 20–30% of adults and nearly 40–50% of children) may carry the bacterium asymptomatically, certain groups are considered at higher risk of disease (non-invasive illnesses and invasive diseases). These include young children, the elderly and individuals who are immunocompromised or affected by pre-existing medical conditions. Italian surveillance data show a significant increase in Invasive Pneumococcal Disease (IPD) incidence in 2023 in comparison with 2021 and 2022, rising from 0.84 cases per 100,000 population in 2021 to 3.02 in 2023. The highest rates were observed in children under 1 year of age [10.41/100,000 (2023)] and in adults aged 65 and over (7.45/100,000 in 2023 compared with 2.11 in 2021 and 4.49 in 2022). Surveillance systems and epidemiological studies on the global distribution of the different pneumococcal serotypes associated with disease continue to be essential to determining which serotypes to include in new vaccines, in order to produce preparations capable of preventing an increasing number of cases, hospitalizations, sequelae and deaths. A milestone in pneumococcal vaccination was the development of conjugate vaccines (PCVs), which started in the 2000s. The first PCV, which covered seven serotypes (PCV7: 4, 6B, 9V, 14, 18C, 19F, and 23F), was introduced in Italy in 2005 for the pediatric population. The introduction of this vaccination strategy leading to a significant reduction in disease among children and an overall decline in the pneumococcal disease burden across all age-groups. However, an increase in disease caused by serotypes not included in PCV7 was observed. This phenomenon, named serotype replacement, led to the development of higher-valency conjugate vaccines. In 2010, the 13-valent pneumococcal vaccine (PCV13) and 10-valent pneumococcal vaccine (PCV10) were approved. However, the phenomenon of serotype replacement continued to be observed, and consequently, the need for broader-spectrum vaccines remained a public health priority. In 2021 and 2022 PCV15 (serotypes: 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F and 33F) and PCV20 (serotypes: 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F) were authorized for immunization in individuals aged ≥18 years, respectively. In March 2025, the use of a new 21-valent pneumococcal vaccine was approved (serotypes: 3, 6A, 7F, 19A, 22F, 33F, 8, 10A, 11A, 12F, 9N, 17F, 20, 15A, 15C, 16F, 23A, 23B, 24F, 31 and 35B) and it included some serotypes particularly aggressive or emerging. Maximizing the effectiveness of a vaccination program in combating diseases related to S. pneumoniae is based on the integration of three key elements: epidemiological need, immunological need and vaccine compliance. From an epidemiological perspective, the 2023 specific data analysis reveals that, out of 1,783 cases, 734 involved individuals over the age of 64 (41.2%). The estimated coverage with the PCV20 vaccine would be 63.6%, while with the PCV21 vaccine it would be 76.4%. The specific analysis of the most recent available data (1st half of 2024) reveals that a total of 1,152 cases were reported, 58.4% of which occurred in individuals over 64. If only the data referring to subjects over the age of 64 are analyzed, the estimated coverage becomes 72.1% for PCV20 and 79.2% for PCV21. From an immunological standpoint, the vaccine should induce an immune response that is at least non-inferior to the comparator, and ideally, robust and long-lasting. Regarding compliance, all possible strategies must be activated in order to raise awareness of the risks of pneumococcal disease and the benefits of vaccination, so as to increase coverage rates. A thorough analysis of epidemiological and clinical data, combined with an assessment of the economic and social impact, is crucial to guiding vaccination policies and supporting efficient decision-making in order to protect the health of the entire population.
High prevalence and associated factors of Mycoplasma pneumoniae infection in children under 5 years with atypical pneumonia
Objectives: To identify the prevalence of Mycoplasma pneumoniae infection and association with age and gender among children aged from 2 months to 5 years, hospitalized with atypical pneumonia in Vietnam. Methods: A retrospective descriptive study was performed using data collected from the electronic medical records. M. pneumoniae infection was determined by the IgM serology test. Results: 1,296 pediatric patients were included. The majority of children with atypical pneumonia were aged 12 months or older, with only 3.6% of cases being under 12 months of age. Male patients accounted for 58.7% of the cases. Prevalence of M. pneumoniae infection was 47.3%. Compared to children under 12 months of age, those aged 12 to under 36 months had a 10 times higher risk of M. pneumoniae infection, with OR = 9.44, 95%CI = [2.90 – 30.77]. Compared to children under 12 months of age, those aged 36 months to under 5 years had a 20 times higher risk of M. pneumoniae infection, with OR = 20.19, 95% CI = [6.20 – 65.69]. Compared to female children, male children had nearly twice the lower risk of M. pneumoniae infection, with OR = 0.62, 95% CI = [0.50 – 0.78]. Conclusion: Our study provides additional evidence on the role of M. pneumoniae in atypical pneumonia in children, while also highlighting significant risk factors for M. pneumoniae infection.
Knowledge, attitudes, and practices (KAP) of the Philippine general public towards human mpox (hMPX): a cross-sectional study
Introduction. In the Philippines, research on knowledge, attitudes, and practices (KAP) regarding human mpox (hMPX) remains limited, despite rising case numbers. While hMPX vaccines are unavailable locally, enhancing community awareness and promoting non-pharmaceutical interventions are crucial for reducing transmission risks. Methods. This cross-sectional study utilized an anonymized online data collection tool to explore the general public’s hMPX KAP and their relationships, and identify sociodemographic groups linked to low hMPX knowledge; 502 respondents were included in the analysis. Results. Knowledge about hMPX was evenly distributed across low, moderate, and high levels. Higher knowledge was associated with being female (b = 0.130, p = 0.004), having higher education (b = 0.134, p = 0.006), and smaller household size (b = –0.098, p = 0.028). Knowledge was not significantly associated with perceived disease susceptibility or severity; however, it strongly predicted perceived effectiveness of preventive measures, which in turn emerged as the most consistent and influential predictor of preventive practices. Full mediation of the effect of knowledge by perceived effectiveness was observed with protective sexual practices and avoiding crowded places, but only partial with proper hand hygiene and disinfection of fomites/high-touch surfaces. Conclusion. This study highlights the complex interplay between knowledge, attitudes, and practices in shaping public health behavior toward hMPX in the Philippines. Significant knowledge gaps and the mediating role of attitudes in influencing preventive practices underscore the need for targeted, stigma-free health communication strategies. Strengthening public understanding and perception through tailored interventions will be critical in mitigating hMPX transmission.