Childhood Immunisation Coverage during the COVID-19 Epidemic in Italy

The COVID-19 pandemic has affected national healthcare systems worldwide, with around 282 million cumulative confirmed cases reported in over 220 countries and territories as of the end of 2021. The Italian National Health System was heavily affected, with detrimental impacts on preventive service delivery. Routine vaccination services were disrupted across the country during the first months of the pandemic, and both access to and demand for vaccines have decreased during the pandemic. In many cases, parents preferred to postpone scheduled appointments for routine paediatric vaccinations because of stay-at-home orders or fear of COVID-19 infection when accessing care. The objective of the current study was to assess the routine childhood vaccine coverage (VC) rates during the COVID-19 epidemic in Italy. We compared 2020 and 2019 VC by age group and vaccine type. The Italian Ministry of Health collected anonymised and aggregated immunisation national data through the local health authorities (LHAs). Results were considered statistically significant at a two-tailed p-value ≤ 0.05. VC rates for mandatory vaccinations decreased in 2020 compared to 2019 (range of VC rate decrease: −1% to −2.7%), while chicken pox increased (+2.2%) in 7-year-old children. Recommended vaccinations were moderately affected (range of VC rate decrease in 2020 vs. 2019: −1.4% to −8.5%), with the exception of anti-HPV in males, Men ACWY, and anti-rotavirus vaccination (VC increase 2020 vs. 2019: +1.8%, +4.7% and +9.4%, respectively). In the COVID-19 era, the implementation of coherent, transparent, and effective communication campaigns and educational programs on safe childhood vaccinations, together with the increase in the number of healthcare staff employed, is essential to support strategies to reinforce vaccination confidence and behaviour, thus avoiding health threats due to VPD during and beyond COVID-19 times.

Impact of the COVID-19 Pandemic on Clinical Pathways for Non-SARS-CoV-2 Related Diseases in the Lazio Region, Italy

Clinical pathways (CPs) are multidisciplinary clinical governance tools necessary for the care management of the patients, whose aim is to outline the best practicable path within a health organization related to an illness or to a complex clinical situation. The COVID-19 pandemic emergency has created the need for an organizational renewal of care pathways based on the principles of “primary health care” recommended by the WHO. In Italy, the Hospitals and Local Health Authorities (ASL) have tried to guarantee the continuity of non-deferrable treatments and the maximum safety of both patients and health professionals. This study analyzes the organizational and managerial responses adopted in pathology-specific care pathways to assess how CPs as diagnostic tools responded to the COVID-19 pandemic in the first two waves. Twenty-four referents of Operational Units (UU OO) from Hospitals (AO) and Local Health Authorities (ASL) of the Lazio Region (Central Italy) that apply four different CPs responded to a survey, which analyzes the managerial and organizational responses of CPs in regard to different contexts. Results show that the structural and organizational adjustments of the CPs have made it possible to maintain an adequate level of care for specific treatment processes, with some common critical aspects that require improvement actions. The adjustments found could be useful for dealing with new outbreaks and/or new epidemics in order to try to mitigate the potential negative impact, especially on the most vulnerable patient categories.

Transmission of SARS-CoV-2 among children and staff in German daycare centers: results from the COALA study

Background: Whereas the majority of children under 6 years of age attend daycare centers in Germany, evidence on the role of daycare centers in the transmission of SARS-CoV-2 is scarce. Aims: This study aims to investigate the transmission risk in daycare centers among children and staff and the spread of infections to associated households. Methods: 30 daycare groups with at least one recent laboratory-confirmed SARS-CoV-2 case (child or staff) were enrolled in the study (10/2020-06/2021). Close contacts within the daycare group and households were examined over a 12-day period (repeated SARS-CoV-2 PCR tests, genetic sequencing of viruses, documentation of symptoms). Households, local health authorities and daycare staff were interviewed to gain comprehensive information on each outbreak. We determined primary cases for all daycare groups. Results: The number of secondary cases varied considerably between daycare groups. The pooled secondary attack rate (SAR) across all 30 daycare centers was 9.6%. The SAR tended to be higher in daycare centers in which the Alpha variant of the virus was detected (15.9% vs. 5.1% with evidence of wild type). The SAR in households was 53.3%. Exposed children were less likely to get infected with SARS-CoV-2 in daycare centers, compared to adults (7.7% vs. 15.5%). Conclusion: Containment measures in daycare programs are critical and become increasingly important with highly transmissible new variants to reduce SARS-CoV-2 transmission, especially to avoid spread to associated households. Virus variants may modify transmission dynamics in daycare programs.

A Scaling Law for PCR Positivity in the COVID Second Wave

In this preliminary report, PCR positivity data in the second wave of the COVID pandemic (September-January 2020) are shown to obey a scaling law given by: where % P0 and Σ0 are the y- and x-intercepts of a plot of positivity, %P, against the number of tests, Σ. The law holds across international, regional and local boundaries, as demonstrated for Great Britain, Austria, Germany and Sweden, the nine English regions, London - Yorkshire & Humber, and various Local Health Authorities in England. One possible explanation for scaling might be Dorfman pooling.The scaling law can be used to remove a systematic or false positive (FP) component from the daily number of positive tests, or cases, to yield the real number of cases. The results correlate strongly with the ZOE survey for London (R2=0.787) and Excess Deaths for England (R2=0.833). The cumulative total of FPs can be estimated as 1.4M by the beginning of 2021, in line with other estimates.

Determination of alcohols in hand sanitisers: Are off-the-shelf hand sanitisers what they claim to be?

Transmission of SARS-CoV-2 – the causative agent of COVID-19 – can be prevented through non-pharmaceutical interventions such as observing proper hand hygiene using alcohol-based hand rubs/sanitisers (ABHRs) as recommended by the WHO and local health authorities. However, this recommendation has led to high demand for ABHRs and proliferation of sub-standard products, which do not contain the recommended amount of alcohol. Fifty products of different origins and formulations obtained off-the-shelf and in public places in and around Pretoria (South Africa) were analysed for their alcohol content using gas chromatography. Ethanol was the most common alcohol used in the products, followed by isopropanol. Only 21 (42%) of the products analysed contained at least 70% alcohol; of these only 14 (28%) met the WHO recommended 80±5% alcohol content to have a virucidal effect on SARS-CoV-2. Of the 41 commercial off-the-shelf products analysed, 27 (66%) contained less than 70% alcohol in comparison to 13% of homemade products. Only 18% of gel products contained 70% alcohol, compared with 47% for liquid-based products. Most of the products did not contain the appropriate or correct declaration as recommended by the South African National Standards (SANS 289 and 490). The proliferation of substandard ABHRs is of great public health concern and calls for stricter regulations and enforcement in order to protect consumers, their rights and well-being during and post the COVID-19 pandemic period. However, in the interim, formulation of ABHRs using the WHO guidelines should be mandatory, as such formulations, when made correctly, do have the required virucidal effect against SARS-CoV-2.

Platformization of healthcare communication: Insights from the early stage of the COVID-19 pandemic in Italy

Over the past few years, public health organizations have adopted new communication practices, such as social media communication, framed by the concepts of Health 2.0 and Medicine 2.0. These concepts need to be reconsidered in the light of the transformation of social media as digital platforms. This article aims to define and critically discuss the concept of the platformization of healthcare communication, investigating the impact of social media incorporation on the local health authorities’ Facebook communication during the early phase of the COVID-19 emergency in Italy. Findings show the progressive incorporation of the mechanisms of platformization by local health authorities and the progressive shift of their Facebook pages from connectors to complementors of healthcare communication and services during the early phase of the pandemic. Conclusions critically discuss the incorporation of social media into the communication strategies of the public healthcare sector.

Audit clinico sugli interventi di adenotonsillectomia in Regione Piemonte: un intervento multilivello

Background: Despite the dissemination of national and international clinical and organizational guidelines, adenotonsillectomy is still subject to a significant variability both at local and regional levels. To address the criticalities related to the different phases leading to adenotonsillectomy, the Department of Health in Piedmont engaged a multi-disciplinary team to carry out an intervention to improve the quality of care. To address the issue, the working group started a regional clinical audit. - Objective: To describe the approach and the process that involved more than one hundred professionals in the management of adenotonsillectomy within the 12 Local Health Authorities of the Piedmont Region in the period 2017-2019 as well as to discuss their main results. - Materials, methods and results: The activities that led to the implementation of the whole audit process were carried out considering both the development of a suitable set of measures and the definition of the sampling procedure for the selection of the patients’ medical files to be analysed. The methodology involved several professionals along the territory. The team was engaged in sharing the audit methodology, defining the evaluation procedures and selecting relevant indicators. All measured values showed an overall improvement that in some cases matched the identified quality standards. - Conclusions: The present research shows that the use of the clinical audit on a regional scale is a favourable tool for professional communities to improve the quality of care and can be used as a valuable participatory educational tool.

SOCIAL MEDIA LOGIC AND HEALTH COMMUNICATION BETWEEN INDEPENDENCE AND CONSTRAINTS: EVIDENCE FROM ITALY DURING THE COVID-19 PANDEMIC

This paper presents the results of a study that investigated how local health authorities (LHAs) located in the most impacted areas by Covid-19 of Lombardy (North of Italy) answered to the challenges imposed by the pandemic through their official Facebook pages during the early weeks of the emergency (January-March 2020). The goal is to understand how the logics of social media affected LHAs’ communication, representing an opportunity for health institutions to enter a new phase of information diffusion and relations with stakeholders and layperson, but also a mean of constraints due to their algorithmic logics and limits of access. The originality of the approach is that, in order to understand the relationship between social media and local health authorities, the theoretical framework hybridizes health communication theories and social media studies. Empirical results showed that LHAs’ communication on Facebook was affected by the logics of programmability and popularity, and also that the institutional language was shaped by social media habits, with an intense use of visuals, hashtags and other engagement strategies. Findings highlighted also that Covid-19 related messaged triggered users’ interactions. The study pointed out the relevance of social media for healthcare communication, opening up new reflections and insights about platforms’ role on ordinary and emergency situations like the pandemic. Interdependence and tensions between public health communication and algorithmic and platform logics are critically discussed.

COVID-19 Planning in United States Youth Sports: a Survey of 1880 Organizations Representing Over 500,000 Youth Athletes

Context: High school (HS) and youth sports organizations (YSO) that restarted participation in the fall of 2020 during the COVID-19 pandemic relied on information sources to develop risk mitigation procedures. Objective: To compare the risk mitigation procedures being employed and the information sources being utilized by HS athletic departments and YSO. Design: Surveys were distributed to HS athletic directors and youth sports directors throughout the US regarding sport restarting, COVID-19 cases, risk reduction procedures, and the information sources used to develop risk reduction plans in fall 2020. The proportion of HS and YSO using different procedures and information sources were compared using chi-square tests. Setting: HS and YSO programs from across the US Participants: 1296 HS and 584 YSO responded, representing 519,241 adolescent athletes. Main Outcome Measures: Risk reduction procedures used and information sources employed Results: HS employed more risk reduction procedures (7.1±2.1 v 6.3±2.4, p<0.001), were more likely to use symptom monitoring (93%v85%, p<0.001), temperature checks on site (66%v49%, p<0.001), face mask use for players on and off the field (37%v23%, p<0.001 and 81%v71%, p<0.001, respectively), social distancing for staff (81%v68%, p<0.001) and players off the field (83%v68%, p<0.001), and increased disinfection (92%v70%, p<0.001). While HS and YSO had similar use of information from local health authorities, there were still some differences. For example, HS were more likely to use information from the National Athletic Trainers Association (72%v15%, p<0.001) than YSO. Conclusions: HS and YSO report using a broad range of risk reduction procedures, but the average number was higher among high schools than youth sports organizations. Use of information from the CDC and local health authorities was high overall, but low from professional healthcare organizations. Professional healthcare organizations should consider additional measures to improve information uptake among stakeholders within youth sports.

Rehabilitation Process Issues and Functional Performance after Total Hip and Knee Replacement

(1) Background: to ensure satisfactory outcomes in patients who have undergone total hip or knee replacement, it is crucial to prioritize postoperative rehabilitation process and its management rather than the successful surgery alone. The goal of our study was to investigate the outcomes of rehabilitation process after the total hip or knee replacement, including local orthopedic follow-up, communication with local health authorities, patients’ satisfaction regarding rehabilitation, and their functional performance after the surgery. (2) Methods: the study included 523 patients who underwent total hip replacement, and 650 patients who underwent total knee replacement. All patients were surveyed via formalized phone interviews containing questions related to postoperative rehabilitation parameters and outcomes. (3) Results: in postsurgical period, nearly 70% of patients had regular local orthopedic follow-up. Lack of the latter at the local level was indicated by approximately 10% of patients, and the rest of the respondents note the practice of sporadic follow-up. Half of patients reported pains of various severity. Good physical activity (e.g., ability to walk unassisted within their residential district) was acknowledged by about a quarter of patients. Ability to walk unassisted was reported by just 54.5% of patients. (4) Conclusions: the disproportion between generally high patient satisfaction of rehabilitation management (> 80%) and low feedback level on the part of local health authorities (9.4%) demonstrated lack of communication between the key parties involved in the rehabilitation process.