Abstract Background Oral vancomycin has had limited use in paediatric Inflammatory Bowel Disease (PIBD), with reported efficacy in primary sclerosing cholangitis (PSC-PIBD)1, acute severe colitis as part of a quadruple antibiotic regimen2, and very early onset IBD3. This study evaluates its effectiveness and safety as single-agent therapy in non-PSC PIBD patients. Methods This single-centre retrospective cohort study included PIBD patients started on oral vancomycin for active IBD or steroid/topical therapy dependency from 01/2017 to 08/2024. Exclusion criteria were PSC diagnosis, positive/equivocal stool test for C. difficile, another induction treatment started within 3 weeks prior and vancomycin use solely in a quadruple regimen2. Disease activity was assessed using PUCAI/wPCDAI, faecal calprotectin (FC), blood parameters at baseline, 1, 3, 6 and 12 months. Treatment regimen, duration, reasons for discontinuation and adverse events (AEs) were recorded. Vancomycin was started at 250mg in patients ≥30kg or 125mg in those <30kg TDS/QDS and tapered in responders after ≥1 month. Results Of 72 patients identified, 31 were included (16 males): 23 (74%) had Ulcerative Colitis (UC), 4 (13%) IBD unclassified (IBDU), 4 (13%) Crohn’s Disease (CD). At baseline, 5/31 were in clinical remission, with 2 also in biochemical remission but drug dependent. Initial vancomycin dosage was 17.5mg/kg/day (IQR 15.3-21.6), with a median duration of 4 (IQR 1-9) months. Concomitant medications are shown in Table 1: 10/31 (32%) were on biologics, with 4 able to discontinue and 2 to reduce biologic doses later. Overall, 17/31 (55%) patients (13 UC, 3 IBDU, 1 CD) achieved/maintained clinical and biochemical remission (Group 1), with 15 reducing/stopping other treatments. Conversely, 14/31 (45%) discontinued vancomycin due to non-response (11) or intolerance (3) (Group 2), with 11 stopping within 1 month. At baseline, Group 1 had lower disease activity score and platelet count than Group 2 (Table 1). A striking difference in response was noticed at 1 month (Figure 1), with FC in Group 1 dropping from 686μg/g (IQR 376-1143) at baseline to 60μg/g (IQR 25-160) at 1 month (p=0.001), while remaining high in Group 2 (p=0.52). In Group 1, 5/17 (29%) stopped vancomycin while in stable remission after 4 (IQR 2-9) months, with 3 restarted due to relapse, recapturing remission in 2/3. No severe AEs were reported. Conclusion Oral vancomycin was rapidly effective and safe, with 55% of non-PSC PIBD patients achieving/maintaining remission and 48% able to reduce/stop concomitant treatments. It was most effective in mildly active disease, especially UC/IBDU, and may offer a medium to long-term treatment option, with promising results in biologic-resistant but antibiotic-responsive PIBD patients. References 1.Ricciuto A, Liu K, El-Matary W, et al. Oral vancomycin is associated with improved inflammatory bowel disease clinical outcomes in primary sclerosing cholangitis-associated inflammatory bowel disease (PSC-IBD): A matched analysis from the Paediatric PSC Consortium. Aliment Pharmacol Ther. 2024;59(10):1236-1247. doi:10.1111/apt.17936. 2.Turner D, Bishai J, Reshef L, et al. Antibiotic cocktail for pediatric acute severe colitis and the microbiome: The PRASCO randomized controlled trial. Inflamm Bowel Dis. 2020;26(11):1733-1742. doi:10.1093/ibd/izz298. 3.Lev-Tzion R, Ledder O, Shteyer E, Tan MLN, Uhlig HH, Turner D. Oral Vancomycin and Gentamicin for Treatment of Very Early Onset Inflammatory Bowel Disease. Digestion. 2017;95(4):310-313. doi:10.1159/000475660

Background: Given the paucity of long-term longitudinal data for inflammatory bowel disease type unclassified (IBDU), we aimed to clarify IBDU disease course and reclassification rate by presenting nationwide data with up to 20 years of follow-up. Methods: We analyzed a prospectively identified 11-year cohort of pediatric patients diagnosed with IBDU between January 1, 2003 and December 31, 2013 at all Scottish pediatric IBD centers and followed up into adult services until December 31, 2022. Data were obtained from electronic medical records at fixed timepoints (5 and 10 years post-diagnosis) and at the final follow-up. Results: Overall, 102 patients were included in the analysis (57/102 [56%] male, median [interquartile range {IQR}] age at diagnosis: 11.5 [9.1-13.2] years) with a median (IQR) follow-up length of 10.5 (8.6-14.0) years. A change of diagnosis was made in 61 of 102 patients (60%); of these, 30 patients (29%) were reclassified to Crohn's disease (CD) and 31 patients (30%) to ulcerative colitis (UC). Patients who remained with IBDU had higher 1- to 5-year remission rates (IBDU 30/39 [77%] vs reclassified 16/57 [28%], P < .05), with lower rates of moderate-to-severe disease (IBDU 3/39 [8%] vs reclassified 31/57 [54%], P < .05) and less need for biologics across all timepoints (IBDU vs reclassified: first timepoint 1/39 [3%] vs 17/57 [30%], second timepoint 1/33 [3%] vs 26/56 [46%], third timepoint 0/18 [0%] vs 16/33 [49%]; all P < .05). Higher rates of surgical resections were observed in reclassified patients (reclassified 11/61 [18%] vs IBDU 1/41 [2%], P = .02). Conclusions: In our nationwide pediatric IBDU cohort, 60% of patients were reclassified to either UC or CD over 10.5 years of median follow-up; those who remained with IBDU had a milder disease course.

Abstract Background Inflammatory bowel disease type unclassified (IBDU) is the least common subtype of IBD accounting for around 10% of incident cases in children. There are a lack of long-term longitudinal data to fully elucidate both disease course and reclassification rate in IBDU. Our aim is to clarify disease course and reclassification rate by presenting nationwide data of an IBDU cohort with long-term (9-20 years) follow-up. Methods In a nationwide study, we analysed our prospectively identified 11 year cohort of IBDU patients diagnosed 01/01/03-31/12/13 via all Scottish paediatric IBD centres (Aberdeen, Edinburgh, Glasgow) and followed-up into adult services until 01/01/23. All had a diagnosis of IBDU based on the Porto diagnostic criteria and Paris PIBD phenotypic classification using a combination of clinical, endoscopic, histological and radiological findings. Follow-up data were obtained retrospectively from electronic medical records (demographics, diagnostic plus all repeat endoscopic and radiological assessments, longitudinal disease severity based on defined global clinician assessment, medical treatment and surgical outcomes) at fixed time points (5 and 10 years post-diagnosis) and at the last follow-up. Results A total of 116 patients were initially identified as IBDU, with 14 patients excluded as they emigrated out of the area before the first time point. 102 patients were included in the analysis (57/102 (56%) male, median (IQR) age at diagnosis 11.5 (9.1-13.2) years) with a median (IQR) length of follow-up of 10.5 (8.6-14.0) years. A change of diagnosis was made in 61/102 (60%) patients with 30/102 (29%) reclassified as Crohn’s disease (CD) and 31/102 (30%) as ulcerative colitis (UC) after a median (IQR) disease duration of 5.0 (2.0-8.2) and 4.7 (1.8 – 7.7) years respectively. Patients who remained as IBDU had a milder disease course compared to those reclassified as CD/UC with higher 1-5 year remission rates (30/39 (77%) in IBDU vs 16/57 (28%) in CD/UC-reclassified, p<0.05), lower rates of moderate-to-severe disease (3/39 (8%) in IBDU vs 31/57 (54%) in CD/UC-reclassified, p<0.05), less need for biologics across all time points (all p<0.05) and a higher proportion managed on aminosalicylates or no medication (all p<0.05). Higher rates of surgical resections were observed by last documented FU in CD/UC-reclassified patients (IBDU 1/41 (2%) vs CD/UC-reclassified 11/61 (18%), p=0.02). Conclusion In our nationwide paediatric IBDU cohort the majority (60%) of patients were reclassified as either UC or CD over the longest published median follow-up (10.5 years); those who remained with an IBDU classification had a milder disease course and decreased need of biologic escalation.

Multisystem inflammatory syndrome is a severe complication of SARS-CoV-2 infection in children (MIS-C). To date, data on long-term sequelae mainly concern cardiac outcomes. All ≤ 18 year olds consecutively admitted to the Buzzi Children’s Hospital with a diagnosis of MIS-C between October 1, 2020, and May 31, 2022, were followed up for up to 12 months by a dedicated multidisciplinary team. They underwent laboratory tests, multi-organ clinical and instrumental assessments, and psychosocial evaluation. 56/62 patients, 40 M, mean age 8.7 years (95

OBJECTIVES:The aim of our study was to assess the effectiveness and side-effect profile of a combination of azithromycin and metronidazole (CD AZCRO) as alternative induction therapy for 8 weeks in mild to moderately active paediatric Crohn's disease (CD). METHODS:We performed a retrospective cohort study (November 2012 to July 2023) of a regional paediatric inflammatory bowel disease service. Disease activity, faecal calprotectin (FC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), haematological parameters and albumin were collected at baseline, 8 and 16 weeks. At Week 8, patients were divided based on (paediatric Crohn's disease activity index) score and inflammatory markers (blood and stool) into: Group 1 clinical remission and Group 2 non-remission. RESULTS:A total of 48 patients were initially identified of whom 44 were included in the intention-to-treat analysis. After 8 weeks, the overall remission rate was 64%. Of the 38 patients who completed the CD AZCRO course, 28 patients (74%) entered remission (Group 1) and 10 (26%) did not (Group 2). At baseline a shorter disease duration, low weight z score and higher inflammatory burden (ESR, platelets and FC levels) were observed in Group 2. After 8 weeks, Group 1 showed improved CRP levels and higher albumin and haemoglobin levels than Group 2. Median FC declined significantly from 650 mcg/g at baseline to 190 mcg/g at Week 8 in Group 1 (p < 0.001). At 16 weeks, 23/28 patients (82%) continued in clinical remission. Nausea and vomiting were reported in 4/44 patients. CONCLUSIONS:Our real-world data demonstrate that CD AZCRO represents an alternative induction therapy for mild to moderate paediatric CD.

Background: This study aimed to evaluate the effect of overweight and obesity at the start of anti-TNF therapy on treatment response and relapse rate in children with inflammatory bowel disease (IBD). Methods: This multicenter, retrospective cohort study included 22 IBD centers in 14 countries. Children diagnosed with IBD in whom antitumor necrosis factor (anti-TNF) was introduced were included; those who were overweight/obese were compared with children who were well/undernourished. Results: Six hundred thirty-seven children (370 [58%] males; mean age 11.5 +/- 3.5 years) were included; 140 (22%) were in the overweight/obese group (OG) and 497 (78%) had BMI <= 1 SD (CG). The mean follow-up time was 141 +/- 78 weeks (median 117 weeks). There was no difference in the loss of response (LOR) to anti-TNF between groups throughout the follow-up. However, children in OG had more dose escalations than controls. Male sex and lack of concomitant immunomodulators at the start of anti-TNF were risk factors associated with the LOR. There was no difference in the relapse rate in the first year after anti-TNF introduction; however, at the end of the follow-up, the relapse rate was significantly higher in the OG compared with CG (89 [64%] vs 218 [44%], respectively, P < .001). Univariate and multivariate analysis revealed that being overweight/obese, having UC, or being of male sex were factors associated with a higher risk for relapse. Conclusions: Overweight/obese children with IBD were not at a higher risk of LOR to anti-TNF. Relapse in the first year after anti-TNF was introduced, but risk for relapse was increased at the end of follow-up.

Down Syndrome (DS) is the most common chromosomal abnormality compatible with life. The life of patients suffering from DS can be strongly impacted by Recurrent Respiratory tract Infections (RRIs), leading to an increased rate of hospitalisation, a higher need for intensive care and fatality. With a literature review, we summarise here the main etiological factors for RRI in this category of patients, particularly focusing on airway malformations such as tracheomalacia, tracheal bronchus and bronchomalacia, comorbidities associated with the syndrome, like congenital heart diseases, dysphagia, gastroesophageal reflux, musculoskeletal involvement and obesity, and immunologic impairments, involving both innate and adaptive immunity. For these patients, a multidisciplinary approach is imperative as well as some preventive strategies, in particular vaccinations in accordance with their national schedule for immunization.

BACKGROUND:Exclusive enteral nutrition (EEN) is the recommended first-line induction treatment in pediatric patients with active luminal Crohn's disease (CD). We aimed to provide a nationwide overview of evolving EEN practices during an era of increasing biologic use. METHODS:We analyzed a prospectively identified nationwide cohort of newly diagnosed pediatric patients with CD in Scotland between January 1, 2015, and June 30, 2022. Patients who received EEN for any indication were divided into 6-monthly epochs and examined over time. Differences during the COVID-19 pandemic (March 16, 2020, to July 19, 2021) were examined. Data were retrospectively collected from electronic medical records: demographics, anthropometrics, concomitant treatments, aspects of EEN administration, and remission/response rates. Descriptive statistics and linear regression were used for analyses. RESULTS:A total of 649 patients with CD were identified (63% male; median age 12.6 [interquartile range, 10.8-14.8] years); 497 (77%) of 649 received EEN as postdiagnosis induction therapy with a median course length of 7.7 (interquartile range, 5.9-8.0) weeks. Including repeat courses, 547 EEN courses were examined. An increasing incidence of CD was observed over time with no significant changes in EEN usage, remission or response rates, nasogastric tube usage, or course completion (all P > .05). Increasing use of EEN combined with biologics (combination induction) as first-line induction was observed over time (P < .001). Considering COVID-19, lower rates of EEN usage were observed (P = .008) with no differences in remission, oral administration, and course completion rates (all P > .05). CONCLUSIONS:Over the past 7.5 years, except during the COVID-19 pandemic, EEN usage rates have not changed despite an increase in biologic use, although combination induction is an emerging trend.

Background A severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 has been described after infection. A limited number of reports have analyzed the long-term complications related to pro-inflammatory status in MIS-C. We evaluated multiorgan impairment at the 6-month follow-up in MIS-C. Methods We enrolled 33 pediatric patients consecutively hospitalized for MIS-C and monitored for almost 6 months. The inter-relationship of patient's features and disease severity at admission with long term complications was studied by multivariate analysis. Results Endo-metabolic derangement, cardiac injury, respiratory, renal and gastrointestinal manifestations and neurological involvement are part of the initial presentation. The most abnormalities appear to resolve within the first few weeks, without significant long term dysfunction at the 6-months follow-up, except for endocrine (non-thyroidal illness syndrome in 12.1%, insulin resistance in 21.2%) and neurological system (27.3% cognitive or psychological, behavioral, adaptive difficulties). Endocrine and heart involvement at admission represent a significant factor on the long term sequelae; however no association between severity score and long-term outcome was noted. Conclusions The severity of initial clinical presentation may be associated to organ domain, however it is not related to long term sequelae. The prevalent organ restoration supports a predominant indirect immune-mediated injury triggered by a systemic inflammatory response; however a direct damage due to the viral entry could be not excluded. Eventhought our preliminary results seem to suggest that MIS-C is not a long-term risk condition for children health, a longer follow-up is mandatory to confirm this hypothesis.

This study aims to examine the changing practices of exclusive enteral nutrition (EEN) in paediatric Crohn's disease (CD) including the influence of the 2021 ECCO-ESPGHAN guidelines and the COVID-19 pandemic. We analysed a prospectively identified cohort of newly diagnosed CD patients in two paediatric regional centres between 01/01/15 and 30/06/22. Data were retrospectively collected from electronic medical records. CD patients who received EEN were divided into biannual epochs for analysis. Continuous outcome measures were analysed using Mann-Whitney U or Chi-squared tests, and linear regression modelling for longitudinal comparison. Of 503 patients (62.2% male; median age 13.0 years, IQR: 10.9 – 14.8), primary EEN was used in 383 (76.1%) with a median course length of 8 weeks (IQR: 7.2 – 8.3). An increasing incidence of CD diagnosis and total EEN courses were observed (p=.01, figure 1). Remission/response rates, nasogastric tube (NG) usage and completion rates were examined; there were no changes in these parameters over time (p=.153, p=.913, p=.601, p=.337 respectively). Weight z-scores increased (pre-EEN -0.11 vs post-EEN 0.33, p≤.001). An increased rate of EEN as induction therapy was observed (first 12-months 66.7% vs last 87.7% - p=.004), with dual induction (EEN combined with biologics) an emerging strategy over time (first 12-months 2.6% vs last 18.7% - p=.018). (Figure 2). During the COVID-19 pandemic, primary EEN was less frequently used (63/96, 65.6% vs 320/407,78.6% - p=.007), completion rates were lower (41/68, 60.3% vs 236/315, 74.9% - p=.015) but remission rates were comparable (37/67, 53.7% vs 181/315, 57.3% - p=.59). Repeat courses of EEN occurred in 47/503 (9.3%) with no difference in remission rates (2nd course 23/47, 46.7% vs 1st course 217/383, 56.7% - p=.463). This large real-world cohort demonstrates EEN usage has increased together with CD incidence despite an increase in biologic use. The use of dual induction therapy with biologics is an emerging trend; further research is required to ascertain the clinical benefit above dose-optimised biologic induction and its cost-effectiveness.

No real-world data are available on subcutaneous infliximab (SC-IFX) in pediatric inflammatory bowel disease (PIBD). We report a single-center cohort experience of an elective switching program from biosimilar intravenous infliximab to SC-IFX, 120 mg fortnightly, as maintenance. Clinical and laboratory data were collected for 7 patients with infliximab trough levels collected prior and at 6 and 40 weeks after the switch. High treatment persistence was registered with a single patient discontinuing the treatment due to high IFX antibodies, already present before switching. All patients remained in clinical remission with no significant changes in laboratory markers and median infliximab trough levels (12.3 µg/mL at baseline; 13.9 and 14.0 µg/mL at 6 and 40 weeks respectively). No newly-developed IFX antibodies were detected and no adverse reactions or rescue therapies were recorded. Our real-world data support the feasibility of an elective switch to SC-IFX in PIBD as maintenance with potential advantages concerning medical resources and patient satisfaction.

Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory disease related to SARS-CoV2 infection, with frequent cardiovascular involvement in the acute setting. The aim of the study was to evaluate the cardiac function at 6 months. Thirty-two patients diagnosed with MIS-C were enrolled and underwent advanced echocardiogram at discharge and at 6 months. According to the left ventricular ejection fraction (LVEF) at admission, the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥ 45%) and the follow-up results were compared. At discharge, all patients had normal LV and RV systolic function (LVEF 61 ± 4.4%, LV global longitudinal strain −22.1%, TAPSE 20.1mm, s’ wave 0.13m/s, RV free wall longitudinal strain −27.8%) with normal LV diastolic function (E/A 1.5, E/e’ 5.7, and left atrial strain 46.5%) and no significant differences at 6 months. Compared to group B, the group A patients showed a reduced, even if normal, LV global longitudinal strain at discharge (−21.1% vs. −22.6%, p-value 0.02), but the difference was no longer significant at the follow-up. Patients with MIS-C can present with depressed cardiac function, but if treated, the cardiac function recovered without late onset of cardiac disease. This favorable result was independent of the severity of acute LV dysfunction.

Background: Inflammatory bowel disease (IBD) patients show a higher risk of developing metabolic and cardiovascular diseases due to the presence of systemic low-grade chronic inflammation. Exercise can improve cardiovascular fitness and modulate the inflammatory processes. We evaluated the physical activity (PA) level and the fitness performance of children and adolescents with IBD. Patients and methods: We considered 54 pediatric patients with IBD (14.6 ± 2.2; 22 M), including CD (n = 27) UC (n = 24) and IBD unclassified (n = 3), and 70 healthy children. In all children, the Physical Activity Questionnaire (PAQ-C) and the International Fitness Enjoyment Scale were self-reported and recorded. Results: PAQ-C showed significant difference in PA levels in patients with IBD compared to controls (p < 0.001). A decrease in general fitness (p = 0.003), cardiorespiratory fitness (p = 0.002), strength (p = 0.01), speed agility (p = 0.003), and flexibility (p = 0.01) were also detected between patients and controls. Speed agility was related to age (p = 0.02) and BMI z-score (p = 0.01), and flexibility to BMI z-score (p = 0.05). We noted a correlation between PA levels and physician global assessment (p = 0.021) and activity disease severity (p = 0.025). Conclusions: A poorer PA level and poor physical competence were found in patients with IBD compared to healthy children and adolescents. Monitored exercise could provide multiple benefits at both physical and psychological levels.

Background: While other viral infections occurring in early pregnancy are known to be associated with fetal cardiac malformations, little is known about CMV and its causative role. Only a few case repots have been described reporting a correlation between congenital CMV infection and cardiac defects.Case-report: We report the case of a 7-day-old neonate who was referred to our Pediatric Infectivology Department for maternal cytomegalovirus (CMV) seroconversion during the first trimester of pregnancy and confirmed congenital infection. At first evaluation, the baby presented with a cardiac murmur and signs of acute heart failure, along with jaundice and hypotonia. At cardiac ultrasound, a perimembranous doubly-committed ventricular septal defect and a reduced aortic isthmus diameter were revealed.Conclusion: Despite further large-scale prospective studies are needed to confirm or rule out this association, CMV DNA urine detection might be worth to be considered as part of the diagnostic process in neonates with isolated heart defects.

Congenital cytomegalovirus infection (cCMV) is the most common congenital viral infection, with a consistent rate of morbidity, mortality, and long-term sequelae, especially in the case of late diagnosis. Nevertheless, a universal screening for CMV is not currently recommended, and global awareness about this infection, as well as accurate and shared indications on follow-up and treatment, are still lacking. We reviewed data about 59 suspect cCMV cases who referred to our center from 2014 to 2021. We report 41 cases of confirmed cCMV diagnosed at birth, with clinical or radiological abnormalities in 36.6% of them. Other five patients received a late diagnosis and all presented neurological impairment. Twelve patients received therapy with Valganciclovir within the first month of life, with favorable outcome in nine cases. Therapy after the first month of life was attempted in four patients, with improvement in one case. The overall awareness about cCMV infection was 32.6%. Considering our population, maternal serological screening followed by targeted testing of neonates could be an effective strategy. Some aspects of cCMV infection management should be further investigated, such as indication of treatment after the first month of life or in asymptomatic patients. Awareness about the infection should be improved to implement preventive strategies.

Emergency rooms (ER) are largely used by patients with oral complaints, who choose the ER over private or public dental offices for oral prevention and treatment. During the COVID-19 pandemic, the activity of most dental facilities was limited, and most hospitals and ERs were dedicated to the treatment of COVID-19 patients. The present study analyzed the number of and reason for visits at the emergency room (ER) of Ospedale dei Bambini "Vittore Buzzi", the main pediatric hospital in Milano, Italy, between 2019 and 2020, with a particular focus on oral emergencies. In 2019, 25,435 children turned to the ER, compared to 16,750 in 2020. About 10% of the children were eventually admitted to the hospital in both years. The number of admissions for infectious diseases, other than COVID-19, signed an important decrease in 2020, while trauma/injuries decreased slightly in number but increased in proportion. The number and proportion of ER visits for oral complaints decreased in 2020 compared to 2019. Stomatitis was the most frequent condition, followed by traumatic injuries, which decreased in number and percentage between 2019 and 2020. Oral infections and painful caries accounted for about 15% of the cases in both 2019 and 2020. These data highlight the need to promote territorial services for the prevention and treatment of oral health complaints, including dental emergencies.

Background: In the Lombardy Region, Italy, HPV vaccination is recommended and offered free of charge to 12-years-old males since 2017. The expected vaccination thresholds are still far to be reached. Methods: A cross-sectional survey to investigate parents' attitudes towards the HPV vaccine and knowledge about HPV was administered to parents of boys aged 6 to 18 years attending a large pediatric hospital for outpatient specialistic evaluations. Two parallel multiple logistic regression analyses were conducted to estimate the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) for attitude towards HPV vaccination and perceived need for more information about HPV vaccination. Results: A positive attitude towards HPV vaccination was found in 74% of interviewed parents. Knowledge of HPV, having a generally positive attitude toward vaccination, and mothers filling in the survey were positively associated with a positive attitude to the HPV vaccine. Parents' perceived need for more information about HPV vaccination was positively associated with the child's age, general positive attitude toward vaccination, Christian religion, and positive attitude toward HPV vaccination; knowing that HPV vaccination is free of charge significantly reduced the risk of asking for more information on HPV vaccination. Conclusions: The majority of parents of male children and adolescents in our study have a positive attitude toward HPV vaccination. Attitude toward HPV vaccination and perceived need for more information on HPV vaccination were directly related to a positive attitude toward vaccines in general. In addition, knowledge of HPV and related pathologies favors a positive attitude toward HPV vaccination. Future health programs should target an even wider diffusion of evidence-based information on vaccines in general and on the HPV vaccine in young males, to support a positive attitude toward vaccines in the general population.