Long-term care facility (LTCF) residents represent one of the populations most vulnerable to SARS-CoV-2 infection and have experienced repeated vaccination and natural viral exposure since the beginning of the COVID-19 pandemic. The long-term dynamics of humoral and cellular immunity in this population remain incompletely characterized. In this multicenter longitudinal study, SARS-CoV-2-specific antibody responses were monitored in LTCF residents over 12 months. A total of 388 residents from LTCF across five Italian regions were enrolled and stratified according to receipt of the SARS-CoV-2 XBB.1.5 mRNA booster during the 2023–2024 vaccination campaign. In a subgroup of residents, peripheral B-cell phenotypes and Spike-specific memory B cells were characterized by flow cytometry and compared with those of younger healthcare workers vaccinated with the same formulation. Anti-Spike IgG titers peaked in residents who received the XBB.1.5 booster and subsequently declined over time, consistent with contraction of vaccine-induced humoral responses. In contrast, individuals who did not receive the booster maintained lower but stable antibody levels. Anti-nucleocapsid seroconversion and clinically diagnosed intercurrent infections occurred at broadly comparable observed rates in boosted and non-boosted residents, suggesting a comparable incidence of SARS-CoV-2 infection during follow-up. Regarding B-cell-mediated immunity, LTCF residents exhibited age-associated remodeling of the B-cell compartment, with reduced total B-cell frequencies but preserved antigen-experienced memory populations. Despite declining circulating antibodies, Spike-specific memory B-cell frequencies remained stable. A late increase in anti-Spike titers coincided with rising anti-nucleocapsid seropositivity, suggesting reactivation of immune memory following natural viral exposure. These findings indicate that repeated vaccination and natural exposure generate durable immunological memory in LTCF residents. In highly exposed populations, immune maintenance may increasingly rely on reactivation of memory responses rather than persistently high antibody titers.

Meningococcal vaccination of adolescents/young adults is recommended in various countries, including the United States (US). This phase 3b, observer-blind study (NCT04318548) evaluated the safety, reactogenicity, and immunogenicity of serogroup B vaccine, 4CMenB, and quadrivalent conjugate vaccine, MenACWY-CRM, when co-administered to healthy individuals aged 16-18 y, as per US Advisory Committee on Immunization Practices recommendations. Adolescents, who had received MenACWY vaccination ≥4 y previously, were randomized (N = 940; 1:1:1) to one of three groups to assess co-administration versus 4CMenB and MenACWY-CRM administered alone. Co-primary objectives were to demonstrate the non-inferiority of antibody responses after concomitant administration to antibody responses after 4CMenB (two doses administered 2 months apart) and MenACWY-CRM (single dose), as measured by human serum bactericidal assay (hSBA). Vaccine safety and reactogenicity were assessed as another primary objective. The co-primary endpoints were met: the lower limit of 2-sided 95% confidence intervals for all between-group ratios of hSBA geometric mean titers was >0.5 for the concomitant administration group versus 4CMenB group and MenACWY-CRM group. hSBA data after two 4CMenB doses and one MenACWY-CRM dose showed comparable between-group geometric mean ratios versus baseline, and percentages of participants with 4-fold rises in titers and titers ≥lower limit of quantitation. The safety profile of 4CMenB co-administered with MenACWY-CRM was comparable with that of 4CMenB administered alone. In conclusion, 4CMenB and MenACWY-CRM co-administration was well tolerated in adolescents aged 16-18 y and immune responses were comparable versus administration of each vaccine alone, which is consistent with a previous study of co-administration in infants.

BACKGROUND:Respiratory syncytial virus (RSV) primarily affects the respiratory tract, with a high burden among older adults. We aimed to estimate the prevalence and characteristics of RSV-associated respiratory infections in community-dwelling older adults across Europe. METHODS:A prospective, observational study was conducted in six European countries over three consecutive RSV seasons (October 2021 until April 2024). Non-RSV vaccinated participants (age ≥60 years) presenting with symptoms of acute respiratory infection (ARI) at general practitioners and outpatient clinics/outpatient hospitals were recruited. Respiratory syncytial virus and other respiratory viruses were detected using a combined nasal and throat swab. Diary cards and regular phone contacts were used to collect information on onset and resolution of symptoms. The prevalence of RT-PCR confirmed RSV-ARI (cRSV-ARI) was estimated, as well as symptom duration, underlying comorbidities, prevalence of RT-PCR confirmed RSV lower respiratory tract disease (cRSV-LRTD), complications, hospitalizations, and co-infections. RESULTS:A total of 2573 participants were enrolled (139 with cRSV-ARI). The prevalence of cRSV-ARI varied by season: 3.6% in Season 1, 9.3% in Season 2, and 4.2% in Season 3. The most frequently reported upper respiratory, lower respiratory, and systemic symptoms were nasal congestion/rhinorrhea, cough, and fatigue (cRSV-ARI: 83.1%, 97.8%, and 64.0%; non-cRSV-ARI: 78.0%, 95.0%, and 68.2%). The overall prevalence of cRSV-LRTD was 3.9% in Season 1, 12.5% in Season 2, and 7.3% in Season 3. CONCLUSIONS:This study highlights the substantial burden of RSV among older adults in Europe and reflects the shift in RSV epidemiology due to the COVID-19 pandemic, indicating a return to prepandemic seasonality trends. CLINICAL TRIAL REGISTRATION:Not applicable.

BACKGROUND:Respiratory syncytial virus (RSV) is an important cause of respiratory illness, affecting individuals of all ages. RSV can cause severe disease in older adults, but the disease burden and how it affects the health-related quality of life (HRQoL) is not well characterized. METHODS:This multicenter, cross-sectional study conducted over three RSV seasons (October 2021-April 2024) in six European countries enrolled adults ≥60 years of age (YOA) who presented to general practitioners or outpatient clinics with an acute respiratory infection (ARI) and who were not vaccinated against RSV. The symptom duration, the effect of medically-attended confirmed RSV-ARI (cRSV-ARI) on symptomology (InFLUenza Patient-Reported Outcome [FLU-PRO] questionnaire) and HRQoL (EuroQoL-5 Dimension [EQ-5D-3L] questionnaire) as well as the healthcare resource utilization and working days lost were assessed. RESULTS:We analyzed 136 participants with a medically-attended cRSV-ARI. The median duration of any ARI symptom was 2.0-19.0 days. cRSV-ARI symptoms mostly affected the chest/respiratory domain (mean score: 1.72; standard deviation [SD]: 0.76) and the nose domain (mean score: 1.58; SD: 1.00). The mean country-specific cRSV-ARI utility scores ranged from 0.81 on Day 1 to 0.90 on Day 29. On Day 57, the score was 0.84. A trend for an increased effect on HRQoL was observed in participants with lower respiratory tract disease. The mean duration of treatment was 16.3 (SD: 11.9) days, and 27.8% of participants in active employment stayed home from work. CONCLUSIONS:medically-attended cRSV-ARIs substantially affect the symptomology and HRQoL of European adults ≥60 YOA who were not vaccinated against RSV.

Healthcare workers (HCW) are at increased risk for SARS-CoV-2 exposure and infection and have been preferentially prioritised in vaccination campaigns. The present study aims to monitor vaccine-induced humoral immune response over a 6-month period in a cohort of 494 HCW who received a booster immunization with bivalent mRNA SARS-CoV-2 vaccines. Overall, the study sample displayed high anti-trimeric Spike IgG levels at baseline (prior vaccine administration), which increased one month after the bivalent booster but declined over the subsequent six months. Sex, type of vaccine, concomitant seasonal flu vaccination, and anti-N IgG seropositivity had no significant impact on antibody levels one-month post-vaccination, while higher antibody increase was seen in individuals with lower baseline immunity and older age groups. Sera from 45 HCWs were tested in neutralization assays against the BA.5 and XBB.1.5 subvariants. Almost all sera neutralized BA.5 before vaccination; 23 (51.1 %) neutralized XBB.1.5 before vaccination, rising to 35 (77.8 %) after six months. MNT against BA.5 was higher than against XBB.1.5 at both time points, and anti-trimeric S IgG levels correlated with MNT for both strains. In conclusion, the present study suggests significant pre-existing immunity, possibly from prior infections, asymptomatic exposure to SARS-CoV-2, and multiple vaccine doses. We found that individuals with lower baseline immunity exhibited a stronger and faster antibody response to vaccination, which was also beneficial in providing a broader antibody repertoire against newly circulating variants. Overall, these findings offer crucial insights for shaping future immunization policies in a population that remains at elevated risk.

Introduction This systematic review aims to assess determinants of vaccine hesitancy (VH) among healthcare professionals, to identify knowledge gaps and inform targeted training programs.Research design and methods A systematic search of PubMed and Scopus was conducted in February 2024. PRISMA criteria were applied, and methodological quality was assessed using a cross-sectional study evaluation tool. Studies addressing HCWs’ VH determinants, including knowledge, attitudes, communication, and organizational factors, were included.Results Out of 1394 records, 221 articles were included. Reported prevalence of VH among HCWs varied across studies, reflecting differences in professional roles, settings, and vaccines studied. Key determinants included gaps in knowledge, personal beliefs, organizational barriers, and communication skills. The review highlights the importance of evidence-based information, continuing education, and effective communication in addressing VH among HCWs.Conclusions Educational and organizational interventions are essential to improve HCWs’ knowledge, attitudes, and practices regarding vaccination. Strengthening vaccine education, fostering effective communication, and addressing organizational challenges can reduce hesitancy and support HCWs in promoting vaccination among patients. Future initiatives should consider the diversity of educational settings, professional roles, and training requirements across healthcare systems.

ABSTRACT Background The introduction of screening tests for Sars‐CoV‐2 has been an extraordinary prevention and control tool during the COVID‐19 pandemic. However, pandemic control interventions, including screening and vaccine mandates, induced refusal reactions in many people. To date, little information is available on the levels of acceptance of screening practices by the young population in school settings. Objective The objective of this work is to survey students' attitudes, behaviours and emotions towards Covid‐19 screening tests by the means of a participatory research method, the World Café (WC). Materials and Methods Between March and May 2023, three WC sessions were conducted in three high schools, with 70 students enrolled on a voluntary basis. As per standard procedure, a moderator was assigned at each table to facilitate dialogue and the WCs were recorded, transcribed and imported into ATLAS.ti software for qualitative analysis. Results The analysis showed that the themes most reported during the WCs were those regarding the emotional domain, particularly feelings of distress, anxiety, fear, frustration, inadequacy and loneliness. Discussion Although the themes ‘Emotions/thoughts’ appear to be the most prominent among students, also ‘Public health policies’ constitutes a predominant theme group. Finally, the theme ‘Communication’ sparked lively debate, being the fourth most discussed topic. Conclusions The many insights from the WC analysis, when properly reframed, bring out useful elements for taking actions during prevention campaigns. Institutions and schools should focus on disseminating clear and targeted messages to help fight misinformation and distrust. Moreover, such evidence suggests that the World Café method proves to be useful and effective for exploring the emotional sphere of adolescents and analysing their thoughts, attitudes and knowledge. Patient or Public Contribution The research team collaborated with the school personnel to set up the right setting for running the World Café sessions. The World Café method allowed the researchers to gather students' insights by the means of a participative process. Honest debate and active engagement of students provided the researchers with a list of statements very useful for informing health policy and recommendations.

Abstract Background RSV is a highly contagious pathogen that can cause severe disease in older adults. We assessed the RSV disease burden among older adults. Methods We present results from the second RSV season (1-Oct-2022/30-Apr-2023) of this ongoing prospective epidemiological study covering 3 consecutive RSV seasons in which adults aged ≥ 60 years from 5 European countries were followed up for ARI symptoms 28 or 56 days if ARI was not resolved by day (D)29. Medical conditions, nasal and throat swab samples for RT-PCR detection of RSV and other respiratory viruses were collected at D1. Results Of 791 participants with an ARI episode, 74 (9.4%) had RT-PCR-confirmed RSV-ARI (cRSV-ARI, 60–74-year-olds: 53/626 [8.5%]; ≥ 75-year-olds: 21/165 [12.7%]) with variation between countries (Table 1). Median duration of the ARI episode was 21 days (range: 5–59) for cRSV-ARI versus 19 days (range: 4–66) for non-cRSV-ARI. Of participants with cRSV-ARI, 70/74 (94.6%) had both upper and lower respiratory symptoms, and 46/74 (62.2%) met the lower respiratory tract disease (LRTD) case definition (Table 1). The most frequently recorded upper respiratory symptoms, lower respiratory symptoms, and systemic symptoms were nasal congestion/rhinorrhoea (63/74 [85.1%]), cough (72/74 [97.3%]), and fatigue (47/74 [63.5%]), respectively. RSV activity peaked in December and January (Figure 1). 68/74 (91.9%) participants with cRSV-ARI and 43/46 (93.5%) participants with cRSV-LRTD had ≥ 1 current and chronic medical condition. The most frequent chronic medical conditions were vascular (cRSV-ARI: 48/74 [64.9%]; cRSV-LRTD: 30/46 [65.2%]) and metabolic disorders (cRSV-ARI: 47/74 [63.5%]; cRSV-LRTD: 29/46 [63.0%]). The most common respiratory viruses other than RSV were SARS-CoV-2 and rhinovirus (Table 2). Conclusion While RSV activity shifted during the COVID-19 pandemic, RSV seasonality during the 2022/2023 season tended to return towards pre-pandemic trends in Europe, with peak activity during the winter months. Country-level prevalence varied, with higher prevalence in Germany and Italy vs other countries. However, the overall prevalence in outpatient settings was within the range of pre-pandemic data from a recent meta-analysis. Future data will enhance understanding of post-COVID RSV epidemiology. Funding: GSK Disclosures Rosa Prato, M.D., Merck & Co., Inc.: Advisor/Consultant|Merck & Co., Inc.: Grant/Research Support Philip Joosten, PhD., GSK: Employment|GSK: Stocks/Bonds (Public Company) Theo Last, Pharm.D, GSK: Employment|GSK: Stocks/Bonds (Public Company) Shubhangi Gawade, MSc., GSK: Employment Jean-Yves Pirçon, PhD., GSK: Employment|GSK: Stocks/Bonds (Public Company) Veronica Hulstrøm, MD, PhD, GSK: Salary as GSK employee with stock options|GSK: Stocks/Bonds (Public Company) Pouya Saeedi, PhD., GSK: Employment

This study assessed the direct costs of using Palivizumab for RSV prevention in the Foggia District, Italy, during the 2023/2024 season, and explored the cost savings coming from reallocating resources to Nirsevimab in a universal RSV program. Switching from Palivizumab to Nirsevimab could protect 57.85 % of newborns per season. Considering also hospitalization expenses, coverage reaches 46.4 % of infants, or 66.2 % if unspecified bronchiolitis is included. These results suggest notable cost savings and greater coverage, supporting a universal RSV initiative.

Objectives To examine the correlation between health literacy (HL) and susceptibility to food-related fake news, and to explore the role of social media and influencers in shaping consumers’ food choices.Design Cross-sectional survey conducted via an online questionnaire.Setting Nine community pharmacies located in northern, central and southern Italy.Participants A total of 2284 consumers recruited between January and March 2024.Results Lower HL levels were significantly associated with poorer self-reported education, health and economic status, as well as precarious employment. These same variables were linked to a higher likelihood of believing and spreading food-related fake news. Individuals from socioeconomically disadvantaged backgrounds were also more likely to trust influencers who influenced their food choices.Conclusions HL plays a key role in reducing the susceptibility to food-related misinformation, particularly in lower socioeconomic groups. Targeted interventions aimed at improving HL may help mitigate the spread of fake news and empower individuals to make healthier food choices.

During the COVID-19 pandemic, some studies suggested that transmission events could originate from schools. This study aimed to evaluate early-warning methods for identifying asymptomatic COVID-19 cases by implementing screening programs in schools. This study was conducted between September 2021 and May 2023, employing a rotation-screening plan for COVID-19 detection on a sample of students aged 14 to 19 years attending secondary schools in the regions of Tuscany, Veneto, Apulia and Friuli-Venezia Giulia. The schools were divided into two groups: experimental and control, with a ratio of 1:2. Two types of molecular salivary tests for SARS-CoV-2 were used to conduct the screening. This study included 16 experimental schools and 32 control schools. Out of 2527 subjects, 11,475 swabs were administrated, with 9177 tests deemed valid for analysis (a 20% loss of tests). Among these, 89 subjects (3.5%) tested positive. In control schools, 1895 subjects (6.5%) tested positive for SARS-CoV-2. This study recorded peaks in infections during the winter and autumn months, consistent with patterns observed in the general population. Beginning in September 2022, a shift occurred, with 2.6% of positive cases reported in the case schools compared to 0.3% in the control schools. Initially, most cases of COVID-19 were detected in the control schools; however, as the pandemic emergency phase concluded, cases were primarily identified through active screening in experimental schools. Although student participation in the active screening campaign was low during the project’s extension phase, this approach was efficacious in the early identification of positive cases.

OBJECTIVES:to review pneumococcal vaccination recommendations in at-risk adults and people aged 65 years or over across the Italian Regions. DESIGN:mapping review of available online resources, both at regional and local health unit level, on pneumococcal vaccination programmes by age and risk group. SETTING AND PARTICIPANTS:the review included institutional websites of regional and local health authorities, freely accessible to the public via generic search engines, containing information on pneumococcal vaccination in frail people. MAIN OUTCOME MEASURES:the following information was collected and classified: • populations targeted by the immunization programme; • type of recommended vaccine (conjugate and/or polysaccharide); • adopted vaccination schedule; • mode of patient contact; • involved health professional; • availability of vaccination registry; • availability of vaccination coverage data; • presence of online awareness campaigns. RESULTS:a total of 24 institutional websites, representative of all Italian Regions, were included in the review. More than 90% of the recommendations collected were published between 2023 and 2024. In 75% of the analyzed documents, the Regions offer pneumococcal vaccination to the cohort aged 65 years; in 46% of the documents, the offer is extended to all persons aged 65 years and over. In 96% of the resources, the vaccination programme includes at-risk adults, and 75% of these give details of the diseases for which vaccination is recommended. In seven resources, it is reported that Regions recommend a single dose of the 20-valent pneumococcal conjugate vaccine, in the others the use of the pneumococcal conjugate vaccine (PCV) followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is indicated, with different schedules. In at-risk adults, 83% of the documents recommend the sequential schedule with PCV followed by PPSV23, with time schedules defined in 63% of cases. The mode of patient contact is reported in 7 web resources, 4 of which include sending an invitation letter at 65 years of age. Vaccination center health professionals (16/24) and general practitioners (15/24) are the healthcare providers most involved in promoting and administering vaccination. In 71% of the resources, the regional health authorities were reported to have promoted targeted communication campaigns. Data on PCV coverage by age were available for 6 Regions, but not by risk group. CONCLUSIONS:the findings of this study highlight significant heterogeneity in the offer of pneumococcal vaccination to at-risk adults and people aged 65 years and older among Italian Regions. Greater efforts are needed to standardize and harmonize vaccination policies and to coordinate vaccination communication. The integration of immunization registries with high-risk patient clinical data will allow the systematic identification of vaccine candidates and facilitate the monitoring of vaccination coverage.

BACKGROUND:The continuous emergence of SARS-CoV-2 variants and subvariants poses significant public health challenges. The latest designated subvariant JN.1, with all its descendants, shows more than 30 mutations in the spike gene. JN.1 has raised concerns due to its genomic diversity and its potential to enhance transmissibility and immune evasion. This study aims to analyse the molecular characteristics of JN.1-related lineages (JN.1*) identified in Italy from October 2023 to April 2024 and to evaluate the neutralization activity against JN.1 of a subsample of sera from individuals vaccinated with XBB.1.5 mRNA. METHODS:The genomic diversity of the spike gene of 794 JN.1* strain was evaluated and phylogenetic analysis was conducted to compare the distance to XBB.1.5. Moreover, serum neutralization assays were performed on a subsample of 19 healthcare workers (HCWs) vaccinated with the monovalent XBB.1.5 mRNA booster to assess neutralizing capacity against JN.1. RESULTS:Sequence analysis displayed high spike variability between JN.1* and phylogenetic investigation confirmed a substantial differentiation between JN.1* and XBB.1.5 spike regions with 29 shared mutations, of which 17 were located within the RBD region. Pre-booster neutralization activity against JN.1 was observed in 42% of HCWs sera, increasing significantly post-booster, with all HCWs showing neutralization capacity three months after vaccination. A significant correlation was found between anti-trimeric Spike IgG levels and neutralizing titers against JN.1. CONCLUSIONS:The study highlights the variability of JN.1* in Italy. Results on a subsample of sera from HCWs vaccinated with XBB.1.5 mRNA booster vaccine suggested enhanced neutralization activity against JN.1.

Influenza can cause serious complications in individuals with chronic diseases. Although vaccination is strongly recommended for the high-risk population, uptake remains suboptimal. This retrospective cohort study assessed the relationship between demographic, clinical, and socio-economic (SE) factors and influenza vaccination uptake among high-risk patients in the Apulia region over four influenza seasons (2019–2023). Data on comorbidities, vaccination history, and demographics were extracted from the User Fee Exemption Registry, the Immunization Information System, and the Total Population Register, respectively. Each geocoded case was linked to the Italian National Deprivation Index to determine SE status at the census tract level. Descriptive statistics, logistic regression, and multilevel mixed general linear models were used to analyze factors associated with vaccination uptake. Vaccination coverage among people with longstanding illnesses was 35.5

Respiratory syncytial virus (RSV) is a leading cause of hospitalization in infants, resulting in millions of cases and hundreds of thousands of deaths worldwide every year. Nirsevimab, a long-acting monoclonal antibody approved in 2023, has 75%-90% protection against RSV-related admissions. This study evaluated the effectiveness of nirsevimab in preventing RSV-hospitalization among infants in southern Italy during 2024-2025 season. Active surveillance was conducted in all hospitals in the Foggia district. Infants born between January 2024 and March 2025 who were hospitalized with lower respiratory tract infections from October 2024 to April 2025 were tested for RSV. Information on immunoprophylaxis was provided by the Regional Immunization Information System. The effectiveness of nirsevimab was estimated using the screening method, a test-negative case-control design and a cohort study approach. Of the 4820 eligible infants, 2635 (54.7%) were immunized. Of the 256 infants admitted with lower respiratory tract infections, 82 tested positives for RSV; of these, 13 had received immunoprophylaxis. The effectiveness was estimated to be 84.4% (95% CI: 71.7-91.4%) using the screening method, 72.5% (42.1%-87.0%) using the test-negative design, and 81.6% (66.4-90.0) using the cohort approach. As in previous study, these findings showed than nirsevimab provide substantial protection against RSV-related hospitalization.

The early innate immune response to vaccination plays a crucial role in shaping adaptive immunity and long-term protection. In this study, we investigated the early cytokine response to COVID-19 and flu vaccination and its association with mid-term humoral immunity. Twenty-nine healthcare workers (HCWs) who received the monovalent SARS-CoV-2 XBB.1.5 mRNA vaccine along with the seasonal quadrivalent inactivated influenza vaccine were enrolled. Serum samples were collected at baseline (T0), five days (T1), three months (T2), and six months (T3) post-vaccination. The levels of seven innate cytokines and chemokines were quantified at T0 and T1, while anti-trimeric spike (S) IgG titers were measured at T0, T2 and T3. Our analysis revealed a significant increase in CXCL10, TNF-α, and IL-6 at T1, whereas CCL3 and IL-8 mean levels remained unchanged. Spearman's correlation analysis showed a coordinated activation of inflammatory mediators, with IL-6 and IL-8 exhibiting the strongest correlation. Notably, early cytokine responses were associated with humoral immunity, as IL-6 and IL-8 levels at T1 were negatively correlated with anti-trimeric S IgG titers at T2 and T3. These findings suggest that early inflammatory cytokine increases may limit the persistence of vaccine-induced antibody response.

Introduction. Adherence to COVID-19 vaccination has declined with the decrease in epidemic waves, despite the clearly higher risk of infection and hospitalization among the unvaccinated. Misinformation, cognitive biases, and other not always measurable factors have contributed to vaccine refusal. Although some studies have explored the causes of vaccine hesitancy, the knowledge of the effect of socio-cultural and economic conditions are still limited. Objective. This analysis aims to evaluate the association between adherence to the first COVID-19 vaccine booster dose (3rd dose) and available deprivation indices (Caranci index and ISTAT’s social and material vulnerability index), to understand whether the social context influences the population’s vaccination behaviour. Methods. A retrospective observational study was conducted on the population residing in Apulia eligible for the first COVID-19 vaccine booster dose between January 1, 2021, and December 31, 2022. Demographic data were obtained from ISTAT [1], while vaccination status information was retrieved from the regional vaccination registry (GIAVA) in aggregated form (number of vaccinated individuals) by municipality of residence, sex, and age. The social and material vulnerability index (ISMV), provided by ISTAT [2], consists of a score with a reference value of 100 (higher values indicate greater vulnerability) determined by seven vulnerability indicators (single-parent households, large household size, illiteracy, elderly members, unemployment, economic hardship). The Caranci deprivation index (ID) [3] is also calculated using census data and is based on five indicators: poor education, job shortages, poor housing, and family conditions. The applied model is a multivariable Poisson regression, with the number of individuals vaccinated with the booster dose as the dependent variable, and ISMV (or ID), sex, and age group as independent variables. Additionally, the COVID-19 case rate was considered as an adjustment variable. Results. The percentage of residents in Apulia who received the booster dose progressively decreases from 75% among individuals with ISMV <99 to 70% among those with ISMV >102, with no significant differences by sex. The age-stratified analysis (<60 and ≥60 years) has shown, among individuals aged ≥60, a slight reduction in the percentage who received the booster dose from 81% (ISMV <99) to 74% (ISMV >102), while the decline is more pronounced in the population <60 years, dropping from 70% with ISMV <99 to 63% with ISMV >102. All factors included in the model are statistically significant, in both model with the ID or the ISMV. The model with ISMV (Figure 1) has shown that in the ISMV >102 class the acceptance of the vaccination is lower compared to classes with lower vulnerability, with rate ratios of 0.97 (0.95–0.99), 0.97 (0.95–0.99), 0.95 (0.93–0.97), and 0.94 (0.92–0.96) for the 101–102, 100–101, 99–100, and <99 classes, respectively. Conclusions. The analysis revealed a significant association between socioeconomic deprivation and lower adherence to the third dose of the COVID-19 vaccine. The decline is more pronounced among individuals under 60 with high levels of vulnerability, while no significant differences emerged with respect to gender. A limitation of the study is the use of aggregated data, which does not allow for in-depth individual-level analysis and may lead to a generalization of the results (a possible “ecological fallacy”). Nevertheless, the findings suggest that in specific social contexts, there are groups—defined by age and vulnerability status—that could benefit from targeted communication strategies aimed at increasing awareness and addressing vaccine hesitancy. Funding. Funded by the European Union – Next Generation EU, Mission 4 Component 2 CUP H93C22000640007, Project PE_0000007.

Objectives Influenza vaccination is a key preventive measure, especially for professional athletes exposed to increased infectious risk due to intense physical activity, frequent travel, and close-contact settings. However, data on vaccine uptake and attitudes in this group are limited. This study examined opinions, behaviors, and determinants of influenza vaccination adherence among male athletes in the Italian Serie A volleyball league during the 2024/25 season to inform targeted immunization strategies. Design Cross-sectional observational study. Methods A self-administered anonymous questionnaire was distributed to 157 athletes between December 2024 and March 2025. Collected variables included socio-demographic characteristics, vaccination history, perceived influenza risk, vaccination importance, and influencing factors such as medical advice and club policy. Results Of 138 respondents (response rate: 87.9 %), 44.9 % intended to vaccinate in the current season, and 63.8 % had been vaccinated previously. Overall, 76.1 % recognized the importance of vaccination. Key motivations were medical recommendations (61.6 %) and club policies (25.4 %). Significant associations were found between perceived influenza risk and vaccination intention (p < 0.001), and between medical recommendation and perceived importance (OR = 3.45, p < 0.01). Age showed no significant association. Conclusions Although vaccination is widely regarded as important among professional athletes, adherence is strongly influenced by organizational factors. Medical advice and club support are critical drivers of vaccine acceptance. Tailored communication strategies, integration of vaccination into routine sports medicine, and structured immunization programs are recommended to improve coverage in elite sports and support public health goals.

The growth of scientific literature on large language models (LLMs), such as ChatGPT, anticipates their central role for accessing health information but poses potential risks, including the false belief that artificial intelligence (AI) could replace doctors in providing reliable information. Our study, part of the Slow AI project launched in partnership with the Slow Medicine ETS Association, reviewed the literature on ChatGPT use by the public, analyzing citizens' and patients' perceptions of using AI for health-related questions, identifying key benefits and concerns, and providing recommendations for the safe and effective use of LLMs. We conducted a narrative review following PRISMA guidelines, including qualitative, quantitative, and mixed-methods studies, selected through a search of the PubMed database. Data were extracted and analyzed using a predefined form. Out of 388 records, 120 studies were included, primarily from the USA (65), Europe (19), and Asia (15). Most studies focused on general medicine (37), with patients (57) being the main participants. Key findings include that LLMs improve access to health information, aiding diagnostic accuracy and patient understanding. However, risks exist, such as inaccurate or outdated information, lack of empathy, and privacy concerns. These challenges highlight the need for reliable AI training with real-world data and clinician oversight to mitigate risks. Lastly, while LLMs can improve communication, they should complement, not replace human interaction. LLMs in healthcare offer great potential but also present risks. Safeguards and clinician oversight are crucial to preserve patient safety and doctor-patient relationship.