(to vaccinate) or - Igienisti on line

The VaccinarSì Project: how to be informed about
vaccinations. The Italian web portal of medical information
about vaccinations created under the supervision of SItI
(Italian Society of Hygiene and Public Health).
Ferro A1, Montante A2, Baldo V2, Signorelli C3,6, Bonanni P4, Castiglia
P5, Conversano M6.
1Department of Prevention, ULSS 17, Este, (Padova), Italy.
2Department of Molecular Medicine, Institute of Hygiene, University of Padova, Padova, Italy.
3Department SBIBIT, Public Health Unit, University of Parma, Parma, Italy.
4Department of Health Sciences, University of Firenze, Firenze, Italy.
5Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
6Società Italiana di Igiene (SItI) – Italian Society of Hygiene and Public Health
Speaker: Carlo Signorelli, MD, MSc, PhD 7th European Public Health Conference Glasgow, 20th November 2014 ABSTRACT
Background. Nowadays internet has become a major means of communication. Over the last few years web performances have
been implemented with a diversification and an enrichment of the services offered. As a result, the use of internet devices has been
largely increasing. In this context, more and more families (in particular young parents) rely on information available on the web even
to choose whether or not to get their children vaccinated.
Immunization is among the most successful and cost-effective public health measures, given its huge positive impact on population
health. Nevertheless, there has always been much debate surrounding vaccination; nowadays, its detractors take advantage of web
to spread anti-vaccine information, often incorrect, through websites, blogs and forums to encourage vaccine refusal. The
misleading information in this field is enhancing skepticism and mistrust in public health Institutions and affects negatively the health
policies. In this context, under the supervision of the Italian Society of Hygiene and Public Health (Società Italiana di Igiene - SItI),
the VaccinarSì project has been created, in order to oppose the anti-vaccine misinformation.
Objective. The objectives of the VaccinarSì project are:
•to provide deep, scientific and easily comprehensible information, promoting an evidence-based approach in opposition to the
misinformation available on the web;
•to underline the importance of vaccinations drawing attention to their benefits;
•to involve public health institutions and authorities about the use of the web as a tool for information research;
•to raise the awareness of communication agencies and the media about a proper scientific knowledge dissemination.
Methods. The target of the VaccinarSì project are:
•the general population and especially families;
•Health workers of the immunization services placed in the Local Health Agencies, as well as all the health workers involved in the
vaccination process (pediatricians, general practitioners, gynecologists, etc.).
To reach this target population, several information devices have been created and are currently implemented, such as: a web
portal, tutorial multimedia presentations, video films, paper-based tools and scientific articles.
Results. The web portal (http://www.vaccinarsi.org) has been put out on 8th May 2013 and over one hundred webpages, on several
topics concerning vaccination, are now available. During this first year also the Forum, the periodical Newsletter, with the news for
the subscribers, and a Facebook and a Twitter profile have become operational. Since the creation of the web portal, an upward
trend in the web traffic has been registered, reaching 3,000 visits per day in March 2014 (the average for the last two months is
2,393), with a total of 453,873 visits so far and 360,202 unique visitors the majority of which are health workers. The visibility of the
website is very good: it obtains the first position on Google search engine, when the keyword chosen is “vaccinarsi” (to vaccinate) or
“vaccinazioni” (vaccinations). Although the vast majority of visits to the portal come from Italy, 4.2% of its users are from other
countries, especially European ones (2.8%). The website has also recently obtained the International HONcode Certification
released by the international independent organism Health On Net Foundation.
Conclusions. The results of the website activity during this first year are extremely encouraging and confirm the importance of such
an initiative. The information tools and the website content provided are permanently implemented and in the future an international
expansion of the project will be also considered.
Vaccine Hesitancy Reasons for vaccination hesitancy Perception that
disease is not
harmful
Perception that
vaccine is harmful
(ie autism)
Lack of knowledge
about
immunisation
Low perception of
risk of acquiring
the disease
Belief in natural
medicine
Lack of knowledge on how
vaccines are formulated
(ie use adjuvants)
Other barriers (ie to MMR vaccina2on) Bosnia-­‐Herzegovina mumps outbreak, 2010–20112 ACributed to failure to vaccinate during war and post-­‐war period (1992–1998) The Netherlands, 2007–20093 Religious objecJon (orthodox Protestant) was reason for non-­‐vaccina2on in majority of unvaccinated people (72–93%)* Lack of knowledge among healthcare workers and parents: varying aUtudes and prac2ce Increasing popularity of alternaJve therapies (e.g. homeopathy, chiroprac2c) *Different databases produced different case numbers in this analysis
1. 
2. 
Muscat M. Mumps surveillance report 2011;1–6; 2. Hukic M, et al. EuroSurveill 2011;16:pii=19959;
3. Wielders CC, et al. EuroSurveill 2011;16:pii=19989.
Annual MMR coverage (%)
Measles-­‐containing vaccine coverage in the UK declined following Wakefield publica2on (rela2onship MMR-­‐au2sm) 100
90
80
UK steps up MMR campaign
Publication of the Lancet paper
70
1990
1995
2000
2005
Year
2010
2012
8 VaccinaJon coverage rate ITALY…
VaccinaJon coverage rate 9 Regione
Piemonte
Valle d'Aosta
Lombardia
P.A. Bolzano
P.A. Trento
Veneto
Friuli Venezia Giulia
Liguria
Emilia Romagna
Toscana
Umbria
Marche
Lazio
Abruzzo
Molise
Campania
Puglia
Basilicata
Calabria
Sicilia
Sardegna
POL3
96,7
93,7
96,0
88,8
94,5
93,7
94,3
95,7
96,1
95,8
97,1
96,8
98,0
97,7
94,6
92,7
95,7
99,0
94,2
95,3
96,8
DTP3
96,6
93,2
95,8
88,3
94,3
93,7
94,2
95,8
95,8
95,9
96,7
96,7
97,9
97,7
94,6
92,7
95,7
99,0
94,2
95,3
96,8
DT-DTP3
96,8
93,8
96,0
88,8
94,4
93,8
94,6
95,8
96,0
96,0
96,8
96,8
97,9
97,7
94,6
92,7
95,7
99,0
94,2
95,3
96,8
EpB3
96,5
93,1
95,8
88,3
94,1
93,5
93,8
95,7
95,8
95,7
96,6
96,7
99,1
97,7
94,6
92,7
95,7
99,0
94,2
95,3
96,8
Italia
Parametro di riferimento
95,4
95,0
95,3
95,0
95,4
95,0
95,3
95,0
Facts
…
MPR1-MPRV M-MPR1-MPRV
92,1
92,1
83,5
83,9
92,6
92,6
68,9
68,9
86,3
86,3
89,8
90,0
87,8
87,8
85,6
85,8
91,1
91,3
90,0
90,1
93,0
93,1
87,4
87,4
88,5
88,5
92,4
92,4
84,5
84,5
86,8
86,8
90,6
90,6
91,3
91,3
87,6
87,6
88,9
88,9
91,1
91,1
88,1
95,0
88,1
95,0
Hib3
96,2
92,9
95,2
89,4
93,6
93,3
93,7
95,3
95,3
95,7
96,6
96,7
97,8
97,7
94,6
92,6
95,6
99,0
80,8
95,3
96,7
94,5
95,0
Consequences 10 Facts…
Congenital Rubella.
Italian Regional data
New Media CommunicaJon Internet use in Italy (and EU)
Internet use in families with at least one child. (half of them use internet for medical informaJon ) Dati ISTAT 2012
12 From B. Gellin, 2014
MisinformaJon on the Internet 14 BEHIND THE ANTIVACCINATION MOVEMENT ILLITERACY
Economic Interest groups:
Alternative Medicine
IDEOLOGICAL
OBSCURANTISM
Conspiracy Theories
In this context, the Italian Society of Hygiene,
Preventive Medicine and Public Health (SItI)
decided to support a web project in order to fight
the misinformation on the web regarding
vaccinations, through a series of information tools,
including scientific articles, educational
information, video and multimedia presentations.
This project is called…..
Which received an unconditioned support from FARMINDUSTRIA
and the patronage of the Ministry of Health
The VaccinarSi Project -­‐ ObjecJves •  To provide deep, scienJfic and easily comprehensible informaJon, promoJng an evidence-­‐based approach in opposiJon to the misinformaJon available on the web; •  To underline the importance of vaccinaJons drawing aZenJon to parents’ and paJents’ benefits; •  To involve public health insJtuJons and authoriJes in the use of the web as a tool for informaJon research; •  To raise the awareness of communicaJon agencies and the media about a proper scienJfic knowledge disseminaJon. The VaccinarSi Project -­‐ Methods •  The target of the VaccinarSì project are: –  The general populaJon and – in parJcular -­‐ the families; –  Healthcare workers involved in immunizaJon services and programmes at the local and regional level (pediatricians, GP’s, gynecologists, etc.) •  To reach this target populaJon, several informaJon devices have been created and are currently implemented, such as: a web portal, tutorial mulJmedia presentaJons, video films, paper-­‐based tools and scienJfic arJcles •  All supported by a “high profile” ScienJfic CommiZee Vaccinarsi.org …launched.. May 8th, 2013
The VaccinarSi on the Social Media RESULTS
VaccinarSì is supported by the Italian Ministero della Salute and the Istituto
Superiore di Sanità, and many Associations (like FIMP – Federazione
Italiana Medici Pediatri, FIMMG – Federazione Italiana Medici di Famiglia e
SIP – Società Italiana di Pediatria).
Vaccinarsi.org is HON certified.
The HONcode certification is an ethical standard aimed
at offering quality health information.
20 Results / 1 •  Since it was launched -­‐ 8th May 2013 -­‐ vaccinarSì.org published over one hundred webpages, on several topics •  During this first year also the Forum, the periodical NewsleZer, with the news for the subscribers, and a Facebook and a TwiZer profile have become operaJonal. •  Since the creaJon of the web portal, an upward trend in the web traffic has been registered, reaching 3,000 visits per day in March 2014 (the average for the last two months is 2,393), with a total of 453,873 visits so far and 360,202 unique visitors the majority of which are healthcare workers. Results / 2 •  The visibility of the website is very good: it obtains the first posiJon on Google search engine, when the keyword chosen is “vaccinarsi” (to vaccinate) or “vaccinazioni” (vaccines) •  Although the vast majority of visits to the portal come from Italy, 4.2% of its users are from other countries, especially European ones (2.8%) RESULTS
May 2013 – September 2014
AUDIENCE
AGE
75,5% : 18-44
GENDER
MALE: 54,1%
FEMALE: 45,8%
23 RESULTS
May 2013 – September 2014
NUMBERS OF VISITS BY PAGE
24  
 
 
 
 
102.773:Hexavalent
76.227: MMR
56.702: HPV
53.417: Vaccines available
42.037: Against misinformation
Users
RESULTS
May 2013 – September 2014
The visibility of
the site is very
good and it
currently
Ranks almost
first in the
Google’s italian
search engine.
25 giugno 20, 2015 CommunicaJon BEFORE vaccinarSì
7,5% Wikipedia
7,5% Vaccinazioni Estero
7,5% Altro
40% istituzionali
35% Antivaccini
Key words used for search: Vaccino Vaccini Vaccinazione Vaccinazioni 26 CommunicaJon AFTER vaccinarSì
Key words used for search: Vaccino Vaccini Vaccinazione Vaccinazioni 27 Conclusions •  The results of the website acJvity during this first 15 months are extremely encouraging and confirm the importance of such an iniJaJve •  The informaJon tools and the website content provided are permanently implemented and in the future an internaJonal expansion of the project will be also considered •  IniJaJves like this should be much more supported by NaJonal and Regional AuthoriJes (in fact the Veneto Region has recently set up an agreement for a sec:on of this portal) Thank you for your a,en.on
Other IniJaJves / 1 (InsJtuJonal) •  Great interest of Italy in the
vaccination policy.
•  In the context of the 12 “Action
Packages” described in the Global
HealthSecurity Agenda, Italy has
held a leadership role in the
Action Package “Immunization”
Italian Ministry of Health
Beatrice Lorenzin
“The State of vaccination in EU”
Rome, 3rd October, 2014
ITALIAN PRESIDENCY OF THE EU
Other IniJaJves / 2 (APP) APP from the Ministry of Health
to be personalised for each
child. It contains the national
immunization schedule (but not
the regional ones !)
Other IniJaJves / 3 (booklet) A booklet containing the 48
questions most commonly
asked by antivaccinists to
vaccination centers personell
(with the appropiate answers).
Set up by the PH professionals
of Region Apulia and supported
by the Italian Society of Hygiene
(SItI)
http://www.sitiappulolucana.it/images/
pdf.scaricabili/vademecum_2014_def.pdf
Other IniJaJves / 4 (Life-­‐course immunizaJon schedule) Vaccino 5° mese 6° mese 7° mese 11° mese DTPa DTPa IPV IPV EpB-­‐EpB* Ep B Hib Hib Pneumococco PCV13 MPRV MPR Epatite B 0gg-­‐30gg 3° mese 4° mese DTPa IPV DTPa 6° anno DTPa** IPV 12°-­‐18° anno 19-­‐49 anni 50-­‐64 anni dTpaIPV > 64 anni 1 dose dTpa*** ogni 10 anni IPV Ep B* Ep B 3 Dosi: Pre Esposizione (0, 1, 6 mesi) 4 Dosi: Post Esposizione (0, 2, 6 sett. + booster a 1 anno) o Pre Esposizione imminente (0, 1, 2, 12) Hib PCV13 Hib PCV13 Meningococco C Meningococco B Men B Men B Men B HPV Influenza Herpes Zoster Rotavirus Epatite A PCV13^^ MPRV MPR V Men C o Men C o Men B MPRV MPR MPR + V oppure MenACWY MenACWY coniugato coniugato Men B PCV13/PPV23 (vedi note) 2 dosi MPR**** + V (0-­‐4/8 settimane) MPR + V MenACWY coniugato 1dose PCV13 o
p
p
u r e Influenza°° Rotavirus## 15° mese Varicella 13° mese HPV°: 2-­‐3 dosi (in funzione di età e vaccino); fino a età massima in scheda tecnica 1 dose all'anno 1 dose all'anno 1 dose# EpA### EpA### 2 dosi (0-­‐6-­‐12 mesi) Other IniJaJves / 5 (media) Incentivate experts presentation
or interview about immunization
practices on national and local
media
Other IniJaJves / 6 (vaccinaJon point) At the 47th National Congress
of the Italian Society of Hygiene
(SItI) was set up a “vaccination
point” to promote pneumococcal
vaccination in adults. About 60
delegates underwent the
vaccination (including the
President of SItI, in the picture).
Other IniJaJves / 7 (research) Thank you for your a,en.on