Cristiana Ferrari

RESEARCH, TEACHING, or OTHER INTERESTS

Medicine, Health Policy, Infectious Diseases, Epidemiology

Scopus Publications

The Influence of Occupational Factors on Contact Dermatitis in Symptomatic Healthcare Workers: A Patch Test Study †
Cristiana Ferrari, Giuseppina Somma, Viola Giovinazzo, Margherita Iarossi, Michele Treglia, Margherita Pallocci, Luca Di Giampaolo, Andrea Magrini, and Luca Coppeta
MDPI AG
Healthcare workers (HCWs) are frequently exposed to a variety of chemical agents, which can result in the development of allergic or irritant contact dermatitis. The present study aimed to assess the prevalence of skin sensitization among HCWs who presented with symptoms of contact dermatitis, considering both occupational and non-occupational risk factors. The study population comprised 127 HCWs who attended routine occupational health surveillance at the Tor Vergata Teaching Hospital in Rome between November 2023 and May 2024. A structured dermatitis questionnaire and patch testing were administered to the participants. Demographic and lifestyle data, including information on occupation, night shift work, smoking habits, and body mass index (BMI), were collected. Patch test positivity was observed in 31.5% of participants, with the most common clinical presentation being erythematous-desquamative allergic contact dermatitis. A significantly higher likelihood of patch test positivity was observed among nurses (57.1%), particularly for nickel sensitization, compared to other occupational groups. A trend towards an association between night shift work and skin sensitization was observed, although this did not reach statistical significance. No significant associations were found for ages over 35 years, sex, or BMI. These findings highlight the elevated risk of contact sensitization among nurses, emphasizing the need for targeted interventions, including exposure reduction strategies and protective measures, to mitigate occupational skin hazards in healthcare settings.


A Survey of the Knowledge, Attitudes and Practices of a Sample of Albanian Medical Students in Relation to Occupational Exposure to Biological Agents
Lorenzo Ippoliti, Luca Coppeta, Ersilia Buonomo, Giuseppina Somma, Giuseppe Bizzarro, Cristiana Ferrari, Andrea Mazza, Agostino Paolino, Claudia Salvi, Vittorio Caputi,et al.
MDPI AG
(1) Background: Exposure to blood carries the risk of transmission of many infectious diseases. Healthcare workers (HCWs), including hospital-based medical students, face high and often under-reported rates of exposure to needlestick and sharps injuries. Previous studies have shown that students’ knowledge of infection control varies, highlighting the importance of pre-placement training. This study aims to assess knowledge, attitudes and practices regarding these risks in a population of medical students from Albania. (2) Methods: A validated questionnaire was administered to 134 medical students in an Italian hospital in May 2023. It assessed HBV vaccination status, adherence to infection control practices, knowledge of pathogen transmission, exposure incidents and attitudes towards infected patients. Three additional questions addressed air-borne transmission of tuberculosis and vaccination recommendations for healthcare workers. (3) Results: Most students (64%) reported being aware of occupational exposure risks. While 93% and 87%, respectively, recognised HIV and HBV as blood-borne pathogens, fewer recognised Treponema pallidum (44%). Awareness of post-exposure prophylaxis for HIV was high (85%), but although 75% reported having received training, only 45% felt it was adequate. Statistical analysis revealed an association between knowledge of infection control, awareness of pathogen transmission and understanding of the importance of vaccination. (4) Conclusions: Our study highlights gaps in medical students’ knowledge of occupational infections and highlights the need for improved pre-clerkship education. Improved education could reduce anxiety, ethical issues and misconceptions and promote safer healthcare practices.


Low Rates of Immunity among Medical Students and Residents in the Era of the Resurgence of Measles
Cristiana Ferrari, Giuseppina Somma, Vittorio Caputi, Michele Treglia, Margherita Pallocci, Fabian Cenko, Ersilia Buonomo, Mariachiara Carestia, Luca Di Giampaolo, Ole F. Olesen,et al.
MDPI AG
Measles is a highly contagious viral disease spread through respiratory droplets. The number of reported cases increased worldwide in 2023, particularly in the European Region. Italy reported 213 cases in the first quarter of 2024, with most of them in unvaccinated adults aged 15–64. Maintaining high vaccination coverage is essential to prevent outbreaks, especially in healthcare settings where measles transmission is a significant risk. In our study, we collected serological and demographic information from all Italian and foreign medical students and residents (850) who underwent a pre-training assessment at the Tor Vergata Occupational Medicine Service, Rome, between 3 April 2023 and 31 January 2024. Of the 850 students and residents analyzed, we found only 546 (64.2%) with a protective level of IgG antibodies against measles, with a median IgG level of 2.00 AI. A significant proportion of students and residents were serologically non-immune, raising concerns about the potential risk of hospital transmission. To manage this risk, it is important to assess serological levels, vaccinate those with inadequate levels, and promote vaccination in the general population.


Forensic Characterisation of Complex Suicides: A Literature Review
Margherita Pallocci, Pierluigi Passalacqua, Claudia Zanovello, Luca Coppeta, Cristiana Ferrari, Filippo Milano, Santo Gratteri, Nicola Gratteri, and Michele Treglia
MDPI AG
Complex suicides refer to using two or more suicide modes. In the literature, complex suicides are distinguished into planned and unplanned. Using multiple methods is related to ensuring a fatal result or because the first method appears too painful, time-consuming, or ineffective. The review aims to provide an overview of the critical features of complex suicides in the forensic context. The review was conducted by searching online databases (PubMed Central and Scopus) up to March 2023. We identified 52 articles that met the inclusion criteria, describing 261 cases. Suicides were classified as planned in 136 cases (52.1%); 105 cases (40.2%) were defined as unplanned, while in the remaining 20 cases (7.7%), the authors did not propose any classification. In 2/261 (0.8%) cases, four modes were indicated, three modes were observed in 34/261 cases (13%), and in 224/261 (85.8%) cases the suicides were carried out using a combination of two distinct methods. The method most frequently employed in the first instance in unplanned suicides were sharp-force injuries and stabbing, followed by mechanical asphyxia (hanging, self-strangulation, plastic bag suffocation) and a fall from height. Regarding planned suicide, the most frequent suicide methods were asphyxia, intoxication (drugs, substances of abuse, or alcohol), and poisoning via toxic substances. Complex suicides represent a relatively rare entity in forensic pathology; nevertheless, they can be challenging for the forensic pathologist in terms of differential diagnosis compared to homicides, due to the sometimes multifaceted presentation.


Questionable Immunity to Mumps among Healthcare Workers in Italy—A Cross-Sectional Serological Study
Cristiana Ferrari, Giuseppina Somma, Michele Treglia, Margherita Pallocci, Pierluigi Passalacqua, Luca Di Giampaolo, and Luca Coppeta
MDPI AG
Highly contagious diseases, such as mumps, are a global concern as new epidemics continue to emerge, even in highly vaccinated populations. The risk of transmission and spread of these viruses is even higher for individuals who are more likely to be exposed, including healthcare workers (HCWs). In healthcare settings, both HCWs and patients are at risk of infection during the care process, potentially leading to nosocomial epidemic outbreaks. Mumps is often underestimated compared with measles and rubella, despite being milder and less likely to spread. In fact, the risk of complications following mumps infection is extremely high, especially if the disease occurs in adulthood. The measles–mumps–rubella (MMR) vaccine has been shown to be an excellent preventive measure. Unfortunately, the mumps component appears to be less effective in inducing immunity than those for measles and rubella (two-dose effectiveness of 85%, 95% and 97%, respectively). The main aim of our study was to investigate the prevalence of detectable mumps antibodies (serum IgG antibodies) in a cohort of Italian and foreign HCWs in relation to personal and occupational factors. We included in the study 468 subjects who underwent health surveillance at the Occupational Medicine Unit of the Tor Vergata Polyclinic in Rome during the period from January 2021 to March 2023. In our study, the proportion of HCWs found to be unprotected against mumps was very high (8.3%), and those found to be immune are below the WHO threshold for herd immunity (95%). From our data, it seems essential that all occupational health services carry out an accurate screening with a dose of anti-mumps antibodies to assess serological protection before starting a job, regardless of an individual’s vaccination history. This approach is proving to be beneficial, accurate, as it allows all serologically non-immune individuals to be vaccinated in the workplace, including those who would be protected by their vaccination history but have lost the antibody response.


Vaccine Hesitancy, Knowledge, and COVID-19 Vaccination in a Sample of Italian and Albanian Healthcare Students Attending an University in Albania
Ersilia Buonomo, Fabian Cenko, Gaia Piunno, Daniele Di Giovanni, Enkeleda Gjini, Bora Kërpi, Mariachiara Carestia, Stefania Moramarco, Cristiana Ferrari, and Luca Coppeta
MDPI AG
Background: Vaccine hesitancy (VH) has increased over the past decade with large geographical variations between countries, posing a threat to global public health. This phenomenon is growing in the general population as well as among healthcare workers (HCWs), who are the most reliable source of vaccine-related information for patients. Special attention must therefore be paid to medical students, who are the future HCWs. Methods: We conducted a cross-sectional study (November 2022–January 2023) on all the Albanian and Italian students attending medical science courses at the Catholic University “Our Lady of Good Counsel” (Tirane, Albania) to investigate VH and the factors contributing to it (using the Vaccination Attitude Examination Scale-VAX), including COVID-19 vaccination. Vaccine knowledge was assessed using the Zingg and Siegrist Scale. Students were asked to voluntarily answer an anonymous questionnaire. Results: 689 questionnaires were collected (58.8% Albanians, 72.3% female; 70.4% aged 20–25 years; 70.4% attending the Medicine and Surgery course). Generally, students showed low VH, especially Italians (p < 0.001); however, some hesitancy was observed regarding the potential long-term effects of vaccines, especially among Albanians (p < 0.05). The results also showed a significant difference in vaccine knowledge scores between different course years (χ2  =  90.058; df  =  40; p = < 0.001) and different degree courses (χ2  =  89.932; df = 40; p  = < 0.001). With regard to COVID-19 vaccination, being of Albanian origin significantly increases the risk of not being vaccinated (OR = 7.215; 95%CI 3.816–13.640, p < 0.001), highlighting possible differences in vaccine coverage and policy between the two countries. Conclusion: Vaccine hesitancy should be addressed at early stages during medical sciences courses, in order to protect future healthcare workers, to preserve essential health services, and reduce the risk of further pandemics.


Assessing gut barrier integrity and reproductive performance following pre-mating oral administration of solid-lipid-nanoparticles designed for drug delivery
Valentina Lacconi, Micol Massimiani, Giulia Antonello, Paolo Gasco, Roberta Bernardini, Cristiana Ferrari, Lorenzo Ippoliti, Gina La Sala, Antonio Pietroiusti, Ivana Fenoglio,et al.
Frontiers Media SA
Solid lipid nanoparticles (SLNs) have gained interest as drug delivery carriers due to their efficient cellular internalization and increased therapeutic effect of the loaded drug, with minimal side effects. Although recently several studies have shown the possibility to administer SLNs during pregnancy to vehicle mRNA to the placenta, data about the effect of premating exposure to SLNs on pregnancy outcome are scant. Considering that assumption of drug-delivering nanocarriers in reproductive age may potentially affect women’s reproductive health, the aim of the present study was to evaluate whether repeated oral administration of SLNs to female mice prior to mating would influence key pregnancy outcomes. For this purpose, SLNs melatonin loaded (SLN + mlt) or unloaded were orally administered to CD1 female mice at two different dosages—low (7.5 mg/kg) and high (750 mg/kg) —three times a week for 6 weeks. Females mice were mated and pregnancy was monitored from conception to delivery. All the assessed pregnancy parameters, including time to pregnancy, pregnancy duration, litter size, and the presence of any gross anomalies in the pups, and maternal key biochemical parameters were not significantly affected by SLN administration. Embryonic development was also evaluated and no effects on the number of implantation sites, fetus numbers, incidence of fetal resorptions, and measurements of crown-rump length, as well as fetal and placental weights, were observed in the treated mothers. The impact of SLNs on maternal intestinal barrier integrity and inflammation was assessed both in vivo in mice and in vitro using an intestinal epithelial barrier model by qRT-PCR. Results showed that unloaded SLNs, but not the SLN + mlt, affected intestinal barrier integrity. Although variation in the expression of inflammatory cytokines was recorded, this did not reflect in significant histological alterations and the integrity of the intestinal barrier was maintained. The in vitro model further confirmed the biocompatibility of SLNs, showing that both loaded and unloaded SLNs did not affect the integrity of the simulated intestinal epithelial barrier. In conclusion, these data suggest that administering SLNs, as a drug delivery vehicle, prior to conception does not affect either maternal health or fetal development, posing no risk to future pregnancy.


Nanomaterials and security in occupational and forensic medicine: insights from nanotoxicology
Lang Tran, Michele Treglia, Luca Coppeta, Cristiana Ferrari, Margherita Pallocci, Luisa Campagnolo, Luiz C. De Miranda Junior, Bruno Piccoli, Sharyn Gaskin, Francisco Cortes Fernandes,et al.
Frontiers Media SA
Nanoenergetics are defined as a class of nanomaterials that possess the ability to release energy in certain situations. These properties have been studied and deepened in recent years, so much so that nanoenergetics have been introduced into the use of the weapons industry, among others. It is therefore an emerging reality that deserves attention with regard to potential harmful effects on human and environmental health. it has been suggested that nanoenergetics may have genotoxic and immunotoxic effects, among others. Problems related to exposure to nanonenergetics can therefore potentially affect both exposed workers (both in the production and use phase) and the civilian population, if used in war scenarios, for example,. Starting from these assumptions, the INNOTOX research project aims to contribute to the in-depth study of the toxicity of nanonenergetics, through an integrated approach involving experts in occupational and forensic medicine, nanotoxicology and bioengineering.


Pulmonary function assessment after COVID-19 in vaccinated healthcare workers
Lorenzo Ippoliti, Luca Coppeta, Giuseppina Somma, Giuseppe Bizzarro, Francesco Borelli, Teresa Crispino, Cristiana Ferrari, Ilaria Iannuzzi, Andrea Mazza, Agostino Paolino,et al.
Springer Science and Business Media LLC
AbstractCOVID-19 typically presents with flu-like symptoms due to the viral infection itself. The most severe cases are characterised by lung damage, an important factor in fatal outcome due to alveolar damage. In some cases, patients develop a long COVID with persistent symptoms of chest pain and fatigue. Causes, including organ damage or inflammation, are being investigated. Clinical outcomes are variable and permanent lung damage is not fully understood, while vaccination is effective against severe infection but its effect on respiratory function in mild cases remains uncertain. This retrospective study aims to analyse changes in lung function in HCWs who had COVID-19 between 2020 and 2022, comparing their spirometric test results before and after the pandemic and taking into account their vaccination status. 321 HCWs were included in the study. The study examined spirometric parameters both before and after the pandemic, and all measured outcomes except the FEV1/FVC ratio showed a significant decrease during the study period. We then assessed the association between SARS-CoV-2 infection and changes in lung function parameters, analysing infections in 2020, 2021 and 2022 separately. We found a statistically significant difference in Forced vital capacity (FVC) between infected and non-infected subjects in 2020 and 2021, but not in 2022. To evaluate the protective effect of SARS-CoV-2 vaccination on respiratory function, a linear regression analysis was performed using changes in FVC, Forced expiratory volume in 1 s (FEV1), FVC/FEV1 ratio and Peak expiratory flow (PEF) as dependent variables. The analysis showed that the decline in FVC was significantly lower in subjects who had been vaccinated prior to infection. The study concludes that subclinical SARS-CoV-2 infections in 2020 and 2021 worsened respiratory parameters (FVC and FEV1), but vaccination protected against these effects. Even healthy individuals with previous infections showed respiratory changes, with vaccination providing protection, especially for FVC decline. This highlights the importance of vaccinating healthcare workers against COVID-19.


Rubella Vaccine Uptake among Women of Childbearing Age in Healthcare Settings
Cristiana Ferrari, Giuseppina Somma, Sandro Gentili, Gianmarco Manili, Gaetano Mauro, Michele Treglia, Marco Trabucco Aurilio, Andrea Magrini, and Luca Coppeta
MDPI AG
Background: Rubella is a contagious viral infection that occurs most often in children and young adults. Rubella is the leading vaccine-preventable cause of birth defects. Rubella infection in pregnant women may cause fetal death or congenital defects known as congenital rubella syndrome. There is no specific treatment for rubella, but the disease is preventable by vaccination with an efficacy of over 95%. Vaccination coverage is still below the recommended levels and many cases have occurred worldwide. The COVID-19 pandemic has had a negative impact on the immunization programs and the quality of disease surveillance worldwide. Operators of the healthcare setting are at increased risk of infection due to their work duties and should receive preventive vaccination or serologic protection to work in a healthcare setting. Aims: To evaluate the serological evidence of rubella IgG antibodies in female healthcare operators of childbearing age, to assess the risk of a breakthrough infection and the need for an additional dose of vaccine. Methods: We collected age and antibody titers from 449 young female operators aged <50 years who underwent the periodic surveillance at the Occupational Medicine Unit of the Policlinico Tor Vergata, Rome, from January to July 2022. Subjects were considered immune if the anti-rubella IgG titer was >11.00 IU/mL. Results: The rate of serologically unprotected subjects was 9.13% (41/449). The mean age of protected subjects was 26.93 years, while the mean age of unprotected subjects was 28.24 years. Age did not correlate with mean titer on statistical analysis (p = 0.10). The acceptance rate among unprotected operators was 31.7%. A positive attitude towards vaccination was found in 11/28 (39.3%) of the unvaccinated subjects, while a negative tendency was found in 2/28 (7.1%) of these subjects; most of the unvaccinated operators 15/28 (53.6%) prefer to postpone the administration of the vaccine. When compared with a similar population from the pre-pandemic period, the actual proportion of immune female subjects was not significantly different from that found in 2019 (90.87% vs. 90.3%). Conclusions: Protection against rubella was suboptimal among female healthcare workers of childbearing age. Acceptance of the rubella vaccine among these operators was low. Most of those who were hesitant intended to postpone the vaccination, while a minority had negative attitudes toward vaccination. A policy of mandatory vaccination policy should overcome the reluctance of operators.


Protective Anti-HBs Antibodies and Response to a Booster Dose in Medical Students Vaccinated at Childhood
Luca Coppeta, Cristiana Ferrari, Greta Verno, Giuseppina Somma, Marco Trabucco Aurilio, Luca Di Giampaolo, Michele Treglia, Andrea Magrini, Antonio Pietroiusti, and Stefano Rizza
MDPI AG
The immune system in humans is regulated by the circadian rhythm. Published studies have reported that the time of vaccination is associated with the immune response to vaccine for some pathogens. Our study aimed to evaluate the association between time of dose administration of challenge HBV vaccine and seroconversion for anti-HBs in medical students vaccinated at birth who were found to be unprotected at pre-training screening. Humoral protection for HBV was assessed in 885 medical students vaccinated during childhood. In total, 359 (41.0%) of them showed anti-HBs titer < 10 UI/mL and received a challenge dose of HBV vaccine followed by post-vaccination screening 30–60 days later. The challenge dose elicited a protective immune response (anti-HBs IgG titer > 10 UI/mL) in 295 (83.8%) individuals. Seroconversion was significantly associated with female gender and time of vaccination after controlling for age group and nationality at logistic regression analysis. Students who received the booster dose in the morning had a higher response rate than those who received the vaccine in the afternoon (OR 1.93; 95% C.I. 1.047–3.56: p < 0.05). This finding suggests that morning administration of the HBV booster may result in a better immune response in susceptible individuals.


Serological Evaluation for Measles among Italian and Foreign Medical Students in a University Hospital in Rome
Luca Coppeta, Cristiana Ferrari, Giuseppina Somma, Viola Giovinazzo, Ersilia Buonomo, Marco Trabucco Aurilio, Michele Treglia, and Andrea Magrini
MDPI AG
Background: Measles infection in the hospital setting is a major issue. Despite the availability of an effective vaccine, measles outbreaks continue to occur in some European countries. We aimed to evaluate the immunological status of medical students attending the Tor Vergata Polyclinic (PTV). Methods: Measles antibodies titers were assessed by venipuncture on a sample of 2717 medical students who underwent annual health surveillance visits from January 2021 to March 2023. Subjects showing serum IgG values above 1.0 S/CO were considered serologically protected. Personal data, country of origin, and main demographic characteristic were also collected. Results: 66.7% (1467 Italian and 346 foreign) of medical students showed protective IgG antibodies levels. Female students were serologically immune more frequently than males (68.6% vs. 63.3%; p < 0.01 at Chi2). The mean antibody titer was 1.72 S/CO, significantly higher in females than males (1.67 vs. 1.75, respectively; p < 0.05), and significantly related to age (p < 0.01). Albanian students, who were the largest foreign population in our study, showed a low serological protection rate (40/90: 44.4%). Conclusions: The proportion of serologically non-immune students is high, raising concerns about the possible risk of hospital transmission. Substantial differences in the rate of immunity have been found between subjects coming from different parts of Europe and the world. Pre-training assessment of all medical students and vaccination of susceptible individuals is highly recommended, particularly for those from low immunization rate countries.


Immunity to measles in COVID-19 era
Cristiana Ferrari, Giuseppina Somma, and Luca Coppeta
Informa UK Limited



Evaluation of Adverse Effects after the Second Dose of BNT162b2 Mrna Vaccination for COVID-19: A Survey-based Analysis among Italian Healthcare Workers
Gianluigi Ferrazza, Alessandro Nucera, Susanna Longo, Cristiana Ferrari, Andrea Mazza, Andrea Magrini, Luca Coppeta, and Stefano Rizza
Bentham Science Publishers Ltd.
Backgrounds and Aims: Since the start of the SARS-CoV-2 pandemic, healthcare workers have been at elevated risk of contracting COVID-19. Although COVID-19 vaccines have contributed to the eradication of, or substantial decreases in, the incidence of lethal diseases, the major determinant of COVID-19 vaccine hesitancy is a fear of associated adverse effects. Here, we performed a survey assessing the reactogenicity and safety of BNT162b2 in a real-world setting. Methods: Data were collected from March 1 and June 14, 2021. A total of 206 hospital employees undergoing BNT162b2 mRNA vaccination completed the survey. These hospital workers received a questionnaire to collect the common and uncommon adverse effects developing 2–6 days after the second dose of the Pfizer-BioNTech vaccine. Results: After the second dose, female sex was found to be associated with a higher risk of vaccine-related severe systemic adverse effects than male sex (odds ratio [OR] 3.116, 95% CI 2.365–7.113). We also observed that the anti-SARS-CoV-2 receptor-binding domain titer, determined on the day when the second dose of the Pfizer-BioNTech vaccine was administered, was significantly higher in participants with severe systemic effects than those without such effects (OR 1.017, 95% CI 1.001–1.034). Conclusion: Our study suggested that healthy female healthcare workers had a three-fold higher risk than healthy male healthcare workers of developing severe adverse effects after the second dose of the Pfizer-BioNTech vaccine. Further research is warranted to determine whether a high anti-SARS-CoV-2 RBD titer determined at the time of the second vaccination might indicate a disproportionate inflammatory systemic reaction leading to severe adverse effects. Our findings might contribute to a decrease in the disappearance of COVID-19 vaccine hesitancy.


Effect of the New Italian Legislative Measures on the Eye Lens Protection of Radioexposed Workers
Cristiana Ferrari, Agostino Paolino, Andrea Vischetti, Alessia Spina, Andrea Magrini, and Luca Coppeta
Bentham Science Publishers Ltd.
Introduction: Legislative Decree no. 101, published on 31 July 2020 in the Italian Official Gazette, the official journal of the Italian Government, sets out the provisions of Directive 2013/59/Euratom, which establishes the basic safety rules for protection against the risks arising from occupational exposure to ionizing radiation. Methods: The main purpose of the legislator was to improve the safety of workers exposed to radiation, updating the previous laws adopted by the Italian government 25 years earlier. Many strategies have been attempted in the past to increase the level of protection of these categories of workers. Still, it is too early to evaluate the effectiveness of the proposed measures. Results: Medical professionals play a leading role among other figures involved in the field of occupational radiation protection. To achieve a reliable and detailed evaluation of the risk assessment, which in Italy must be reported in a specific mandatory report called the “Risk Assessment Document”, the legislator has assigned differentiated but coordinated tasks to all the actors involved with different responsibilities in radiation protection. Conclusion: The drastic reduction of the dose limits for the crystalline lens is a tool for more effective protection of workers against exposure to ionizing radiation.


Measles vaccine uptake among Italian medical students compared to the pre-COVID-19 era
Cristiana Ferrari, Giuseppina Somma, Ole Olesen, Ersilia Buonomo, Matteo Pasanisi Zingarello, Andrea Mazza, Stefano Rizza, Luca Di Giampaolo, Andrea Magrini, Francesca Ponzani,et al.
Informa UK Limited
ABSTRACT The COVID-19 pandemic has severely affected health systems worldwide and raised the issue of vaccine hesitancy. In 2022, the World Health Organization reported an outbreak of measles infection among people over 20 years of age in the European Region. Previous studies found low rates of measles immunization among Italian healthcare workers (HCWs) and medical students. Vaccine hesitancy is a relevant cause of low immunization rate among HCWs and the general population. We aim to evaluate the measles vaccine uptake among medical students of a large teaching hospital, compared to the pre-pandemic period. This is a retrospective observational study, that evaluated the immune status and the vaccine acceptance rate for measles in medical students at the University of Tor Vergata, Rome, who underwent occupational health surveillance from 1 January to 1 December 2022. We also compared the data with the results of a pre-pandemic survey conducted in 2018. Vaccine uptake among unprotected medical students was 59.5%. The data showed no significant difference in vaccine uptake compared with the pre-COVID-19 period. Conversely, the rate of serologically immune subjects to measles increased from 89.66% in 2018 to 97.45% in 2022 as a result of the recent mandatory vaccination policy. Despite efforts to tackle vaccine hesitancy during the COVID-19 pandemic, measles vaccine uptake is still low among young adults starting their medical training, and their compliance with free workplace vaccination offers is suboptimal. Occupational health services should raise awareness among workers and work together to implement strategies to achieve comprehensive measles vaccination coverage among occupational health workers.


Global Policy to Reduce the Incidence of Infection Spreading in Non-Vaccinated Healthcare Workers: A Literature Review
Cristiana Ferrari, Giuseppina Somma, Lorenzo Ippoliti, Andrea Magrini, Luca Di Giampaolo, and Luca Coppeta
MDPI AG
Healthcare workers (HCWs) are at increased risk of SARS-CoV-2 infection because of their occupational exposure. Moreover, they can be a vehicle for the virus transmission among patients. The vaccination of healthcare personnel against COVID-19 is crucial in fighting the spread of SARS-CoV-2 infection, together with strict sanitary procedures that aim to limit the risk of contagion. Unfortunately, even if COVID-19 vaccination has been proved one of the most effective tools for protecting against COVID-19, many healthcare professionals are not yet vaccinated. The aim of the current review is to contribute to identifying an effective strategy for COVID-19 prevention especially among non-vaccinated HCWs. In this review, we collected the most recent and relevant findings from literature on the protection of unvaccinated HCWs, identifying three types of measures as principal actions to protect those operators: addressing vaccine hesitancy, improving non-pharmaceutical interventions and promoting actions at personal level (respiratory hygiene, hand hygiene and use of PPE). All these interventions are very effective in preventing contagion, if well respected and conducted; nevertheless, it is essential to promote vaccination, as it is the most effective measure.


Main Predictors of COVID-19 Vaccination Uptake among Italian Healthcare Workers in Relation to Variable Degrees of Hesitancy: Result from a Cross-Sectional Online Survey
Marco Trabucco Aurilio, Francesco Saverio Mennini, Cristiana Ferrari, Giuseppina Somma, Luca Di Giampaolo, Matteo Bolcato, Fabio De-Giorgio, Roberto Muscatello, Andrea Magrini, and Luca Coppeta
MDPI AG
Background: Hesitancy remains one of the major hurdles to vaccination, regardless of the fact that vaccines are indisputable preventive measures against many infectious diseases. Nevertheless, vaccine hesitancy or refusal is a growing phenomenon in the general population as well as among healthcare workers (HCWs). Many different factors can contribute to hesitancy to COVID-19 vaccination in the HCWs population, including socio-demographic characteristics (female gender, low socio-economical status, lower age), individual beliefs regarding vaccine efficacy and safety, as well as other factors (occupation, knowledge about COVID-19, etc.). Understanding the determinants of accepting or refusing the COVID-19 vaccination is crucial to plan specific interventions in order to increase the rate of vaccine coverage among health care workers. Methods: We conducted a cross-sectional online survey on HCWs in seventeen Italian regions, between 30 June and 4 July 2021, in order to collect information about potential factors related to vaccine acceptance and hesitancy. Results: We found an overall vaccine uptake rate of 96.4% in our sample. Acceptance was significantly related to job task, with physicians showing the highest rate of uptake compared to other occupations. At univariate analysis, the HCWs population’s vaccine hesitancy was significantly positively associated with fear of vaccination side effects (p < 0.01), and negatively related to confidence in the safety and efficacy of the vaccine (p < 0.01). Through multivariate analysis, we found that only the fear of possible vaccination side effects (OR: 4.631, p < 0.01) and the confidence in vaccine safety and effectiveness (OR: 0.35 p < 0.05) remained significantly associated with hesitancy. Conclusion: Action to improve operator confidence in the efficacy and safety of the vaccine should improve the acceptance rate among operators.


Night Shift Work Is Associated with Reduced Rate of Humoral Response Following Vaccination for HBV
Luca Coppeta, Cristiana Ferrari, Marco Trabucco Aurilio, Gianluigi Ferrazza, Andrea Magrini, and Stefano Rizza
MDPI AG
Night shift work has been associated with cardiovascular and metabolic disease, endocrine and immunological disorders. Published studies have reported that a reduced total sleep time with sleep-wake cycle alterations were associated with a reduced rate of humoral response following vaccination. Our study aimed to evaluate the association between night shift work and serological status for HBV among workers employed in a university hospital in Rome. We evaluated medical records of 986 HCWs working at Tor Vergata Policlinic of Rome. We screened all study subjects for anti-HBs IgG, anti-HBc IgG and HBsAg. Serological protection for HBV was evaluated in relation to sex, age group, job task, risk setting and night shift work status. Protective titer was found in 856 (86.8%) study participants and the mean titer was significantly high in females, in subjects aged less than 40 years, in night shift workers and in high-risk setting workers. After adjustment for study covariates, night shift work was no longer associated with an HBV-protective titer. This finding suggests that a vaccination strategy for dampening HBV transmission should be carefully addressed in health care workers (HCWs) doing night shift.


Reduced Titers of Circulating Anti-SARS-CoV-2 Antibodies and Risk of COVID-19 Infection in Healthcare Workers during the Nine Months after Immunization with the BNT162b2 mRNA Vaccine
Luca Coppeta, Cristiana Ferrari, Giuseppina Somma, Andrea Mazza, Umberto D’Ancona, Fabbio Marcuccilli, Sandro Grelli, Marco Trabucco Aurilio, Antonio Pietroiusti, Andrea Magrini,et al.
MDPI AG
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has had a tremendous impact on health services; hundreds of thousands of healthcare workers (HCWs) have died from coronavirus disease 2019 (COVID-19). The introduction of the BNT162b2 mRNA vaccine in Italy provided recipients with significant protection against COVID-19 within one to two weeks after the administration of the second of the two recommended doses. While the vaccine induces a robust T cell response, the protective role of factors and pathways other than those related to memory B cell responses to specific SARS-CoV-2 antigens remains unclear. This retrospective study aimed to evaluate the determinants of serological protection in a group of vaccinated HCWs (n = 793) by evaluating circulating levels of antiviral spike receptor-binding domain (S-RBD) antibodies during the nine-month period following vaccination. We found that 99.5% of the HCWs who received the two doses of the BNT162b2 vaccine developed protective antibodies that were maintained at detectable levels for as long as 250 days after the second dose of the vaccine. Multivariate analysis was performed on anti-S-RBD titers in a subgroup of participants (n = 173) that were evaluated twice during this period. The results of this analysis reveal that the antibody titer observed at the second time point was significantly related to the magnitude of the primary response, the time that had elapsed between the first and the second evaluation, and a previous history of SARS-CoV-2 infection. Of importance is the finding that despite waning antibody titers following vaccination, none of the study participants contracted severe COVID-19 during the observational period.


Factors associated with pre-vaccination sars-cov-2 infection risk among hospital nurses facing covid-19 outbreak
Luca Coppeta, Cristiana Ferrari, Andrea Mazza, Marco Trabucco Aurilio, and Stefano Rizza
MDPI AG
The objective of this work was to evaluate the magnitude of COVID-19 spread and the related risk factors among hospital nurses employed in a COVID hospital in Rome, before the beginning of the vaccination programmes commenced in 2021. Participants periodically underwent (every 15–30 days) nasopharyngeal swab and/or blood sample for SARS-CoV-2 IgG examination. From 1 March 2020 to 31 December 2020, we found 162 cases of COVID-19 infection (n = 143 nasopharyngeal swab and n = 19 IgG-positive) in a total of 918 hospital nurses (17.6%). Most SARS-CoV-2-infected hospital nurses were night shift workers (NSWs), smokers, with higher BMI and lower mean age than that of individuals who tested negative. After adjusting for covariates, age (OR = 0.923, 95% C.I. 0.895–0.952), night shift work (OR = 2.056, 95% C.I. 1.320–2.300), smoking status (OR = 1.603, 95% C.I. 1.080–2.378) and working in high-risk settings (OR = 1.607, 95% C.I. 1.036–2.593) were significantly associated with SARS-CoV-2 hospital infection, whereas BMI was not significantly related. In conclusion, we found a high prevalence of SARS-CoV-2 infection among hospital nurses at a Rome COVID hospital in the pre-vaccination period. Smoking, young age, night shift work and high-risk hospital settings are relevant risk factors for hospital SARS-CoV-2 infection; therefore, a close health surveillance should be necessary among hospital nurses exposed to SARS-CoV-2.


Risk of latent tuberculosis infection among healthcare workers in Italy: a retrospective study with Quantiferon Test
L. Coppeta, C. Ferrari, M. Ferraro, Savino Baldi, Stefania Grande, L. D. De Zordo, Pier Francesco Mattone, Maria Teresa Doddato, Ottavia Balbi, Andrea Magrini,et al.

Summary Objective The latent tuberculosis infection (LTBI) is a state of persistent immune response to stimulation by Mycobacterium Tuberculosis antigens without clinical manifestation: the healthcare workers (HCWs) have a higher exposure risk so prevention is an important challenge for occupational medicine. The aim of our study is to evaluate the prevalence of LTBI among HCWs of the Foundation Policlinic “Tor Vergata”. Methods This is a retrospective study conducted by analyzing the clinical records of 825 HCWs of the PTV, from January 1st to December 31th 2016. To evaluate the TB infection we used the Quantiferon TB Gold interferon-gamma release assay. Results Our study underlines the low prevalence of LTBI in the Italian healthcare workers. Conclusion Although the LTBI status is not contagious, the diagnosis and the safety strategies require specific clinical and preventive considerations.


Persistence of anti-s titre among healthcare workers vaccinated with bnt162b2 mrna covid-19
Luca Coppeta, Giuseppina Somma, Cristiana Ferrari, Andrea Mazza, Stefano Rizza, Marco Trabucco Aurilio, Stefano Perrone, Andrea Magrini, and Antonio Pietroiusti
MDPI AG
The COVID-19 pandemic has led to health, social and economic consequences for public health systems. As a result, the development of safe and effective vaccines, in order to contain the infection quickly became a priority. The first vaccine approved by the Italian Agency for Drugs Authorization (AIFA) was the BNT162b2 mRNA vaccine, developed by BioNTech and Pfizer (Comirnaty). Comirnaty contains a molecule called messenger RNA (mRNA), which is a nucleoside-modified RNA that encodes the SARS-CoV-2 spike glycoprotein. Even if data from phase I suggest that vaccine induced antibodies can persist for up to six months following the second shot of BNT vaccine, data regarding the real duration of immunological protection are lacking. In this study, we aimed to evaluate the duration of serological protection by detecting the presence of anti-S-RBD (receptor-binding domain) antibodies for SARS-CoV-2 among a large group of healthcare workers (HCWs) three months after vaccination. 99% of HCWs had a detectable titre of anti-S SARS-CoV-2 antibodies 90 days after the second vaccine shot. Elderly operators showed significantly lower levels of protective antibodies when compared to the younger ones, thus they could become unprotected earlier than other operators.


Evaluation of immunity for mumps among vaccinated medical students
Cristiana Ferrari, Marco Trabucco Aurilio, Andrea Mazza, Antonio Pietroiusti, Andrea Magrini, Ottavia Balbi, Matteo Bolcato, and Luca Coppeta
MDPI AG
Healthcare workers are considered at higher risk for mumps infection than the general population. Since 2017, the national immunization plan recommended the administration of a dose of measles–mumps–rubella (MMR) vaccine to the healthcare operators who are unable to demonstrate a complete vaccination history or that are seronegative for at least one of the three agents. Regarding mumps infection, based on actual concerns regarding the loss of protection over the years after vaccination, the Advisory Committee on Immunization Practices (ACIP) recommended to administer a third dose of vaccine to operators previously vaccinated with two doses of MMR vaccine who belong to a group at increased risk of mumps infection in the event of an epidemic. This guideline, however, is not currently followed in Italy, resulting in a potential risk for vaccinated operators to become unprotected from mumps over the years. The aim of our study is to evaluate the persistence of a protective antibody level for mumps among medical students vaccinated during infancy or adolescence, at the start of their hospital internship. We retrospectively evaluated mumps-specific IgG levels in a group of medical students, in the period from 1 January to 31 December 2020. We evaluated the persistence of the detectable level of mumps-specific antibodies in relation to their vaccinal status, gender and time elapsed from vaccination. We found that 17.4% (65 subjects) of our sample were seronegative for mumps. The univariate analysis showed a significant difference in serological protection between male and female gender (77.0% vs. 86.2%; p < 0.05 with chi2 test) and between age classes (86.5% vs. 76.4%; p < 0.05 for subjects aged 18–23 years and over 23 years, respectively). Female gender was significantly related to higher serological protection even after adjusting for age classes and number of vaccine doses administered in a multivariate analysis model. Our study shows a substantial percentage of subjects lacking a protective mumps titer among medical students who were vaccinated in childhood. Given the higher risk of infection among those subjects, routine pre-employment screening should be performed among those operators regardless of their vaccination history and a third dose of MMR should be offered to unprotected students.


Intention to be vaccinated for COVID-19 among italian nurses during the pandemic
Marco Trabucco Aurilio, Francesco Saverio Mennini, Simone Gazzillo, Laura Massini, Matteo Bolcato, Alessandro Feola, Cristiana Ferrari, and Luca Coppeta
MDPI AG
Background: While the COVID-19 pandemic has spread globally, health systems are overwhelmed by both direct and indirect mortality from other treatable conditions. COVID-19 vaccination was crucial to preventing and eliminating the disease, so vaccine development for COVID-19 was fast-tracked worldwide. Despite the fact that vaccination is commonly recognized as the most effective approach, according to the World Health Organization (WHO), vaccine hesitancy is a global health issue. Methods: We conducted a cross-sectional online survey of nurses in four different regions in Italy between 20 and 28 December 2020 to obtain data on the acceptance of the upcoming COVID-19 vaccination in order to plan specific interventions to increase the rate of vaccine coverage. Results: A total of 531 out of the 5000 nurses invited completed the online questionnaire. Most of the nurses enrolled in the study (73.4%) were female. Among the nurses, 91.5% intended to accept vaccination, whereas 2.3% were opposed and 6.2% were undecided. Female sex and confidence in vaccine efficacy represent the main predictors of vaccine intention among the study population using a logistic regression model, while other factors including vaccine safety concerns (side effects) were non-significant. Conclusions: Despite the availability of a safe and effective vaccine, intention to be vaccinated was suboptimal among nurses in our sample. We also found a significant number of people undecided as to whether to accept the vaccine. Contrary to expectations, concerns about the safety of the vaccine were not found to affect the acceptance rate; nurses’ perception of vaccine efficacy and female sex were the main influencing factors on attitudes toward vaccination in our sample. Since the success of the COVID-19 immunization plan depends on the uptake rate, these findings are of great interest for public health policies. Interventions aimed at increasing employee awareness of vaccination efficacy should be promoted among nurses in order to increase the number of vaccinated people.