Invasive Meningococcal Disease and Meningococcal Serogroup B Vaccination in Adults and Their Offspring: Knowledge, Attitudes, and Practices in Italy (2019)

Abstract

Despite its effectiveness in preventing invasive meningococcal disease (IMD), pediatric uptake of recombinant meningococcal vaccination for serogroup B meningitis (MenB) is low in Italy. This study aimed to investigate knowledge, attitudes, and practice (KAP) about IMD and the vaccine uptake for MenB from July to December 2019, in a sample collected from a series of local Facebook discussion groups from the provinces of Parma and Reggio Emilia (North-Eastern Italy; 337,104 registered users). A self-administered anonymous web-based questionnaire was used to collect demographics, knowledge status, perceived risk for contracting meningitis, attitude towards the utility of meningococcal vaccine, and willingness to receive/perform MenB vaccine in their offspring. In total, 541 parents returned a fully completed questionnaire (response rate of 1.6% of potential recipients), with a mean age of 39.2 years ± 6.3 (78.1% females). Meningococcal infection was identified as severe or highly severe by most participants (88.9%), while it was recognized as being frequent/highly frequent in the general population by 18.6% of respondents. The overall knowledge status was unsatisfactory (57.6% ± 33.6 of correct answers to the knowledge test). Even though 63.4% of participants were somewhat favorable to MenB/MenC vaccines, offspring's vaccination towards MenB was reported by only 38.7% of participants. In a binary logistic regression model, the male gender of respondents (adjusted odds ratio [aOR] 3.184, 95% confidence interval [95%CI] 1.772 to 5.721), living in a municipality >15,000 inhabitants (aOR 1.675, 95%CI 1.051 to 2.668), reporting a favorable attitude on meningococcus B vaccine (aOR 12.472, 95%CI 3.030 to 51.338), having been vaccinated against serogroup B (aOR 5.624, 95%CI 1.936 to 16.337) and/or serogroup C (aOR 2.652, 95%CI 1.442 to 4.872), and having previously vaccinated their offspring against serogroup C meningococcus (aOR 6.585, 95%CI 3.648 to 11.888) were characterized as positive effectors of offspring's vaccination. On the contrary, having a higher risk perception on vaccines was identified as the only negative effector (aOR 0.429, 95%CI 0.241 to 0.765). Our results hint towards extensive knowledge gaps on IMD and preventive interventions in the general population, suggesting that a positive attitude towards vaccines and vaccinations could be identified as the main effector also for MenB acceptance. Interventions in the general population aimed at improving confidence, compliance, and acknowledgment of the collective responsibility, as well as preventing actual constraints and the sharing of false beliefs on infectious diseases and their preventive measures, could therefore increase vaccination acceptance in both targeted individuals and their offspring.

Keywords: knowledge; meningitis; meningococcus; risk perception; vaccine preventable diseases.

Figure A1

Geographical areas involved in the survey (i.e., provinces of Parma and Reggio Emilia). Original maps available from open source material: https://it.m.wikipedia.org/wiki/File:Map_of_comune_of_Reggio_nell%27Emilia_%28province_of_Reggio_Emilia,_region_Emilia-Romagna,_Italy%29.svg, https://it.m.wikipedia.org/wiki/File:Map_of_comune_of_Parma_(province_of_Parma,_region_Emilia-Romagna,_Italy).svg and https://it.m.wikipedia.org/wiki/File:Italy_map_with_provinces.svg (accessed on 16 January 2023).

Figure A2

Density plots on General Knowledge Score (GKS) for the sample as a whole (No. = 1010, 100% of the sample), classified as having or not having received the vaccine against serogroup B meningococcus. Overall distribution did not pass the normality check (D’Agostino–Pearson K2 = 149.5); individuals having been vaccinated with MenB reported higher estimates (77.6% ± 21.5 vs. 61.4% ± 30.8; Mann–Whitney U 84,557.5, p < 0.001).

Figure A3

Density plots for Risk Perception Score (RPS) on Neisseria meningitis B serogroup (MenB) natural infections (a) and vaccines (b) for the whole of the sample (i.e., 1010 respondents). All cumulative scores were substantially skewed (K2 = 6.830, p = 0.033 for RPS on natural infections; K2 = 219.7, p < 0.001 for RPS on vaccines). When cumulative scores were classified as having or not having received MenB vaccine, perceived RPS was higher among vaccinated than among unvaccinated (50.9% ± 19.2 vs. 42.6% ± 21.1; Mann–Whitney (M–W) U 79,134.0, p < 0.001), while RPS was conversely lower among vaccinated than among unvaccinated (12.8% ± 17.6 vs. 23.4% ± 23.6; M–W U 47,625.0, p < 0.001).

Figure A4

Correlation between General Knowledge Score (GKS), Risk Perception Score (RPS), on the side effects of Meningitis B vaccine and Neisseria meningitidis natural infection in all participants (No. = 1010). Subfigure (a) RPS on vaccines vs. GKS; subfigure (b) RPS on natural infection vs. GKS; subfigure (c), RPS on natural infection vs. RPS on vaccine. In fact, GKS was positively correlated with RPS on natural infection (Spearman’s rho = 0.400, p < 0.001) and negatively correlated with RPS on vaccine side effects (rho = −0.666, p < 0.001), while RPS on vaccines and natural infection were negatively correlated (rho = −0.235, p < 0.001).

Figure 1

Flow chart of included questionnaires.

Figure 2

Density plots on General Knowledge Score (GKS) for participants fulfilling all inclusion criteria (No. = 558, 55.2% of the original sample), classified as having or not having received MenB vaccine. Distributions did not pass the normality check (D’Agostino–Pearson K2 = 8486.0; p < 0.001); individuals having been vaccinated against meningococcus serogroup B (MenB) reported substantially higher estimates (74.7% ± 24.6 vs. 47.5% ± 34.5; Mann–Whitney U 48,958.0, p < 0.001).

Figure 3

Density plots for Risk Perception Score (RPS) on Neisseria meningitis B serogroup natural infections (a) and vaccines (MenB) (b) in participants reporting any son/daughter (No. = 558, 55.2% of the original sample). All cumulative scores were substantially skewed (K2 = 11.36, p = 0.003 for RPS on natural infection; K2 = 72.75, p < 0.001 for RPS on vaccines). When cumulative scores were classified as having or not having received MenB, the perceived RPS for natural infection was higher among vaccinated than among unvaccinated (44.8% ± 20.5 vs. 39.8% ± 23.7; Mann–Whitney (M–W) U 39,307.0, p = 0.017), while RPS for the vaccine was conversely lower among vaccinated than among unvaccinated (16.8% ± 21.3 vs. 32.9% ± 26.2; M–W U 19,615.0, p < 0.001).

Figure 4

Correlation between General Knowledge Score (GKS), Risk Perception Score (RPS), on the side effects of Meningitis B vaccine and Neisseria meningitidis natural infection in participants with children (No. = 558, 55.2% of the original sample): subfigure (a) RPS on vaccines vs. GKS; subfigure (b) RPS on natural infection vs. GKS, subfigure (c) RPS on natural infection vs. RPS on vaccines. GKS was positively correlated with RPS on natural infection (Spearman’s rho = 0.432, p < 0.001) and negatively correlated with RPS on vaccine side effects (rho = −0.725, p < 0.001), while RPS on vaccines and natural infection were negatively correlated (rho = −0.238, p < 0.001).