Knowledge, Attitudes, Practices (KAP) of Italian Occupational Physicians towards Tick Borne Encephalitis.

Matteo Riccò,Nicola Luigi Bragazzi,Silvia Ranzieri,Pietro Ferraro,Giovanni Gualerzi

doi:10.3390/tropicalmed5030117

Abstract

Tick-Borne Encephalitis (TBE) is an occupational health threat with increasing incidence in the geographic area of Italy. Despite this, TBE vaccination rates have ranged from 10% to 40% in Italy, even in at-risk workers. The reasons for this low rate are investigated in this present study of the knowledge, attitudes, and practices of occupational physicians (OP) regarding TBE disease and vaccination in at-risk workers. A total of 229 OP participated in an internet-based survey by completing a structured questionnaire. Adequate general knowledge of TBE disease was found in 58% of OP. Accurate perception of TBE risk in occupational settings was found in 20%. TBE vaccination for at-risk workers was recommended by 19%. Willingness to recommend TBE vaccination was more likely by OP practicing in endemic areas (Odds Ratio 3.10, 95% confidence intervals 1.47–6.55), who knew the existence of the term “arboviruses” (3.10, 1.29–7.44), or exhibited a better understanding of TBE (2.38, 1.11–5.12)—and were positive predictors for promoting TBE vaccine, while acknowledging that TBE as a severe disease was a negative one. Tick-borne disorders in Italy are a still rare (but increasing) occupational health threat, and vaccination gaps for TBE virus may find an explanation in OP incomplete knowledge of evidence-based recommendations.

Highlights

Tick-borne encephalitis (TBE) is a potentially lethal vaccine-preventable infection of the central nervous system (CNS) caused by an arbovirus (TBE virus, or TBEV) included within the Flavivirus genus, Flaviviridae family [1]
41.9% of participants came from Northern regions (i.e., Valle d’Aosta, Piemonte, Liguria, Lombardia, Veneto, Trentino-Südtirol, Friuli-Venezia-Giulia, Emilia-Romagna), 40.6% came from Central Italy (i.e., Toscana, Umbria, Marche, Abruzzo, Lazio), and residual 17.5% from Southern regions (i.e., Campania, Molise, Puglia, Basilicata, Calabria) and major islands of Sicilia and Sardinia
Our results suggest an extensive lack of knowledge of sampled occupational physicians on TBE vaccination

Summary

Introduction

Tick-borne encephalitis (TBE) is a potentially lethal vaccine-preventable infection of the central nervous system (CNS) caused by an arbovirus (TBE virus, or TBEV) included within the Flavivirus genus, Flaviviridae family [1]. The geographical distribution of the competent vector, Ixodes spp., is expanding as an effect of climate change For this reason, previously spared countries have become endemic for TBE [8,10,11], in northern regions and in mountainous territory, whose forests support the life cycle of Ixodes ricinus [1,2,3,8,9]. Recent estimates suggest that some smaller areas in the aforementioned regions of Trentino (1.0 case/100,000 inhabitants for the province of Trento as a whole during 2000–2013, peaking to 41.6 in the municipality of Tres), Friuli-Venezia-Giulia (1.0 case/100,000 inhabitants for the whole province of Udine, but 181.2/100,000 for the community of Tramonti di Sopra in the time period 2000–2013) [3,12], and Veneto (e.g., 5.95/100,000 population in the province of Belluno 2007–2018, peaking to 35.9/100,000 in the municipality of Limana in 2000–2013), [2] largely exceed national TBE estimates [3,8,9,12,13], and could be classified as highly endemic areas (i.e., >5 cases/100,000 inhabitants/year) according to current World Health Organization (WHO) definition [1,2,3,6,7,8,9,12]

Methods

Results

Discussion

Conclusion