Increased Vaccination Coverage among Adolescents and Young Adults in the District of Palermo as a Result of a Public Health Strategy to Counteract an 'Epidemic Panic'

"The fear of meningitis, managed by the Sicilian public health authorities, had positive impacts in terms of prevention. In particular, the communication strategies that were adopted contributed to educating Sicilian young adults about vaccination issues."

During the summer of 2016, four cases of invasive meningococcal disease (IMD) in rapid succession among young adults in the district of Palermo, Italy, resulting in one death, were widely reported by local and national mass media. The aim of this study was to assess whether such an emergency, together with communication strategies and measures provided by the Sicilian public health authorities, could lead not only to an increase in the anti-meningococcal vaccination coverage among adolescents and young adults but also to a positive effect on vaccine compliance in the general population and increased coverage of other vaccinations of the Sicilian schedule.

As reported here, after each meningitis case occurred, punctual communication by public health authorities was carried out through institutional channels and mass media in order to inform the general population and to reassure the public about the risk of contracting the disease. Despite this, "the local and national media coverage of the cases was disproportionate, dedicating a large amount of space for news regarding the 'outbreak' on every platform, including newspapers, television, websites and social networks. In the following days, news and updates about each suspected case were disseminated without waiting for the laboratory confirmation of the case and without a response from the local health authorities to the potentially inaccurate information reported. This situation caused an unjustified fear of contagion among the general population and the incorrect notion that it was a real meningitis outbreak. As a consequence, subjects of all ages, but above all adolescents and young adults, swamped vaccination services, not only in the city of Palermo but also in the entire district to request anti-meningococcal vaccinations." The researchers explain that the panic among the general population probably originated from the fear that what occurred in the Tuscany Region in 2015, where there has been a noticeable increase in cases of IMD due to a particularly aggressive Neisseria strain, could be repeated in Sicily.

Strategies implemented by the Sicilian and local public health authorities to counteract the panic included: (i) extension of active and free-of-charge anti-meningococcal tetravalent vaccination from 12-18 to 12-30 years; (ii) during the second semester of 2016 (from July until December), the offer of catch-up vaccinations of anti-diphtheriatetanus-pertussis + poliomyelitis (dTpa + IPV-diptheria, tetanus, pertussis, and inactivate poliomyelitis) and the anti-papillomavirus (HPV) vaccinations to all subjects attending vaccination services for the anti-meningococcal tetravalent vaccine; (iii) implementation of vaccination units during normal clinic hours in rooms tailored for vaccine administration; and (iv) development of informative institutional tools and timely communication throughout local mass media to reassure the general population. For example, numerous interviews with local and national media by public health authorities took place throughout the summer, and public announcements were made to explain the real risk. In addition, both on the official website of the local health unit and in the main sites where youth gathered (e.g., schools, public places, and nightlife venues), informative material on preventive measures for meningitis infection was disseminated.

The data analysed in the present study showed a consistent increase in the anti-meningococcal vaccination rates in the two cohorts of 16- and 18-year-olds. Specifically, as a result of the above-described efforts efforts, in 2016, an increase in the anti-meningococcal coverage was observed in the Palermo district (+18% for 16-year-olds and +14% for 18-year-olds) and at the regional level (+11.2% and +13.5%, respectively). Concurrent catch-up of other recommended vaccinations (diphtheria-tetanus-pertussis-poliomyelitis and HPV) resulted in a further increase of administered doses.

The researchers explain that, though alarm of a potential epidemic was unjustified, as correctly reiterated by the public health authorities. "The demand for vaccination services in the days immediately following the first two cases of meningitis confirmed that communication to the general population on relevant public health topics should not be left to journalists who are not experts in the field. This event allowed counselling to be given to adolescents and young adults on the anti-meningococcal vaccination and also allowed for the catch-up of any vaccinations not carried out previously (i.e., anti-HPV, anti-dTpa + IPV). The observed increase in anti-meningococcal vaccination coverage and of the other vaccinations was a positive effect of the 'epidemic of panic'." Specific suggestions for future similar circumstances:

• On the institutional level, public health authorities should adopt effective communication strategies to provide timely and effective information on appropriate prevention measures and regulated access for the population to receive vaccination services.
• At the local level, healthcare workers of the vaccination services can tailor counselling to adolescents and young adults in order to promote a greater confidence in vaccination.
• The media should address health issues by using appropriate medical expert to inform the population of the risks and dangers through risk-minimisation strategies.
• Public health authorities should be aware of new communication platforms of which adolescents and young adults are the main users.