Vaccination Offer during the Occupational Health Surveillance Program for Healthcare Workers and Suitability to Work: An Italian Retrospective Cohort Study

Round 1

Reviewer 1 Report

This paper evaluated multifaceted psychological and social indicators influencing willingness to receive a COVID-19 vaccine booster dose. Although there is some interesting material presented in the manuscript, there are some important omissions and limitations that need to be addressed. In addition, a revision in English is required to improve the quality of the text.

 

 

 This paper evaluated multifaceted psychological and social indicators influencing willingness to receive a COVID-19 vaccine booster dose. Although there is some interesting material presented in the manuscript, there are some important omissions and limitations that need to be addressed. In addition, a revision in English is required to improve the quality of the text.

 

Major Revision

Abstract

LINE 25: specify to the period of the study.

 

LINE 29: write IC data and OR as at LINE 30.

 

LINE 71: For a more international breath, the results of other countries Japan, Australia, USA, Europe, etc. should be added.

 

Methodology

 

Measures

LINE 112-145 There are many sub-paragraphs on the description of the questionnaire. I would suggest that we have a single paragraph where the questionnaire for each individual question and the different types of response should be detailed. In addition, add the references for the construction of the questionnaire.

 

Statistical analysis

LINE 172: Adding the reference of Hosmer-Lemeshow statistics.

 

Results

Specify the response rate

 

Table 1

Table 1 is too long, should be better organized to make reading more immediate.

I could suggest two tables. The first to present the data of the main characteristics of the participants and the univariate analysis and the second to present the data related to the multivariate analysis.

 

Discussion

Comparisons with studies in other countries should be added.

 

Limitations

Add the limits derived from the cross-sectional study;

Add the limits derived from the non-probability convenience sampling;

Add the limits derived from the survey;

Finally, explain what has been done to attempt to overcome the limits described

Author Response

Q1. This paper evaluated multifaceted psychological and social indicators influencing willingness to receive a COVID-19 vaccine booster dose. Although there is some interesting material presented in the manuscript, there are some important omissions and limitations that need to be addressed. In addition, a revision in English is required to improve the quality of the text.

A1. We revised according to your suggestions.

 

Q2. LINE 25: specify to the period of the study.

A2. The study period is December 2017-october 2021, as already reported in the abstract.

 

Q3. LINE 29: write IC data and OR as at LINE 30.

A3. Revised.

 

Q4. LINE 71: For a more international breath, the results of other countries Japan, Australia, USA, Europe, etc. should be added.

A4. We added these evidences in the discussion paragraph.

 

Reviewer 2 Report

 

Summary

The manuscript is well written, well structured, and therefore easy to read. The manuscript describes the impact of a program to rise vaccine coverage in health care workers. In summary it shows, that hospital procedures, easy access to vaccination and dedicated human assets show a good benefit in increasing vaccine coverage within a closed setting but on a public base an additional  public health strategy is mandatory.

Comments to Authors:

Dear Authors,

I thank the authors for their efforts in providing an interesting insight in methods to increase vaccine coverage in health care setting. In general, the paper is well written and the work is thoroughly performed. To my opinion, there are only minor remarks that should be addressed:

Minor remarks:

1)      Abstract: line 31: Please correct “public health…” into “Public health …”

2)      Materials and Methods: Line 73: please revise the sentence linguistically, did you mean “This is a retrospective cohort study.”

3)      Materials and Methods: Line 74-76 : needs linguistic revision

4)      Materials and Methods: Line 94: please explain why 20 to 25 days were selected. 25 days seems ok, but 20 days could be a bit short to get the full seroconversion as MMR and VZV are live attenuated vaccines and it normally takes about 28 days until a full seroconversion  can be detected. As the virus has to replicate at first bevor the immunsystem can start with an appropriate answer.

5)       Materials and Methods: Line 117. What do you mean with “imputed”? Do you mean “entered”

6)      Results: Line 138: please change “mansion” into “profession”

7)      Results: Line 175: please correct “avents” into “events”

8)      Results: Line177: “sequelae” should be changed into “consequences”

9)      Discussion:Line 201-205: please revise the sencence linguistically, the meaning is not completely clear

10)   Discussion: Line 255: please change “…to job in…” into “… to work in…”

 

Author Response

Q1. Abstract: line 31: Please correct “public health…” into “Public health …”

A1. Revised.

 

Q2. Materials and Methods: Line 73: please revise the sentence linguistically, did you mean “This is a retrospective cohort study.”

A2. Revised.

 

Q3. Materials and Methods: Line 74-76 : needs linguistic revision

A3. Revised.

 

Q4. Materials and Methods: Line 94: please explain why 20 to 25 days were selected. 25 days seems ok, but 20 days could be a bit short to get the full seroconversion as MMR and VZV are live attenuated vaccines and it normally takes about 28 days until a full seroconversion  can be detected. As the virus has to replicate at first bevor the immunsystem can start with an appropriate answer.

A4. Revised, it was a typo from another paper.

 

Q5. Materials and Methods: Line 117. What do you mean with “imputed”? Do you mean “entered”

A5. Revised.

 

Q6. Results: Line 138: please change “mansion” into “profession”

A6. Revised.

 

Q7. Results: Line 175: please correct “avents” into “events”

A7. Revised.

 

Q8. Results: Line177: “sequelae” should be changed into “consequences”

A8. Revised.

 

Q9. Discussion:Line 201-205: please revise the sencence linguistically, the meaning is not completely clear

A9. Revised.

 

Q10. Discussion: Line 255: please change “…to job in…” into “… to work in…”

A10. Revised.

Reviewer 3 Report

Overall, this paper is solid; however, it requires proofreading. The premise is solid and the methdology is straight-forward.

The topic has general scientific interest in understanding vaccine non-adherence and presents a potential solution to improving HCW adherence to vaccines.

Here are points of confusion in the paper:

1.  In the abstract, the authors note: The active immunization of health care workers (HCWs) is a crucial measure to avoid 15 nosocomial infection; neverthless, vaccine coverage (VC) among health personell is not sufficient.

What is sufficient?  The authors never set this bar. This sentence should be reworded for precision and clarity.

2. Next sentence in the abstract:

To rise VC in the healthcare set, the Hygiene and Occupational Medicine departments of Bari Poli-17 clinico General University-Hospital applied a specific program.

Rise is a poor word choice.  Improve might be a better word choice. Stating the goal of the pilot (e.g., imrpove VC by 10% in HCW) would be even better.

3. In the abstract, defining susceptibility rates is important for clarity.  Do that mean poor/low titers, vaccine non-adherence, or both?

4. Adding a paragraph discussion for primary vaccine failures (failure to develop a titer) and the options would improve the manuscript.

5. In the abstract,  the authors state "Our experience suggests that, 29 despite hospital procedures and dedicated human assets, satisfactory VC can not be reached with-30 out the provision of federal regulations. public health policymakers have to select between the im-31 plementation of the promotion or the approval of a mandatory strategy."

The authors could take a stand based on the evidence in the paper. to improve the paper.

6.  A discussion of why only MMRV was selected for the program would improve the paper's analysis and readability. 

7.  The demographics should be presented in a table for clarity.

8.  Authors note "At the end of the study period, 3.5% of tested subjects were susceptible to measles or 178 had not received vaccine prophylaxis, 5.2% to mumps, 4.3% to rubella and 2.6% to Vzv."

Referencing a table would be helpful here.  What is meant by susceptible?  No titers? and what is this in relation to in terms of adherence?

9. The last paragraph's analysis is missing analysis.  This paper presents evidence about promotion rather than mandates.  The authors then proceed to espouse mandates.  More discussion on improving adherence rather than mandates would be appropriate for this manuscript.

 

 

 

 

 

 

Author Response

Q1. In the abstract, the authors note: The active immunization of health care workers (HCWs) is a crucial measure to avoid 15 nosocomial infection; neverthless, vaccine coverage (VC) among health personell is not sufficient. What is sufficient?  The authors never set this bar. This sentence should be reworded for precision and clarity.
A1. Revised.

 

Q2. Next sentence in the abstract. To rise VC in the healthcare set, the Hygiene and Occupational Medicine departments of Bari Poli-17 clinico General University-Hospital applied a specific program. Rise is a poor word choice.  Improve might be a better word choice. Stating the goal of the pilot (e.g., imrpove VC by 10% in HCW) would be even better.

A2. Revised.

 

Q3. In the abstract, defining susceptibility rates is important for clarity.  Do that mean poor/low titers, vaccine non-adherence, or both?

A3. Revised.

 

Q4. Adding a paragraph discussion for primary vaccine failures (failure to develop a titer) and the options would improve the manuscript.

A4. We added few sentences in limitations paragraph.

 

Q5. In the abstract,  the authors state "Our experience suggests that, 29 despite hospital procedures and dedicated human assets, satisfactory VC can not be reached with-30 out the provision of federal regulations. public health policymakers have to select between the im-31 plementation of the promotion or the approval of a mandatory strategy." The authors could take a stand based on the evidence in the paper. to improve the paper.

A5. Revised.

 

Q6. A discussion of why only MMRV was selected for the program would improve the paper’s analysis and readability.

A6. MMRV were chosen because we considered them of particularly scientific interest, considering that in Italy many oubreaks of measles were record in the years before COVID pandemic.

 

Q7. The demographics should be presented in a table for clarity.

A7. Revised.

 

Q8. Authors note “At the end of the study period, 3.5% of tested subjects were susceptible to measles or 178 had not received vaccine prophylaxis, 5.2% to mumps, 4.3% to rubella and 2.6% to Vzv.” Referencing a table would be helpful here.  What is meant by susceptible?  No titers? and what is this in relation to in terms of adherence?

A8. We can not describe another table because the journal guidelines does not allow more than 5 tables. We revised the text.

 

Q9. The last paragraph’s analysis is missing analysis.  This paper presents evidence about promotion rather than mandates.  The authors then proceed to espouse mandates.  More discussion on improving adherence rather than mandates would be appropriate for this manuscript.

A9. Revised.

Round 2

Reviewer 1 Report

None

Author Response

thank you

Reviewer 3 Report

This paper is acceptable in current revision.

The first sentence of the abstract does not say "in Italy".  It makes it sound like it is a problem everywhere.  Slight revision necessary to clarify.

 

The authors discuss vaccine failures in terms of secondary vaccine failures (at least that is what the authors wording suggests.).  One sentence distinguishing the impact on types would be helpful.

Author Response

Dear referee, we revised the text according to your suggestions.  Our study did not focus on secondary vaccine failure