Comparison of rubella immunization rates in immigrant and Italian women of childbearing age: Results from the Italian behavioral surveillance system PASSI (2011-2015)

Abstract

BackgroundInternational migration rapidly increased in the last decade, raising a renewed attention to its impact on public health. We evaluated differences in rubella immunization rate (RIR) between immigrant and Italian women of childbearing age and tried to identify the driving factors causing them.MethodsWe analyzed data from the Italian behavioral surveillance system PASSI collected in 2011–2015 in a nationally representative sample of residents in Italy. The analysis was performed using log-binomial models to compare RIR between 41,094 Italian women and 3140 regular immigrant women of childbearing age (18–49 years), stratifying the latter by area of origin and length-of-stay in Italy (recent: ≤ 5-years; mid-term: 6-10-years; long-term: > 10-years).ResultsImmigrant women showed a RIR of 36.0% compared to 60.2% among Italian women (RIR-ratio = 0.60, 95% confidence interval (CI): 0.57–0.63). Adjusting for demographic characteristics (i.e., sex, age and area of residence), socio-economic factors (i.e., education, occupation, family composition and economic status) and an indicator of the presence of at least one health-risk behavior (i.e., physical inactivity, current cigarette smoking, excessive alcohol consumption and excess weight) did not significantly change this difference (RIR-ratio = 0.56, 95% CI: 0.53–0.59). Recent immigrants (RIR-ratio = 0.47, 95% CI: 0.42–0.53) and immigrants from high migratory pressure countries (HMPC) in sub-Saharan Africa (RIR-ratio = 0.41, 95% CI: 0.31–0.56) and Asia (RIR-ratio = 0.42, 95% CI: 0.33–0.53) showed the greatest differences in RIR compared with Italian women.ConclusionsDifferences in RIR between immigrant and Italian women were not explained by different demographic, socioeconomic and health-risk behaviors characteristics. As entitlement to free-of-charge immunization in Italy is universal, regardless of migration status, other informal barriers (e.g., cultural and barriers to information access) might explain lower RIRs in immigrant women, especially recent immigrants and those from HMPC in sub-Saharan Africa and Asia. Further investigations are needed to identify obstacles and appropriate promotion and access-enabling strategies for rubella immunization.

Rubella serosurvey and factors related to vaccine hesitancy in childbearing women in Italy

“…In this study, women born abroad seem to be well represented due to their frequent access to hospital care for VTP and delivery procedures, but our data showed differences to that extracted from the last surveys on serological status among childbearing immigrants in Italy (Fabiani et al, 2017; Lo Giudice et al, 2014; De Paschale et al, 2012). We may speculate that it was probably due to their epidemiological characteristics, possibly related to both origin from not-high migratory pressure countries and sufficient length-of-stay in Italy contributing to higher responsiveness to public health agenda targets.…”

Defining the determinants of under-vaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review

“…We did not identify a strong overall association with gender/sex or age in the data. Seven (24,41,42,44,45,79,80) out of 10 studies found no association with gender/sex and seven (28,29,42,75,79,81,85) out of 16 studies found no association with age. Of the nine studies reporting an association with age, the direction of association varied across samples, and the broadly different reference groups mean it is not possible to draw reliable conclusions.…”

“…Thirty-seven studies (23, 24, 28-30, 41, 42, 44, 45, 47, 49, 51, 59, 67-90) (70,81); Syria (30,44); Iraq (44,47); Afghanistan (47,81); Iran (47)); six studies with Asian origin (28,70,72,74,86,89), and two studies with Central/South America origin (73, 74) (See Table 4 for full list of associations). Six (28,29,75,(79)(80)(81) out of eight studies found that under-vaccination was significantly associated with more recent migration to the host country (28,29,75,79,81) or lower acculturation with the host society (80).…”

“…Thirty-seven studies (23, 24, 28-30, 41, 42, 44, 45, 47, 49, 51, 59, 67-90) (70,81); Syria (30,44); Iraq (44,47); Afghanistan (47,81); Iran (47)); six studies with Asian origin (28,70,72,74,86,89), and two studies with Central/South America origin (73, 74) (See Table 4 for full list of associations). Six (28,29,75,(79)(80)(81) out of eight studies found that under-vaccination was significantly associated with more recent migration to the host country (28,29,75,79,81) or lower acculturation with the host society (80). Other common predictors of under-vaccination included higher income (3 out of 4 studies; (41,45,85), being a refugee/asylum seeker (2/3 studies; (49, 81)), having not accessed healthcare in more than a year (2/2; (41, 45)), having no private health insurance (2/2; (41,45)) and region of residence (2/2; (28,45)).…”

“…Six (28,29,75,(79)(80)(81) out of eight studies found that under-vaccination was significantly associated with more recent migration to the host country (28,29,75,79,81) or lower acculturation with the host society (80). Other common predictors of under-vaccination included higher income (3 out of 4 studies; (41,45,85), being a refugee/asylum seeker (2/3 studies; (49, 81)), having not accessed healthcare in more than a year (2/2; (41, 45)), having no private health insurance (2/2; (41,45)) and region of residence (2/2; (28,45)). Specific familial characteristics, such as parental education level, difficulties speaking the host country language or larger family size were also associated with under-vaccination.…”