Table 4.
Incorrect answers given in pre- and post-course tests.
| Incorrect Answers | Overall N = 449 (%) |
Pharmacy N = 165 (%) |
Medicine N = 261 (%) |
Hygiene N = 23 (%) |
||||
|---|---|---|---|---|---|---|---|---|
| Pre | Post | Pre | Post | Pre | Post | Pre | Post | |
| Question 1—Vaccines: | 152 (33.9) | 23 (5.1) | 52 (31.5) | 16 (9.7) | 94 (36.0) | 7 (2.7) | 6 (26.1) | - |
| Are comparable in all respects to drugs | 93 (20.7) | 15 (3.3) | 29 (17.6) | 10 (6.1) | 58 (22.2) | 5 (1.9) | 6 (26.1) | - |
| Allow to treat people | 8 (1.8) | - | 1 (0.6) | - | 7 (2.7) | - | - | - |
| All act only at the level of the individual vaccinated subject | 51 (11.4) | 8 (1.8) | 22 (13.3) | 6 (3.6) | 29 (11.1) | 2 (0.8) | - | - |
| Question 2—Combined vaccines are: | 48 (10.7) | 5 (1.1) | 25 (15.2) | 3 (1.8) | 22 (8.4) | 2 (0.8) | 1 (4.4) | - |
| Produced using the recombinant DNA technique | 25 (5.6) | 3 (0.7) | 13 (7.9) | 3 (1.8) | 11 (4.2) | - | 1 (4.4) | - |
| Different vaccines administered in the same vaccination session but in different anatomical sites | 10 (2.2) | 1 (0.2) | 3 (1.8) | - | 7 (2.7) | 1 (0.4) | - | - |
| Very effective but unfortunately they always result in an exponential increase in adverse events | 13 (2.9) | 1 (0.2) | 9 (5.5) | - | 4 (1.5) | 1 (0.4) | - | - |
|
Question 3—Flu vaccines actually
available in Italy are: |
160 (35.6) | 23 (5.1) | 81 (49.1) | 18 (10.9) | 77 (29.5) | 5 (1.9) | 2 (8.7) | - |
| Whole inactivated virus | 127 (28.3) | 18 (4.0) | 67 (40.6) | 14 (8.5) | 58 (22.2) | 4 (1.5) | 2 (8.7) | - |
| Based on anatoxins | 9 (2.0) | 5 (1.1) | 3 (1.8) | 4 (2.4) | 6 (2.3) | 1 (0.4) | - | - |
| Based on polysaccharides | 24 (5.4) | - | 11 (6.7) | - | 13 (5.0) | - | - | - |
| Question 4—What was the first SARS-CoV-2 vaccine to be approved by EMA? | 8 (1.8) | 2 (0.4) | 6 (3.6) | - | 2 (0.8) | 2 (0.8) | - | - |
| Moderna | 2 (0.5) | - | 2 (1.2) | - | - | - | - | - |
| Oxford—AstraZeneca | 4 (0.9) | 1 (0.2) | 4 (2.4) | - | - | 1 (0.4) | - | - |
| Sanofi—GSK | 1 (0.2) | - | - | - | 1 (0.4) | - | - | - |
| J and J (Johnson and Johnson) | 1 (0.2) | 1 (0.2) | - | - | 1 (0.4) | 1 (0.4) | - | - |
| Question 5—The Pfizer-Biontech vaccine differs from the Moderna vaccine in one of the following options: | 127 (28.3) | 21 (4.7) | 66 (40.0) | 14 (8.5) | 60 (23.0) | 7 (2.7) | 1 (4.4) | - |
| It does not need to be reconstituted with the physiological solution. unlike the Moderna vaccine which must be reconstituted | 17 (3.8) | 10 (2.2) | 10 (6.1) | 8 (4.9) | 7 (2.9) | 2 (0.8) | - | - |
| It exploits the mechanism of messenger RNA (mRNA). unlike the Moderna which is made up of purified antigens | 60 (13.4) | 2 (0.5) | 35 (21.2) | 2 (1.2) | 24 (9.2) | - | 1 (4.4) | - |
| It cannot be administered to subjects over 55 years of age | 6 (1.3) | 2 (0.5) | 5 (3.0) | 1 (0.6) | 1 (0.4) | 1 (0.4) | - | - |
| None of the above | 44 (9.8) | 7 (1.6) | 16 (9.7) | 3 (1.8) | 28 (10.7) | 4 (1.5) | - | - |
| Question 6—How many doses of Pfizer-Biontech vaccine can be obtained from each vial. according to the latest AIFA legislation? | 117 (26.1) | 3 (0.7) | 57 (34.6) | 2 (1.2) | 59 (22.6) | 1 (0.4) | 0 (4.4) | - |
| 1 dose | 30 (6.7) | 2 (0.5) | 16 (9.7) | 2 (1.2) | 14 (5.4) | - | - | - |
| 3 doses | 24 (5.4) | - | 14 (8.5) | - | 10 (3.8) | - | - | - |
| 4 doses | 15 (3.3) | - | 11 (6.7) | - | 4 (1.5) | - | - | - |
| 5 doses | 48 (10.7) | 1 (0.2) | 16 (9.7) | - | 31 (11.9) | 1 (0.4) | 1 (4.4) | - |
| Question 7—Development phases of drugs and vaccines in which safety is also assessed are: | 176 (39.2) | 26 (5.8) | 92 (55.8) | 13 (7.9) | 80 (30.6) | 9 (3.4) | 4 (17.4) | 4 (17.4) |
| Phases 1 and 2 | 62 (13.8) | 10 (2.2) | 20 (12.1) | 3 (1.8) | 39 (14.9) | 4 (1.5) | 3 (13.1) | 3 (13.1) |
| Phases 2 and 3 | 59 (13.1) | 10 (2.2) | 29 (17.6) | 6 (3.6) | 29 (11.1) | 3 (1.1) | 1 (4.4) | 1 (4.4) |
| Phase 4 | 55 (12.3) | 6 (1.3) | 43 (26.1) | 4 (2.4) | 12 (4.6) | 2 (0.8) | - | - |
| Question 8—The selection of adjuvants is performed: | 212 (47.2) | 67 (14.9) | 77 (46.7) | 30 (18.2) | 126 (48.3) | 28 (10.7) | 9 (39.2) | 9 (39.2) |
| In phase 3 | 41 (9.1) | 7 (1.6) | 12 (7.3) | 2 (1.2) | 28 (10.7) | 4 (1.5) | 1 (4.4) | 1 (4.4) |
| After vaccine authorisation | 13 (2.9) | 2 (0.5) | 8 (4.9) | 2 (1.2) | 5 (1.9) | - | - | - |
| In phase 1-2 | 158 (35.2) | 58 (12.9) | 57 (34.5) | 26 (15.8) | 93 (35.6) | 24 (9.2) | 8 (34.8) | 8 (34.8) |
| Question 9—The first legislative rules on the development of vaccines date back to: | 318 (70.8) | 123 (27.4) | 133 (80.6) | 66 (40.0) | 171 (65.5) | 42 (16.1) | 14 (60.9) | 15 (9.0) |
| 1950 | 184 (41.0) | 61 (13.6) | 76 (46.1) | 31 (18.8) | 103 (39.5) | 30 (11.5) | 5 (21.7) | - |
| 1970 | 97 (21.6) | 16 (3.6) | 46 (27.9) | 9 (5.5) | 47 (18.0) | 6 (2.3) | 4 (17.4) | 1 (4.4) |
| 1802 | 37 (8.2) | 46 (10.2) | 11 (6.7) | 26 (15.8) | 21 (8.1) | 6 (2.3) | 5 (21.7) | 14 (60.9) |
| Question 10—Which of these is one of the main ethical challenges in vaccination against SARS-CoV-2? | 246 (54.8) | 55 (12.2) | 135 (76.8) | 43 (26.1) | 107 (41.0) | 12 (4.6) | 4 (17.4) | - |
| Splitting of the doses | 54 (12.0) | 20 (4.5) | 26 (15.8) | 14 (8.5) | 28 (10.7) | 6 (2.3) | - | - |
| Adverse effects | 62 (13.8) | 16 (3.6) | 31 (18.8) | 15 (9.1) | 31 (11.9) | 1 (0.4) | - | - |
| mRNA technology | 130 (29.0) | 19 (4.2) | 78 (42.3) | 14 (8.5) | 48 (18.4) | 5 (1.9) | 4 (17.4) | - |
| Question 11—Which groups of subjects were excluded from pre-marketing testing of SARS-CoV-2 vaccines? | 67 (14.9) | 8 (1.8) | 26 (15.8) | 5 (3.0) | 41 (15.7) | 3 (1.1) | - | - |
| Developing countries | 43 (9.6) | 6 (1.4) | 13 (7.9) | 4 (2.4) | 30 (11.5) | 2 (0.8) | - | - |
| Elderly people | 10 (2.2) | - | 5 (3.0) | - | 5 (1.9) | - | - | - |
| Obese patients | 14 (3.1) | 2 (0.5) | 8 (4.9) | 1 (0.6) | 6 (2.3) | 1 (0.4) | - | - |
| Question 12—Authorisation of the Comirnaty vaccine has been granted: | 342 (76.2) | 174 (38.8) | 129 (78.2) | 131 (79.4) | 197 (75.5) | 37 (14.1) | 16 (69.6) | 6 (26.1) |
| Simultaneously on a global level | 76 (16.9) | 16 (3.6) | 38 (23.0) | 12 (7.3) | 37 (14.2) | 4 (1.5) | 1 (4.4) | - |
| Firstly by the FDA in the USA | 229 (51.0) | 157 (35.0) | 70 (42.4) | 118 (71.5) | 144 (55.2) | 33 (12.5) | 15 (65.2) | 6 (26.1) |
| First. the Chinese government | 37 (8.2) | 1 (0.2) | 21 (12.7) | 1 (0.6) | 16 (6.1) | - | - | - |
| Question 13—How is the Quality Unit structured? | 155 (34.5) | 12 (2.7) | 44 (26.6) | 4 (2.4) | 105 (40.2) | 6 (2.3) | 6 (26.1) | 2 (8.7) |
| Quality Control + Pharmacovigilance | 139 (31.0) | 12 (2.7) | 36 (21.8) | 4 (2.4) | 97 (37.2) | 6 (2.3) | 6 (26.1) | 2 (8.7) |
| Quality Assurance + Device monitoring | 7 (1.6) | - | 4 (2.4) | - | 3 (1.1) | - | - | - |
| None of the above | 9 (2.0) | - | 4 (2.4) | - | 5 (1.9) | - | - | - |
| Question 14—GMP stands for: | 268 (59.7) | 161 (35.9) | 116 (70.3) | 108 (65.4) | 141 (54.0) | 44 (16.9) | 11 (47.8) | 9 (39.1) |
| Standards of good manufacturing | 12 (2.7) | 4 (0.9) | 9 (5.5) | 4 (2.4) | 3 (1.1) | - | - | - |
| Good Manufacturing Practices | 251 (55.9) | 156 (34.7) | 103 (62.4) | 104 (63.0) | 137 (52.5) | 43 (16.5) | 11 (47.8) | 9 (39.1) |
| Standards of good production practice | 5 (1.1) | 1 (0.2) | 4 (2.4) | - | 1 (0.4) | 1 (0.4) | - | - |
| Question 15—The materials for the production of a vaccine: | 20 (4.5) | 8 (1.8) | 11 (6.7) | 3 (1.8) | 9 (3.4) | 4 (1.5) | - | 1 (4.4) |
| Include only the raw materials purchased | 4 (0.9) | - | 1 (0.6) | - | 3 (1.1) | - | - | - |
| Include only packaging materials | 4 (0.9) | - | 3 (1.8) | - | 1 (0.4) | - | - | - |
| Are not analysed upon arrival and are stored at controlled temperature and humidity | 12 (2.7) | 8 (1.8) | 7 (4.2) | 3 (1.8) | 5 (1.9) | 4 (1.5) | - | 1 (4.4) |
| Question 16—In the pharmacy vaccines can be found: | 266 (59.2) | 123 (27.4) | 111 (67.3) | 92 (55.7) | 145 (55.6) | 26 (10.0) | 10 (43.5) | 5 (21.8) |
| Only in the refrigerator | 204 (45.4) | 111 (24.7) | 91 (55.2) | 88 (53.3) | 105 (40.2) | 19 (7.3) | 8 (34.8) | 4 (17.4) |
| Only outside the refrigerator | 1 (0.2) | - | 1 (0.6) | - | - | - | - | - |
| All the above | 61 (13.6) | 12 (2.7) | 19 (11.5) | 4 (2.4) | 40 (15.3) | 7 (2.7) | 2 (8.7) | 1 (4.4) |
| Question 17—The most frequent temperature range for thermolabile vaccines is: | 108 (24.1) | 9 (2.0) | 48 (29.1) | 2 (1.2) | 59 (22.6) | 7 (2.7) | 1 (4.4) | - |
| Below −15 °C | 86 (19.2) | 7 (1.6) | 39 (23.6) | 2 (1.2) | 46 (17.6) | 5 (1.9) | 1 (4.4) | - |
| Between 15 °C and 25 °C | 10 (2.2) | - | 5 (3.0) | - | 5 (1.9) | - | - | - |
| Between 8 °C and 15 °C | 12 (2.7) | 2 (0.5) | 4 (2.4) | - | 8 (3.1) | 2 (0.8) | - | - |
| Question 18—The cold chain includes: | 92 (6.9) | 35 (7.6) | 55 (33.3) | 29 (17.6) | 34 (13.0) | 5 (1.9) | 3 (13.1) | - |
| A final report of the load temperatures along the entire route and during storage in the pharmacy | 20 (4.5) | 6 (1.3) | 11 (6.7) | 3 (1.8) | 7 (2.7) | 3 (1.1) | 2 (8.7) | - |
| Constant temperature monitoring by drivers and control centres | 11 (2.5) | 4 (0.9) | 7 (4.2) | 3 (1.8) | 4 (1.5) | 1 (0.4) | - | - |
| The use of temperature-controlled equipment | 61 (13.6) | 24 (5.4) | 37 (22.4) | 23 (13.9) | 23 (8.8) | 1 (0.4) | 1 (4.4) | - |
| Question 19—AEFI stands for: | 116 (25.8) | 8 (1.8) | 47 (28.5) | 2 (1.2) | 64 (24.5) | 6 (2.3) | 5 (21.8) | - |
| Association of Italian Exhibitions and Fairs | 32 (7.1) | 5 (1.1) | 21 (12.7) | 2 (1.2) | 10 (3.8) | 3 (1.1) | 1 (4.4) | - |
| Adverse Events Following Injection | 77 (17.2) | 3 (0.7) | 21 (12.7) | - | 52 (19.9) | 3 (1.1) | 4 (17.4) | - |
| None of the above | 7 (1.6) | - | 5 (3.0) | - | 2 (0.8) | - | - | - |
| Question 20—Which of these features is NOT used to classify an AEFI: | 227 (50.6) | 93 (20.7) | 102 (61.8) | 73 (44.2) | 118 (45.2) | 18 (6.9) | 7 (30.4) | 2 (8.7) |
| Errors in vaccination | 182 (40.5) | 48 (10.7) | 64 (38.8) | 36 (21.8) | 111 (42.5) | 11 (4.2) | 7 (30.4) | 1 (4.4) |
| Defects in the quality of the vaccine | 23 (5.1) | 10 (2.2) | 18 (10.9) | 5 (3.0) | 5 (1.9) | 5 (1.9) | - | - |
| Characteristics of the vaccine | 22 (4.9) | 35 (7.8) | 20 (12.1) | 32 (19.4) | 2 (0.8) | 2 (0.8) | - | 1 (4.4) |
| Question 21—To perform the causality assessment of an AEFI. the following is used: | 91 (20.3) | 43 (9.6) | 82 (49.7) | 25 (15.2) | 108 (41.4) | 16 (6.1) | 8 (34.8) | 2 (8.7) |
| CIOMS/RUCAM algorithm | 16 (3.6) | 9 (2.0) | 13 (7.9) | 3 (1.8) | 47 (18.0) | 4 (1.5) | 2 (8.7) | 2 (8.7) |
| Schumock and Thornton algorithm | 25 (5.6) | 15 (3.3) | 24 (14.6) | 12 (7.3) | 31 (11.9) | 3 (1.1) | 1 (4.4) | - |
| Naranjo scale | 50 (11.1) | 19 (4.2) | 45 (27.3) | 10 (6.1) | 30 (11.5) | 9 (3.4) | 5 (21.7) | - |
| Question 22—Which of the following statements is correct? | 89 (19.8) | 23 (5.1) | 85 (51.5) | 13 (7.9) | 89 (34.1) | 8 (3.1) | 3 (13.1) | 2 (8.7) |
| Formaldehyde is used in vaccines as an adjuvant | 55 (12.3) | 15 (3.3) | 53 (32.1) | 10 (6.1) | 47 (18.0) | 5 (1.9) | 1 (4.4) | - |
| The same amount of formaldehyde produced by an infant is present in vaccines | 7 (1.6) | 3 (0.7) | 6 (3.6) | 1 (0.6) | 14 (5.4) | 1 (0.4) | 1 (4.4) | 1 (4.4) |
| No vaccine contains formaldehyde | 27 (6.0) | 5 (1.1) | 26 (15.8) | 2 (1.2) | 28 (10.7) | 2 (0.8) | 1 (4.4) | 1 (4.4) |
| Question 23—Which of the following statements is correct? | 202 (45.0) | 22 (4.9) | 106 (64.2) | 13 (10.6) | 91 (15.7) | 9 (3.4) | 5 (21.8) | - |
| At two months the child’s immune system is not already able to respond to vaccination | 68 (15.1) | 13 (2.9) | 29 (17.6) | 6 (3.6) | 38 (14.6) | 7 (2.7) | 1 (4.4) | - |
| Vaccines weaken the immune system if administered too early | 13 (2.9) | - | 8 (4.9) | - | 3 (1.1) | - | 2 (8.7) | - |
| The newborn’s immune system is fragile and cannot be subjected to more than ten vaccinations in the first year of life | 121 (27.0) | 9 (2.0) | 69 (41.8) | 7 (4.2) | 50 (19.2) | 2 (0.8) | 2 (8.7) | - |
| Question 24—Which of the following statements is correct? | 114 (25.4) | 10 (2.2) | 58 (35.1) | 6 (3.6) | 53 (20.3) | 4 (1.5) | 3 (13.1) | - |
| Aluminium salts are used in vaccines as a preservative | 85 (18.9) | 9 (2.0) | 39 (23.6) | 6 (3.6) | 43 (16.5) | 3 (1.1) | 3 (13.1) | - |
| The aluminum injected into the muscle with vaccines enters the blood immediately | 7 (1.6) | - | 4 (2.4) | - | 3 (1.1) | - | - | - |
| Vaccines must not contain aluminium salts | 22 (4.9) | 1 (0.2) | 15 (9.1) | - | 7 (2.7) | 1 (0.4) | - | - |
| Question 25—According to the Italian National Immunization Plan 2017–2019. which of these vaccinations are recommended in pregnancy? | 129 (28.7) | 22 (4.9) | 57 (34.6) | 17 (10.3) | 72 (27.6) | 5 (1.9) | - | - |
| Hepatitis B | 29 (6.5) | - | 11 (6.7) | - | 18 (6.9) | - | - | - |
| Varicella (Chickenpox) | 12 (2.7) | 1 (0.2) | 7 (4.2) | 1 (0.6) | 5 (1.9) | - | - | - |
| Measles-Mumps-Rubella | 88 (19.6) | 21 (4.7) | 39 (23.6) | 16 (9.7) | 49 (18.8) | 5 (1.9) | - | - |
| Question 26—Which of the following vaccines are mandatory for school attendance under Law 119/2017 in Italy? | 49 (10.9) | 8 (1.8) | 28 (17.0) | 6 (3.6) | 21 (8.0) | 2 (0.8) | - | - |
| Anti-meningococcal | 39 (8.7) | 3 (0.7) | 20 (12.1) | 2 (1.2) | 19 (7.3) | 1 (0.4) | - | - |
| Anti-influenza | 6 (1.3) | 4 (0.9) | 6 (3.6) | 4 (2.4) | - | - | - | - |
| Anti-pneumococcal | 4 (0.9) | 1 (0.2) | 2 (1.2) | - | 2 (0.8) | 1 (0.4) | - | - |
| Question 27—The impact of vaccination programmes is assessed through: | 64 (14.3) | 31 (6.9) | 28 (17.0) | 26 (15.8) | 34 (13.0) | 5 (1.9) | 2 (8.7) | - |
| Monitoring the hospitalizations trend | 30 (6.7) | 17 (3.8) | 14 (8.5) | 17 (10.3) | 16 (6.1) | - | - | - |
| Monitoring of vaccination coverage | 23 (5.1) | 10 (2.2) | 9 (5.5) | 6 (3.6) | 13 (5.0) | 4 (1.5) | 1 (4.4) | - |
| Monitoring the trend of mandatory disease notifications | 11 (2.5) | 4 (0.9) | 5 (3.0) | 3 (1.8) | 5 (1.9) | 1 (0.4) | 1 (4.4) | - |
| Question 28—A vaccine. to be included in the National Plan for Vaccine Prevention and. therefore. be offered actively and free of charge: | 48 (10.7) | 5 (1.1) | 34 (20.6) | 4 (2.4) | 14 (5.4) | 1 (0.4) | - | - |
| It is sufficient that it is not too expensive | - | 2 (0.5) | - | 2 (1.2) | - | - | - | - |
| It is sufficient that has proven effective | 18 (4.0) | 1 (0.2) | 17 (10.3) | 1 (0.6) | 1 (0.4) | - | - | - |
| It is sufficient that it has been shown to be safe | 30 (6.7) | 2 (0.5) | 17 (10.3) | 1 (0.6) | 13 (5.0) | 1 (0.4) | - | - |
| Question 29—The HTA applied to vaccinations includes assessing: | 72 (16.0) | 3 (0.7) | 41 (24.9) | 2 (1.2) | 31 (11.9) | 1 (0.4) | - | - |
| Organizational aspects | 34 (7.6) | 1 (0.2) | 17 (10.3) | 1 (0.6) | 17 (6.5) | - | - | - |
| The ethical aspects | 20 (4.5) | 1 (0.2) | 12 (7.3) | 1 (0.6) | 8 (3.1) | - | - | - |
| Possible alternative interventions | 18 (4.0) | 1 (0.2) | 12 (7.3) | - | 6 (2.3) | 1 (0.4) | - | - |
| Question 30—The economic evaluations of vaccinations show that: | 59 (13.1) | 19 (4.2) | 42 (25.5) | 15 (9.1) | 17 (6.5) | 3 (1.1) | - | 1 (4.4) |
| Vaccinations are only a cost to the NHS | 15 (3.3) | 5 (1.1) | 10 (6.1) | 3 (1.8) | 5 (1.9) | 1 (0.4) | - | 1 (4.4) |
| There is no need to carry out economic assessments for vaccination | 22 (4.9) | 1 (0.2) | 18 (10.9) | 1 (0.6) | 4 (1.5) | - | - | - |
| Only in some rare cases vaccination is cost-effective | 22 (4.9) | 13 (2.9) | 14 (8.5) | 11 (6.7) | 8 (3.1) | 2 (0.8) | - | - |
AEFI, adverse event following immunization; HTA, health technology assessment; NHS, national health system.