Background:
Italy reported the highest number of tetanus cases in the EEA in 2014-2018. The most affected group are the elderly, particularly females, because of the low vaccination coverage. Sporadic diphtheria cases continue to occur in not properly vaccinated people, especially travellers from endemic countries. High vaccination coverage is required to ensure indirect and direct protection from pertussis in infants and the elderly, the most vulnerable groups to this disease. Booster dTpa doses are recommended in adults every 10 years for all life. We aimed to evaluate which factors may be associated with our country’s immunisation rate decline.

Methods:
In September 2021, we conducted a cross-sectional survey among the population of the Tuscany Region, Italy. We collected data on demographics, knowledge of dTpa vaccination, vaccine-preventable diseases and healthcare access knowledge. In addition, we performed a descriptive and inferential analysis with the software Rv4.0. The significance level was set at p<0.05.

Results:
Of the sample (N=408), 57% received dTpa booster in 10 years, and 69% it is free. We observed an association between receiving dTpa and knowledge of diphtheria (OR 3.28 95%CI 1.27-8.46 p=0.011) and pertussis (OR 2.65 1.19-5.92 p=0.015). Moreover, people who know that dTpa booster is recommended every 10 years (OR 10.0 5.59-18 p<0.001), that it is free (OR 6.97 3.69-13.2 p<0.001), and have a healthcare service app on their phone (OR 2.29 1.38-3.80 p0.001) are more likely to getting vaccinated.

Conclusion:
In Italy, we must promote dTpa campaign to protect vulnerable people. Our study shows that health literacy increases the likelihood of getting vaccinated. Therefore, it is essential to encourage communication campaigns on dTpa and propose strategies to strengthen the vaccination coverage (e.g. offering vaccination during the driving license renewal visit or implementing co-administrations).