{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:10:39Z","timestamp":1788307839235,"version":"build-2803163510"},"reference-count":47,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T00:00:00Z","timestamp":1658880000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health\u2014Current research IRCCS"},{"name":"the University of Milan"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>(1) Background: The identification of vaccination status and attitudes towards vaccines among celiac disease (CD) patients is of great importance, but it has not yet been investigated. The aim of this study was to investigate coverage against vaccine-preventable diseases (VPDs), attitudes towards vaccinations, and its determinants among CD patients. (2) Methods: An anonymous web-based validated questionnaire was sent to a mailing list of CD adult patients. Patients were asked to self-report their previous vaccinations and attitudes towards vaccinations, which were defined as positive, negative, and partially positive\/negative. The influencing factors towards vaccinations were investigated, and crude and adjusted odds ratios (AdjORs) with 95% confidence intervals (CIs) were calculated. (3) Results: The questionnaire was sent to 412 patients, with a response rate of 31.6% (130 patients, 105 women, median age 40 years, interquartile range 36\u201351). Patients self-reported vaccination against the following diseases: 73.8% tetanus, 42.3% flu, 20% measles, mumps and rubella, 19.2% meningitis, and 16.2% pneumococcus. Thirty-two people (24.6%) did not remember all of their previous vaccinations. In total, 104 (80%) respondents had a positive attitude towards vaccines, 25 (19.2%) a partially positive\/negative one, and 1 a negative one. The determinants significantly influencing the positive attitude were being a graduate (AdjORs 7.49) and a belief in the possible return of VPDs with declining vaccination coverage rates (AdjORs 7.42), while the use of complementary and alternative medicines (AdjORs 0.11) and past negative experience (AdjORs 0.16) were associated with a negative attitude. (4) Conclusions: Despite four out of five CD patients showing a strong positive attitude towards vaccinations, one out of five had a partially negative one. Only a minority (16\u201320%) reported being vaccinated against some VPDs potentially harmful to their CD because of hyposplenism, such as meningitis and pneumococcus. The low vaccination rate against some VPDs, in spite of the 80% of CD patients stating a positive attitude towards vaccination, may be explained in part by patients\u2019 vaccine hesitancy and in part by a possible role of physicians in under-prescribing vaccinations to these patients. These results may be a starting point for developing specific vaccination campaigns to increase vaccination rates against VPDs in CD patients.<\/jats:p>","DOI":"10.3390\/vaccines10081199","type":"journal-article","created":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T01:41:16Z","timestamp":1659058876000},"page":"1199","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Vaccination Status and Attitudes towards Vaccines in a Cohort of Patients with Celiac Disease"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4345-6051","authenticated-orcid":false,"given":"Andrea","family":"Costantino","sequence":"first","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9522-9814","authenticated-orcid":false,"given":"Marco","family":"Michelon","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leda","family":"Roncoroni","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Doneda","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenza","family":"Lombardo","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3397-7331","authenticated-orcid":false,"given":"Claudio","family":"Costantino","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90145 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Vecchi","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Elli","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e004206","DOI":"10.1136\/bmjgh-2020-004206","article-title":"Social media and vaccine hesitancy","volume":"5","author":"Wilson","year":"2020","journal-title":"BMJ Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e258","DOI":"10.1016\/S2589-7500(19)30136-0","article-title":"Vaccine misinformation and social media","volume":"1","author":"Burki","year":"2019","journal-title":"Lancet Digit. Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4161","DOI":"10.1016\/j.vaccine.2015.04.036","article-title":"SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants","volume":"33","author":"MacDonald","year":"2015","journal-title":"Vaccine"},{"key":"ref_4","first-page":"175","article-title":"Addressing vaccine hesitancy: Clinical guidance for primary care physicians working with parents","volume":"65","author":"Shen","year":"2019","journal-title":"Can. Fam. Physician"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1111\/hex.13240","article-title":"Understanding COVID-19 misinformation and vaccine hesitancy in context: Findings from a qualitative study involving citizens in Bradford, UK","volume":"24","author":"Lockyer","year":"2021","journal-title":"Health Expect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1111\/j.1469-0691.2012.03944.x","article-title":"Vaccines for the elderly","volume":"18","author":"Weinberger","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Napolitano, F., Della Polla, G., Capano, M.S., Augimeri, M., and Angelillo, I.F. (2020). Vaccinations and Chronic Diseases: Knowledge, Attitudes, and Self-Reported Adherence among Patients in Italy. Vaccines, 8.","DOI":"10.3390\/vaccines8040560"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Gall\u00e8, F., Sabella, E.A., Roma, P., Ferracuti, S., Da Molin, G., Diella, G., Montagna, M.T., Orsi, G.B., Liguori, G., and Napoli, C. (2021). Knowledge and Lifestyle Behaviors Related to COVID-19 Pandemic in People over 65 Years Old from Southern Italy. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182010872"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Caio, G., Volta, U., Sapone, A., Leffler, D.A., De Giorgio, R., Catassi, C., and Fasano, A. (2019). Celiac disease: A comprehensive current review. BMC Med., 17.","DOI":"10.1186\/s12916-019-1380-z"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s11894-020-0756-8","article-title":"Refractory celiac disease","volume":"22","author":"Hujoel","year":"2020","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1038\/ajg.2010.506","article-title":"Causes of death in people with celiac disease spanning the pre- and post-serology era: A population-based cohort study from Derby, UK","volume":"106","author":"Grainge","year":"2011","journal-title":"Am. J. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1177\/2050640619844125","article-title":"European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders","volume":"7","author":"Volta","year":"2019","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1038\/ajg.2010.352","article-title":"Increased risk of hospital admission for influenza in patients with celiac disease: A nationwide cohort study in Sweden","volume":"105","author":"Fredlund","year":"2010","journal-title":"Am. J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Costantino, A., Topa, M., Roncoroni, L., Doneda, L., Lombardo, V., Stocco, D., Gramegna, A., Costantino, C., Vecchi, M., and Elli, L. (2021). COVID-19 vaccine: A survey of hesitancy in patients with celiac disease. Vaccines, 9.","DOI":"10.3390\/vaccines9050511"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1080\/21645515.2017.1264733","article-title":"Information sources and knowledge on vaccination in a population from southern Italy: The ESCULAPIO project","volume":"13","author":"Tabacchi","year":"2017","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_16","first-page":"93","article-title":"Dalla lotta per la libert\u00e0 alla negazione dell\u2019evidenza: Storia dei movimenti anti-vaccinisti in Europa [From the struggle for freedom to the denial of evidence: History of the anti-vaccination movements in Europe]","volume":"23","author":"Tafuri","year":"2011","journal-title":"Ann. Ig."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1016\/j.vaccine.2018.01.065","article-title":"The impact of immunization programs on 10 vaccine preventable diseases in Italy: 1900\u20132015","volume":"36","author":"Pezzotti","year":"2018","journal-title":"Vaccine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.4081\/jphr.2018.1523","article-title":"Vaccination policy in Italy: An update","volume":"7","author":"Crenna","year":"2018","journal-title":"J. Public Health Res."},{"key":"ref_19","unstructured":"Filia, A., Bella, A., del Manso, M., and Rota, C. (2020, May 06). Morbillo: Aspetti Epidemiologici [Measles: Epidemiological Aspects]. EpiCentro\u2013Il portale dell\u2019Epidemiologia per la Sanit\u00e0 Pubblica a Cura dell\u2019Istituto Superiore di Sanit\u00e0. Available online: https:\/\/www.epicentro.iss.it\/morbillo\/epidemiologia-italia."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.ypmed.2019.02.011","article-title":"Measles outbreaks in Italy: A paradigm of the re-emergence of vaccine-preventable diseases in developed countries","volume":"121","author":"Siani","year":"2019","journal-title":"Prev. Med."},{"key":"ref_21","unstructured":"European Centre for Disease Prevention and Control (2022, May 24). Let\u2019s Talk about Protection. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/lets-talk-about-protection-enhancing-childhood-vaccination-uptake."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Passanisi, S., Dipasquale, V., and Romano, C. (2020). Vaccinations and immune response in celiac disease. Vaccines, 8.","DOI":"10.3390\/vaccines8020278"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"A9","DOI":"10.1136\/gutjnl-2013-304907.021","article-title":"OC-021 a retrospective audit of pneumococcal & influenza vaccination in coeliac disease","volume":"62","author":"Khan","year":"2013","journal-title":"Gut"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/S1542-3565(05)00982-1","article-title":"Splenic hypofunction and the spectrum of autoimmune and malignant complications in celiac disease","volume":"4","author":"Rosado","year":"2006","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1136\/gut.24.3.228","article-title":"Effect of gluten-free diet on splenic hypofunction of adult coeliac disease","volume":"24","author":"Corazza","year":"1983","journal-title":"Gut"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.amjms.2020.04.022","article-title":"Hyposplenism, Hashimoto\u2019s autoimmune thyroiditis and overlap syndrome (celiac disease and autoimmune hepatitis type 1)","volume":"360","author":"Balaceanu","year":"2020","journal-title":"Am. J. Med. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1080\/10245330600938463","article-title":"Hyposplenism: A comprehensive review. Part II: Clinical manifestations, diagnosis, and management","volume":"12","author":"William","year":"2007","journal-title":"Hematology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.amjmed.2017.07.021","article-title":"Celiac disease and increased risk of pneumococcal infection: A systematic review and meta-analysis","volume":"131","author":"Simons","year":"2018","journal-title":"Am. J. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.3748\/wjg.v19.i15.2313","article-title":"Is it worth investigating splenic function in patients with celiac disease?","volume":"19","author":"Brunetti","year":"2013","journal-title":"World J. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1080\/17474124.2019.1607295","article-title":"Pneumococcal vaccination in celiac disease","volume":"13","author":"Casella","year":"2019","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.socscimed.2017.11.022","article-title":"\u201cDo-it-yourself\u201d: Vaccine rejection and complementary and alternative medicine (CAM)","volume":"196","author":"Attwell","year":"2018","journal-title":"Soc. Sci. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S90","DOI":"10.1016\/S0264-410X(01)00290-0","article-title":"Rise in popularity of complementary and alternative medicine: Reasons and consequences for vaccination","volume":"20","author":"Ernst","year":"2001","journal-title":"Vaccine"},{"key":"ref_33","first-page":"674","article-title":"Coeliac disease: Where are we in 2014?","volume":"43","author":"Kenrick","year":"2014","journal-title":"Aust. Fam. Physician"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1093\/heapro\/dat063","article-title":"Gender differences in health information behaviour: A Finnish population-based survey","volume":"30","author":"Ek","year":"2015","journal-title":"Health Promot. Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.pvr.2018.05.002","article-title":"Differential misclassification between self-reported status and official HPV vaccination records in Japan: Implications for evaluating vaccine safety and effectiveness","volume":"6","author":"Yamaguchi","year":"2018","journal-title":"Papillomavirus Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"245","DOI":"10.4161\/hv.4589","article-title":"Millennium Cohort Study Team. Smallpox vaccination: Comparison of self-reported and electronic vaccine records in the millennium cohort study","volume":"3","author":"LeardMann","year":"2007","journal-title":"Hum. Vaccines"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1093\/ibd\/izab172","article-title":"COVID-19 vaccination willingness and hesitancy in patients with inflammatory bowel diseases: Analysis of determinants in a national survey of the Italian IBD Patients\u2019 Association","volume":"28","author":"Costantino","year":"2022","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Costantino, A., Invernizzi, F., Centorrino, E., Vecchi, M., Lampertico, P., and Donato, M.F. (2021). COVID-19 Vaccine Acceptance among Liver Transplant Recipients. Vaccines, 9.","DOI":"10.3390\/vaccines9111314"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Gabutti, G., Cetin, I., Conversano, M., Costantino, C., Durando, P., and Giuffrida, S. (2022). Experts\u2019 Opinion for Improving Pertussis Vaccination Rates in Adolescents and Adults: A Call to Action. Int J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19074412"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1093\/oxfordjournals.epirev.a017992","article-title":"Improving immunization coverage rates: An evidence-based review of the literature","volume":"21","author":"Shefer","year":"1999","journal-title":"Epidemiol. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Trucchi, C., Amicizia, D., Tafuri, S., Sticchi, L., Durando, P., Costantino, C., Varlese, F., Silverio, B.D., Bagnasco, A.M., and Ansaldi, F. (2020). Assessment of Knowledge, Attitudes, and Propensity towards HPV Vaccine of Young Adult Students in Italy. Vaccines, 8.","DOI":"10.3390\/vaccines8010074"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Costantino, C., Rizzo, C., Rosselli, R., Battista, T., Conforto, A., Cimino, L., Poscia, A., and Fiacchini, D. (2022). Ten Actions to Counteract Vaccine Hesitancy Suggested by the Italian Society of Hygiene, Preventive Medicine, and Public Health. Vaccines, 10.","DOI":"10.3390\/vaccines10071030"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s40520-019-01154-1","article-title":"Adult vaccination as the cornerstone of successful ageing: The case of herpes zoster vaccination. A European Interdisciplinary Council on Ageing (EICA) expert focus group","volume":"31","author":"Ecarnot","year":"2019","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s40520-019-01145-2","article-title":"A successful experience implementing Herpes Zoster vaccination strategies","volume":"31","author":"Giuffrida","year":"2019","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Gall\u00e8, F., and Napoli, C. (2022). Vaccine and Vaccination: On Field Research. Vaccines, 10.","DOI":"10.3390\/vaccines10071027"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/MCG.0b013e31827a6f83","article-title":"World Gastroenterology Organisation global guidelines on celiac disease","volume":"47","author":"Bai","year":"2013","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1038\/ajg.2013.79","article-title":"ACG clinical guidelines: Diagnosis and management of celiac disease","volume":"108","author":"Hill","year":"2013","journal-title":"Am. J. Gastroenterol."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/8\/1199\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:57:46Z","timestamp":1760140666000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/8\/1199"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,27]]},"references-count":47,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["vaccines10081199"],"URL":"https:\/\/doi.org\/10.3390\/vaccines10081199","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,27]]}}}