title: H1N1 Influenza Pandemic in Italy Revisited: Has the Willingness to Get Vaccinated Suffered in the Long Run?
abstract: BACKGROUND
  The aim of the study is to assess the long-term secondary effects of personal experience with the H1N1 pandemic of 2009/2010 and the perception of the institutional reaction to it on Italians' willingness to get vaccinated in case of a novel influenza pandemic.
  
  
  METHODS
  We conducted 140 face-to-face interviews in the Registry Office of the Municipality of Milan, Italy, from October to December 2012.
  
  
  RESULTS
  Willingness to get vaccinated during a novel influenza pandemic was best predicted by having been vaccinated against the seasonal flu in the past (OR=5.18; 95%CI: 1.40 to 19.13) and fear of losing one's life in case of an infection with H1N1 (OR=4.09; 95%CI: 1.68 to 9.97). It was unaffected by the assessment of institutional performance.
  
  
  CONCLUSIONS
  The findings of this study do not point to long-term secondary effects of the institutional handling of the H1N1 pandemic. The results highlight the fact that behavioural intention is not the same as behaviour, and that the former cannot simply be taken as an indicator of the latter. Significance for public healthWhereas influenza pandemics occurred rather rarely in the last centuries, their frequency can be expected to increase in the future due to the enhanced globalisation and still raising importance of air travelling. Recent examples (Ebola, H1N1, SARS, avian influenza) demonstrate that initially local disease outbreaks often become worldwide health threats of international concern. National and international health authorities are consequently urged to present preparedness plans on how to manage such health crises. However, their success highly depends on their acceptance by the public. To ensure the public compliance with recommended actions, effective communication is needed. Since communication is most successful when it meets the needs of the target audience, a full understanding of the audience is crucial. This study can help public health experts to better understand the variables determining people's willingness to get vaccinated during influenza pandemic, in terms of behavioural and perceptual variables. This knowledge enables them to correctly address the public's concerns when having to communicate during the next outbreak of pandemic influenza.
authors.affiliation: Institute of Communication and Health, University of Lugano , Switzerland.
authors.forename: Ramona
authors.initials: R
authors.lastname: Ludolph
authors.affiliation: Institute of Communication and Health, University of Lugano , Switzerland ; Phd Program in Public Health, University of Milan , Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Nobile
authors.affiliation: Institute of Communication and Health, University of Lugano , Switzerland.
authors.forename: Uwe
authors.initials: U
authors.lastname: Hartung
authors.affiliation: IRCC Foundation Ca' Cranda Major Hospital of Milan, Department of Biomedical Sciences for Health, University of Milan , Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Castaldi
authors.affiliation: Institute of Communication and Health, University of Lugano , Switzerland.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schulz
keywords: H1N1 pandemic; Italy; vaccination