Abstract
Medical meetings should be an occasion for common reflection on specific topics, rather than help to spread information which, especially for experts on the subject, are often easily accessible. Paediatricians have approached the subject âvaccinationâ with great caution due to the scarce skills training offered today by most post-graduate Specialty Schools. Since 2001 the FIMP (Federazione Italiana Medici Pediatri) has created a regional network of Referents capable of spreading âGood Vaccination Practiceâ among General Paediatricians; this activity resulted with the prepa- ration of (vaccine) scheduled recommendations first in 2003, until approval of (vaccination) schedules with other scientific societies in 2010.Certainly the role of the clinician is consistently enriched with the related scientific literature to better understand the diseases in terms of surveillance, epidemiology and etiology but for the paediatrician, âdiseaseâ means above all an ill child and the diseases caused by pneumococcus have a wide spectrum of pathological manifestations.
In the pre-vaccination period [1], the pneumococcal bac- teremia in children were almost 90%, 55% meningitis, pneumonians more than 70% between the bacterials ones for childrens under 5 years old of age and middle ear otitis exceed 40%.
The Ligurian experience [2] shows that pneumococcal vaccination, which has reached sizeable levels of cover- age in the region, allows significant reduction of these diseases, in fact there has been a decrease of 15% for childhood pneumonia from all causes, 70 % for pneumococcal pneumonia and a reduction of 36% for acute middle ear otitis.
The otologic disease, certainly not the primary goal of vaccination, is a daily vocational commitment for pae- diatricians.
The vaccine efficacy is demonstrated by many studies: among others, the study in Greece [3] show that cases in A&E Departments for otorrhea (signal of particularly virulence of the disease) have decreased by 38% dur- ing the observation period compared to the pre-vaccine period and by 48% for ear infections caused by pneu- mococcus, even though the need Startup monitoring demonstrates an increased incidence of serotype 19A (a rise from 2% up to 25%) and resistance to amoxicillin growth from 4% up to 13%.
Translated into numerical terms, the term âdiscrete re- ductionsâ of Cochrane review about vaccination impact on acute middle ear infections [4], we can say that in Italy, (we) Paediatricians , have to treat approximately 60-70,000 less cases every year.
The reported increase in mastoiditis also relative to the recent Guide Line of SIP, which would decline the an- tibiotic therapy in certain conditions, increase often due to the serotype 19A not included in the Heptavalent Pnu- mococcal Vaccine, in reality [5], appears mainly as a result of complications due to previous middle ear prob- lems, being wrongly diagnosed and poorly treated. Would point out that these publications are related to a reality that does not provide a General Paediatric Assist- ance as in Italy.