Keywords
Measles
Varicella
Neisseria meningitidis type C
Italy
Abstract
The World Health Organization (WHO) has established specific targets for control, elimination or eradication of some vaccine preventable infectious diseases, which were periodically updated. In Italy, WHO recommendations have been endorsed and implemented over time, through the national and regional health prevention plans. The aim of the study was to assess the impact of the immunization practices against measles, varicella and Neisseria meningitidis type C (Men C) in Italy and in Tuscany Region, during the last decades, by analyzing national and regional surveillance databases. Benefits of vaccination strategies were discussed from different points of view (clinical, epidemiological, economic, ethical, social and communicative). The implementation of measles, varicella and Men C vaccination, caused a considerable decrease of incidence rates over the years in Italy and in Tuscany too. However, in the last years, notifications of measles and Men C cases in subjects not targeted by immunization campaigns, in Italy and in Tuscany, are a cause for concern for public health and for the achievement of the elimination goals. Achieving and maintaining high vaccine coverage guarantees a decrease in the incidence of serious diseases and their clinical and economic consequences, but it is necessary to strengthen surveillance system of infectious diseases in order to monitor epidemiological trends. Moreover, outreach campaigns are necessary to raise awareness in the general population and create the culture of prevention with the same nationwide health goals for all.References
WHO. Global vaccination targets ‘off-track’ warns WHO. News release 22 April, 2015. Available online at: http://www.who.int/mediacentre/news/releases/2015/global-vaccination-targets/en/
WHO, Global Health Observatory (GHO) data, Under-five mortality: http://www.who.int/gho/child_health/mortality/mortality_under_five_text/en/
WHO. Global Vaccine Action Plan 2011-2020. 2013. Available online at: http://www.who.int/immunization/global_vaccine_action_plan/GVAP_doc_2011_2020/en/
Ministry of Health. Italian National Plan for Vaccine Prevention 2017-2019. Available online at: http://www.salute.gov.it/imgs/C_17_pubblicazioni_2571_allegato.pdf
Bechini A, Levi M, Boccalini S, Tiscione E, Panatto D, Amicizia D, Bonanni P. Progress in the elimination of measles and congenital rubella in Central Italy. Human Vaccines and Immunotherapeutics. 2013 Mar 1; 9 (3): 649-656.
Istituto Superiore di Sanità. Gruppo di lavoro ICONA. ICONA 2008: Indagine di copertura vaccinale nazionale nei bambini e negli adolescenti. Rapporti ISTISAN 2009; 09/29, p. 118. Available online at: http://www.iss.it/binary/publ/cont/09_29_web.pdf
Ministry of Health. Piano nazionale per l’eliminazione del morbillo e della rosolia congenita 2010-2015. Available online at: http://www.salute.gov.it/imgs/C_17_pubblicazioni_1519_allegato.pdf
Istituto Superiore di Sanità. Measles in Italy: weekly bulletin. Update as of 10 October 2017. Available online at: http://www.epicentro.iss.it/problemi/morbillo/bollettino/Measles_WeeklyReport_N29eng.pdf
Filia A, Tavilla A, Bella A, Magurano F, Ansaldi F, Chironna M, Nicoletti L, Palù G, Iannazzo S, Declich S, Rota MC. Measles in Italy, July 2009 to September 2010. Eurosurveillance 16 (29), 21 July 2011. Available online at: http://www.eurosurveillance.org/images/dynamic/ee/v16n29/art19925.pdf
Bechini A, Pesavento G, Boccalini S, Tiscione E, Balocchini E, Graziani G, Pecori L, Santini MG, Azzari C, Peruzzi M, Mannelli F, Tomasi A, Montomoli E, Mazzoli F, Bonanni P. Implementazione del piano per l'eliminazione del morbillo e della rosolia congenita in Toscana: progressi verso la seconda fase di controllo dell'infezione. BEN Notiziario ISS Vol. 19 n. 4, Aprile 2006. Available on line at: http://www.epicentro.iss.it/ben/2006/aprile/aprile.pdf
Bechini A, Boccalini S, Tiscione E, Pesavento G, Mannelli F, Peruzzi M, Rapi S, Mercurio S, Bonanni P. Progress towards measles and rubella elimination in Tuscany, Italy: the role of population seroepidemiological profile. Eur J Public Health. 2012 Feb;22(1):133-9. doi: 10.1093/eurpub/ckq134. Epub 2010 Sep 29.
Gruppo di Lavoro del CNESPS - Istituto Superiore di Sanità. Dati e evidenze disponibili per l’introduzione della vaccinazione anti-meningococco B nei nuovi nati e negli adolescenti. Giugno 2014. Available online at: http://www.epicentro.iss.it/temi/vaccinazioni/pdf/Istruttoria%20MENINGOCOCCO%20B.pdf
Bechini A, Levi M, Boccalini S, Tiscione E, Ceccherini V, Taddei C, Balocchini E, Bonanni P. Present situation and new perspectives for vaccination against Neisseria meningitidis in Tuscany, Central Italy. J Prev Med Hyg. 2012 June;53(2): 61-67.
Bechini A, Levi M, Boccalini S, Tiscione E, Balocchini E, Canessa C, Azzari C, Bonanni P. Impact on disease incidence of a routine universal and catch-up vaccination strategy against Neisseria meningitidis C in Tuscany, Italy. Vaccine. 2012 Oct 5;30(45):6396-401.
Tuscany Region. Legislation in the field of vaccination and guidelines for the preparation of the new regional immunization program [Italian: Direttive in materia di vaccinazioni e indirizzi per la stesura del nuovo calendario regionale delle vaccinazioni. Modifiche alla delibera G.R. 24.11.2003 n. 1249. DGR n. 379 del 7/03/2005. BURT n. 13 del 30.03.2005]
Tuscany Region. Update on regional legislation in the field of vaccination. [Italian: Aggiornamento direttive regionali in materia di vaccinazioni. DGR n. 1020 del 27/12/2007. BURT n. 2 del 9.01.2008]
Bechini A, Pieralli F, Paolini D, Boccalini S, Nieddu F, Moriondo M, Azzari C, Bonanni P. Recrudescenza di casi di malattia meningococcica invasiva in Toscana e strategie vaccinali adottate dal 2015. RIAP Rivista di Immunologia e Allergologia Pediatrica, due 2016 – 2-7
Tuscany Region. Update on regional legislation in the field of vaccination. [Italian: Aggiornamento del calendario vaccinale della Regione Toscana e prosecuzione delle misure straordinarie di profilassi per contrastare la diffusione dell'infezione da meningococco C. DGR n. 1374 del 27-12-2016.]
Tuscany Region. Update on regional legislation in the field of vaccination. [Italian: Calendario vaccinale della Regione Toscana, Aggiornamento al 2010 a cura della Commissione regionale per gli indirizzi, le strategie vaccinali e la prevenzione delle patologie infettive e del Settore Igiene Pubblica della Regione Toscana. DGR n. 448 del 31/03/2010. BURT n. 15 del 14.04.2010]
Tuscany Region. Update on regional legislation in the field of vaccination. [Italian: Calendario vaccinale della Regione Toscana e direttive in materia di vaccinazioni. Aggiornamento al 2014. Delibera n.823 del 06-10-2014]. Available on: http://www301.regione.toscana.it/bancadati/atti/DettaglioAttiG.xml?codprat=2014DG00000001043
Bechini A, Boccalini S, Baldo V, Cocchio S, Castiglia P, Gallo T, Giuffrida S, Locuratolo F, Tafuri S, Martinelli D, Prato R, Amodio E, Vitale F, Bonanni P. Impact of universal vaccination against varicella in Italy Experiences from eight Italian Regions. Human Vaccines & Immunotherapeutics. 2015; 11:1, 1–9.
Signorelli C, Odone A, Cella P, Iannazzo S, D'Ancona F, Guerra R. Infant immunization coverage in Italy (2000-2016). Ann Ist Super Sanita. 2017 Jul-Sep;53(3):231-237.
Bechini A, Boccalini S, Levi M, Bonanni P. Universal varicella vaccination programme in Tuscany region (Italy), 2008-2011: impact on disease incidence, immunization coverage and adverse reactions. Proceedings of the 31 Annual Meeting of the European Society of Paediatric Infectious diseases. Milan, Italy, 28 May – 1 June 2013. [Abstract reference number: A-534-0044-00814; Number 322]
Ciofi degli Atti ML, Rota MC, Mandolini D, Bella A, Gabutti G, Crovari P, Salmaso S. Assessment of varicella underreporting in Italy. Epidemiol Infect. 2002 Jun;128(3):479-84.
Boccalini S, Bechini A, Levi M, Bonanni P. Impact of universal varicella vaccination on hospitalisation in children under 15 years in Tuscany region, Italy. Proceedings of the 31 Annual Meeting of the European Society of Paediatric Infectious diseases. Milan, Italy, 28 May – 1 June 2013. [Oral presentation]
Bechini A, Boccalini S, Levi M, Bonanni P. Universal varicella vaccination programme in Tuscany region (Italy), 2008-2011: impact on disease incidence, immunization coverage and adverse reactions. Proceedings of the 31 Annual Meeting of the European Society of Paediatric Infectious diseases. Milan, Italy, 28 May – 1 June 2013. [Abstract reference number: A-534-0044-00814; Number 322]
Pollard AJ, Perrett KP, Beverley PC. Maintaining protection against invasive bacteria with protein– polysaccharide conjugate vaccines. Nat Rev Immunol. 2009 Mar;9(3):213-20. doi: 10.1038/nri2494
Tuscany Region. Update on regional legislation in the field of vaccination. [Italian: Calendario vaccinale della Regione Toscana e direttive in materia di vaccinazioni. Aggiornamento aprile 2015. DGR n. 571 del 27-04-2015]. Available on: http://www301.regione.toscana.it/bancadati/atti/DettaglioAttiG.xml?codprat=2015DG00000000653
Ferro A, Bonanni P, Castiglia P. Il valore scientifico e sociale della vaccinazione, Aprile 2013. Available online at: http://www.vaccinarsi.org/vantaggi-rischi-vaccinazioni/il-valore-scientifico-e-sociale-della-vaccinazione.html
CDC. Morbidity and Mortality Weekly Report (MMWR). General Recommendations on Immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP). February 8, 2002 / Vol. 51 / No. RR-2. Available online at: https://www.cdc.gov/mmwr/PDF/rr/rr5102.pdf
Boccalini S, Bonanni P, Bechini A. Preparing to introduce the varicella vaccine into the Italian immunisation programme: varicella-related hospitalisations in Tuscany, 2004–2012. Eurosurveillance, published on 16 June 2016.
Giammanco G, Ciriminna S, Barberi I, Titone L, Lo Giudice M, Biasio LR. Universal varicella vaccination in the Sicilian paediatric population: rapid uptake of the vaccination programme and morbidity trends over five years. Euro Surveill. 2009 Sep 3;14(35).
Cuccia M, Pollina Addario S, Cernigliaro A, Palmigiano V. Ospedalizzazioni per varicella in Sicilia dopo l’introduzione della vaccinazione. Bollettino Epidemiologico Nazionale (Ben) Notiziario ISS Volume 22 numero 3, Marzo 2009. Available at: http://www.epicentro.iss.it/ben/2009/marzo/1.asp.
Baldo V, Ferro A, Napoletano G, Milani S, Bertoncello L, Baldovin T, Trivello R. Universal varicella vaccination in the Veneto Region, Italy: launch of a programme targeting all children aged 14 months and susceptible adolescents. Euro Surveill. 2007 Nov 1;12(11):E071101.3.
Baldo V, Baldovin T, Russo F, Busana MC, Piovesan C, Bordignon G, Giliberti A, Trivello R. Varicella: epidemiological aspects and vaccination coverage in the Veneto Region. BMC Infect Dis. 2009 Sep 8;9:150.
Pozza F, Piovesan C, Russo F, Bella A, Pezzotti P, Emberti Gialloreti L. Impact of universal vaccination on the epidemiology of varicella in Veneto, Italy. Vaccine. 2011 Nov 28;29(51):9480-7.
Pozza F., Russo F. Andamento epidemiologico e coperture vaccinali della varicella. Dati al 31 dicembre 2011. Documento Direzione Prevenzione. Servizio Promozione e Sviluppo Igiene e Sanità Pubblica, Regione Veneto. Available online at: http://www.fimp.veneto.it/sites/default/files/Varicella%20tassi%20copertura%202011.pdf
De Mei B. La complessità della scelta vaccinale. April 2013. Available online at: http://www.epicentro.iss.it/approfondimenti/2013/VaccinazioniComplessitaScelta.asp.
Giovanetti F, Laudani E. Analisi del rifiuto vaccinale nell’Asl 18 della Regione Piemonte su 23 anni di osservazione. Bollettino epidemiologico nazionale - Notiziario Iss, Vol.16, n.5, Maggio 2003.
Valsecchi M, Speri L, Simeoni L, Campara P, Brunelli M. Progetto “Indagine sui Determinanti del Rifiuto dell’Offerta Vaccinale nella Regione Veneto”, 2009. Available online at: http://prevenzione.ulss20.verona.it/docs/RicercheScelteVaccinali/Indagine-Determinanti-Scelta-Vaccinale-Report.pdf
Macdonald L, Cairns G, Angus K, De Andrade M. Promotional communications for influenza vaccination: a systematic review. J Health Commun. 2013 Dec;18(12):1523-49.
Azzari C, Massai C, Poggiolesi C, Indolfi G, Spagnolo G, De Luca M, Gervaso P, De Martino M, Resti M. Cost of varicella-related hospitalisations in an Italian paediatric hospital: comparison with possible vaccination expenses. Current Medical Research & Opinion, 2007, Vol. 23, No. 12 , Pages 2945-2954. Available online at: http://informahealthcare.com/doi/abs/10.1185/030079907X242610
DE. The value of vaccination. Adv Exp Med Biol. 2011;697:1-8.
Curtale F, Perrelli F, Mantovani J, Ciofi degli Atti M, Filia A, Nicoletti L, Magurano F, Borgia P, Di Lallo D. Description of two measles outbreaks in the Lazio Region, Italy (2006-2007). Importance of pockets of low vaccine coverage in sustaining the infection. BMC Infectious Diseases 2010, 10:62 doi:10.1186/1471-2334-10-62 published 11 March 2010