Current immunization policies for pneumococcal, meningococcal C, varicella and rotavirus vaccinations in Italy

Istituto Superiore di Sanità (ISS), National Center for Epidemiology Surveillance and Health Promotion (CNESPS), Rome, Italy.
Health Policy (Impact Factor: 1.91). 12/2011; 103(2-3):176-83. DOI: 10.1016/j.healthpol.2011.10.002
Source: PubMed


As Italian Regions can implement different policies for immunizations that are not already recommended "across the board" in the country, the present study aimed to describe Regional recommendations and strategies concerning pneumococcal, meningococcal C, varicella and rotavirus vaccines.
In July 2010, a self-administered cross-sectional questionnaire was mailed to the Regional coordinators for infectious diseases and vaccinations. Data were analysed and compared with the results of previous surveys conducted two and four years before.
To date, a universal vaccination programme is implemented free of charge in 18 out of 21 Regions (86%) and 17 out of 21 Regions (81%) for pneumococcal and meningococcal C vaccine, respectively. Varicella immunization policies still differ widely among Regions: seven Regions (33%) have adopted a universal free of charge programme, while in the remaining 14 varicella vaccination is offered only to at risk groups. Nine of these Regions also provide immunization to susceptible adolescents. Rotavirus vaccination has not been identified as a priority in Italy, and only 5 Regions have officially introduced it in their schedule.
Italian Regions are moving towards a common vaccination strategy concerning pneumococcal and meningococcal C vaccine. The debate on a common varicella and rotavirus vaccination strategy is still on-going.

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    • "The Emilia-Romagna region actively provided pneumococcal immunization to all infants since 2006; while, the Lombardy region initially offered vaccination only to disease-specific risk groups of children. Since 2009, Lombardy has offered vaccination to all infants upon the parents’ or pediatricians’ request [13]. As expected, different vaccine coverage rates were observed in the two regions in 2008, with 95% PCV7 coverage in Emilia-Romagna and 27% in Lombardy [14]. "
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    ABSTRACT: In mid 2010, the 7-valent pneumococcal conjugate vaccine (PCV7) was replaced by the 13-valent conjugate vaccine (PCV13) for childhood immunization in Italy. Our objective in this study was to obtain a snapshot of pneumococcal carriage frequency, colonizing serotypes, and antibiotic resistance in healthy children in two Italian cities one year after PCV13 was introduced. Nasopharyngeal swabs were obtained from 571 children aged 0-5 years from November 2011-April 2012. Pneumococcal isolates were serotyped and tested for antimicrobial susceptibility. Penicillin and/or erythromycin non-susceptible isolates were analyzed by Multi Locus Sequence Typing (MLST). Among the children examined, 81.2% had received at least one dose of PCV7 or PCV13 and 74.9% had completed the recommended vaccination schedule for their age. Among the latter, 57.3% of children had received PCV7, 27.1% PCV13, and 15.6% a combination of the two vaccines. The overall carriage rate was 32.9%, with children aged 6-35 months the most prone to pneumococcal colonization (6-23 months OR: 3.75; 95% CI: 2.19-6.43 and 24-35 months OR: 3.15, 95%CI: 2.36-4.22). A total of 184 pneumococcal isolates were serotyped and divided into PCV7 (5.4%), PCV13 (18.0%), and non-PCV13 (82.0%) serotypes. Serotypes 6C, 24F, and 19A were the most prevalent (10.3%, 8.6%, and 8.1%, respectively). The proportion of penicillin non-susceptible (MIC >0.6 mg/L) isolates was 30.9%, while 42.3% were erythromycin resistant. Non-PCV13 serotypes accounted for 75.4% and 70.8% of the penicillin and erythromycin non-susceptible isolates, respectively. Our results revealed low rates of PCV7 and PCV13 serotypes in Italian children, potentially due to the effects of vaccination. As the use of PCV13 continues, its potential impact on vaccine serotypes such as 19A and cross-reactive serotypes such as 6C will be assessed, with this study providing a baseline for further analysis of surveillance isolates.
    PLoS ONE 10/2013; 8(10):e76309. DOI:10.1371/journal.pone.0076309 · 3.23 Impact Factor
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    • "Varicella is usually mild in immunocompetent children, but occasionally there are severe complications and even fatalities [1-5]. To reduce general morbidity as well as the number of severe cases, several countries outside Europe (Australia, Canada, Costa Rica, Ecuador, Israel, New Zealand, Oman, Panama, Qatar, Saudi-Arabia, South Korea, Taiwan, the United Arab Emirates, Uruguay and USA) [1,6-8] as well as some European countries (Germany, Greece, Latvia, Luxembourg) [8-11] and regions (seven out of 21 in Italy [12], two out of 17 in Spain [13]) have introduced routine varicella vaccination during the last two decades. "
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    ABSTRACT: In 2004, routine varicella vaccination was recommended in Germany for children 11-14 months of age with one dose, and since 2009, with a second dose at 15-23 months of age. The effects on varicella epidemiology were investigated. Data on varicella vaccinations, cases and complications were collected from annual parent surveys (2006-2011), monthly paediatric practice surveillance (Oct 2006 - Sep 2011; five varicella seasons) and paediatric hospital databases (2005-2009) in the area of Munich (about 238,000 paediatric inhabitants); annual incidences of cases and hospitalisations were estimated. Varicella vaccination coverage (1st dose) in children 18-36 months of age increased in two steps (38%, 51%, 53%, 53%, 66% and 68%); second-dose coverage reached 59% in the 2011 survey. A monthly mean of 82 (62%) practices participated; they applied a total of 50,059 first-dose and 40,541 second-dose varicella vaccinations, with preferential use of combined MMR-varicella vaccine after recommendation of two doses, and reported a total of 16,054 varicella cases <17 years of age. The mean number of cases decreased by 67% in two steps, from 6.6 (95%CI 6.1-7.0) per 1,000 patient contacts in season 2006/07 to 4.2 (95%CI 3.9-4.6) in 2007/08 and 4.0 (95%CI 3.6-4.3) in 2008/09, and further to 2.3 (95%CI 2.0-2.6) in 2009/10 and 2.2 (95%CI 1.9-2.5) in 2010/11. The decrease occurred in all paediatric age groups, indicating herd protection effects. Incidence of varicella was estimated as 78/1,000 children <17 years of age in 2006/07, and 19/1,000 in 2010/11. Vaccinated cases increased from 0.3 (95%0.2-0.3) per 1,000 patient contacts in 2006/07 to 0.4 (95%CI 0.3-0.5) until 2008/09 and decreased to 0.2 (95%CI 0.2-0.3) until 2010/11. The practices treated a total of 134 complicated cases, mainly with skin complications. The paediatric hospitals recorded a total of 178 varicella patients, including 40 (22.5%) with neurological complications and one (0.6%) fatality due to varicella pneumonia. Incidence of hospitalisations decreased from 7.6 per 100,000 children <17 years of age in 2005 to 4.3 in 2009, and from 21.0 to 4.7 in children <5 years of age. Overall, the results show increasing acceptance and a strong impact of the varicella vaccination program, even with still suboptimal vaccination coverage.
    BMC Infectious Diseases 07/2013; 13(1):303. DOI:10.1186/1471-2334-13-303 · 2.61 Impact Factor
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    • "There was also no information concerning the pneumococcal or influenza vaccination status of the children. Heptavalent pneumococcal conjugate vaccine was gradually introduced into Italy in late 2005 [33], with different regions adopting different policies that varied from the vaccination of specific groups to the vaccination of all infants. However, about half of the PCPs participating in the study were working in regions in which it was initially recommended only for specific high-risk groups, and it is unlikely that the lack of the information regarding vaccination would have been a major confounding factor in such a setting. "
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    ABSTRACT: Background The incidence of acute otitis media (AOM) vary from country to country. Geographical variations together with differences in study designs, reporting and settings play a role. We assessed the incidence of AOM in Italian children seen by primary care paediatricians (PCPs), and described the methods used to diagnose the disease. Methods This secondary data analysis from the Pedianet database considered children aged 0 – 6 years between 01/2003 and 12/2007. The AOM episodes were identified and validated by means of patient diaries. Incidence rates/100 person-years (PY) were calculated for total AOM and for single or recurrent AOM. Results The 92,373 children (52.1% males) were followed up for a total of 227,361 PY: 23,039 (24.9%) presented 38,241 episodes of AOM (94.6% single episodes and 5.4% recurrent episodes). The total incidence rate of AOM in the 5-year period was 16.8 episodes per 100 PY (95% CI: 16.7-16.9), including single AOM (15.9 episodes per 100 PY; 95% CI: 15.7-16.1) and recurrent AOM (0.9 episodes per 100 PY; 95% CI: 0.9-0.9). There was a slight and continuously negative trend decrease over time (annual percent change −4.6%; 95%CI: -5.3, -3.9%). The AOM incidence rate varied with age, peaking in children aged 3 to 4 years (22.2 episodes per 100 PY; 95% CI 21.8-22.7). The vast majority of the AOM episodes (36,842/38,241, 96.3%) were diagnosed using a static otoscope; a pneumatic otoscope was used in only 3.7%. Conclusions Our data fill a gap in our knowledge of the incidence of AOM in Italy, and indicate that AOM represents a considerable burden for the Italian PCP system. Educational programmes concerning the diagnosis of AOM are needed, as are further studies to monitor the incidence in relation to the introduction of wider pneumococcal conjugate vaccines.
    BMC Pediatrics 11/2012; 12(1):185. DOI:10.1186/1471-2431-12-185 · 1.93 Impact Factor
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