Current immunization policies for pneumococcal, meningococcal C, varicella and rotavirus vaccinations in Italy
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.
[Show abstract] [Hide abstract] ABSTRACT: . Rotavirus (RV) is the commonest pathogen in the hospital and primary care settings, followed by Adenovirus (AV) and Norovirus (NV). Only few studies that assess the burden of RV gastroenteritis at the community level have been carried out. Objectives . To estimate incidence, disease characteristics, seasonal distribution, and working days lost by parents of RV, AV, and NV gastroenteritis leading to a family pediatrician (FP) visit among children < 5 years. Methods . 12-month, observational, prospective, FP-based study has been carried out using Pedianet database. Results . RVGE incidence was 1.04 per 100 person-years with the highest incidence in the first 2 years of life. Incidences of AVGEs (1.74) and NVGEs (1.51) were slightly higher with similar characteristics regarding age distribution and symptoms. Risk of hospitalisation, access to emergency room (ER), and workdays lost from parents were not significantly different in RVGEs compared to the other viral infections. Conclusions . Features of RVGE in terms of hospitalisation length and indirect cost are lower than those reported in previous studies. Results of the present study reflect the large variability of data present in the literature. This observation underlines the utility of primary care networks for AGE surveillance and further studies on community-acquired gastroenteritis in children.0Comments 0Citations
- "In 2 regions (Lazio and Tuscany), vaccination is offered to all infants with a copayment system; in Basilicata and Piedmont, it is free for preterm infants and high-risk groups and in Apulia children can receive RV vaccination for free based on a FP's request. In the Veneto Region it is strongly suggested but not included in the vaccinations plan, so families have to pay to receive it . Analyzing the possible reasons of low RV vaccination diffusion, the most common barriers are represented by the low perception of RV disease burden, potential safety concerns , and unfavorable cost-effectiveness. "
[Show abstract] [Hide abstract] ABSTRACT: In Italy, the effectiveness of pneumococcal universal vaccination in preventing vaccine-type invasive pneumococcal disease (IPD) in the PCV7/PCV13 shifting period was estimated to be 84.3% (95% CI: 84.0-84.6%) in children <5 years. This study aims at corroborating the estimation of both the effectiveness (VE) of PCVs and its impact in reducing pneumococcal diseases. A 1 : 3 matched-case-control study was conducted among children <5 years old hospitalized for IPD or pneumococcal pneumonia (PP) between 2006 and 2012 in the Puglia region. Moreover, hospitalizations for pneumococcal outcomes in the pre- and postvaccination period and the hospitalization risk ratios (HRRs) with 95% CIs were computed in Italy and in the first eight regions that introduced PCVs in 2006. The overall effectiveness of PCVs was 75% (95% CI: 61%-84%); it was 69% (95% CI: 30%-88%) against IPD and 77% (95% CI: 61%-87%) against PP. PCVs showed a significant impact on IPD and acute otitis media either at a national level or in those regions with a longer vaccination history, with a nearly 40% reduction of hospitalizations for both outcomes. Our findings provide further evidence of the effectiveness of PCVs against pneumococcal diseases and its impact on nasopharyngeal carriage in children <5 years, indicating the importance of maintaining high immunization coverage.0Comments 1Citation
- "showed a peak in all age groups during and after the flu pandemic in 2009 . Moreover, surveillance of pneumococcal diseases presents a number of challenges because of differences in surveillance systems and reporting practices among Italian regions, therefore producing false trends . In addition, underascertainment remains considerable for the scarce attitude to investigate cases using adequate laboratory tests, as the large number of the discharge records coded as allcause pneumonia in this study has showed. "
[Show abstract] [Hide abstract] ABSTRACT: In Italy, the meningococcal C conjugate vaccine (MenC) has been offered in most regions since 2009-2010. The incidence of Invasive Meningococcal Disease (IMD) was 0.25 confirmed cases per 100,000 in 2011, but this may be considerably underestimated due to underdetection and underreporting. This study estimates the impact of the MenC universal vaccination (URV) in the Puglia region by assessing the completeness of three registration sources (notifications, hospitalizations, and laboratory surveillance). Capture-recapture analysis was performed on meningococcal meningitis collected within 2001–2013. The impact of URV among ≤ 18-year-olds was assessed by attributable benefit, preventable fraction, and prevented fraction. Missed opportunities for vaccination were evaluated from surveillance of IMD. The proportion of detected serogroups was applied to the number of IMD in the postvaccination period to compute the cases still preventable. The sensitivity of the three sources was 36.7% (95% CI: 17.5%–57.9%) and registrations lost nearly 28 cases/year in the period. Attributable benefit of URV was −0.5 cases per 100,000, preventable fraction 19.6%, and prevented fraction 31.3%. Three adolescent cases missed the opportunity to be vaccinated. The multicomponent serogroup B meningococcal vaccine has the potential to further prevent at least three other cases/year. Vaccination strategy against serogroup B together with existing programmes makes IMD a 100% vaccine-preventable disease.0Comments 0Citations
- "To the best of our knowledge, this is the first study in Italy to provide an assessment of the sensitivity of data sources available for monitoring the incidence of meningococcal meningitis. In some areas, all three registries have the disadvantage of incompleteness due to underdiagnosis (underascertainment), misclassification, and underreporting of IMD . Capture-recapture analysis represents a unique tool to estimate the sensitivity of surveillance registrations and hence the total number of cases . "