Measles-Related Hospitalizations in Italy, 2004-2016: The Importance of High Vaccination Coverage

Measles in Romania - clinical and epidemiological characteristics of hospitalized measles cases during the first three years of the 2016-ongoing epidemic

A large measles epidemic has been ongoing in Romania and many European countries, since 2016. We report case-based surveillance data for all patients (n = 1371) with laboratory-confirmed and epidemiologically-confirmed measles hospitalized in a major infectious diseases hospital in Bucharest Romania during the first three years of the current measles epidemic (July 2016–July 2019).

More than half of the patients (57.6%) had ages below 5 years; 6% (n = 82) had preexisting comorbidities. Only 1.5% of the patients had been fully vaccinated, 5.9% had received only one vaccine dose, while 92.8% had not been vaccinated at all against measles. The rate of measles-related complications was 93.4%; complications occurred more frequently among patients who were not eligible for vaccination due to young age or underlying diseases, and among children, who developed pneumonia and enterocolitis more frequently than adults. The median hospital length-of-stay was 6 days. Eight cases (0.6%) required intensive care and mechanical ventilation, and three deaths (0.2%) were recorded.

Measles disproportionately affects patient groups who are not eligible for vaccination. During the current epidemic in Romania, 98.5% of the patients hospitalized for measles had not been vaccinated and among these, 75.7% would have been eligible for vaccination. For the remaining pool of unvaccinated children, supplementary immunization activities are urgently needed.

Pertussis in Italy: how to protect the "unprotectable"?

Whooping cough continues to be an important public health issue despite high levels of vaccination coverage with acellular pertussis vaccine. Young unimmunized infants represent the most vulnerable group with the highest rates of complications and death. As infant-specific pertussis epidemiologic data, especially among neonates, in Italy were limited, a retrospective observational study of hospitalizations for whooping cough in Italian infants aged <12 months between 2007 and 2018 was conducted to address this knowledge gap. The temporal trend of rates, also stratified for age classes according to the expected age for the administration of vaccine doses, were analyzed by the slope of the regression line. The mean age at the time of admission was 92 d (±64). A clear seasonal pattern in the occurrence of pertussis hospitalizations with a summer peak was observed. Infants younger than 3 months old had the highest hospitalization rates (169 x 100000 infants on average), with a significant rising trend of 9 x 100000 infants on average per year. Limiting the analysis to Bordetella pertussis-related hospitalizations such trend was even more evident. In the other age classes, hospitalization rates were considerably lower and gradually decreased with increasing age. This study demonstrated that pediatric populations, too young to be protected by vaccination, had a greater risk of contracting pertussis. Thus, it is necessary to promote additional immunization strategies besides one booster dose in adolescents, including vaccination during pregnancy.

Trends in Hospital Admissions for Pertussis Infection: A Nationwide Retrospective Observational Study in Italy, 2002-2016

Background: Pertussis is a highly contagious infectious disease which continues to be an important public-health issue despite the high immunization coverage rates achieved. However, evidence of increased circulation of pertussis among adolescents and adults due to waning immunity and atypical clinical manifestations seem to be the main reasons for its resurgence. The aim of this study was the analysis of the epidemiological trend for pertussis-related hospitalizations in Italy, in relation with vaccination coverage and information from laboratory confirmed cases of pertussis. Methods: A retrospective observational study investigating hospitalizations for pertussis from 2002 to 2016 in Italy was conducted. Frequencies and rates of hospitalization were analyzed and hospitalization data were compared with a series of already published laboratory confirmed data. Results: This study highlighted a rising trend for pertussis hospitalizations in Italy since 2008. Infants aged <1 year showed the highest frequencies (63.39%) and average rates (74.60 × 100000 infants) of hospitalization despite an extremely high vaccination coverage (95.89%). An increasing trend of hospitalization frequency emerged for the age group with levels of IgG antibodies to pertussis toxin compatible with pertussis infection within the last year (20–29 years old age group). Conclusions: The rising trend for pertussis hospitalizations and the greater involvement of infants aged <1 year require an integrated approach, including the implementation of booster doses administration in adolescence and adulthood, the vaccination of pregnant women and the cocoon strategy.