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Attwell K, Hannah A. Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates. Int J Health Policy Manag 2022; 11:2660-2671. [PMID: 35397484 PMCID: PMC9818102 DOI: 10.34172/ijhpm.2022.6518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 02/05/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Vaccine hesitancy is a global problem with diverse local policy responses, from voluntaristic to coercive. Between 2015 and 2017, California, Australia, France, and Italy increased the coerciveness of their childhood vaccine regimes. Despite this apparent convergence, there is little evidence of imposition, policy learning, or diffusion - the drivers that are usually discussed in scholarly literature on policy convergence. The fact that the four governments were oriented across the political spectrum, with quite different political and institutional systems, further indicates an empirical puzzle. METHODS To better understand the drivers of enhanced vaccine mandates, a crucial issue during the coronavirus disease 2019 (COVID-19) global rollout, this article engages with four case studies assembled from qualitative analysis of semi-structured in-country interviews and document analysis between November 2018 and November 2020. Key informants had specific expert knowledge or played a role in the introduction or implementation of the new policies. Interview transcripts were coded inductively and deductively, augmented with extensive analysis of legal, policy, academic and media documents. RESULTS The case analysis identifies two key and interacting elements in government decisions to tighten vaccine mandates: functional and political pressures. Policy-makers in Italy and France were primarily driven by functional challenges, with their vaccination governance systems under threat from reduced population compliance. California and Australia did not face systemic threats to the functioning of their systems, but activists utilised local opportunities to heighten political pressure on decision makers. CONCLUSION In four recent cases of high-income jurisdictions making childhood vaccination policies more coercive, vaccine hesitancy alone could not explain why the policies arose in these jurisdictions and not others, while path dependency alone could not explain why some jurisdictions with mandates made them more coercive. Explanation lies in restrictive mandates being attractive for governments, whether they face systemic functional problems in vaccine governance, or political pressures generated by media and activists. Mandates can be framed as targeting whole populations or localised groups of refusers, and implemented without onerous costs or policy complexity.
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Affiliation(s)
- Katie Attwell
- Political Science and International Relations, School of Social Sciences, University of Western Australia, Perth, WA, Australia
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2
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Vaccination—A Step Closer to Universal Health Coverage. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01322-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Seroepidemiology of Measles, Mumps, Rubella and Varicella in Italian Female School Workers: A Cross-Sectional Study. Vaccines (Basel) 2021; 9:vaccines9101191. [PMID: 34696299 PMCID: PMC8538669 DOI: 10.3390/vaccines9101191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Determining the proportion of susceptible workers can represent a first step to the biological risk assessment related to measles, mumps, rubella and varicella exposure. This study aimed to assess the immunity against measles, mumps, rubella and varicella viruses in a cohort of female school workers. METHODS A cross-sectional seroepidemiological study in a sample of 263 school workers undergoing routine annual workplace health surveillance program was conducted. As part of the health surveillance program, serum samples were collected and tested for measles, mumps, rubella and varicella IgG antibodies. RESULTS Overall seropositivity was 90.5%, 85.2%, 94.7% and 97.3% for measles, mumps, rubella and varicella, respectively. In relation to mumps occupation-specific seropositivity, a statistically significant difference was observed, showing the lowest prevalence of protected individuals in other occupation groups. Moreover, in relation to rubella, school workers born in Centre Italy had the lowest seropositivity of protective antibodies and the difference between groups was statistically significant. Measles and rubella seropositivity showed a significant decrease after 2015. CONCLUSIONS This study showed a relevant proportion of school workers susceptible to the aforementioned diseases. These results highlighted the need for proper health surveillance and immunological controls in school workers, especially for females, and provided useful insights to policymakers to select effective strategies aimed at containing the risk of vaccine-preventable diseases at schools.
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Kuznetsova L, Cortassa G, Trilla A. Effectiveness of Mandatory and Incentive-Based Routine Childhood Immunization Programs in Europe: A Systematic Review of the Literature. Vaccines (Basel) 2021; 9:vaccines9101173. [PMID: 34696280 PMCID: PMC8538772 DOI: 10.3390/vaccines9101173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
There is a lack of comprehensive and systematic data and evidence regarding the effectiveness of mandatory and incentive-based vaccination schemes. The results of such programs in some countries have not been adequately studied. A number of countries have recently introduced tightening vaccination measures, and it is important to analyze and assess the results of these programs. The unprecedented situation due to the COVID-19 pandemic and mass vaccination made the topic of the effectiveness of vaccination policies and mandates even more relevant. The aim of the study is to assess childhood vaccination programs implemented in selected countries. The study focuses on initiatives implemented in the European Region of the World Health Organization (WHO). A total of 466 full-text articles were assessed for eligibility, and 26 articles on seven countries were included in the synthesis. Additionally, we obtained and performed an analysis of data on the impact of COVID-19 on vaccine coverage and incidence of vaccine-preventable diseases, and the implementation of vaccine mandates in the selected countries. The evidence collected and analyzed in this review allowed us to conclude that the introduction of children routine vaccination mandates increases vaccine coverage and reduces the incidence of vaccine-preventable diseases when compared to the situation before the introduction of the mandates.
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Affiliation(s)
- Lidia Kuznetsova
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain;
- Correspondence:
| | - Giorgio Cortassa
- Emergency Department, Hospital Santa Corona, 17027 Pietra Ligure, Italy;
| | - Antoni Trilla
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain;
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Veljkovic M, Loncarevic G, Kanazir M, Kisic-Tepavcevic D, Gazibara T. Trend in mandatory immunisation coverage: linear and joinpoint regression approach, Serbia, 2000 to 2017. ACTA ACUST UNITED AC 2021; 26. [PMID: 34212841 PMCID: PMC8326657 DOI: 10.2807/1560-7917.es.2021.26.26.2000417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Analyses of temporal trends in immunisation coverage may help to identify problems in immunisation activities at specific points in time. These data are essential for further planning, meeting recommended indicators, monitoring, management and advocacy. Aim This study examined the trends of mandatory vaccination coverage in the period 2000–2017 in Serbia. Methods Data on completed immunisations were retrieved from annual national reports of the Institute of Public Health of Serbia during the period 2000–2017. To assess the trends of immunisation coverage, both linear and joinpoint regression analyses were performed. A probability p < 0.05 was considered significant. Results Over the period 2000–2017 linear regression analysis showed a significant decline in coverage with the primary vaccination against poliomyelitis, diphtheria, tetanus, pertussis and measles, mumps, rubella (MMR) (p ≤ 0.01). In the same period, coverage of all subsequent revaccinations significantly decreased, namely, first revaccination for pertussis (p < 0.01); first, second and third revaccination against diphtheria, tetanus and poliomyelitis (p < 0.01); and second dose against MMR before enrolment in elementary school (p < 0.05). Although linear regression analysis did not show change in vaccination coverage trend against tuberculosis (Bacillus Calmette–Guérin; BCG), hepatitis B (HepB3) in infants and diseases caused by Haemophilus influenzae type b (Hib3), the joinpoint regression analysis showed that the coverage declined for BCG after 2006, HepB3 after 2010 and Hib3 after 2008. Conclusion To achieve and keep optimum immunisation coverage, it is necessary to address barriers to immunisation, such as the availability of all vaccines and vaccine-hesitancy among parents and healthcare workers in Serbia.
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Affiliation(s)
- Marko Veljkovic
- Institute of Public Health of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | - Goranka Loncarevic
- Institute of Public Health of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | - Milena Kanazir
- Institute of Public Health of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | - Darija Kisic-Tepavcevic
- Institute of Public Health of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia.,Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Pisaniak P, Konarska M, Tarczon A, Stawowy B, Bejster K, Piórek W, Mędrzycka-Dąbrowska W, Ozga D. Mothers' Opinions on Vaccinations and Penal Responsibility for Vaccination Avoidance in Nine Selected European Countries: Findings from a Cross-Sectional Survey. Risk Manag Healthc Policy 2021; 14:1241-1254. [PMID: 33790669 PMCID: PMC8001651 DOI: 10.2147/rmhp.s283796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/29/2021] [Indexed: 01/31/2023] Open
Abstract
Aim Relations between penal responsibility and vaccination obligation can be essential for raising the vaccination rate. Social media play a vital role in distributing information. The attitude towards vaccination consists of many factors, including the criminal law situation in the field of vaccination in a given country. The aim of the study was to assess the impact of criminal law liability and other social factors such as age and education on mothers’ desire to vaccinate their children. Methods Survey target: mothers from nine European countries (Poland, Germany, Slovakia, France, Norway, Serbia, Romania, Greece, Italy). Response count: 2205. Questionnaire content: adjusted to country-specific legal regulations concerning vaccinations - considering whether vaccines are mandatory, recommended, additional, and how to cover costs. The way of dissemination of the questionnaire: general parental groups on Facebook. Results The respondents: Poles (30%), Italians, Germans, Slovaks, Greeks (10% each), Norwegians, Frenchwomen, Romanians, Serbians (5% each). The average respondent age: highest: Norway (38.14±10.08) and Italy (37.35±8.12), lowest: Slovakia (30.22±6.19). Respondents with higher, secondary, vocational, primary education represent 58%, 27%, 12%, 3%, respectively, of the group. Countries with above 90% rate of answers that they vaccinate their children: Greece, Norway, Slovakia, France. The lowest rate (55%) recorded for Romania. Sixty-seven percent aware of the existence of anti-vaccination movements. High rates were recorded for Norway (88%), Romania (82%), Poland (78%), Serbia (71%), Greece (67%), Germany (66%). The lowest rate for France (31%). Countries without vaccination at all (Germany, Norway, Romania, Greece), the rest of the countries mentioned above – have some mandatory, recommended and additional vaccinations. Conclusion In countries with mandatory vaccinations parents have their children vaccinated less willingly than in countries with voluntary vaccinations. The rising level of education and providing information about complications following infectious diseases appear to increase the vaccination rate.
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Affiliation(s)
- Paulina Pisaniak
- EMS Students Association, Medical College, Rzeszów University, Rzeszów, Poland
| | - Milena Konarska
- Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovakia
| | - Aleksander Tarczon
- EMS Students Association, Medical College, Rzeszów University, Rzeszów, Poland
| | - Bartłomiej Stawowy
- EMS Students Association, College of Social Sciences, Rzeszów University, Rzeszów, Poland
| | - Karolina Bejster
- EMS Students Association, College of Social Sciences, Rzeszów University, Rzeszów, Poland
| | - Weronika Piórek
- EMS Students Association, Medical College, Rzeszów University, Rzeszów, Poland
| | | | - Dorota Ozga
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, Rzeszów, 35-310, Poland
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Vaccination Status of Mothers and Children from the 'Mamma & Bambino' Cohort. Vaccines (Basel) 2021; 9:vaccines9020168. [PMID: 33671412 PMCID: PMC7921954 DOI: 10.3390/vaccines9020168] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 01/12/2023] Open
Abstract
According to the evidence demonstrating vaccines’ safety and effectiveness in anticipation of and during pregnancy, several countries have established immunization programs during the periconceptional period. Here, we evaluated vaccination status among 220 mother–child pairs, using data from the ‘Mamma & Bambino’ cohort. The self-reported data were evaluated at delivery, and with planned follow-ups at 1–2 years after delivery. In general, we noted that the vaccination status among the women was heterogeneous, ranging from 8.3% (vaccine against Human Papillomavirus, HPV) to 65.6% (vaccine against Diphtheria Tetanus and Pertussis, DTaP). Excluding the women who contracted the diseases in the past, the main ground for refusal was the lack of information. We also demonstrated that increasing age was associated with higher odds of not being vaccinated against Measles-Mumps-Rubella (MMR; OR = 1.12; 95% CI = 1.04–1.21; p = 0.004), HPV (OR = 1.20; 95% CI = 1.08–1.33; p = 0.001) and DTaP (OR =1.09; 95% CI = 1.01–1.18; p = 0.040). As expected, we showed that the proportion of newborns vaccinated with the Hexavalent and Pneumococcal vaccines was high (99.5% and 98.6%, respectively), while the vaccination coverage against MMRV did not reach the auspicated threshold (84.1%). Overall, these results underlined the need for the improvement of women’s knowledge about the recommendations for vaccination, especially during pregnancy.
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Baccolini V, Sindoni A, Adamo G, Rosso A, Massimi A, Bella A, Filia A, Magurano F, Marzuillo C, Villari P, De Vito C. Measles among healthcare workers in Italy: is it time to act? Hum Vaccin Immunother 2020; 16:2618-2627. [PMID: 32209017 PMCID: PMC7746257 DOI: 10.1080/21645515.2020.1737458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/27/2020] [Indexed: 12/22/2022] Open
Abstract
Vaccination of healthcare workers (HCWs) against measles is strongly recommended in Europe. In this study, we examined the impact of measles on Italian HCWs by systematically and quantitatively analyzing measles cases involving HCWs over time and by identifying the epidemiological characteristics of the respective measles outbreaks. We retrieved data on measles cases from the Italian national integrated measles and rubella surveillance system from January 2013 to May 2019. Additionally, we performed a systematic review of the literature and an analysis of the measles and rubella aggregate outbreaks reporting forms from 2014 to 2018. Our review suggests that preventing measles infection among HCWs in disease outbreaks may be crucial for the elimination of measles in Italy. National policies aiming to increase HCW immunization rates are fundamental to the protection of HCWs and patients, will limit the economic impact of outbreaks on the institutions affected and will help achieve the elimination goal.
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Affiliation(s)
- Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandro Sindoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giovanna Adamo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Annalisa Rosso
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Local Health Unit Roma 2, Rome, Italy
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Antonietta Filia
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Fabio Magurano
- Department of Infectious Parasitic and Immune-mediated Diseases, National Institute of Health, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Serino L, Maurici M, D’Alò GL, Amadori F, Terracciano E, Zaratti L, Franco E. Healthcare Workers Training Courses on Vaccinations: A Flexible Format Easily Adaptable to Different Healthcare Settings. Vaccines (Basel) 2020; 8:vaccines8030514. [PMID: 32911808 PMCID: PMC7563464 DOI: 10.3390/vaccines8030514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/28/2022] Open
Abstract
Since 2017, Italy has expanded the compulsory vaccination from 4 to 10 for those aged 0 to 16 years. Because of the great organizational effort required for the immunization services, minor attention was given to the vaccinations not included among the mandatory ones. This situation led to a real difficulty in harmonizing the vaccination procedures even inside a single region. In the Lazio region, the Laboratory of Vaccinology of the University of Rome Tor Vergata established a working group to create a new training model for healthcare professionals. The course program proposed an update of three vaccinations which are not mandatory but actively offered. It included the same part of scientific updating and a variable part based on local experiences. A specific anonymous questionnaire on knowledge and attitude was administered. The study aimed to propose a general format of training courses for vaccination centers adaptable to the individual local health units (ASLs) and to evaluate through questionnaires. The results show differences in knowledge and attitudes toward non-mandatory vaccinations among the ASLs of Lazio, confirming the usefulness of a support to make knowledge and procedures homogeneous. This model could be adapted to any healthcare setting and exported to other services.
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Affiliation(s)
- Laura Serino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (L.S.); (M.M.); (G.L.D.); (L.Z.)
- Department of Prevention, Local Health Unit Roma 1, 00173 Rome, Italy
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (L.S.); (M.M.); (G.L.D.); (L.Z.)
| | - Gian Loreto D’Alò
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (L.S.); (M.M.); (G.L.D.); (L.Z.)
- Department of Prevention, Local Health Unit Roma 1, 00173 Rome, Italy
| | - Fabiana Amadori
- Specialization School for Hygiene and Preventive Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (F.A.); (E.T.)
| | - Elisa Terracciano
- Specialization School for Hygiene and Preventive Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (F.A.); (E.T.)
| | - Laura Zaratti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (L.S.); (M.M.); (G.L.D.); (L.Z.)
| | - Elisabetta Franco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (L.S.); (M.M.); (G.L.D.); (L.Z.)
- Correspondence:
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Odone A, Bucci D, Croci R, Riccò M, Affanni P, Signorelli C. Vaccine hesitancy in COVID-19 times. An update from Italy before flu season starts. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020031. [PMID: 32921733 PMCID: PMC7716975 DOI: 10.23750/abm.v91i3.10549] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic and response caused a worrying decline in vaccine uptake around the world. In Italy, the immunization coverage targets set in the 2017-19 National Immunization Prevention Plan (PNPV) have been met only partially. The current public health emergency is likely to have negatively impacted on immunization , with the risk of re-occurrence of Vaccine-Preventable Diseases (VPDs) outbreaks. As flu season approaches, both National Health Institutions and the scientific community in Italy have taken action. Well in advance as compared to previous years, the Ministry of Health released the Circular to launch the 2020-2021 influenza immunization campaign which this year is longer (starting on October 2020) and extends flu vaccine recommendations to more "at risk" subgroups, offered the vaccine free of charge. In addition, some Italian Regions have recently tried to make flu vaccination compulsory for all Healthcare Workers (HCWs). Since 2017, when the law on childhood vaccination in Italy was passed, compulsory vaccination has proved to be a successful strategy towards coverage increase.
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Affiliation(s)
- Anna Odone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Daria Bucci
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Roberto Croci
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | | | | | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; University of Parma, Parma, Italy.
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Nasso C, Mecchio A, Rottura M, Valenzise M, Menniti-Ippolito F, Cutroneo PM, Squadrito V, Squadrito F, Pallio G, Irrera N, Arcoraci V, Altavilla D. A 7-Years Active Pharmacovigilance Study of Adverse Drug Reactions Causing Children Admission to a Pediatric Emergency Department in Sicily. Front Pharmacol 2020; 11:1090. [PMID: 32765282 PMCID: PMC7379477 DOI: 10.3389/fphar.2020.01090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/06/2020] [Indexed: 01/22/2023] Open
Abstract
Children represent one of the most susceptible groups to adverse drug reactions (ADRs), as a consequence of physiological growth and maturation of different organ systems. The aim of this study was to characterize the frequency, preventability and seriousness of ADRs recorded in the Pediatric Emergency Department (ED) of the University hospital of Messina, in Sicily. All the suspected adverse reactions to drugs and vaccines collected from 2012 to 2018 were selected and then analyzed. Only adverse drug reactions (ADRs) with a probable or possible causality assessment were included, according to the Naranjo Algorithm and the World Health Organization criteria; the preventability assessment using Schumock and Thornton criteria was also carried out. The Medical Dictionary for Regulatory Activities (MedDRA) was used to group ADRs. Of 75,935 admissions to the Pediatric ED, 120 were due to suspected ADRs. The rate of hospital admission due to ADRs (75.8%) was significantly greater than that of patients without ADRs (11.9%). Among pediatric patients with ADRs the median (Q1–Q3) age was 29.5 (12–73.25) months. Most of ADRs were observed in infants and children (43.3% and 41.7%, respectively vs adolescents, 15%). In addition, in children with ADRs, females [41 (14–105)] were older than males [23 (11–45)] (p=0.044). Most adverse reactions were serious (75.8%) and 20.8% were preventable or probably preventable; however, the majority of serious ADRs (93.4%) resulted without sequelae. The reactions were found to be as probable (54.2%) or possible (45.8%). Vaccines (n=63), antibacterials (n=31) and anti-inflammatory medicines (n=14) were the most frequently drugs involved. Organ toxicity mapping due to vaccines was general disorders and administration site conditions (65.1%), nervous disorders (50.2%), cutaneous disorders (35%), followed by gastrointestinal disorders (20.6%). Cutaneous disorders (76%) gastrointestinal (20.7%), general (15.5%), and nervous disorders (8.6%) were the organ toxicity mapping due to drugs. Active pharmacovigilance has an essential role in supporting the development of strategies aimed at intervention to reduce admissions due to ADRs. Our data suggest that ADRs represent the first cause of hospitalization to the Pediatric Emergency Department. Furthermore, according to the literature, vaccines and antibiotics are the most frequent cause of adverse drug reactions in children.
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Affiliation(s)
- Chiara Nasso
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Anna Mecchio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Michelangelo Rottura
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | | | - Paola Maria Cutroneo
- Sicilian Regional Pharmacovigilance Center, Clinical Pharmacology Unit, University Hospital of Messina, Messina, Italy
| | - Violetta Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Pallio
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domenica Altavilla
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Montagna MT, De Giglio O, Napoli C, Fasano F, Diella G, Donnoli R, Caggiano G, Tafuri S, Lopalco PL, Agodi A. Adherence to Vaccination Policy among Public Health Professionals: Results of a National Survey in Italy. Vaccines (Basel) 2020; 8:E379. [PMID: 32664507 PMCID: PMC7565131 DOI: 10.3390/vaccines8030379] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/05/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
Starting from 2013, the number of unvaccinated people alarmingly increased in Italy; therefore, in 2017 a new Vaccine National Plan was approved. Healthcare workers (HCWs), especially public health professionals (PHPs, i.e., workers in in the sector of hygiene and preventive medicine), have an important role in informing and promoting vaccinations. In this context, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (GISIO-SItI) conducted a national survey to assess knowledge, attitude, and practices towards recommended vaccinations among PHPs. The survey was conducted during October 2019 with an anonymous questionnaire distributed to PHPs attending the 52° SItI National Congress. Overall, 57.1% of operators answered correctly to all seven recommended vaccinations, 12.8% reported to be vaccinated for all seven recommended vaccinations, while 30% were naturally immunized. A higher immunization coverage was reported for anti-hepatitis B (88.9%) and measles (86.1%), and 81.3% of the participants reported being offered the influenza vaccination during the 2018/2019 season. The majority of our sample indicated that hepatitis B (95%) and influenza (93.7%) were the recommended vaccines for HCWs, while less was known regarding varicella, pertussis, diphtheria, and tetanus boosters every 10 years. PHPs who were vaccinated (or who intended to be vaccinated) were more likely to recommend vaccinations to their patients and provided a reassuring example to those hesitant patients. Finally, this is the first study that identified good algorithms (using the techniques of machine learning as Random Forest and Deep Learning) to predict the knowledge of PHPs regarding recommended vaccinations with possible applications in other national and international contexts.
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Affiliation(s)
- Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.T.M.); (F.F.); (G.D.); (G.C.); (S.T.)
| | - Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.T.M.); (F.F.); (G.D.); (G.C.); (S.T.)
| | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy;
| | - Fabrizio Fasano
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.T.M.); (F.F.); (G.D.); (G.C.); (S.T.)
| | - Giusy Diella
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.T.M.); (F.F.); (G.D.); (G.C.); (S.T.)
| | | | - Giuseppina Caggiano
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.T.M.); (F.F.); (G.D.); (G.C.); (S.T.)
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.T.M.); (F.F.); (G.D.); (G.C.); (S.T.)
| | - Pier Luigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy;
| | - Antonella Agodi
- Coordinator of GISIO-SItI Working Group, Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy;
| | - GISIO-SItI Working Group
- GISIO-SItI Working Group–Italian Study Group of Hospital Hygiene–Italian Society of Hygiene, Preventive Medicine and Public Health, Viale Cittá d’Europa, 74, 00144 Rome, Italy;
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Monali R, De Vita E, Mariottini F, Privitera G, Lopalco PL, Tavoschi L. Impact of vaccination on invasive pneumococcal disease in Italy 2007-2017: surveillance challenges and epidemiological changes. Epidemiol Infect 2020; 148:e187. [PMID: 32418558 PMCID: PMC7482190 DOI: 10.1017/s0950268820001077] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/10/2020] [Accepted: 03/09/2020] [Indexed: 01/20/2023] Open
Abstract
Surveillance of new cases of invasive pneumococcal disease (IPD) in Italy was started in 2007 by the Ministry of Health (MoH). In 2012, pneumococcal childhood vaccination was introduced at the national level and, in 2017, for citizens aged 65 years and over. We describe here IPD epidemiology in Italy over the past 10 years investigating the impact of the vaccine programme on disease burden. Reports of IPD cases, data on serotype and vaccination coverage (VC) data were obtained from MoH annual reports, for the period 2007-2017. IPD notification rate and proportion by year, region, age and serotype were calculated. In 2007, 525 cases were reported (rate 0.88/100 000), rising to 1703 cases (rate 2.82/100 000) in 2017. The distribution of IPD cases by age group over time registered the largest share among individuals aged 65 years and over. A decreasing trend in notification rate was observed among those aged 0-4 years. During the same period, the 24-month VC increased, ranging from 80.9% to 96.7% in 2017. Molecular data indicated re-emergence of PPSV23-specific serotypes and non-vaccine serotypes. We observed an increase in IPD notifications during 2007-2017, likely due to an improved surveillance system, at least in some regions, with the relative quota of IPD notifications decreasing among vaccinated children cohorts. Further strengthening of IPD surveillance system, including molecular and vaccine coverage data, would be needed to assess and inform pneumococcal vaccination strategies in Italy.
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Affiliation(s)
- R. Monali
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - E. De Vita
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - F. Mariottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - G. Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - P. L. Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - L. Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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14
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Amerio A, Bianchi D, Santi F, Costantini L, Odone A, Signorelli C, Costanza A, Serafini G, Amore M, Aguglia A. Covid-19 pandemic impact on mental health: a web-based cross-sectional survey on a sample of Italian general practitioners. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:83-88. [PMID: 32420931 PMCID: PMC7569634 DOI: 10.23750/abm.v91i2.9619] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/26/2020] [Indexed: 11/23/2022]
Abstract
Background: Since the World Health Organization declared the new 2019 coronavirus disease (Covid-19) outbreak first a Public Health Emergency of International Concern and then a pandemic, Italy held more than 195.350 cases and 26.380 deaths. Working in the frontline with suspected Covid-19 infection patients, general practitioners (GPs) are daily under both physical and psychological pressure. Methods: A web-based cross-sectional survey was carried out on italian GPs working in Genoa (Italy), to assess the impact of Covid-19 pandemic on mental health. The survey was anonymous and a free Google Forms® software was used. Results: One hundred thirty-one GPs completed the survey. Compared to GPs with absent or mild depressive symptoms (PHQ-9 < 10), GPs reporting moderate to severe depressive symptoms (N=30, 22.9%; PHQ-9 ≥ 10) reported more helplessness (96.7% vs. 79.2%, p=.025), spent more than three hours searching for COVID-19 information (43.3% vs. 19.8%, p=.024), perceived less adequate personal protective equipment (PPE) (6.7% vs. 23.8%, p=.049) and visited more COVID-19 infected patients (16.63 ± 27.30 vs. 9.52 ± 11.75, p=.041). Moreover, PHQ-9 ≥ 10 GPs reported a significant higher severity for both anxiety and insomnia (13.43 ± 4.96 vs. 4.88 ± 3.53 and 11.60 ± 5.53 vs. 4.84 ± 3.81, respectively; p<.001), and a worse quality of life in both mental (34.60 ± 7.45 vs. 46.01 ± 7.83, p<.001) and physical (43.50 ± 9.37 vs. 52.94 ± 4.78, p<.001) component summary. Conclusions: Our results give early insight into the urgent need to provide continuity of care for patients at the community-level, adequate PPE to GPs and a clear guidance from public health institutions. A precarious healthcare system both at a national and regional level might have triggered negative mental health outcomes in Italian GPs. (www.actabiomedica.it)
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Affiliation(s)
- Andrea Amerio
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy. Mood Disorders Program, Tufts Medical Center, Boston, USA..
| | - Davide Bianchi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Francesca Santi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Luigi Costantini
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Anna Odone
- Vita-Salute San Raffaele University, Milan, Italy.
| | | | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland; Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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15
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Sprengholz P, Betsch C. Herd immunity communication counters detrimental effects of selective vaccination mandates: Experimental evidence. EClinicalMedicine 2020; 22:100352. [PMID: 32462116 PMCID: PMC7240331 DOI: 10.1016/j.eclinm.2020.100352] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Low vaccine uptake results in regular outbreaks of severe diseases, such as measles. Selective mandates, e.g. making measles vaccination mandatory (as currently implemented in Germany), could offer a viable solution to the problem. However, prior research has shown that making only some vaccinations mandatory, while leaving the rest to voluntary decisions, can result in psychological reactance (anger) and decreased uptake of voluntary vaccines. Since communicating the concept of herd immunity has been shown to increase willingness to vaccinate, this study assessed whether it can buffer such reactance effects. METHODS A total of N = 576 participants completed a preregistered 2 (policy: selective mandate vs. voluntary decision) × 2 (communication: herd immunity explained yes vs. no) factorial online experiment (AsPredicted #26007). In a first scenario, the concept of herd immunity was either introduced or not and vaccination either mandatory or voluntary, depending on condition. The dependent variable was the intention to vaccinate in the second scenario, where vaccination was always voluntary. Additionally, we explored the mediating role of anger between policies and intentions. FINDINGS Herd immunity communication generally increased vaccination intentions; selective mandates had no overall effect on intentions, and there was no interaction of the factors. However, selective mandates led to increased anger when herd immunity was not explained, leading in turn to lower subsequent vaccination intentions. INTERPRETATION Explaining herd immunity can counter potential detrimental effects of selective mandates by preventing anger (reactance). FUNDING This study was funded by the University of Erfurt and the German Research Foundation (BE-3979/11-1).
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16
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Costantino C, Casuccio A, Sannasardo CE, Vella C, Scarpitta F, Randazzo MA, Foresta A, Casuccio N, Ventura G, Bono SE, Vitale F, Restivo V. Public health strategies adopted to manage the increase of accesses to vaccination services, as a result of the application of the law 119/2017. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:35-40. [PMID: 32275265 PMCID: PMC7975909 DOI: 10.23750/abm.v91i3-s.9413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 11/25/2022]
Abstract
Background and aim of the work: In response to the alarming reduction of vaccination coverage rates, Italian Ministry of Health approved the law number 119/2017, which has extended the number of mandatory vaccinations, for school attendance, from four to ten. The present study aims to evaluate accesses to the vaccination services of the Palermo Local Health Unit (LHU) and the variation of the vaccination coverage rates for hexavalent and measles, mumps, rubella and varicella (MMRV) vaccines, after the implementation of the law 119/2017. Methods: An extent of opening hours and an involvement of other health-care professionals in the vaccination services of the Palermo LHU have been adopted to manage the excess of accesses after the introduction of 119/2017 law and to limit the discomfort of general population. Vaccination accesses and coverage rates were calculated from the electronic immunization registers. Results: An overall increase of about 15% of single vaccination accesses was observed in the three semester after the introduction of the law in the LHU of Palermo. A peak of 35,516 accesses was observed during the second semester of 2017 (+ 30% compared to the same semesters of 2016 and 2018). From 2016 to 2018, coverage rates for full hexavalent cycle and first dose of MMRV, at 24 and 36 months, and for full MMRV cycle and fourth dose of diphtheria, tetanus, pertussis, poliomyelitis (DTPa+IPV), among 6 years old children, showed considerable increases. Conclusions: Law 199/2017 demonstrated a high efficacy in increase vaccination coverage rates also in Sicily. The synergy established between the LHU and the University of Palermo allowed an excellent management of the accesses to vaccination services, making it possible to respond to the public health needs of the general population.
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Affiliation(s)
- Claudio Costantino
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Alessandra Casuccio
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Claudia Emilia Sannasardo
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Carlotta Vella
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Francesco Scarpitta
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | | | - Angelo Foresta
- Local Health Unit of Palermo, Department of Medical Prevention.
| | - Nicolò Casuccio
- Local Health Unit of Palermo, Department of Medical Prevention.
| | - Gianmarco Ventura
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Stefania Enza Bono
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Francesco Vitale
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Vincenzo Restivo
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
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17
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Rossi D, Croci R, Affanni P, Odone A, Signorelli C. [Influenza vaccination coverage in Lombardy Region: a twenty-year trend analysis (1999-2019)]. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:141-145. [PMID: 32275279 PMCID: PMC7975897 DOI: 10.23750/abm.v91i3-s.9455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022]
Abstract
Influenza vaccination coverage in Lombardy Region: a twenty-year trend analysis (1999-2019). Recent events and phenomena, such as A(H1N1) pandemic in 2009, “Fluad case” (2014-2015) and the spread of vaccine hesitancy, affected influenza vaccination coverage rates in Italy. In this study, the annual coverage rates in Lombardy Region and in Italy (from 1999-2000 season) have been critically described and compared. Regarding both the general population and the elderly over-65s, Lombardy’s coverages always remained consistently below the national average. However, declines and peaks occurred simultaneously. The current slight recovery, both at national and regional level, is not sufficient. Coverages are still widely below the recommended thresholds.
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Affiliation(s)
| | | | | | - Anna Odone
- Università Vita-Salute San Raffaele, Milano.
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18
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Signorelli C, Priori M, Odone A, Vezzosi L, Colucci ME, Affanni P, Veronesi L, Maio T. [New challenges in vaccination policies: the role of General Practitioners]. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:135-140. [PMID: 32275278 PMCID: PMC7975910 DOI: 10.23750/abm.v91i3-s.9452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/25/2022]
Abstract
New challenges in vaccination policies: the role of General Practitioners. The phenomenon of “Vaccine Hesintacy” and the consequent decrease in vaccination coverage with the re-ignition of some epidemic outbreaks has led Italian national and regional authorities to set a new vaccination plan (PNPV 2017-19) and even coercive measures such as the the Law n.119/2017. In addition, there have been initiatives by scientific societies also in order to increase involvement of professionals in information and education campaigns. Among the professional figures involved, the general practitioners represents the starting point from which to regain the citizen’s trust. This article assesses their important role in the implementation of vaccination policies in Italy by identifying the essential points of the campaigns carried out on their patients.
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Affiliation(s)
- Carlo Signorelli
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy. Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | | | - Anna Odone
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy.
| | | | | | - Paola Affanni
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
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19
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Croci R, Rossi D, Colucci ME, Odone A, Signorelli C. Trends in childhood vaccinations coverage in Lombardy Region after the National Vaccine Prevention Plan (2017-19) and the new law on mandatory vaccinations. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:71-76. [PMID: 32275270 PMCID: PMC7975904 DOI: 10.23750/abm.v91i3-s.9458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 11/23/2022]
Abstract
In Italy, over the last decade, the spread of vaccine hesitancy has caused a steep decrease in vaccination coverage rates, both at the national and regional level. In this study, we pool and critically analyze childhood immunization coverage rates (2011-2018) in Lombardy, Italy’s most populated region, and compare them to national trends. Overall, childhood vaccination coverage in Lombardy is slightly higher the Italian national average. In 2017, the law on mandatory vaccinations came into force, acting as a powerful tool for coverage increase.
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Affiliation(s)
| | | | | | - Anna Odone
- University Vita-Salute San Raffaele, Milan.
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20
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Gori D, Costantino C, Odone A, Ricci B, Ialonardi M, Signorelli C, Vitale F, Fantini MP. The Impact of Mandatory Vaccination Law in Italy on MMR Coverage Rates in Two of the Largest Italian Regions (Emilia-Romagna and Sicily): An Effective Strategy to Contrast Vaccine Hesitancy. Vaccines (Basel) 2020; 8:vaccines8010057. [PMID: 32019092 PMCID: PMC7158674 DOI: 10.3390/vaccines8010057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/18/2020] [Accepted: 01/23/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Vaccine hesitancy has increased worldwide, leading to reduction in vaccination coverage rates. In particular, reduction in the coverage for the trivalent Measles-Mumps-Rubella vaccine has led to an increase of measles cases. The aim of this study is to analyze the coverage rates for the MMR vaccine in the Emilia-Romagna Region (RER) and Sicily Region (SR) between 2009 and 2018, and to correlate any significant change to index events which could have modified the trend of vaccination rates. Methods: Official aggregate data on vaccination coverage at 24 months provided by the RER and the SR were analyzed through trend analysis and related to important index events. Results: The two regions showed similar results; both achieved the lowest coverage rates in 2015 and both showed an increase in the rates after the introduction of mandatory vaccinations for access to schools. In 2018, both reached the starting point before the decrease. Conclusions: Our results confirm the effectiveness of legislative coercive measures in favor of vaccination. A potential decrease in the coverage rates may be observed as a result of an attenuation of the positive effects of coercive measures over time. It is thus necessary to combine these measures together with information campaigns and political initiatives at different levels (i.e., national, regional).
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Affiliation(s)
- Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy;
- Correspondence:
| | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (C.C.); (F.V.)
| | - Anna Odone
- School of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy; (A.O.); (C.S.)
| | - Beatrice Ricci
- School of Hygiene and Preventive Medicine, University of Bologna, 40138 Bologna, Italy; (B.R.); (M.I.)
| | - Magda Ialonardi
- School of Hygiene and Preventive Medicine, University of Bologna, 40138 Bologna, Italy; (B.R.); (M.I.)
| | - Carlo Signorelli
- School of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy; (A.O.); (C.S.)
| | - Francesco Vitale
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (C.C.); (F.V.)
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy;
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21
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Pacenti M, Maione N, Lavezzo E, Franchin E, Dal Bello F, Gottardello L, Barzon L. Measles Virus Infection and Immunity in a Suboptimal Vaccination Coverage Setting. Vaccines (Basel) 2019; 7:vaccines7040199. [PMID: 31795157 PMCID: PMC6963570 DOI: 10.3390/vaccines7040199] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 11/24/2022] Open
Abstract
Despite efforts to improve surveillance and vaccination coverage, measles virus (MeV) continues to cause outbreaks also in high-income countries. As the reference laboratory of the Veneto Region, Italy, we analyzed changes in population immunity, described measles outbreaks, investigated MeV genetic diversity, and evaluated cross-protection of measles vaccination against MeV epidemic strains. Like most European areas, the Veneto Region has suboptimal measles vaccination coverage and is facing a growing public mistrust of vaccination. A progressive decline of measles vaccine uptake was observed during the last decade in the Veneto Region, leading to immunity gaps in children and young adults. Measles outbreaks were caused by the same MeV genotype B3, D4, and D8 strains that were circulating in other European countries. Eleven cases of measles were observed in immunized subjects. These cases were not associated with particular MeV genotypes nor with mutations in epitopes recognized by neutralizing antibodies. Accordingly, sera from fully vaccinated subjects cross-neutralized epidemic MeV strains, including the genotypes B3, D4, and D8, with the same high efficiency demonstrated against the vaccine strain. In fully vaccinated subjects, high MeV IgG antibody titers persisted up to 30 years following vaccination. These results support the use of the current measles-containing vaccines and strategies to strengthen vaccination.
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Affiliation(s)
- Monia Pacenti
- Microbiology and Virology Unit, Padova University Hospital, 35128 Padova, Italy; (M.P.); (E.F.); (F.D.B.)
| | - Nataskya Maione
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (N.M.); (E.L.)
| | - Enrico Lavezzo
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (N.M.); (E.L.)
| | - Elisa Franchin
- Microbiology and Virology Unit, Padova University Hospital, 35128 Padova, Italy; (M.P.); (E.F.); (F.D.B.)
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (N.M.); (E.L.)
| | - Federico Dal Bello
- Microbiology and Virology Unit, Padova University Hospital, 35128 Padova, Italy; (M.P.); (E.F.); (F.D.B.)
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (N.M.); (E.L.)
| | - Lorena Gottardello
- Department of Hygiene and Public Health, Azienda ULSS 6 Euganea, 35131 Padova, Italy;
| | - Luisa Barzon
- Microbiology and Virology Unit, Padova University Hospital, 35128 Padova, Italy; (M.P.); (E.F.); (F.D.B.)
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (N.M.); (E.L.)
- Correspondence: ; Tel.: +39-049-821-8946
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22
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Gori D, Ialonardi M, Odone A, Ricci B, Pascucci MG, Frasca G, Venturi S, Signorelli C, Fantini MP. Vaccine Hesitancy and Mandatory Immunizations in Emilia-Romagna Region: the case of MMR vaccine. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:394-397. [PMID: 31580332 PMCID: PMC7233739 DOI: 10.23750/abm.v90i3.8865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 11/23/2022]
Abstract
Background and aim: An increase of vaccine hesitancy has spread worldwide and lead to reduction in coverage rates. The trivalent Measles-Mumps-Rubella (MMR) vaccine has been one of the most targeted leading due to possible (but never proven) adverse effects. This resulted in an increase of measles cases. The aim of the study is to analyze the 24-months coverage rates for the MMR vaccine in Emilia-Romagna Region (RER) between 2007 and 2018 and to correlate any significant changes to index events. Methods: Official aggregate data on vaccination coverage at 24-month provided by the RER and the Italian Ministry of health were analyzed and discussed. Results: From 2012 to 2015 a significant reduction in vaccination rates has been registered. In the following years an increase was recorded temporarily related to national and regional laws. Conclusion: The mandatory vaccination strategies seem to be in the short period effective in RER to counteract the growing population neegative attitudes towards vaccination and mitigate vaccine hesitancy. (www.actabiomedica.it) Premesse e obiettivi: Un aumento dell’esitazione vaccinale si è diffusa in tutto il mondo e ha portato alla riduzione significativa dei tassi di copertura. Il vaccino trivalente morbillo-parotite-rosolia (MMR) è stato uno dei più interessati a causa di presunti (e mai dimostrati) effetti collaterali e il calo della copertura di questa vaccinazione ha portato ad un aumento dei casi di morbillo. L’obiettivo della ricerca è quello di analizzare i tassi di copertura per il vaccino MMR a 24 mesi di età nella Regione Emilia-Romagna (RER) tra il 2007 e il 2018 e di correlare eventuali cambiamenti significativi ad eventi esterni. Metodi: Sono stati analizzati e discussi i dati aggregati ufficiali sulla copertura vaccinale a 24 mesi forniti dalla Regione e dal Ministero della Salute. Risultati: Dal 2012 al 2015 è stata registrata una riduzione significativa dei tassi di vaccinazione. Negli anni seguenti è stato registrato un aumento temporalmente correlato all’entrata in vigore delle leggi nazionali e regionali. Conclusioni: Le strategie di vaccinazione obbligatorie sembrano essere efficaci nel breve periodo nella RER per contrastare l’atteggiamento della popolazione nei confronti della vaccinazione e mitigare l’esitazione vaccinale.
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Affiliation(s)
- Davide Gori
- University of Bologna, Department of Biomedical and Neuromotor Sciences.
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Holzmann H, Wiedermann U. Mandatory vaccination: suited to enhance vaccination coverage in Europe? Euro Surveill 2019; 24:1900376. [PMID: 31266587 PMCID: PMC6607742 DOI: 10.2807/1560-7917.es.2019.24.26.1900376] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/27/2019] [Indexed: 01/03/2023] Open
Affiliation(s)
| | - Ursula Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Austria
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WFPHA: World federation of public health associations www.wfpha.org : Bettina Borisch and Marta Lomazzi, Federation's Pages Editors. J Public Health Policy 2019; 40:377-380. [PMID: 30976060 DOI: 10.1057/s41271-019-00167-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Signorelli C. Forty years (1978-2018) of vaccination policies in Italy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:127-133. [PMID: 30889167 PMCID: PMC6502166 DOI: 10.23750/abm.v90i1.7900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/09/2019] [Indexed: 12/19/2022]
Abstract
The paper traces the evolution of vaccination policies in Italy in the first 40 years of the National Health Service. Four phases have been identified: the first (1978-98) characterized by the eradication of smallpox, the hopes of further eradications and the introduction of hepatitis B and acellular antipertussis vaccines; the second (1999-2008) coincided with the first national vaccination plans and with the hypothesis of a progressive transition from mandatory vaccinations to nudging initiatives with the relevant experimentation in the Veneto Region; the third phase (2009-14) was characterized by the spread of health information on the web and social networks, by anti-scientific judgments and by an increasingly vaccines hesitancy that led to incorrect perceptions, falls in coverage rates and re-ignition of some epidemics; in the last phase (2015-18) there was a strong political committment that led to the approval of the National Plan (PNPV) 2017-19, to the extension of the mandatory vaccinations and to the sanctions against the anti-vaxxers doctors. This has led to a rapid rise in coverage, but also to a heated political and media debate on the ethical and social aspects linked to the admission bans and sancions of unvaccinated children in schools. (www.actabiomedica.it) Riassunto. Il lavoro ripercorre l’evoluzione delle politiche vaccinali in Italia nei primi 40 anni del Servizio Sanitario Nazionale. Sono state identificate quattro fasi: la prima (1978-98) caratterizzata dall’eradicazione del vaiolo, dalle speranze di ulteriori eradicazioni e dall’introduzione dei vaccini antiepatite B e antipertosse acellulare; la seconda (1999-2008) è coincisa con i primi piani vaccinali nazionali e con l’ipotesi di un progressivo passaggio dall’obbligo all’adesione consapevole, segnata dall’importante sperimentazione della Regione Veneto; la terza fase (2009-14) è stata caratterizzata dalla diffusione dell’informazione sanitaria su web e social, da sentenze giudiziarie antiscientifiche e da una sempre più diffusa vaccine hesitancy che hanno portato a errate percezioni, cali generalizzati delle coperture e riaccensione di focolai epidemici; nell’ultima fase (2015-18) c’è stata una reazione delle istituzioni che ha portato all’approvazione del PNPV 2017-19, all’estensione degli obblighi vaccinali e a sanzioni contro i medici antivaccinisti. Ciò ha portato ad un rapido rialzo delle coperture ma anche ad un acceso dibattito politico e mediatico sugli aspetti etici e sociali legati alle sanzioni e ai divieti di ammissione dei bambini non vaccinati nelle scuole.
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Acquafredda S, Tafuri S. "My son can not attend the school because 5 classmates are unvaccinated". On the question of compulsory vaccinations and the risk for immune-compromised children into the schools: the case of paediatric cancer patients. Hum Vaccin Immunother 2018; 15:643-644. [PMID: 30352002 PMCID: PMC6605721 DOI: 10.1080/21645515.2018.1537757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Since 2017, 10 vaccines are compulsory for newborns in Italy and unvaccinated children are not admitted to kindergartens. Recently the Italian Government announced the perspective of reforming the law about the compulsory vaccination. A debated started about the presence, in the same class of the schools, of unvaccinated and immunocompromised children. Cancer is the one of the most important cause of immunodepression among children: after the chemoterapy, there is a period of 13–23 months in which the cancer survivors have to come back at the school and at to the “normal life” (even for psychological exigency) but remain at risk of infectious disease for the immunodepression. The most important chance to protect this subgroup of patients remains the herd immunity.
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Affiliation(s)
- Silvana Acquafredda
- a Department of Biomedical Sciences and Human Oncology , Aldo Moro University of Bari , Italy
| | - Silvio Tafuri
- a Department of Biomedical Sciences and Human Oncology , Aldo Moro University of Bari , Italy
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