Every year 2.5 million lives are saved by vaccines. In this slideset Professor Susanna Esposito gives an overview on the vaccine coverage in Italy, including the latest laws on mandatory and recommended vaccines. To learn more please visit www.waidid.org

1. MANDATORY VACCINATIONS: THE
ITALIAN EXPERIENCE
Susanna Esposito
Pediatric Clinic, University of Perugia,
Perugia, Italy

2. 2
How many lives are saved by vaccines?
2.5 million per year
7,000 per day
300 per hour
5 per minute
WHO – 2011-2020

3. Vaccination has a major beneficial impact1
1. Plotkin SL & Plotkin SA. Chapter 1 in Plotkin SA et al. Vaccines. 6th Edition, Elsevier Saunders, 2012; 2. WHO, 2003. Influenza.
http://www.who.int/mediacentre/factsheets/2003/fs211/en/ (accessed October 2016); 3. Andre FE et al. Bull World Health Organ 2008;86:81–106;
4. Ehreth J. Vaccine 2003;21:4105–4117
–With the exception of safe water, no other
modality, not even antibiotics, has had such
a major effect on mortality reduction1
Economic growth3
Mortality, morbidity,
global financial
burden2–4
Illustrative figure based on Plotkin SL & Plotkin SA. 2012; WHO, 2003; Andre FE et al. 2008; Ehreth J. 2003

4. Vaccine coverage trends by 24 months of age
in Italy, 2000-2015

5. N. of cases of measles and vaccine coverage
by 24 months per year, Italy 1970-2016*
*preliminary data

6. 92,25
79,42
85,59
82,37
92,18
92,54
93,80 89,65
94,16
91,25
83,60
76,63
93,4898,47
92,02
91,74
n/a
94,63
84,41
86,78
79,43
88,10
82,62
83,12
88,28
87,82 76,64
86,50
n/a 62,20
42,72
77,7586,33
66,21
60,17
n/a
74,15
77,78
81,73
61,31
Men C Pneumococcus
87,10
80,69
Vaccine coverage for MenC and Pneumococcus

7. Main news in the Lifetime
Immunization Schedule, 2017
• Introduction of dTp/IPV in the adolescence
• Universal MenB in infancy
• MenACYW to all adolescents
• Universal anti-varicella vaccination among children, with
MMRV (or MRR+V)
• HPV to 12 years old females and males
• Universal Rotavirus vaccination
• PCV13/PPV23 ≥65 years and at risk inividuals of any
age
• Zoster in at least one cohort of elderly and at risk
individuals

8. In Italy, vaccines account for a small proportion of
the all pharmaceutical costs
8

9. Hurdles to the introduction of
new vaccines in the schedule
• Increase workload for vaccination centres
• Involvement of pediatricians and GPs
• Reorganization of the vaccination framework
• Possible parents’ reactions to increased
number of vaccine administrations
• Sustainability of high levels of vaccine
coverage for both mandatory and
recommended vaccines

10. 10
• anti-polio
• anti-diphtheria
• anti-tetanus
• anti-hepatitis B
• anti-pertussis
• anti Haemophilus influenzae type b
• anti-measles
• anti-rubella
• anti-mumps
19 May 2017: 10 mandatory vaccines because of reduction of
vaccine coverage
licenza CC-BY-NC-SA 3.0 IT

11. 11
… Anti-vax movements

12. 12
Italian Minister of Health and experts opinion published
in >200 articles

13. 13
News on vaccines appeared in >250
TV and Radio

14. Vaccini, Salvini: dieci sono inutili. No ad espulsione bimbi - Rai News
www.rainews.it/.../Vaccini-Salvini-dieci-sono-inutili-no-ad-espulsione-bimbi-
2096827...
22 giu 2018 - Il ministro dell'Interno: "Troppi vaccini fanno male. Priorità è che i bimbi
non vengano espulsi dalle classi" anche se non vaccinati.
Hai visitato questa pagina 2 volte. Ultima visita: 21/06/18
Vaccini, la ministra Grillo vuole “l'obbligo flessibile” - Wired
https://www.wired.it › Lifestyle › Vaccini, la ministra Grillo vuole “l’obbligo flessibile”
9 ago 2018 - La ministra della Salute Giulia Grillo ritorna sulle critiche che le sono state
rivolte sui vaccini dall'Associazione nazionale dei presidi, unita nel ..
Grillo: nuovo Ddl sui vaccini per superare il vecchio - Tecnica della ...
https://www.tecnicadellascuola.it › Attualità
11 set 2018 - La ministra della Salute, Giulia Grillo, ritorna sui vaccini per superare
l'insufficiente impostazione del decreto Lorenzin, che ha prodotto una

15. Discontinuation/interruption of vaccination programmes
results in increased disease incidence1
1. Gangarosa EJ et al. Lancet 1998;351:356–361; 2. Carlsson RM & Gustafsson L. Ten year report – pertussis surveillance in Sweden. Swedish Institute for Infectious Disease
Control 2008. https://www.folkhalsomyndigheten.se/pagefiles/14930/pertussis-surveillance%20in-sweden-ten-year-report.pdf (accessed October 2016)
DTP, diphtheria, tetanus and pertussis; DTaP, diphtheria, tetanus and acellular pertussis
Sweden: No
DTP coverage
Norway: 92%
DTP coverage
1974 1978 1982 1986 1990 1994
Year
Incidenceofpertussis
per100,000
individuals
DTP vaccine
withdrawn in
Sweden
0
50
100
150
200
1986 1990 1994 1998 2002
DTaP-vaccination
introduced
Totalnumberofpertussiscases
Year
0
500
1000
1500
2000
In Sweden, reintroduction of pertussis
vaccination using acellular vaccines in
1996 resulted in a major drop in
pertussis cases2
In Sweden, following withdrawal of the
whole-cell DTP vaccine in 1979,
incidence of pertussis increased
considerably compared with Norway1
Adapted from Gangarosa EJ et al. 1998, copyright permission from Elsevier Adapted from Carlsson RM & Gustafsson L. 2008
2006

16. Thanks