Impact of measles national vaccination coverage on burden of measles across 29 Member States of the European Union and European Economic Area, 2006-2011.

BACKGROUND: Challenges in reaching good vaccination coverage against measles emerged in several European Union/European Economic Area Member States (EU/EEA MS) leading to progressive accumulation of susceptible individuals and outbreaks. The Burden of Communicable Diseases in Europe (BCoDE) project developed a methodology for measuring the burden of communicable diseases expressed in Disability-Adjusted Life Years (DALYs) in the EU/EEA MS. The aim of this study was to compare national vaccination coverage and burden of measles across EU/EEA MS. METHODS: Country-specific data on measles national vaccination coverage 2006-2011 from 29 EU/EEA MS (MCV1) were retrieved from Centralized Information System for Infectious Diseases (CISID). DALYs were calculated for each country separately using a disease progression model with a single input parameter (annual measles incidence, adjusted for under-estimation). A software application was used to compute estimated DALYs according to country-specific and year-specific population age-distributions (data retrieved from Eurostat). Log-linear mixed-effect regression modeling approach was used to investigate a linear relation between natural logarithm-transformed DALYs and coverage. RESULTS: The reported annual vaccination coverage ranged from 72.6% to 100%. The estimated national annual burden ranged from 0 to 30.6 DALYs/100,000. Adjusting for year, there was a significant negative relationship between coverage and burden. For a given country there was a decrease in log-transformed DALYs/100,000 of 0.025 (95% confidence interval: -0.047 to -0.003) for every percentage increase in vaccination coverage. The largest effect of calendar time on estimated burden of measles was observed for the year 2011, the smallest was for the year 2007. CONCLUSIONS: This study shows that the degree of success of national measles vaccination programs, when measured by the coverage obtained, is significantly associated with overall impact of measles across EU/EEA MS. In EU/EEA MS each percentage point increase in national vaccination coverage seems to lead to early significant reduction of overall burden of measles

Impact of measles national vaccination coverage on burden of measles across 29 Member States of the European Union and European Economic Area, 2006-2011.

BACKGROUND: Challenges in reaching good vaccination coverage against measles emerged in several European Union/European Economic Area Member States (EU/EEA MS) leading to progressive accumulation of susceptible individuals and outbreaks. The Burden of Communicable Diseases in Europe (BCoDE) project developed a methodology for measuring the burden of communicable diseases expressed in Disability-Adjusted Life Years (DALYs) in the EU/EEA MS. The aim of this study was to compare national vaccination coverage and burden of measles across EU/EEA MS. METHODS: Country-specific data on measles national vaccination coverage 2006-2011 from 29 EU/EEA MS (MCV1) were retrieved from Centralized Information System for Infectious Diseases (CISID). DALYs were calculated for each country separately using a disease progression model with a single input parameter (annual measles incidence, adjusted for under-estimation). A software application was used to compute estimated DALYs according to country-specific and year-specific population age-distributions (data retrieved from Eurostat). Log-linear mixed-effect regression modeling approach was used to investigate a linear relation between natural logarithm-transformed DALYs and coverage. RESULTS: The reported annual vaccination coverage ranged from 72.6% to 100%. The estimated national annual burden ranged from 0 to 30.6 DALYs/100,000. Adjusting for year, there was a significant negative relationship between coverage and burden. For a given country there was a decrease in log-transformed DALYs/100,000 of 0.025 (95% confidence interval: -0.047 to -0.003) for every percentage increase in vaccination coverage. The largest effect of calendar time on estimated burden of measles was observed for the year 2011, the smallest was for the year 2007. CONCLUSIONS: This study shows that the degree of success of national measles vaccination programs, when measured by the coverage obtained, is significantly associated with overall impact of measles across EU/EEA MS. In EU/EEA MS each percentage point increase in national vaccination coverage seems to lead to early significant reduction of overall burden of measles

Impact of measles national vaccination coverage on burden of measles across 29 Member States of the European Union and European Economic Area, 2006-2011

BACKGROUND: Challenges in reaching good vaccination coverage against measles emerged in several European Union/European Economic Area Member States (EU/EEA MS) leading to progressive accumulation of susceptible individuals and outbreaks. The Burden of Communicable Diseases in Europe (BCoDE) project developed a methodology for measuring the burden of communicable diseases expressed in Disability-Adjusted Life Years (DALYs) in the EU/EEA MS. The aim of this study was to compare national vaccination coverage and burden of measles across EU/EEA MS. METHODS: Country-specific data on measles national vaccination coverage 2006-2011 from 29 EU/EEA MS (MCV1) were retrieved from Centralized Information System for Infectious Diseases (CISID). DALYs were calculated for each country separately using a disease progression model with a single input parameter (annual measles incidence, adjusted for under-estimation). A software application was used to compute estimated DALYs according to country-specific and year-specific population age-distributions (data retrieved from Eurostat). Log-linear mixed-effect regression modeling approach was used to investigate a linear relation between natural logarithm-transformed DALYs and coverage. RESULTS: The reported annual vaccination coverage ranged from 72.6% to 100%. The estimated national annual burden ranged from 0 to 30.6 DALYs/100,000. Adjusting for year, there was a significant negative relationship between coverage and burden. For a given country there was a decrease in log-transformed DALYs/100,000 of 0.025 (95% confidence interval: -0.047 to -0.003) for every percentage increase in vaccination coverage. The largest effect of calendar time on estimated burden of measles was observed for the year 2011, the smallest was for the year 2007. CONCLUSIONS: This study shows that the degree of success of national measles vaccination programs, when measured by the coverage obtained, is significantly associated with overall impact of measles across EU/EEA MS. In EU/EEA MS each percentage point increase in national vaccination coverage seems to lead to early significant reduction of overall burden of measles

Risultati riguardanti la sorveglianzadelle malattie invasive di origine battericanella Regione Veneto a tre annidall\u2019implementezione del Sistemadi Sorveglianza delle Malattie BattericheInvasive

OBIETTIVI: La sorveglianza, in Sanit\ue0 Pubblica, \ue8 fondamentale per identificare strategie o azioni di prevenzione e avere a disposizione degli indicatori di qualit\ue0 delle cure. I sistemi di sorveglianza attiva offrono vantaggi rispetto ai passivi che possono risentire dell\u2019incompletezza e della sottostima delle segnalazioni. In Veneto, dal gennaio 2007, \ue8 presente un Sistema di Sorveglianza delle Malattie Batteriche Invasive basato sui dati dei Laboratori di Microbiologia territoriali (SSM) in aggiunta al Flusso di Sorveglianza Speciale (FSS) e al Sistema Informatizzato Malattie Infettive (SIMI). L\u2019obiettivo \ue8 rilevare l\u2019incidenza delle malattie batteriche invasive, analizzare l\u2019andamento epidemiologico evidenziando tempestivamente eventuali variazioni e definire le caratteristiche microbiologiche dei ceppi isolati. Integrare, infine, i dati del SSM con i flussi informativi esistenti creando un network composto da tutti i flussi attualmente esistenti nella Regione Veneto. MATERIALI: Attraverso il SSM sono state analizzate le notifiche riguardanti i nuovi casi di malattia batterica invasiva provenienti dai Laboratori di Microbiologia territoriali e le informazioni relative alla caratterizzazione microbiologica degli isolati effettuata dal Laboratorio Regionale di Riferimento. Si \ue8 proceduto, inoltre, all\u2019aggregazione dei dati tra i diversi flussi informativi RIASSUNTO: Nei primi tre anni di attivit\ue0 del sistema, sono state inviate al SSM 617 schede e prelevati 651 campioni. L\u2019incidenza delle notifiche \ue8 risultata maggiore nei soggetti sotto l\u2019anno di et\ue0. Streptococcus pneumoniae e Neisseria meningitidis sono stati isolati rispettivamente nel 66,3% e nel 10,1% dei campioni analizzati. Nel 5,7% dei casi la prognosi \ue8 risultata infausta. Dall\u2019unione dei tre flussi informativi \ue8 emersa un\u2019incidenza per malattia batterica invasiva pari a 5,2 per 100.000 abitanti con trend costante nei tre anni di osservazione e un tipico andamento stagionale, un massimo di segnalazioni nei mesi invernali ed una diminuzione nel periodo estivo. Il tasso di notifica per 100.000 abitanti \ue8 risultato pari a 2,9 per Streptococcus pneumoniae, a 0,5 per Neisseria meningitidis e a 0,2 per Haemophilus Influenzae. CONCLUSIONI: La presenza di un flusso proveniente dai Laboratori di Microbiologia ha consentito di migliorare la specificit\ue0 del sistema di rilevazione e di tracciare un profilo pi\uf9 accurato dell\u2019assetto epidemiologico. Tale flusso \ue8, inoltre, cruciale in relazione all\u2019introduzione della vaccinazione universale contro Neisseria meningitidis, Haemophilus Influenzae e Streptococcus pneumoniae. Infine, la sovrapposizione delle tre diverse fonti informative consente di migliorare la sensibilit\ue0 del sistema di rilevazion

La vaccinazione anti-varicella: analisidei risultati della strategia applicatanella Regione Veneto

OBIETTIVI: La varicella \ue8 una patologia di interesse prevalentemente infantile, ma in grado di colpire gli adulti con manifestazioni pi\uf9 severe e con maggior frequenza di complicanze. Dopo l\u2019introduzione del Nuovo Calendario Vaccinale del DGR 4403/05, il Veneto ha scelto di offrire in modo attivo e gratuito il vaccino contro la varicella ai nuovi nati al 14\ub0 mese di vita e agli adolescenti con anamnesi negativa, raggiungendo una media di adesione regionale intorno al 50%. Con l\u2019obiettivo di raggiungerelivelli di adesione pi\uf9 elevati, ed in conformit\ue0 al DGR 411/08, la Regione Veneto ha proposto la somministrazione del vaccino anti-varicella nella medesima seduta della vaccinazione contro morbillo, parotite e rosolia (MPR). Dal 2007 \ue8 stato inoltre reso disponibile il vaccino con formulazione quadrivalente (MPRV) al 14\ub0mese ed al 6\ub0 anno di et\ue0. Lo scopo dello studio \ue8 stato valutare i dati di copertura vaccinale e l\u2019efficacia dell\u2019applicazione della nuova strategia vaccinale. MATERIALI: I dati di copertura vaccinale 2006-2009 delle diverse Aziende ULSS sono stati ricavati dal sistema di sorveglianza speciale delle malattie infettive della Regione Veneto. I casi di varicella per gli anni 2006-2010 sono stati ricavati dal sistema di notifica SIMIWEB. Le segnalazioni degli eventi avversi sono state raccolte dal Canale Verde. RIASSUNTO: I casi di varicella registrati nel Veneto sono stati 14.096 (295 casi per 100.000) nel 2006, 9.963 (206 casi per 100.000) nel 2007, 6.239 (128 casi per 100.000) nel 2008, 3.830 (78 casi per 100.000) nel 2009. La copertura media regionale della vaccinazione anti-varicella al 31/03/2009 risulta essere intorno ad una media regionale del 77,3%, con copertura da MPRV pari al 57,4% e copertura del solo vaccino anti-varicella al 19,8%. La frequenza di segnalazione degli eventi avversi secondo la stima dei dati del 2009 corrisponde a 16,2/10.000 dosi di MPRV, di cui solo 4,2/10.000 vengono segnalati come eventi avversi gravi (2,1/10.000 sono segnalati come convulsioni). CONCLUSIONI: L\u2019introduzione dell\u2019offerta della vaccinazione sembra avere avuto un buon impatto sull\u2019incidenza di varicella e la possibilit\ue0 di poter utilizzare il vaccino quadrivalente MPRV, vaccino che si \ue8 dimostrato sicuro e che incontra migliore compliance, ha sicuramente permesso il rapido raggiungimento di tassi copertura vaccinale posti negli obiettivi della progettualit\ue0 della Regione Veneto

Hospitalisation for rotavirus gastroenteritis in the paediatric population in the Veneto Region, Italy.

BACKGROUND: This study evaluates the epidemiological impact of RVGE hospitalisation in the Veneto Region during the period spanning from 2000-2007 along with the associated costs. The analysis was conducted in an area where rotavirus vaccination is not included into immunization programmes and is an attempt to assess the potential benefits of such introduction. METHODS: To update the estimates of acute RVGE hospitalisation rates in children 645 years in the Veneto Region, we conducted an 8 year retrospective observational population-based analysis (2000-2007). RESULTS: Over the study period, a total of 4,119 admissions for RVGE were reported, with a mean hospital stay of 3.5 days. The population-based hospitalisation RVGE incidence rate was 195.8 per 100,000 children aged 645 years (lower than other European countries). CONCLUSIONS: RVGE is an important cause of paediatric hospitalisation in the Veneto Region. The data reaffirm the substantial burden of rotavirus hospitalisations in children and the potential health benefits of the vaccination as well as the possibility of adding rotavirus vaccination to the current schedul

Growth Trajectories, Breast Size, and Breast-Tissue Composition in a British Prebirth Cohort of Young Women.

Mammographic percent density, the proportion of fibroglandular tissue in the breast, is a strong risk factor for breast cancer, but its determinants in young women are unknown. We examined associations of magnetic resonance imaging (MRI) breast-tissue composition at age 21 years with prospectively collected measurements of body size and composition from birth to early adulthood and markers of puberty (all standardized) in a sample of 500 nulliparous women from a prebirth cohort of children born in Avon, United Kingdom, in 1991-1992 and followed up to 2011-2014. Linear models were fitted to estimate relative change in MRI percent water, which is equivalent to mammographic percent density, associated with a 1-standard-deviation increase in the exposure of interest. In mutually adjusted analyses, MRI percent water was positively associated with birth weight (relative change (RC) = 1.03, 95% confidence interval (CI): 1.00, 1.06) and pubertal height growth (RC = 1.07, 95% CI: 1.02, 1.13) but inversely associated with pubertal weight growth (RC = 0.86, 95% CI: 0.84, 0.89) and changes in dual-energy x-ray absorptiometry percent body fat mass (e.g., for change between ages 11 years and 13.5 years, RC = 0.96, 95% CI: 0.93, 0.99). Ages at thelarche and menarche were positively associated with MRI percent water, but these associations did not persist upon adjustment for height and weight growth. These findings support the hypothesis that growth trajectories influence breast-tissue composition in young women, whereas puberty plays no independent role

European enhanced surveillance of invasive pneumococcal disease in 2010: data from 26 European countries in the post-heptavalent conjugate vaccine era.

Streptococcus pneumoniae is a leading cause of severe infectious diseases worldwide. This paper presents the results from the first European invasive pneumococcal disease (IPD) enhanced surveillance where additional and valuable data were reported and analysed. Following its authorisation in Europe in 2001 for use in children aged between two months and five years, the heptavalent pneumococcal conjugate vaccine (PCV7) was progressively introduced in the European Union (EU)/European Economic Area (EEA) countries, albeit with different schemes and policies. In mid-2010 European countries started to switch to a higher valency vaccine (PCV10/PCV13), still without a significant impact by the time of this surveillance. Therefore, this surveillance provides an overview of baseline data from the transition period between the introduction of PCV7 and the implementation of PCV10/PCV13. In 2010, 26 EU/EEA countries reported 21 565 cases of IPD to The European Surveillance System (TESSy) applying the EU 2008 case definition. Serotype was determined in 9946/21565 (46.1%) cases. The most common serotypes were 19A, 1, 7F, 3, 14, 22F, 8, 4, 12F and 19F, accounting for 5949/9946 (59.8%) of the serotyped isolates. Data on antimicrobial susceptibility testing (AST) in the form of minimum inhibitory concentrations (MIC) were submitted for penicillin 5384/21565 (25.0%), erythromycin 4031/21565 (18.7%) and cefotaxime 5252/21565 (24.4%). Non-susceptibility to erythromycin was highest at 17.6% followed by penicillin at 8.9%. PCV7 serotype coverage among children <5 years in Europe, was 19.2%; for the same age group, the serotype coverage for PCV10 and PCV13 were 46.1% and 73.1%, respectively. In the era of pneumococcal conjugate vaccines, the monitoring of changing trends in antimicrobial resistance and serotype distribution are essential in assessing the impact of vaccines and antibiotic use control programmes across European countries

Poliprescrizione farmacologica e mortalit\ue0nella popolazione anziana

OBIETTIVI: Diversi studi correlano la poliprescrizione farmacologica negli anziani con un aumentato rischio di eventi avversi e ospedalizzazione; meno studiati sono gli effetti sulla mortalit\ue0. Lo scopo di questo studio \ue8 stimare la prevalenza della poliprescrizione farmacologica negli anziani, nonch\ue8 verificare l\u2019eventuale correlazione con la mortalit\ue0. MATERIALI: I dati utilizzati provengono dall\u2019archivio elettronico dell\u2019ULSS 18 di Rovigo e comprendono dati di anagrafe sanitaria e prescrizioni farmacologiche di una coorte di soggetti con almeno una prescrizione (17.063) nella fascia di et\ue0 70-79, raccolti tra il 1 Gennaio e il 31 Dicembre 2002. La poliprescrizione \ue8 stata valutata come numero di prescrizioni (1- 4, 5-9, 10+) e come numero di classi ATC (da 1 a 6+). Il follow-up dei soggetti \ue8 durato sei anni. I dati di mortalit\ue0 sono stati ricavati dai certificati di morte e le cause classificate sulla base della classificazione internazionale delle malattie (ICD), nona e decima revisione. L\u2019analisi della sopravvivenza \ue8 stata effettuata con il metodo di Kaplan Mayer e aggiustata mediante il modello di Cox. RIASSUNTO: Il campione rappresenta il 92% della popolazione nella fascia di et\ue0 70-79 residente nell\u2019ULSS 18. Il numero medio di prescrizioni farmacologiche e di classi ATC \ue9 rispettivamente 23,2 e 3,5. Il 73% dei soggetti (12.478) riceve pi\uf9 di 10 prescrizioni farmacologiche e il 14,4% (2.467) tra 5 e 9 prescrizioni. Considerando le classi ATC, l\u201986,3% (14.720) assume pi\uf9 di 1 classe ATC e il 27,9% (4.754) pi\uf9 di 5 classi ATC. I farmaci della classe cardiovascolare sono quelli pi\uf9 prescritti (77,8%), seguiti dalle classi alimentare-metabolismo (50%) e muscoloscheletrico (49,1%). Il 20% (3.418) della coorte \ue8 deceduta nel corso del follow up; la pi\uf9 frequente causa di morte \ue8 la patologia cardiocircolatoria (1.411), seguita dalla patologia neoplastica (1.113) e da altre cause (894). Un numero di prescrizioni farmacologiche e\u201d10 \ue8 correlato con un aumentato rischio di mortalit\ue0, con un hazard ratio (HR) pari a 1,81 (IC 95% 1,60-2,04); tale significativit\ue0 permane dopo correzione con l\u2019indice di comorbidit\ue0. Il rischio di morte cresce all\u2019aumentare del numero di classi ATC e raddoppia con pi\uf9 di 6 classi (HR 2,45, IC 95% 2,15-2,79). CONCLUSIONI: L\u2019elevata prevalenza della poliprescrizione farmacologica nella popolazione anziana, confermata dai nostri dati, correla con un aumentato rischio di mortalit\ue0. Il numero di classi ATC sembra essere un predittore migliore di mortalit\ue0 rispetto al numero di prescrizioni; permette inoltre di differenziare la sopravvivenza sulla base delle diverse classi ATC