Progress in the research on HPV vaccination: updates from the 25th International Papillomavirus Conference in Malmo, Sweden, 2009

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Lifelong vaccination as a key disease-prevention strategy

AbstractVaccination is traditionally considered as a measure addressed to infants and children. Indeed, in natural conditions, vaccine-preventable infections are mainly spread at a young age. The implementation of routine and mass vaccination programmes has led to the eradication of smallpox and to the elimination of poliomyelitis in many regions of the world, together with the control of once life-threatening diseases like diphtheria and tetanus. In more recent times, the development of new generation vaccines and the changing epidemiological profile of many vaccine-preventable diseases have greatly changed the objectives and the target of today’s immunization strategies. The objective of this article is to highlight and discuss the evolution of vaccination strategies from measures aimed at protecting children to a practice that is needed throughout life. Adolescents and adults need immunization for several reasons: they may not have received the vaccines usually administered in childhood; new vaccines tailored for adolescents and adults have become available; immunity acquired thanks to immunization in childhood can fade; and older adults or those who are chronically ill are more susceptible to vaccine-preventable diseases and to their complications. The changing demographic profile of both industrialized countries and of countries in transition towards an ‘aging’ population, and the shift of several infectious diseases towards adulthood make it imperative that new infrastructures to deliver vaccines and new investments in immunization are investigated. Such a change of perspective is needed both to preserve health and to guarantee the sustainability of health systems

Selection of antiseizure medications for first add-on use: A consensus paper.

Abstract Introduction When monotherapy used alone or sequentially fails to achieve seizure control, a trial of combination therapy may be considered. Objective To define optimal criteria to guide choice of an antiseizure medication (ASM) for use as first add-on. Methods A standardized Delphi procedure was applied to produce a list of consensus statements. First, an Expert Board consisting of 5 epileptologists agreed on a set of 46 statements relevant to the objective. The statements were then finalized through an iterative process by a Delphi Panel of 84 Italian pediatric and adult neurologists with expertise in the management of epilepsy. Panel members provided anonymous ratings of their level of agreement with each statement on a 9-point Likert scale. Results Consensus, defined as agreement by at least 80% of Panel members, was reached for 36 statements. Medication-related factors considered to be important for drug selection included efficacy, tolerability and safety, interaction potential, mechanism of action, and ease of use. The need to optimize adherence and to tailor drug selection to individual characteristics was emphasized. Conclusions Choice of an ASM for first add-on requires consideration of many factors, many of which also apply to choose initial treatment. Factors more specifically relevant to add-on use include drug interaction potential and the preference for an ASM with a different mechanism of action

Varicella vaccination in Italy and Germany - different routes to success: a systematic review.

Italy (in pilot regions) and Germany (nationwide) were the first European countries to introduce universal varicella vaccination (UVV) programs.A systematic review was performed to assess varicella epidemiology before UVV programs and the impact of 1-dose and 2-dose UVV programs in Italy and Germany.Italy implemented 1- or 2-dose UVV programs successively in eight pilot regions between 2003 and 2011 and nationwide in 2017. Germany implemented 1- and 2-dose UVV programs in 2004 and 2009, respectively. While Italy had two nationwide surveillance systems in place for varicella in the pre-vaccination era, in Germany, a mandatory notification system for varicella was only introduced in the New Federal States 2 years before the 1-dose UVV implementation. Substantial reductions in moderate/severe varicella and varicella-related hospitalization incidence occurred during the 1-dose era. Further reductions were reported in Italy and Germany after the recommendation of a second dose in a long or short schedule, respectively. Different benefit-risk evaluations of a tetravalent varicella-containing vaccine (MMRV) used as a first dose led to different recommendations (MMRV versus MMR+V) in these countries. Vaccination strategies in both countries tailored to country-specific needs and goals led to a reduction in varicella-related health care hospitalization costs

HPV vaccination and allocative efficiency: regional analysis of the costs and benefits with the bivalent AS04-adjuvanted vaccine, from the perspective of public health, for the prevention of cervical cancer and its pre-cancerous lesions

Introduction: by means of the decisions on whether to introduce the HPV vaccination, Public Health has already established the importance of associating the vaccination strategy to the policy of secondary prevention. The screening + vaccination strategy is more effective than the two methods taken individually. In support of this combined strategy and in order to make available per each region concrete elements for their regional planning, an assessment has been made, which also takes into account the effect of cross-protection regarding high-risk strains not contained in both vaccines, bivalent and quadrivalent, and more frequently responsible for pre-cancerous lesions and cervical cancer (CCU). This analysis evaluates the costs and benefits of screening + vaccination strategy in a 12-year-old female cohort. Furthermore, the paper provides results that may be useful to assess the opportunity to extend the vaccination to a second cohort of 24-25-year-old women. The analysis is preceded by a brief summary of CCU epidemiology available data, public health policies that give precise guidelines for vaccination strategies and analytical tools suitable to support public policy makers to efficiently allocate resources. Methods: two different models were used for two regional analyses.The vaccines may have different sustained- and cross-protection levels against non-vaccine oncogenic HPV-types. In the first analysis, a prevalence-based model estimated the potential net difference in HPV-related lesions (abnormal pap smear, cervical intraepithelial neoplasia (CIN), cervical cancer (CC) and genital warts (GW)) and associated costs generated by the two vaccines. Vaccine efficacy rates were based on published data for each vaccine. Lifetime vaccine efficacy was assumed. Results are reported over one year after reaching a steady state. Incidence and treatment costs were obtained from Italian and European sources. We also performed a cost-effectiveness analysis with a Markov model for each Italian region, previously described and successfully adapted to the national scenario. The analysis compares the HPV vaccination of a single cohort (12-year-old females) with a multiple cohort (12- + 25-year-old girls). Resource use was based on a standard therapeutic path applied to all regions. However we quantified the impact of the so-called "decentralization progress" by collecting regional data on: pap test coverage, tariffs for treatments, and cost of the vaccination course. Results: the results are set out in 21 regional reports. Conclusions: in the Italian scenario, characterized by decentralization and local autonomy, a further level of detail is essential in order to describe the specific local settings and implications of a new health intervention. The results show that the vaccination on a multiple cohort is more effective than a single cohort. Indeed, a major number of pre-cancerous lesions, cases of cancer, and related deaths are avoided. In a period of sharp decline in the health budget, investment in prevention seems to be the most reasonable choice in view of avoiding in the medium term pre-cancerous and cancerous lesions generating a significant expense. Our analysis places the extent of HPV vaccination among the measures that the regional decision-makers should put in place to maximize the efficiency of scarce resource

Coverage or Efficacy: Which Factor is the Most Influential for Reducing Varicella with Routine Childhood Vaccination in Italy?

none6siopenSauboin, C; Holl, K; Amodio, E; Bonanni, P; Gabutti, G; Vitale, FSauboin, C; Holl, K; Amodio, E; Bonanni, P; Gabutti, Giovanni; Vitale, F