Pharmacoeconomic evaluation of the MF59 ? adjuvanted influenza vaccinein the elderly population in Italy

Introduction. Influenza vaccination has proven effective in the reduction of influenza-like illness (ILI) cases and influenza-related hospitalizations, drug consumption, primary care consultations and deaths in the elderly population. The aim of this study is the assessment of the financial budget impact of a seasonal vaccination program based on the use of the MF59 adjuvanted vaccine as compared with the traditional vaccine or the absence of vaccination in Italian elderly population. Methods. A pharmacoeconomic simulation model was developed to simulate the effect of the three different vaccination programs during a single influenza season. Health economics and demographic data were taken from specific Italian sources, and vaccine effectiveness data derived from published literature. Direct medical costs were considered according to current Italian prices and tariffs. Results. About 83% of the 12 million people of at least 65 years of age currently resident in Italy can be considered at high risk for influenza complications due to underlying chronic diseases. Absence of vaccination could lead to more than 2 million ILI cases, and 29,000 related deaths. The vaccination program with a coverage rate of 65.6% would lead to an estimated 1.5 million ILI cases (26.9% reduction) with a standard vaccine and to 1.3 million (35.8% reduction) with the MF59 adjuvanted vaccine with a relative increase of avoided cases of 33,1%. The standard vaccination program produced a moderate direct cost increase of about 50 million Euro (+4.6%), whereas the adjuvanted vaccine provided an estimated saving of about 74 million Euro (-6.8%), both compared to the non vaccination. Cost savings were mainly related to hospital admissions avoided in the elderly population (? 65 years of age). Conclusions. The vaccination with the MF59 adjuvanted vaccine resulted more effective and cost saving when compared with the standard vaccination and with no vaccination, thus representing the optimal strategy for the elderly population. The standard vaccine, even though a light cost increase, still proved to be effective compared to the null option, with the initial cost for the vaccination program nearly offset by healthcar

Regional reports for the subnational monitoring of measles elimination in Italy and the identification of local barriers to the attainment of the elimination goal

Although most countries in the WHO European Region were verified in 2017 as having interrupted endemic measles transmission, nine countries were still endemic. Among these, Italy accounted for the second highest number of measles cases reported in Europe in 2017. The elimination of measles is verified at national level by each country's National Verification Committee (NVC) through the production of an Annual Status Update (ASU). Since in Italy decentralization has led to an inhomogeneous implementation of immunization strategies among the 21 administrative Regions, the Italian NVC proposed that measles elimination should also be documented at the subnational level through regional ASUs and Synthetic Regional Reports (SRRs). The regional ASUs and the SRRs for 2014, 2015 and 2016 were produced and appraised by the NVC to evaluate the Regions' performances in each individual year as well as over the whole period. A specific analysis of vaccination coverage, including official immunization data for 2017, was performed. Moreover, the measles epidemic of 2017 was examined. Firstly, in the period 2014±2016, low immunization rates were registered in most Regions. Sixty-three per cent of southern Regions reported rates below the national mean and an overall low-quality performance. The approval of Italy's mandatory vaccination law in 2017 resulted in a marked increase in vaccination coverage; however, this increase was not homogeneous among Regions. Secondly, more than 50% of Regions did not report any supplemental immunization activity (SIA) for the period 2014-2016. Thirdly, from 2014 to 2016, fewer than one-third of Regions improved their reporting of outbreaks. Finally, over the study period, only two Regions reached the target required by the WHO for measles laboratory investigations. In countries with decentralized health policies, subnational monitoring can help identify local barriers to measles elimination. In Italy it has highlighted the need for further SIAs and a stronger surveillance system

Infant immunization coverage in Italy (2000-2016)

BackgroundIn Italy, national-level immunization polices are included in the National Immunization Prevention Plan (PNPV), whose latest edition - 2017-2019 PNPV- was approved in February 2017. Immunization coverage is a key measure of immunization system performance; it can inform and support national and regional immunization polices’ implementation monitoring, as well as measure the impact of interventions aimed at increase vaccine uptake. MethodsWe collected, analysed and critically interpreted 2000-2015 Italian national infant immunization coverage trends, by different vaccine, target population, and by Region. Data were provided by the Directorate General for Prevention of the Italian Ministry of Health.ResultsIn 2015, none of mandatory or recommended vaccines reached the 95% national coverage target set in the PNPV. Weighted average national coverage for mandatory vaccines (against polio, tetanus, diphtheria, hepatitis B) and other antigens included in the hexavalent vaccine (pertussis, and Haemophilus influenzae type b) in 2015 was 93.3%; it was lower for measles, mumps and rubella vaccines (85.2%), pneumococcal (88.7%) and meningococcal C conjugate vaccines (76.6%), with a high degree of heterogeneity by Region. Both hexavalent and MMR vaccines coverage rates have been decreasing since 2012, with an annual decrease of, respectively 1% and 1.5%.DiscussionFurther efforts are needed to increase vaccine uptake in Italy, to improve data collection and reporting, as well as to fight the growing phenomenon of the vaccine hesitancy so that PNPV objectives and target can be met in the near future.Ep

Measles in Italy, July 2009 to September 2010.

Outbreaks of measles continue to occur in Italy, as in other European countries. We present here details of cases reported through the Italian enhanced measles surveillance system from July 2009 to September 2010. In total, 2,151 cases were reported, 42% (n=895) of which were laboratory confirmed. The median age of cases was 18 years and 1,709 of 1,856 cases (92%) were unvaccinated. Many cases with complications were reported (n=305), including three with encephalitis. A total of 652 of 1,822 cases (36%) were hospitalised. Molecular characterisation revealed circulation of a limited number of measles virus genotypes (D4, D8 and B3), which is consistent with the current epidemiology of the disease in Italy. A national measles elimination plan was approved in 2003 with the aim of interrupting endemic measles transmission by 2007. Since elimination was not achieved, the target date was recently moved to 2015. The emphasis of the new elimination plan, approved in March 2011, is on strengthening surveillance, implementing evidence based-interventions to increase measles-mumps-rubella vaccine uptake in children, adolescents and young adults, and implementing communication activities related to the vaccine. The strategies proposed by the plan should be implemented fully and appropriately by all regions in order to meet the elimination goal by 2015

Epidemiology of pertussis in Italy: disease trends over the last century.

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Measles in Italy, laboratory surveillance activity during 2010

Introduction. The European Regional Office of the World Health Organization (WHO/Europe) developed a strategic approach to stop the indigenous transmission of measles in its 53 Member States by 2015. This study describes the measles laboratory surveillance activity performed by the National Reference Laboratory for Measles and Rubella at the Italian National Institute of Health (Istituto Superiore di Sanità) during 2010. Methods. Urine, oral fluid and capillary blood samples from 211 suspected measles cases arrived to the NRL from different regions of Italy for confirmation of the clinical diagnosis. Serological and/or molecular assays were performed; after molecular detection, positive samples were sequenced and genotyped.Results and discussion. 85% (180/211) of the specimens were confirmed as measles cases and 139 of these were analyzed phylogenetically. The phylogenetic analysis revealed a co-circulation of D4 and D8 genotypes for the reviewed period

Increased incidence of invasive meningococcal disease of serogroup C / clonal complex 11, Tuscany, Italy, 2015 to 2016

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National immunization strategies targeting migrants in six European countries

Over the last three years an unprecedented flow of migrants arrived in Europe. There is evidence that vaccine preventable diseases have caused outbreaks in migrant holding centres. These outbreaks can be favored by a combination of factors including low immunization coverage, bad conditions that migrants face during their exhausting journey and overcrowding within holding facilities. In 2017, we conducted an online survey in Croatia, Greece, Italy, Malta, Portugal and Slovenia to explore the national immunization strategies targeting irregular migrants, refugees and asylum seekers. All countries stated that a national regulation supporting vaccination offer to migrants is available. Croatia, Italy, Portugal and Slovenia offer to migrant children and adolescents all vaccinations included in the National Immunization Plan; Greece and Malta offer only certain vaccinations, including those against diphtheria-tetanus-pertussis, poliomyelitis and measles-mumps-rubella. Croatia, Italy, Malta and Portugal also extend the vaccination offer to adults. All countries deliver vaccinations in holding centres and/or community health services, no one delivers vaccinations at entry site. Operating procedures that guarantee the migrants' access to vaccination at the community level are available only in Portugal. Data on administered vaccines is available at the national level in four countries: individual data in Malta and Croatia, aggregated data in Greece and Portugal. Data on vaccination uptake among migrants is available at national level only in Malta. Concluding, although diversified, strategies for migrant vaccination are in place in all the surveyed countries and generally in line with WHO and ECDC indications. Development of procedures to keep track of migrants' immunization data across countries, development of strategies to facilitate and monitor migrants' access to vaccinations at the community level and collection of data on vaccination uptake among migrants should be promoted to meet existing gaps. The study was conducted in the framework of the CARE (''Common Approach for REfugees and other migrants' health") project (717217/CARE) that received funding from the EU health Programme (2014–2020). info:eu-repo/semantics/publishedVersio

Risk factors for death from invasive pneumococcal disease, europe, 2010

We studied the possible association between patient age and sex, clinical presentation, Streptococcus pneumoniae serotype, antimicrobial resistance, and death in invasive pneumococcal disease cases reported by 17 European countries during 2010. The study sample comprised 2,921 patients, of whom 56.8% were men and 38.2% were >65 years of age. Meningitis occurred in 18.5% of cases. Death was reported in 264 (9.0%) cases. Older age, meningitis, and nonsusceptibility to penicillin were signifcantly asso ciated with death. Non-pneumococcal conjugate vaccine (PCV) serotypes among children 65 years of age, risk did not differ by serotype. These fndings highlight differences in case-fatality rates between sero types and age; thus, continued epidemiologic surveillance across all ages is crucial to monitor the long-term effects of PCVs

Immunisation of migrants in EU/EEA countries: Policies and practices

In recent years various EU/EEA countries have experienced an influx of migrants from low and middle-income countries. In 2018, the “Vaccine European New Integrated Collaboration Effort (VENICE)” survey group conducted a survey among 30 EU/EEA countries to investigate immunisation policies and practices targeting irregular migrants, refugees and asylum seekers (later called “migrants” in this report). Twenty-nine countries participated in the survey. Twenty-eight countries reported having national policies targeting children/adolescent and adult migrants, however vaccinations offered to adult migrants are limited to specific conditions in seven countries. All the vaccinations included in the National Immunisation Programme (NIP) are offered to children/adolescents in 27/28 countries and to adults in 13/28 countries. In the 15 countries offering only certain vaccinations to adults, priority is given to diphtheria-tetanus, measles-mumps-rubella and polio vaccinations. Information about the vaccines given to child/adolescent migrants is recorded in 22 countries and to adult migrants in 19 countries with a large variation in recording methods found across countries. Individual and aggregated data are reportedly not shared with other centres/institutions in 13 and 15 countries, respectively. Twenty countries reported not collecting data on vaccination uptake among migrants; only three countries have these data at the national level. Procedures to guarantee migrants’ access to vaccinations at the community level are available in 13 countries. In conclusion, although diversified, strategies for migrant vaccination are in place in all countries except for one, and the strategies are generally in line with international recommendations. Efforts are needed to strengthen partnerships and implement initiatives across countries of origin, transit and destination to develop and better share documentation in order to guarantee a completion of vaccination series and to avoid unnecessary re-vaccination. Development of migrant-friendly strategies to facilitate migrants' access to vaccination and collection of vaccination uptake data among migrants is needed to meet existing gaps