Slow progress in measles and rubella elimination in Italy

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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

Childhood vaccinations: A pilot study on knowledge, attitudes and vaccine hesitancy in pregnant women

Background. The objective of this pilot study was to test a questionnaire aimed at assessing knowledge of and attitudes towards vaccination, as well as intention to vaccinate, among pregnant women. Methods. The questionnaire was self-administered by 49 pregnant women attending antenatal classes at three Family Centers in Rome. Results. Poor knowledge of vaccinations, inadequate attention from healthcare professionals, recurrent consultation of unreliable sources of information, and misconceptions about the side effects of vaccines, all contribute to vaccine hesitancy. Where appropriate, questionnaire sections were shown to be internally consistent. Conclusion. The questionnaire proved reliable and is suitable for further studies

Increasing subnational commitment for measles and rubella elimination: the role of regional reports

Issue/problem To assess the progress towards measles and rubella elimination in the WHO European Region, the National Verification Committee of each Member State is requested to submit an annual status report (ASR) to the WHO Verification Commission for review and evaluation. Documentation required for Italian ASR are provided by the Ministry of Health, the National Institute of Health, and the 21 Regions. However, these ASR do not allow Regions to understand deeply their situation in the elimination process. Description of the problem The aim of this project is to produce regional synthetic annual reports, using the same data sources of the national ASR, that are sent to Regions to give them feedback about their progress towards elimination. A set of indicators has been identified within the framework of the national ASR. A green or red flag has been assigned to each indicator when regional data are better or worse than the national average, respectively. Where available, international targets were provided. Results In 2014 the incidence of measles and rubella in Italy was respectively 27 and 0.4 per million population. For all Regions coverage for both 1st and 2nd doses of routine measles and rubella vaccines was below the target of 95%. Analyzing those Regions with a percentage of red flags higher than the average percentage of red flags of the country, it emerged that 6/8 Regions were in the South of Italy (75%), 4/9 in the North (44.4%) and 1/4 in the Centre (25%). Lessons Regional reports are a valid tool to enhance the verification process at the sub-national level and may encourage regional and local authorities to implement appropriate strategies to remove barriers to the elimination goals. Southern Regions of Italy need to increase their efforts compared to other Regions. Key messages: In line with WHO recommendations to reinforce the commitment of the 21 Italian Regions, regional reports are able to provide Regions with detailed information about their progress and critical issues Regions of South Italy should mobilize better their financial, technical and human resources to achieve the elimination goals

The end of measles and congenital rubella: an achievable dream?

Despite substantial progress towards measles and rubella control, outbreaks continue to threaten elimination goals worldwide

Childhood vaccinations. Validation of a tool for measuring knowledge, attitudes and vaccine hesitancy in pregnant women

Background. The objective of this pilot study was to test a questionnaire aimed at assessing knowledge of and attitudes towards vaccination, as well as intention to vaccinate, among pregnant women. Methods. The questionnaire was self-administered by 49 pregnant women attending antenatal classes at three Family Centers in Rome. Results. Poor knowledge of vaccinations, inadequate attention from healthcare professionals, recurrent consultation of unreliable sources of information, and misconceptions about the side effects of vaccines, all contribute to vaccine hesitancy. Where appropriate, questionnaire sections were shown to be internally consistent. Conclusion. The questionnaire proved reliable and is suitable for further studies

[The elimination of measles and rubella in Italy]

Despite the WHO target for measles and rubella elimination in 2015, outbreaks still occur in all WHO Regions. After a description of the epidemiological situation of measles and rubella worldwide and especially in Europe, this paper aims to provide a detailed analysis of the current epidemiological context of Italy. The surge in the number of measles cases since the beginning of 2017, together with vaccination coverage still far from the 95% target, requires priority actions to be taken to achieve the elimination goals. Alongside the recently approved decree reintroducing compulsory vaccinations for school admissions, further measures are needed and should include the increase in the commitment of the 21 Regions; the implementation of supplemental immunization activities; improving the communication skills of health care workers; ensuring an effective communication with citizens; the enhancement of the surveillance network