2.11. Diseases that can be prevented with vaccines

Vaccination coverage for mandatory vaccination has always been more than satisfactory and has never been below 95% of the population, reaching peaks as high as 99%, albeit with inevitable differences between the Regions. Vaccination coverage for Haemophilus influenzae b (Hib) has gradually improved and since 2006, it has been stably above 95%.

Vaccination coverage for measles, mumps and rubella (MMR), however remains more critical, and is still below 95%, the level to be met in order to eliminate these diseases set for 2015 in the WHO’s Europe Region. In 2009, mean national MMR coverage in children under 2 years of age was 89.9% (range per Region 70.8-95.5%) and only two regions met the 95% target. The ICONA 2008 survey showed that estimated MMR coverage within the first 15 months of life is 17% lower than that estimated for over 15 months. There is therefore a clear delay in the vaccine calendar, which means pointless exposure to the risk of disease.

As regards vaccination against human papilloma virus (HPV), the only definitive information available to date is for the 1997 birth cohort, in which coverage amongst females is 59%.

Lastly, as regards influenza vaccination, vaccine coverage amongst the over-65s is 66%, compared to 18-19% in the general population.

Wild-type poliomyelitis and diphtheria are absent in Italy.

Over the past ten years, an average of 70 cases of tetanus have been reported, equal to an incidence of 1.1 cases per 1,000,000 inhabitants, with a slight downward trend. Those most affected are the elderly, particularly women.

The number of cases of hepatitis B virus is also constantly, gradually dropping. Considering all age ranges, the total number of reported cases has dropped from 2,922 in 1990 (incidence of 5.2 cases per 100,000 inhabitants) to 714 in 2009 (incidence of 1.2 cases per 100,000 inhabitants).

The same downward trend can be observed for whooping cough: for the period 1998-2009, the incidence dropped from 12.1 per 100,000 to 1 per 100,000.

The effect of the introduction of the vaccination has also been clear for invasive Hib infections.

In 2009, 252 cases of measles were reported to the special surveillance system, whereas the number rose to 2,726 in 2010. During the first seven months of 2009 there was a small epidemic that peaked in May 2009. A new epidemic started in December 2009 and reached a peak of 433 cases in June 2010.

The all-time minimum low as regards incidence (for the period 1985-2008) was recorded in 2006, with a mean of approximately 0.5 cases per 100,000. The peak for the ten-year period, on the other hand, was registered in 2002 (over 10 cases per 100,000 inhabitants). In 2008, there were 5,877 cases, equal to an incidence of 9.8 cases per 100,000 inhabitants. The same year 57 cases of rubeola virus in pregnancy were reported, of which 4 were asymptomatic. There were 17 voluntary interruptions of the pregnancy and reports of 15 confirmed cases congenital rubella syndrome (with an incidence of 2.7 cases per 100,000 new births)and 8 of infection alone. The lack of information available made it impossible to classify 14 cases.

The incidence rate for mumps remained unchanged until 2001. In 2007, it reached an all-time minimum of reported cases (987). The incidence, over the past 3 years, was on average 2 cases per 100,000 inhabitants.

During the 2008-2009 flu season, the country reported medium activity of the disease, with an overall rate of 72 cases per 1,000 persons. As always during the flu season, children were the most affected age group, whilst the elderly were the least affected; the elderly are the main target of flu immunization programmes together with individuals of all ages affected by some diseases that increase the risk of complications.

The computerisation of vaccination registers is necessary in order to guarantee a correct conduct of vaccine programmes and implement many of the measures of proven efficacy for increasing vaccine coverage.