MANDATORY VACCINATIONS: THE
ITALIAN EXPERIENCE
Susanna Esposito
Pediatric Clinic, University of Perugia,
Perugia, Italy

2
How many lives are saved by vaccines?
2.5 million per year
7,000 per day
300 per hour
5 per minute
WHO – 2011-2020

Vaccination has a major beneficial impact1
1. Plotkin SL & Plotkin SA. Chapter 1 in Plotkin SA et al. Vaccines. 6th Edition, Elsevier Saunders, 2012; 2. WHO, 2003. Influenza.
http://www.who.int/mediacentre/factsheets/2003/fs211/en/ (accessed October 2016); 3. Andre FE et al. Bull World Health Organ 2008;86:81–106;
4. Ehreth J. Vaccine 2003;21:4105–4117
–With the exception of safe water, no other
modality, not even antibiotics, has had such
a major effect on mortality reduction1
Economic growth3
Mortality, morbidity,
global financial
burden2–4
Illustrative figure based on Plotkin SL & Plotkin SA. 2012; WHO, 2003; Andre FE et al. 2008; Ehreth J. 2003

Vaccine coverage trends by 24 months of age
in Italy, 2000-2015

N. of cases of measles and vaccine coverage
by 24 months per year, Italy 1970-2016*
*preliminary data

92,25
79,42
85,59
82,37
92,18
92,54
93,80 89,65
94,16
91,25
83,60
76,63
93,4898,47
92,02
91,74
n/a
94,63
84,41
86,78
79,43
88,10
82,62
83,12
88,28
87,82 76,64
86,50
n/a 62,20
42,72
77,7586,33
66,21
60,17
n/a
74,15
77,78
81,73
61,31
Men C Pneumococcus
87,10
80,69
Vaccine coverage for MenC and Pneumococcus

Main news in the Lifetime
Immunization Schedule, 2017
• Introduction of dTp/IPV in the adolescence
• Universal MenB in infancy
• MenACYW to all adolescents
• Universal anti-varicella vaccination among children, with
MMRV (or MRR+V)
• HPV to 12 years old females and males
• Universal Rotavirus vaccination
• PCV13/PPV23 ≥65 years and at risk inividuals of any
age
• Zoster in at least one cohort of elderly and at risk
individuals

In Italy, vaccines account for a small proportion of
the all pharmaceutical costs
8

Hurdles to the introduction of
new vaccines in the schedule
• Increase workload for vaccination centres
• Involvement of pediatricians and GPs
• Reorganization of the vaccination framework
• Possible parents’ reactions to increased
number of vaccine administrations
• Sustainability of high levels of vaccine
coverage for both mandatory and
recommended vaccines

10
• anti-polio
• anti-diphtheria
• anti-tetanus
• anti-hepatitis B
• anti-pertussis
• anti Haemophilus influenzae type b
• anti-measles
• anti-rubella
• anti-mumps
19 May 2017: 10 mandatory vaccines because of reduction of
vaccine coverage
licenza CC-BY-NC-SA 3.0 IT

11
… Anti-vax movements

12
Italian Minister of Health and experts opinion published
in >200 articles

13
News on vaccines appeared in >250
TV and Radio

Vaccini, Salvini: dieci sono inutili. No ad espulsione bimbi - Rai News
www.rainews.it/.../Vaccini-Salvini-dieci-sono-inutili-no-ad-espulsione-bimbi-
2096827...
22 giu 2018 - Il ministro dell'Interno: "Troppi vaccini fanno male. Priorità è che i bimbi
non vengano espulsi dalle classi" anche se non vaccinati.
Hai visitato questa pagina 2 volte. Ultima visita: 21/06/18
Vaccini, la ministra Grillo vuole “l'obbligo flessibile” - Wired
https://www.wired.it › Lifestyle › Vaccini, la ministra Grillo vuole “l’obbligo flessibile”
9 ago 2018 - La ministra della Salute Giulia Grillo ritorna sulle critiche che le sono state
rivolte sui vaccini dall'Associazione nazionale dei presidi, unita nel ..
Grillo: nuovo Ddl sui vaccini per superare il vecchio - Tecnica della ...
https://www.tecnicadellascuola.it › Attualità
11 set 2018 - La ministra della Salute, Giulia Grillo, ritorna sui vaccini per superare
l'insufficiente impostazione del decreto Lorenzin, che ha prodotto una

Discontinuation/interruption of vaccination programmes
results in increased disease incidence1
1. Gangarosa EJ et al. Lancet 1998;351:356–361; 2. Carlsson RM & Gustafsson L. Ten year report – pertussis surveillance in Sweden. Swedish Institute for Infectious Disease
Control 2008. https://www.folkhalsomyndigheten.se/pagefiles/14930/pertussis-surveillance%20in-sweden-ten-year-report.pdf (accessed October 2016)
DTP, diphtheria, tetanus and pertussis; DTaP, diphtheria, tetanus and acellular pertussis
Sweden: No
DTP coverage
Norway: 92%
DTP coverage
1974 1978 1982 1986 1990 1994
Year
Incidenceofpertussis
per100,000
individuals
DTP vaccine
withdrawn in
Sweden
0
50
100
150
200
1986 1990 1994 1998 2002
DTaP-vaccination
introduced
Totalnumberofpertussiscases
Year
0
500
1000
1500
2000
In Sweden, reintroduction of pertussis
vaccination using acellular vaccines in
1996 resulted in a major drop in
pertussis cases2
In Sweden, following withdrawal of the
whole-cell DTP vaccine in 1979,
incidence of pertussis increased
considerably compared with Norway1
Adapted from Gangarosa EJ et al. 1998, copyright permission from Elsevier Adapted from Carlsson RM & Gustafsson L. 2008
2006

Thanks