Towards elimination of measles and rubella in Italy: Progress and challenges

Abstract

IntroductionIn the WHO European Region, endemic transmission of measles and rubella had been interrupted by 37 and 42 of the 53 member states (MSs), respectively, by 2018. Sixteen MSs are still endemic for measles, 11 for rubella and nine for both diseases, the latter including Italy. Elimination is documented by each country’s National Verification Committee (NVC) through an annual status update (ASU).ObjectiveBy analysing data used to produce the ASUs, we aimed to describe the advances made by Italy towards elimination of measles and rubella. Moreover, we propose a set of major interventions that could facilitate the elimination process.MethodsA total of 28 indicators were identified within the six core sections of the ASU form and these were evaluated for the period 2013–2018. These indicators relate to the incidence of measles/rubella; epidemiological investigation of cases; investigation of outbreaks; performance of the surveillance system; population immunity levels; and implementation of supplemental immunization activities (SIAs).ResultsFrom 2013 to 2018, epidemiological and laboratory analyses of measles cases in Italy improved substantially, allowing timely investigation in 2017 and 2018 of most outbreak and sporadic cases and identification of the majority of genotypic variants. Moreover, since 2017, vaccination coverage has increased significantly. Despite these improvements, several areas of concern emerged, prompting the following recommendations: i) improve outbreak monitoring; ii) strengthen the MoRoNet network; iii) increase the number of SIAs; iv) reinforce vaccination services; v) maintain regional monitoring; vi) design effective communication strategies; vii) foster the role of general practitioners and family paediatricians.ConclusionsThe review of national ASUs is a crucial step to provide the NVC with useful insights into the elimination process and to guide the development of targeted interventions. Against this background, the seven recommendations proposed by the NVC have been shared with the Italian Ministry of Health and the Technical Advisory Group on measles and rubella elimination and have been incorporated into the new Italian Elimination Plan 2019–2023 as a technical aid to facilitate the achievement of disease elimination goals.

Increasing Measles Seroprevalence in a Sample of Pediatric and Adolescent Population of Tuscany (Italy): A Vaccination Campaign Success

“…The highest percentage of anti-measles seroprevalence was found in children who received one dose of vaccine (98%) and, more recently, was followed by those received two/three doses (89.2%), even after a long time (up to 13 years) prior to the serological test, as already observed in the literature [ 39 , 40 ]. Despite the fact that the percentage of seropositivity in subjects who received two or three doses was lower than the percentage measured in those who received just one dose, this result was not confirmed by the statistical analysis carried out, and it is reasonable to consider it a vaccination campaign success.…”

“…This study confirms that the promotion of measles vaccination campaigns were successful when considering the Florentine pediatric and adolescent population. The effort in increasing the vaccination coverage resulted in Tuscany being the leader region in Italy with the highest measles immunization coverage at 24 months [ 39 ]. In addition, serological studies allow the monitoring of immunization levels in a population over time.…”

COVID-19 Vaccine Hesitancy among Italian University Students: A Cross-Sectional Survey during the First Months of the Vaccination Campaign

“…The importance of these interventions may be further confirmed by the fact that, while we do not detect any evidence relating to the age of respondents-probably because the age range investigated was narrow-students at the beginning of their academic career were more likely to be hesitant, as reported in France [15]. Therefore, implementing tailored approaches in the university setting during the early years of students' education could improve vaccination compliance among young people, not only in the case of COVID-19, but also for other infectious diseases, such as measles or human papillomavirus, whose immunization rates are currently sub-optimal in this subgroup [40][41][42].…”

Effect of the mandatory vaccination law on measles and rubella incidence and vaccination coverage in Italy (2013-2019)

“…Data were collected from the Annual Status Update (ASU), a form sent annually by the Italian National Verification Committee (NVC) to the Regional Verification Committee for Europe, within the project “Actions to support the National Plan for the Elimination of Measles and Congenital Rubella.” The form is divided in four sections (section 1: country measles and rubella profile; section 2: update of general programme activities by components; section 3: activities of the National verification Committee and its Secretariat; section 4: additional data on measles, rubella and congenital rubella syndrome) plus annexes and includes five core components: epidemiology, molecular data, performance of the surveillance system, immunity data and sustainability of the National Immunization Programme. 3 , 14 Immunity data are collected by the Ministry of Health from the Regions with the respective administrative territories, whereas data on the incidence rates of measles and rubella are provided by the Italian Institute of Health, through the electronic platform used by the Regions in the National Integrated Surveillance System for Measles and Rubella. Measles surveillance is integrated with rubella surveillance, as both measles and rubella affect the same age groups, have similar symptoms and can be difficult to distinguish on a clinical basis.…”

“…1 Achieving and maintaining high rates of vaccination coverage are key public health strategies aimed at reducing measles incidence and reaching the elimination target established by the World Health Organization (WHO) Regional Committee for Europe. [2][3][4] Specifically, the WHO has recommended two doses and a minimum 95% coverage to reach herd immunity, which also confers indirect protection on unvaccinated individuals, and prevents outbreaks. 5 Despite the introduction of the trivalent measles, mumps and rubella (MMR) vaccine in national vaccination schedules more than 20 years ago, its underutilization has meant that measles outbreaks have still occurred throughout Europe.…”