Giovanni Caputi

Towards the 13-valent pneumococcal conjugate universal vaccination: effectiveness in the transition era between PCV7 and PCV13 in Italy, 2010-2013.

Pneumococcal disease epidemiology has changed after introduction of pneumococcal conjugate vaccines. Seven-valent vaccine (PCV7) has been effective in reducing invasive pneumococcal disease (IPD). In Europe, PCV13 effectiveness was estimated at 78% (95% CI: −18–96%) for 2-priming doses. In Italy, PCV7 was introduced in 2006 in the childhood immunization schedule and replaced with PCV13 in 2010. In Apulia, vaccination coverage has reached 95.1% (birth-cohort 2010). We estimated PCV program effectiveness and its impact on S. pneumoniae diseases. PCV Effectiveness: We used the screening method. We calculated the Proportion of Population Vaccinated from immunization registries and detected cases through a laboratory-confirmed surveillance among hospitalized children ≤60 months. A confirmed IPD case was a child with PCR positive for S. pneumoniae. Differences among children were assessed with the Chi-square or the Fisher exact test (P value < 0.05). PCV Impact: We constructed time series using outcome-specific Poisson regression models: hospitalization rate in pre-PCV era and hospitalization risk ratios (RRs) with 95% CIs for both PCV7 and PCV7/PCV13 shifting era. We calculated hospitalization RR with 95% CIs comparing pre-PCV years with vaccination period. The PCV effectiveness was 84.3% (95% CI: 84.0–84.6%). In May 2010-January 2013, we enrolled 159 suspected IPD of whom 4 were confirmed. Two (fully vaccinated) were caused by serotype 9V, 1 (not vaccinated) by serotype 3, 1 (vaccinated with 2 PCV13 doses) by 15B/C. The most important reduction was for pneumococcal pneumonia (RR: 0.43, 95% CI: 0.21–0.90). The PCV program show promising results in terms of both PCV13 effectiveness and its impact in reducing IPD in children <5 years.

An audit of vaccination coverage among vaccination service workers in Puglia, Italy

The aim of the study is to assess the determining factors and the level of vaccination coverage for those vaccinations recommended to health care workers. The employees of the Apulian Vaccination Services were given an interview-based standardized anonymous questionnaire. Of the 302 replies from the employees, 54.5% of the respondents had received the hepatitis B vaccine and 32.7% the influenza vaccine in the 2007-2008 season. There were 4.6% susceptible to varicella, and 2.6% had been vaccinated. Of the replies received, 9.3% were susceptible to measles or mumps or rubella, and 5.9% had been vaccinated. There is the need for on-going education for vaccine requirements to improve immunoprophylaxis among health care workers.

Eight years of active proposal of pneumococcal 23-valent polysaccharide vaccine: Survey on coverage rate among elderly and chronic patients

BACKGROUND Streptococcus pneumoniae, lancet-shaped, gram-positive, facultative anaerobic organisms, are common inhabitants of the respiratory tract and may be isolated from the nasopharynx of 5% to 70% of healthy adults. OBJECTIVE The aims of the study were to estimate the vaccination coverage for pneumococcal 23-valent polysaccharide vaccine and to assess the impact its introduction in the Italian region of Puglia, where a program to provide this vaccination has been operative since 2000. METHODS Estimation of the coverage for pneumococcal 23-valent polysaccharide vaccine was implemented by a 2-step study consisting of data collection from local health unit vaccination registers between 2000 and 2008 in Puglia and of a cluster sampling study among general practitioners to validate routine data collected during the first step. Moreover, hospitalization for invasive pneumococcal diseases was studied. RESULTS From 2000 to 2004, among individuals > or =65 years, the overall coverage rate estimated by routine data amounted to 26.3%; between 2005 and 2007, annual coverage rates did not exceed 8%/year. Between 2002 and 2007, the overall coverage rate estimated by interviewing general practitioners was 46.6% (95% confidence interval: 39.9-53.4). The coverage rate in chronic patients by routine data was approximately 23%, whereas the rate provided by general practitioners was 17.6% (95% confidence interval: 12.5-22.8). From 2001 to 2007, hospitalization data did not show a reduction in invasive pneumococcal disease trends among the elderly population in Puglia. CONCLUSION The results of this study demonstrate the need for improving vaccine coverage and implementing new immunization strategies and practices.

Mortality trends for primary liver cancer in Puglia, Italy.

In the region of Puglia, Italy, the mortality rates from primary liver cancer (PLC) show a considerable geographical variability. In an area including the city of Bari and the northern province [high-risk (HR) area] the mortality rates are significantly higher than elsewhere in the region [low-risk (LR) area]. The aim of this study is to analyze mortality because of PLC from 1980 to 2002 in the HR and LR areas using an age–period–cohort model to identify their respective trend characteristics and the differences that emerge from their comparison. Attention was focused on the identifiable effects, which are on the drift and on the deviations from this regular trend (curvature), specifically attributable to the cohort and the period effects by applying the method recently proposed by Carstensen. The HR area is characterized by a more marked increase in the mortality trend compared with that observed in the LR area, as indicated in the model by a greater drift effect. In both areas the cohort (curvature) effect shows a decreasing trend starting from the early 1930s whereas the period effect shows a peak in the first half of the 1990s. Despite the correspondence of the trends, the rate ratio of death from PLC between the two areas is not constant and tends to rise uniformly by age, birth cohort, and period of time: in 2002, the rate ratio of death was 1.40 [confidence interval (CI): 1.15–1.70] at 40 years old, 1.73 (CI: 1.55–1.93) at 60 years old, and 2.14 (CI: 1.92–2.38) at 80 years old.

Italian healthcare workers' views on mandatory vaccination

BackgroundMandatory vaccination has contributed to the success of immunisation programmes but voluntary vaccination allows people to be responsible for their own health. There are benefits from both policies and the arguments between them remain subject to debate within and without the scientific community, both nationally and internationally. The aim of this study is to assess the opinions of those who actually work in the Vaccination Service.MethodsThe survey was carried out using a self-administered standardised anonymous questionnaire given to all of the Vaccination Service employees in the Apulia Region.ResultsOf 302 completed questionnaire replies, 4.4% stated that mandatory vaccination should be abandoned now, 21.2% that it should be phased out, and 74.4% that it should be retained.ConclusionAn educational program should be set up to explain to Vaccination staff the value and worth of voluntary compared to mandatory vaccination and why high vaccination rates do not have to depend on compulsion.

Simultaneous administration of vaccines in immunization protocols: an audit in healthcare workers in the Puglia region of Italy.

Through a standardized questionnaire, this study investigated the opinions and attitudes of Vaccine Service staff in the Puglia Region of Italy regarding simultaneous administration of vaccines. Coadministration was practiced by 89.4%, and the staff’s positive opinions were that it is important for work organization (80.8%) and as an opportunity to increase vaccine take-up (59.9%). Negative opinions were that it increases the risk of adverse reactions or undesired effects (11.3%) and can engender fear of such reactions in parents (31.1%).