Bacterial Meningitis Hospitalizations after the 2009 L'Aquila Earthquake: A Retrospective Observational Study

Human Vaccines & Immunotherapeutics

Necozione

Mattei

2020

Whooping cough continues to be an important public health issue despite high levels of vaccination coverage with acellular pertussis vaccine. Young unimmunized infants represent the most vulnerable group with the highest rates of complications and death. As infant-specific pertussis epidemiologic data, especially among neonates, in Italy were limited, a retrospective observational study of hospitalizations for whooping cough in Italian infants aged <12 months between 2007 and 2018 was conducted to address this knowledge gap. The temporal trend of rates, also stratified for age classes according to the expected age for the administration of vaccine doses, were analyzed by the slope of the regression line. The mean age at the time of admission was 92 d (±64). A clear seasonal pattern in the occurrence of pertussis hospitalizations with a summer peak was observed. Infants younger than 3 months old had the highest hospitalization rates (169 x 100000 infants on average), with a significant rising trend of 9 x 100000 infants on average per year. Limiting the analysis to Bordetella pertussis-related hospitalizations such trend was even more evident. In the other age classes, hospitalization rates were considerably lower and gradually decreased with increasing age. This study demonstrated that pediatric populations, too young to be protected by vaccination, had a greater risk of contracting pertussis. Thus, it is necessary to promote additional immunization strategies besides one booster dose in adolescents, including vaccination during pregnancy.

Section: Discussionmentioning

confidence: 98%

Pertussis in Italy: how to protect the “unprotectable”?

Human Vaccines & Immunotherapeutics

Necozione

Mattei

2020

“…Limitations of the study. Using the hospital discharge database as informational flow, some diagnoses could be excluded [32,33,34].…”

Section: Discussionmentioning

confidence: 99%

Trends in Hospital Admissions for Pertussis Infection: A Nationwide Retrospective Observational Study in Italy, 2002–2016

Gabutti

Mattei

2019

IJERPH

Background: Pertussis is a highly contagious infectious disease which continues to be an important public-health issue despite the high immunization coverage rates achieved. However, evidence of increased circulation of pertussis among adolescents and adults due to waning immunity and atypical clinical manifestations seem to be the main reasons for its resurgence. The aim of this study was the analysis of the epidemiological trend for pertussis-related hospitalizations in Italy, in relation with vaccination coverage and information from laboratory confirmed cases of pertussis. Methods: A retrospective observational study investigating hospitalizations for pertussis from 2002 to 2016 in Italy was conducted. Frequencies and rates of hospitalization were analyzed and hospitalization data were compared with a series of already published laboratory confirmed data. Results: This study highlighted a rising trend for pertussis hospitalizations in Italy since 2008. Infants aged <1 year showed the highest frequencies (63.39%) and average rates (74.60 × 100000 infants) of hospitalization despite an extremely high vaccination coverage (95.89%). An increasing trend of hospitalization frequency emerged for the age group with levels of IgG antibodies to pertussis toxin compatible with pertussis infection within the last year (20–29 years old age group). Conclusions: The rising trend for pertussis hospitalizations and the greater involvement of infants aged <1 year require an integrated approach, including the implementation of booster doses administration in adolescence and adulthood, the vaccination of pregnant women and the cocoon strategy.

“…Furthermore, since the study was on national dimension, it is unlikely that this possible bias changed our final results [38]. However, as these findings were based on admission data, we took only severely affected subjects into account, excluding cases of mild measles that did not require hospital care.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the vaccination status of each case included in the analysis was not consider, as these data were not available. Finally, hospital discharge records did not allow to discriminate between nosocomial transmission of the infection and community acquired infection [38].…”

Section: Discussionmentioning

confidence: 99%

Measles-Related Hospitalizations in Italy, 2004–2016: The Importance of High Vaccination Coverage

Annals of Global Health

Necozione

Fabiani

et al. 2019

Background: Measles is a highly contagious human infectious disease. It can lead to serious complications and often requires hospitalization. In Italy, as in other European countries, the goal of measles elimination in 2015 failed. To reach this target, identifying susceptible individuals, closing any immunity gaps and reaching adequate vaccination coverage is necessary. Objective: To contribute to these purposes, a retrospective observational study on measles-related hospitalization between 2004 and 2016 in Italy was conducted, using the national hospital discharge database as informational flow. Methods: Admission frequencies and hospitalization rates were compared between regions with low (<90%) and high (≥90%) vaccination coverage for measles at age 24 months. Categorical variables were analyzed using the χ2 test or the χ2 test for trend for ordinal variables; t test was performed to verify the significance when annual average hospitalization rates were compared. Trends of vaccination coverage and hospitalization rates were analyzed using the slope of the regression line. Findings: During the study period, 9,546 measles-related hospitalizations were collected in Italy, with an average annual number equal to 734. The overall measles hospitalization rates increased from 0.21 × 100,000 persons in 2004 to 0.82 × 100,000 in 2016 (β = 0.04; p = 0.689). A shift of mean age (from 1–17 years to 18–44 years) of measles-related hospitalizations was shown. A number of admissions for the low vaccination coverage group about twice as much as recorded for the other regional group was shown (6,344 vs 3,202). The involvement of 18–44 age class in the high vaccination coverage group was 14% higher compared with the low vaccination coverage group, in which, however, the 1–17 age class presented a 16% higher frequency. Conclusions: These findings confirmed that large measles epidemics continue to occur in Italy, although with regional differences related to different rates of measles immunization. Vaccination coverage >90% led to a halving of measles hospitalizations, but it is insufficient for the elimination: ≥95% coverage continues to be the target to be reached.