Il punto di vista della Commissione di Verifica

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1 CONVEGNO MoRoNet: la Rete Nazionale dei Laboratori di Riferimento per il Morbillo e la Rosolia Il punto di vista della Commissione di Verifica PAOLO VILLARI Paolo Villari, MD MPH Professore Ordinario di Igiene, Direttore Dipartimento di Sanità Pubblica e Malattie Infettive Sapienza Università di Roma paolo.villari@uniroma1.it

2 The study of the Italian Health Care System may be interesting because (I) Life expectancy at birth in 2011 (or latest year available): females and males, number of years, OECD countries

3 The study of the Italian Health Care System may be interesting because (II) Infant mortality rates in 2011 (or latest year available): OECD countries

4 The study of the Italian Health Care System may be interesting because (III)

5 The study of the Italian Health Care System may be interesting because (III) OECD (2013), "Country statistical profile: Italy", Country statistical profiles: Key tables from OECD.

6 The study of the Italian Health Care System may be interesting because (IV)

7 The study of the Italian Health Care System may be interesting because (IV) April Sapienza and Internationalization 7 for Tomorrow s Medical World

8 SATISFACTION WITH HEALTH CARE SYSTEMS IN TEN NATIONS 60 Canada 50 The Netherlands % satisfaction United Kingdom Spain Germany Japan Australia France Sweden 10 Italy U.S.A pro-capite health expenditure ($) Blendon et al. Health Aff (Millwood) 1990; 9:

9 Ministry of Health, Directorate General of Heath Prevention Italy: Country information 21 Regions: Regional Health Authorities 146 Local Health Units Total population: 60,782,668

10 N. of reported measles cases and measles vaccination coverage (in 24 month-old children), by year. Italy, Number of cases Vaccination coverage (%) at 24 months of age Monovalent vaccine available Source: MOH, statutory notification system ( ) Source: ISS, enhanced measles surveillance ( ) Source: ISS, integrated measles-rubella surveillance ( ) MMR MMR in national immunization schedule First elimination plan ( ) Second elimination plan ( ) SPES Sentinel Surveillance Year N. Cases Vaccination coverage (VC %)

11 Number of cases N. reported rubella cases and MMR vaccination coverage (at 24 months of age), by year. Italy, Vaccination coverage (%) at 24 months of age Source: MOH, statutory notification system ( ) Source: ISS, integrated measles-rubella surveillance ( ) Incidence in 2008: 104 / 1,000,000 Surveillance of rubella in pregnancy and congenital rubella Year N. Cases Vaccination coverage (VC %)

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16 Status di eliminazione del morbillo e della rosolia negli Stati membri della Regione europea dell Oms, anni Il morbillo rimane endemico in 18 Paesi (34%), come pure la rosolia, mentre sono 16 i Paesi che sono endemici per entrambe le malattie. Tra questi ultimi è inclusa l Italia. Source: Cnesps-ISS, aprile 2016

17 Stati membri della Regione europea dell Oms dove è ancora endemica la trasmissione del morbillo, della rosolia o di entrambe le malattie (dati 2014) Tre Paesi (Albania, Monaco e San Marino) non hanno inviato la documentazione richiesta e non è stato quindi possibile avviare il processo di verifica. Source: Cnesps-ISS, aprile 2016

18 Vaccination coverage for 1st dose of measles vaccine, in 24-monthold children, by Region. Italy: 2000, 2007 and Italy: 74.1% Italy: 89.6% Italy: 88.3% < 85% 85% - 90% > 90% Not available Source: Italian Ministry of Health

19 incidence per 1 million population Vaccination coverage (%) Incidence and vaccination coverage for measles and rubella. National trend , , ,7 MCV-1 85, ,1 MCV ,7 82, Measles Rubella RCV-1 MCV-2 RCV-2 MCV-1 78 Source: Italian MR Annual Reports for the years 2013, 2014, 2015; *ECDC, Disease surveillance data: 1 July June 2016

20 ISS. Morbillo & Rosolia News, Rapporto 35 Febbraio 2017

21 ISS. Morbillo & Rosolia News, Rapporto 35 Febbraio 2017

22 Vaccination coverage (%) Measles-containing vaccine, 1st dose. Regional trend ,00 90,00 Target 95% 80,00 70,00 60,00 50,00 40,00 30,00 20,00 10,00 0,00 68,8 77,4 79,2 79,9 80,8 81,5 82,0 82,3 84,2 84,2 84,4 84,5 84,6 85,3 87,2 87,2 87,5 87,5 88,7 88,7 90,3 90,3 MVC-1, 2013 MVC-1, 2014 MVC-1, 2015 Source: Ministry of Health, Directorate General of Heath Prevention

23 Vaccination coverage (%) Measles-containing vaccine, 2nd dose. Regional trend ,00 90,00 Target 95% 80,00 70,00 60,00 50,00 40,00 30,00 59,8 67,7 69,3 74,7 77,3 77,8 79,7 83,0 83,1 84,6 85,3 85,8 86,4 86,6 87,3 87,5 87,8 87,9 88,1 89,6 91,4 91,7 20,00 10,00 0,00 MVC-2, 2013 MVC-2, 2014 MVC-2, 2015 Source: Ministry of Health, Directorate General of Heath Prevention

24 Ministero della Salute Direzione Generale della Programmazione Sanitaria Ufficio VI

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27 Mantenimento dell erogazione dei LEA Valutazione 2014 Adempiente Valutazione 2015 Adempiente con impegno su alcuni indicatori

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29 Nell attuale contesto di crisi economico-finanziaria, la prevenzione è difesa da molti, se non da tutti.

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36 Ioannidis et al. PLoS ONE, 2011;6:e28346

37 Publication delay of urgently needed randomized evidence on 2009 influenza A(H1N1) vaccination Cumulative sample size in launched and published trials of 2009 H1N1 vaccines over time. Comparison of launched versus published evidence over time (2009 H1N1 vaccine) Sample size May 09 June 09 July 09 Aug. 09 Sep. 09 Oct. 09 Nov. 09 Dec. 09 Jan. 10 Feb. 10 Mar. 10 Apr. 10 May 10 June 10 July 10 Aug. 10 Sep. 10 Oct. 10 Nov. 10 Dec. 10 Jan. 11 Feb. 11 Mar. 11 Apr. 11 May 11 June 11 Launched RCTs Published RCTs Ioannidis JP, Manzoli L, De Vito C, D Addario M, Villari P. Plos One, 2012

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39 Recommendations (after WHO site visit) Increase political committment (Central Government and Regions) Develop alliances within the National Plan of Action (scientific societies, civil associations, etc.) Improve vaccination campaigns Improve surveillance Increase committment of health care workers Improve data flow (National Institute of Health Ministry of Health NVC) Revitalize National Verification Committee Strenghten communication

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41 Data sources for the Italian national status report Population immunity against measles and rubella Sustainability of the national immunization program Ministry of Health Epidemiology of measles, rubella and CRS during the previous 36 months Molecular epidemiology of measles and rubella viruses National Institute of Health NVC RVC Supplemental immunization activities Outbreak reporting forms Regions

42 If regional data is below the national mean If regional data is above the national mean If regional data cannot be evaluated

43 Results for regional synthetic reports 2014 South 2 below 6 above Centre 3 below 1 above North 5 below 4 above 75% 25% 44,4%

44 Results for regional synthetic reports 2015 South 2 below 6 above Centre 2 below 2 above North 5 below 4 above 75% 50% 44,4%

45 Regioni con percentuale di bandierine rosse al di sopra del valore medio nazionale: anni 2014 e 2015 a confronto

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48 PROGRAMMA ELIMINAZIONE MORBILLO E ROSOLIA RESOCONTO REGIONALE SINTETICO ANNO 2015 REGIONE LAZIO

49 PROGRAMMA ELIMINAZIONE MORBILLO E ROSOLIA RESOCONTO REGIONALE SINTETICO ANNO 2015 REGIONE LAZIO

50 PROGRAMMA ELIMINAZIONE MORBILLO E ROSOLIA RESOCONTO REGIONALE SINTETICO ANNO 2015 REGIONE LAZIO

51 PROGRAMMA ELIMINAZIONE MORBILLO E ROSOLIA RESOCONTO REGIONALE SINTETICO ANNO 2015 REGIONE LAZIO