Il punto di vista della Commissione di Verifica

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

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

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

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

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.

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

The study of the Italian Health Care System may be interesting because (IV) April 12 2012 Sapienza and Internationalization 7 for Tomorrow s Medical World

SATISFACTION WITH HEALTH CARE SYSTEMS IN TEN NATIONS 60 Canada 50 The Netherlands % satisfaction 40 30 20 United Kingdom Spain Germany Japan Australia France Sweden 10 Italy U.S.A. 0 0 500 1000 1500 2000 2500 pro-capite health expenditure ($) Blendon et al. Health Aff (Millwood) 1990; 9:185-192.

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

N. of reported measles cases and measles vaccination coverage (in 24 month-old children), by year. Italy, 1970-2014. Number of cases 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Vaccination coverage (%) at 24 months of age 90000 80000 70000 Monovalent vaccine available Source: MOH, statutory notification system (1970-2007) Source: ISS, enhanced measles surveillance (2008-2012) Source: ISS, integrated measles-rubella surveillance (2013 2014) MMR MMR in national immunization schedule 100 90 80 60000 70 50000 40000 First elimination plan (2003-2007) Second elimination plan (2010-2015) 60 50 40 30000 20000 SPES Sentinel Surveillance 30 20 10000 10 0 0 Year N. Cases Vaccination coverage (VC %)

Number of cases N. reported rubella cases and MMR vaccination coverage (at 24 months of age), by year. Italy, 1970-2014 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 6.183 221 122 142 353 66 28 Vaccination coverage (%) at 24 months of age Source: MOH, statutory notification system (1970 2012) 70000 Source: ISS, integrated measles-rubella surveillance (2013 2014) 100 60000 90 80 50000 40000 30000 20000 10000 Incidence in 2008: 104 / 1,000,000 Surveillance of rubella in pregnancy and congenital rubella 70 60 50 40 30 20 10 0 0 Year N. Cases Vaccination coverage (VC %)

http://www.ecdc.europa.eu/en/healthtopics/measles/epidemiological_data/pages/annual_epidemiological_reports.aspx

http://ecdc.europa.eu/en/publications/_layouts/forms/publication_dispform.aspx?list=4f55ad51-4aed-4d32-b960-af70113dbb90&id=1443

Status di eliminazione del morbillo e della rosolia negli Stati membri della Regione europea dell Oms, anni 2012-2014 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

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

Vaccination coverage for 1st dose of measles vaccine, in 24-monthold children, by Region. Italy: 2000, 2007 and 2013 2000 2007 2013 56.0 57.0 70.0 86.2 90.5 91. 8 88.0 67.7 87.7 90.6 91.7 90.6 83.9 68.9 86.3 92.6 90.0 87.8 67.6 74.0 90.4 78.5 80.0 84.4 90.6 86.6 93.5 92.2 91.2 93.4 92.1 85.8 91.3 90.1 87.4 93.1 71.0 59.9 92.0 93.1 97.3 88.5 92.4 87.6 53. 90.0 0 58.9 91.5 86.8 92.2 89.4 86.4 91.1 86.8 90.6 91.3 87.6 Italy: 74.1% Italy: 89.6% Italy: 88.3% 88. 9 < 85% 85% - 90% > 90% Not available Source: Italian Ministry of Health

incidence per 1 million population Vaccination coverage (%) Incidence and vaccination coverage for measles and rubella. National trend 2011-2015 90 92 80 90,1 90 90,4 90 70 88 60 50 86,7 MCV-1 85,3 86 40 84,1 MCV-2 84 30 82,7 82,9 82 20 10 80 0 2011 2012 2013 2014 2015 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 2015 30 June 2016

ISS. Morbillo & Rosolia News, Rapporto 35 Febbraio 2017

Vaccination coverage (%) Measles-containing vaccine, 1st dose. Regional trend 2013-2015 100,00 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

Vaccination coverage (%) Measles-containing vaccine, 2nd dose. Regional trend 2013-2015 100,00 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

Ministero della Salute Direzione Generale della Programmazione Sanitaria Ufficio VI

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

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

www.vaccinarsi.org

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

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) 60000 50000 41238 42638 43090 49804 50496 51576 51576 52385 52685 52765 52765 52765 52765 52765 52765 52765 52765 52765 52765 52765 40000 36578 Sample size 30000 20000 11686 13476 23144 30912 15319 15319 15319 15529 15529 16472 16472 16702 16702 18200 18826 19300 19647 19647 19647 19905 19905 19905 19905 10000 0 0 0 0 0 416 2616 2616 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

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

SINCE 2012

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

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

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%

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%

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

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