[Antitetanus vaccination: benefits and risks]. / Vaccinazione antitetanica: benefici e rischi.

The significant reduction of the cases of tetanus in the years led to an increased perception of risk associated with vaccination, which, like any medical procedure, entails the possibility of adverse reactions. Although the reviews of the literature show that the tetanus vaccine is implicated as responsible for serious adverse events, the neurological complications associated with it are extremely rare, as confirmed also by the small number of cases reported in the literature. It's necessary that all events temporally associated with vaccination are properly investigated and brought to the attention of healthcare workers and citizens, in order to establish an early treatment, which in most cases leads to complete recovery.

[Epidemiology and prevention of hepatitis A and B in developing countries]. / Attualità in epidemiologia e prevenzione delle epatiti A e B nei Paesi in via di sviluppo.

Viral hepatitis A and B are serious public health problems all over the world. Effective prophylactic measures and improvement in the hygienic and sanitary conditions have considerably modified the diseases trend, characterized by high prevalence levels in developing countries. In this paper the epidemiology of hepatitis A and B is reviewed, focused on endemic areas, on the basis of data collected from local and international studies in order to evaluate prevention strategies for both local population and travelers.

[Survey among female university students on HPV infection epidemiology and prevention]. / Conoscenze sull'infezione da HPV a due anni dall'inizio della campagna vaccinale: indagine tra le studentesse dell'Università di Roma Tor Vergata.

Human papilloma virus (HPV) is one of the most common sexually transmitted infections. The vaccine has the maximum benefit when given before starting sexual activity and its efficacy is proved also in sexually active women in which the incidence of the infection is higher. In 2010 a questionnaire on HPV was administered to 299 female students of University of Rome Tor Vergata. The results compared with those obtained in a similar 2007-08 survey, and with international data, showed that knowledge about HPV is still low, with a negative impact on the acceptance of specific preventive measures.

[Application of the QuavaTAR model to vaccination services in Latium, Italy]. / Sistema di misura della qualità QuaVaTar: dal modello matematico all'applicazione nei servizi vaccinali del Lazio.

Definition, categorization, and measuring of Quality have become increasingly important concerns in the era of managed care and cost containment. Most attempts to develop quality indicators have been based on outcome measures. The Donabedian model of Structure-Process-Outcome has been universally accepted and used as the basis for much of the work addressing quality and outcomes. Adequate indicators for vaccination services are scant therefore are applied to this setting a new quality measurement process based on a probabilistic approach called MQS (Misure di Qualità in Sanità-Quality Measures in Healthcare), developed by our working group since 2005 in several hospital settings. This new application, called "Quality in Vaccination Theory and Research"(QuaVaTAR), was used to measure the efficiency of the vaccination centers of three Local Health Units (ASL RM B, RM F, RM H) in Lazio Region (Italy). The measure method combines the evidences obtained from the supplied services (objective measurements) and the judgments of the services' stakeholders collected by an "ad hoc" questionnaire (subjective measurements). The subjective evaluations were expressed with a number (between 0-100) representing a personal judgment on the organizational and the communicational efficiency and the comfort of the "ideal" vaccination center. The objective measurements were collected in performance grids on the same points investigated with the questionnaire. Combining objective and subjective measures we obtained "Quality Scores", useful to make improvements in the vaccination centers and to compare different services.

[Hepatitis A in Europe today: epidemiology and prevention]. / L'epatite A in Europa oggi: epidemiologia e prospettive di prevenzione.

The susceptibility to Hepatitis A virus infection is growing among the European population and many hepatitis outbreaks have been described in 2004-2008. The change in epidemiological characteristics observed in the last decades has to be taken in account in issuing specific recommendations about the use of the vaccine in pre and post exposure prophylaxis.

[Combined vaccines and simultaneous administration in newborns]. / Combinazioni e cosomministrazioni per le vaccinazioni nell'infanzia.

Combined vaccines and simultaneous administration are widely studied due to the increasing number of antigens available for newborns immunization. By means of simultaneous administration and combination of vaccines, an effective preventive strategy can be adopted, in order to obtain parents compliance and an optimal coverage of the target population.

Quality measurement and benchmarking of HPV vaccination services: a new approach.

BACKGROUND: A new measurement process based upon a well-defined mathematical model was applied to evaluate the quality of human papillomavirus (HPV) vaccination centers in 3 of 12 Local Health Units (ASLs) within the Lazio Region of Italy. The quality aspects considered for evaluation were communicational efficiency, organizational efficiency and comfort. RESULTS: The overall maximum achievable value was 86.10%, while the HPV vaccination quality scores for ASL1, ASL2 and ASL3 were 73.07%, 71.08%, and 67.21%, respectively. CONCLUSIONS: With this new approach it is possible to represent the probabilistic reasoning of a stakeholder who evaluates the quality of a healthcare provider. All ASLs had margins for improvements and optimal quality results can be assessed in terms of better performance conditions, confirming the relationship between the resulting quality scores and HPV vaccination coverage. METHODS: The measurement process was structured into three steps and involved four stakeholder categories: doctors, nurses, parents and vaccinated women. In Step 1, questionnaires were administered to collect different stakeholders' points of view (i.e., subjective data) that were elaborated to obtain the best and worst performance conditions when delivering a healthcare service. Step 2 of the process involved the gathering of performance data during the service delivery (i.e., objective data collection). Step 3 of the process involved the elaboration of all data: subjective data from step 1 are used to define a "standard" to test objective data from step 2. This entire process led to the creation of a set of scorecards. Benchmarking is presented as a result of the probabilistic meaning of the evaluated scores.

Hepatitis A: Epidemiology and prevention in developing countries.

Hepatitis A is the most common form of acute viral hepatitis in the world. Major geographical differences in endemicity of hepatitis A are closely related to hygienic and sanitary conditions and other indicators of the level of socioeconomic development. The anti-hepatitis A virus (HAV) seroprevalence rate is presently decreasing in many parts of the world, but in less developed regions and in several developing countries, HAV infection is still very common in the first years of life and seroprevalence rates approach 100%. In areas of intermediate endemicity, the delay in the exposure to the virus has generated a huge number of susceptible adolescents and adults and significantly increased the average age at infection. As the severity of disease increases with age, this has led to outbreaks of hepatitis A. Several factors contribute to the decline of the infection rate, including rising socioeconomic levels, increased access to clean water and the availability of a hepatitis A vaccine that was developed in the 1990s. For populations with a high proportion of susceptible adults, implementing vaccination programs may be considered. In this report, we review available epidemiological data and implementation of vaccination strategies, particularly focusing on developing countries.

Hepatitis B: Epidemiology and prevention in developing countries.

Hepatitis B virus (HBV) infection is a serious global public health problem. The infection may be transmitted through sexual intercourse, parenteral contact or from an infected mother to the baby at birth and, if contracted early in life, may lead to chronic liver disease, including cirrhosis and hepatocellular carcinoma. On the basis of the HBV carrier rate, the world can be divided in 3 regions of high, medium and low endemicity. The major concern is about high endemicity countries, where the most common route of infection remains vertical transmission from mother to child. Screening of all pregnant women and passive immunization with human hepatitis B immunoglobulin are not affordable for many developing countries. The infection rate can be reduced by modifying behavior, improving individual education, testing all blood donations, assuring asepsis in clinical practice and screening all pregnant women. However, availability of a safe and efficacious vaccine and adoption of appropriate immunization strategies are the most effective means to prevent HBV infection and its consequences. The unsolved problem for poorest countries, where the number of people currently infected is high, is the cost of the vaccine. A future challenge is to overcome the social and economic hurdles of maintaining and improving a prevention policy worldwide to reduce the global burden of the disease.