Influenza vaccination in pregnancy: careful assessment confirms safety concerns for the offspring.

Valid evidence does not support universal influenza vaccination for pregnant women, the LTE objections are unfounded. The observational evidence is less valid than that from RCTs: important safety signals in all the RCTs require high consideration. In RCTs, influenza vaccinated women have mostly local adverse effects, while their offspring shows a nonsignificant excess of deaths, and a significant excess of serious presumed/neonatal infections in the larger RCT. Several Authors have financial relationships with vaccine producers, several conclusions omit the safety signals. A cited systematic review has methodological problems and excluded important published RCTs. Waiting for new independent RCTs, the precautionary principle suggests avoiding to promote pregnant women vaccination. Health services could offer it highlighting existing uncertainties, with balanced informations allowing informed choices.

[Varicella vaccination: scientific reasons for a different strategic approach]. / Vaccinazione antivaricella: argomenti scientifici per possibili strategie diverse dalle attuali.

The Italian Parliament has recently introduced 10 mandatory immunisations, including the one against varicella. For this vaccination, the obligation starts with the birth cohort of 2017, but it is offered free of charge to subjects with a negative history and not previously vaccinated. This paper presents up-to-date evidence on this issue and illustrates a number of critical arguments that may question the opportunity of this choice. Particularly, while the disease is relatively mild in children aged between 1 and 9 years, the risk of worsening its consequences is progressive with age, becoming worst in the elderly, so the vaccination of children may increase the age of the cases. Some vaccine side effects are not trivial and the duration of protection is still uncertain, as well as the cost-effectiveness of mass vaccination and its long-term effects, referring to virus reactivation and to the incidence of Herpes zoster in the general population, which could be increased and anticipated in the long run. Varicella vaccination is not included in international eradication goals and very few Europeans Countries have considered it as a public health priority. A different rational choice could have been to offer a selective vaccination only to adolescents with a negative history of chickenpox; or at least to delay the beginning of the universal campaign in the Italian regions that had not started the mass vaccination yet, evaluating the results over time. Lastly, this paper lists a number of preventive interventions of proven effectiveness and cost-effectiveness, with extraordinary margins of improvement, whose mandatory introduction in the population have never been considered, even as a matter of debate.