Available evidence on the co-administration of the four-component meningococcal B vaccine (4CMenB) with three vaccines at the same visit among pediatric individuals.

Vaccine co-administration is a useful strategy for improving vaccine coverage and adherence. In Italy, an update to the national immunization program (NIP) in 2023 included recommendations for co-administration of pediatric vaccines, including the four-component vaccine for meningococcus B (4CMenB), pneumococcal conjugate vaccine (PCV), hexavalent vaccines, and oral rotavirus vaccines. Safety is a major concern when considering vaccine co-administration; therefore, a literature review of the available evidence on 4CMenB co-administration with PCV, hexavalent/pentavalent, and rotavirus vaccines was performed. Of 763 publications screened, two studies were reviewed that reported safety data on 4CMenB co-administration with PCV, hexavalent/pentavalent, and rotavirus vaccines in infants aged 0-24 months. Overall, these studies supported that there were no significant safety signals when co-administering 4CMenB with PCV, hexavalent/pentavalent, and rotavirus vaccines, compared with individual vaccination. This review provides key insights for healthcare professionals on the tolerability of co-administering 4CMenB with routine vaccines.

Overall effectiveness of pneumococcal conjugate vaccines: An economic analysis of PHiD-CV and PCV-13 in the immunization of infants in Italy.

Pneumococcal diseases are associated with a significant clinical and economic burden. The 7-valent pneumococcal conjugate vaccine (PCV-7) has been used for the immunization of newborns against invasive pneumococcal diseases (IPD) in Italy while now, the pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) and the 13-valent pneumococcal conjugate vaccine (PCV-13) are available. The aim of this analysis was to compare the estimated health benefits, cost and cost-effectiveness of immunization strategies vs. non-vaccination in Italy using the concept of overall vaccine effectiveness. A published Markov model was adapted using local data wherever available to compare the impact of neonatal pneumococcal vaccination on epidemiological and economic burden of invasive and non-invasive pneumococcal diseases, within a cohort of newborns from the Italian National Health Service (NHS) perspective. A 18-year and a 5-year time horizon were considered for the base-case and scenario analysis, respectively. PHiD-CV and PCV-13 are associated with the most important reduction of the clinical burden, with a potential marginal advantage of PHiD-CV over PCV-13. Compared with no vaccination, PHiD-CV is found on the higher limit of the usually indicated willingness to pay range (30,000 - 50,000€/quality-adjusted life year [QALY] gained), while the incremental cost-effectiveness ratio (ICER) for PCV-13 is slightly above. Compared with PCV-13, PHiD-CV would provide better health outcomes and reduce costs even at parity price, solely due to its differential effect on the incidence of NTHi acute otitis media (AOM). The analysis on a shorter time horizon confirms the direction of the base-case.

A reflection on invasive pneumococcal disease and pneumococcal conjugate vaccination coverage in children in Southern Europe (2009-2016).

Higher-valent pneumococcal conjugate vaccines (PCVs) were licensed from 2009 in Europe; similar worldwide clinical effectiveness was observed for PCVs in routine use. Despite a proven medical need, PCV vaccination in Southern Europe remained suboptimal until 2015/16. We searched PubMed for manuscripts published between 2009 and mid-2016. Included manuscripts had to contain data about invasive pneumococcal disease (IPD) incidence, or vaccination coverage with higher-valent PCVs. This review represents the first analysis of vaccination coverage and impact of higher-valent PCVs on overall IPD in Southern European countries (Portugal, Spain, Italy, Greece, Cyprus). Vaccination coverage in the Portuguese private market peaked around 2008 at 75% (children ≤ 2 years) but declined to 63% in 2012. In Madrid, coverage was 95% (2007-2012) but dropped to 67% (2013/14; children ≤ 2 years) after funding termination in May 2012. PCVs were recently introduced in the national immunisation program (NIP) of Portugal (2015) and Spain (2015/16). In Italy, coverage for the complete PCV schedule (children ≤ 2 years) was 88% in 2013, although highly variable between regions (45-99%). In Greece, in 2013, 82.3% had received 3 PCV doses by 12 months, while 62.3% received the fourth dose by 24 months. Overall IPD (net benefit: effect on vaccine types, vaccine-related types, and non-vaccine types) has decreased; in Greece, pneumococcal meningitis incidence remained stable. Continued IPD surveillance or national registers using ICD-10 codes of clinically suspected IPD are necessary, with timely publicly available reports and adequate national vaccination registers to assess trends in vaccination coverage, allowing evaluation of PCVs in NIPs.

[A prospective descriptive study on the practice of management of urinary tract infections by general practitioners in Italy: epidemiology (Part I)]. / A prospective descriptive study on the practice of management of urinary tract infections by general practictioners in Italy: epidemiology (Part I).

OBJECTIVES: The aim of this prospective descriptive study was to draw the picture of the diagnostic and therapeutic pathways of general practitioners (GPs) in the practice of management of urinary tract infections (UTIs) in Italy. The study results are published in two separate papers. We report here the epidemiological data collected on the prevalence of UTIs and their etiology. MATERIALS AND METHODS: A total of 2.696 GPs were requested to fulfill a questionnaire on their perception of the prevalence of UTIs and their habits in the management of patients either before (IVU1 study, 1.111 GPs) or after (IVU2 study, 1.585 GPs) a specific training course. Epidemiological data from both studies were merged and analyzed. RESULTS: The perceived prevalence of UTIs among the GPs was 1.7% ambulatory-related patients/GP/month, leading to an average of 18.7 UTIs cases/GP/month. UTIs were higher among women (75%) with respect to men (25%), being acute uncomplicated cystitis in women the more prevalent (nearly 50% of female ambulatory-related patients). E. coli was considered the most frequently isolated bacterial pathogen in urine. CONCLUSION: The epidemiological results of this study contribute to assess the prevalence and etiology of UTIs among Italian outpatients. These data may be helpful for urologists in the management of community-acquired UTIs.

[A prospective, descriptive study on the practice of management of urinary tract infections by general practitioners in Italy: clinical pathways (Part II)]. / A prospective, descriptive study on the practice of management of urinary tract infections by general pratictioners in Italy: clinical pathways (Part II).

OBJECTIVES: The aim of this prospective, descriptive study was to draw the picture of the diagnostic and therapeutic pathways of general practitioners (GPs) in the practice of management of urinary tract infections (UTIs) in Italy. The study results are published in two separate papers. We report here the clinical pathways followed by GPs to diagnose and treat UTIs. MATERIALS AND METHODS: A total of 2.696 GPs were requested to fulfill a questionnaire on their perception of the prevalence of UTIs and their habits in the management of patients either before (IVU1 study, 1.111 GPs) or after (IVU2 study, 1.585 GPs) a specific training course. The clinical management pathway was analysed. RESULTS: GPs turned out to share an appropriate management of UTIs, even though some discrepancies between the clinical habits and UTIs guidelines were focused. After the training course the discrepancies were partly amended (IVU2 study). Urinalysis and urine culture are nearly always requested by GPs, frequently including blood examinations. Older and newer fluoroquinolones are mostly prescribed for UTIs, followed by fosfomycin tromoetamol. Lifestyle recommendations for UTIs containment and prevention are released to patients by GPs. CONCLUSION: The clinical results of this study contribute to assess the habits of Italian GPs in diagnosing and treating UTIs. These data may be helpful for urologists in the management of community-acquired UTIs.