Childhood vaccine coverage in Italy after the new law on mandatory immunization.

BACKGROUND: The Italian National Immunization Prevention Plan (PNPV) identifies vaccines actively offered free of charge to target populations within the National Health Service. Despite this, childhood immunization coverage has been declining in Italy in recent years. As a response, the Italian Parliament in July 2017 approved law n. 119 extending mandatory childhood vaccines from four to ten, this stimulating a lively debate at both the scientific and policy level. METHODS: We analysed and critically interpreted 2000-2017 Italian national childhood immunization coverage trends, by different vaccine, target population, birth cohort and by Region. In particular, in order to preliminarily assess the impact of the new law, we computed percentage changes in 2016-2017 vaccine coverage for both mandatory and recommended vaccine programs. Data were provided by the Directorate General of Health Prevention of the Italian Ministry of Health. RESULTS: In 2017 national-level vaccine coverage at 24 months of age was 94.5% for Polio and 91.7% for Measles, this representing, respectively 1.2% and 4.4% increase, as compared to 2016. Conjugate Pneumococcal and Meningococcal C vaccines coverage increased, respectively, by +2.5% and +2.4% between 2016 and 2017. National-level polio vaccine coverage remained above the 95% PNPV coverage target between 2000 and 2013 and has remained below since then. In particular, it has had been steadily declining between 2011 and 2016 (-2.8%). Measles coverage remained well below the 95% coverage target for the entire study period. In recent times, it declined by 4.8% between 2011 and 2015 with the lowest coverage rate reported for year 2015 (85.3%). There is high heterogeneity in coverage within Regions for both mandatory and recommended vaccines. CONCLUSION: Preliminary data show that childhood immunization coverage increased since the approval of the new law on mandatory vaccination. Nonetheless, as additional data are accumulating and will make it possible to further assess the impact of the new law, strengthened efforts are needed in Italy to promote informed and proactive vaccine uptake.

Human papillomavirus 9-valent vaccine for cancer prevention: a systematic review of the available evidence.

In 2014, the Food and Drug Administration approved a new human papillomavirus 9-valent vaccine (9vHPV), targeting nine HPV types: HPV types 6, 11, 16, and 18, which are also targeted by the quadrivalent HPV vaccine (qHPV), plus five additional high cancer risk HPV types (HPV types 31, 33, 45, 52, and 58). The aim of the current study was to systematically retrieve, qualitatively and quantitatively pool, as well as critically appraise all available evidence on 9vHPV from randomized controlled trials (RCTs). We conducted a systematic review of the literature on 9vHPV efficacy, immunogenicity and safety, as well as a systematic search of registered, completed, and ongoing RCTs. We retrieved and screened 227 records for eligibility. A total of 10 publications reported on RCTs' results on 9vHPV and were included in the review. Sixteen RCTs on 9vHPV have been registered on RCT registries. There is evidence that 9vHPV generated a response to HPV types 6, 11, 16 and 18 that was non-inferior to qHPV. Vaccine efficacy against five additional HPV type-related diseases was directly assessed on females aged 16-26 years (risk reduction against high-grade cervical, vulvar or vaginal disease = 96·7%, 95% CI 80·9%-99·8%). Bridging efficacy was demonstrated for males and females aged 9-15 years and males aged 16-26 years (the lower bound of the 95% CIs of both the geometric mean titer ratio and difference in seroconversion rates meeting the criteria for non-inferiority for all HPV types). Overall, 9vHPV has been proved to be safe and well tolerated. Other RCTs addressed: 9vHPV co-administration with other vaccines, 9vHPV administration in subjects that previously received qHPV and 9vHPV efficacy in regimens containing fewer than three doses. The inclusion of additional HPV types in 9vHPV offers great potential to expand protection against HPV infection. However, the impact of 9vHPV on reducing the global burden of HPV-related disease will greatly depend on vaccine uptake, coverage, availability, and affordability.

Creatine supplementation exacerbates ethanol-induced hepatic damage in mice.

OBJECTIVE: The aim of this study was to investigate the effects of creatine supplementation on early stages of ethanol-induced hepatic damage. METHODS: Male Swiss mice were divided into three groups (n = 12/group): control (C), ethanol (E), and ethanol supplemented with creatine (EC). The control group received a diet containing 15.8% of total calories from proteins, 46.3% from carbohydrates, and 37.9% from lipids. The ethanol and ethanol and creatine groups received diets containing 15.8% of total calories from proteins, 16.2% from carbohydrates, and 34.5% from lipids; the remaining calories were obtained from the addition of 5% of 95% ethanol. Creatine (1%; weight/vol) was added to the diet of EC mice. After 14 and 28 d, six animals from each group were sacrificed, generating subdivisions in each group: C14 and C28, E14 and E28, EC14 and EC28. After sacrifice, the liver was removed, weighed, and prepared for histologic, biochemical, and molecular analysis, and blood was collected. RESULTS: Ethanol intake induced mild cell degeneration, liver damage, oxidative lesions, and inflammation. Surprisingly, ethanol intake combined with creatine exacerbated cell degeneration and fat accumulation, hepatic expression of genes related to ethanol metabolism, oxidative stress and inflammation, and promoted oxidative stress and elevated plasma alanine aminotransferase (P < 0.05). CONCLUSION: Creatine supplementation associated with ethanol is able to interfere in the alcohol metabolism and oxidative stress and to exacerbate ethanol-induced hepatic damage. These new findings are opposite to those observed in several studies where protective effects of creatine in a wide variety of injury models, including non-alcoholic fatty liver disease, were described.

The Parma High School Epidemiological Survey: obsessive-compulsive symptoms.

OBJECTIVE: This study was undertaken to assess the prevalence of obsessive-compulsive symptoms in a population of Italian adolescents. METHOD: A sample of 2877 high-school students, 1463 males (51%) and 1414 females (49%), aged 16-21 years were assessed with the Leyton Obsessional Inventory--Child Version (LOI-CV). Two groups of subjects were defined as 'positive' on the screen: the high interference (HI) (i.e. all subjects who scored 25 or more in the interference score), and the supernormals (Sn). RESULTS: Females scored higher than males both on yes and interference scores. One hundred and nineteen (4.1%) and 87 (3.0%) constitute, respectively, the HI and the Sn groups. The most interfering symptoms were obsessions linked to dirt phobia, rumination and nail biting. CONCLUSION: The prevalence estimates of OCD symptoms confirmed the recent data of the literature that adolescent OCD symptoms are more frequent than was believed previously. Females showed more symptoms and more interference on personal functioning than males.