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Epidemiology of pertussis in a developed country with low vaccination coverage: the Italian experience
N J Binkin1, S Salmaso, A E Tozzi
1Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy.
Insights
Pertussis vaccination in Italy is optional, leading to low coverage and high disease incidence in children under five. Pediatrician ambivalence, not parental safety concerns, drives low uptake, prompting consideration of mandatory vaccination.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Public health policy
Background:
- Pertussis vaccination in Italy is optional, with less than 40% of children under five vaccinated.
- Pertussis remains a prevalent childhood illness in Italy, particularly affecting infants.
- Low vaccination rates contribute to significant disease burden and severity in young children.
Purpose of the Study:
- To examine trends and characteristics of pertussis in Italian children.
- To identify reasons for low pertussis vaccine coverage in Italy.
- To inform public health strategies and policy decisions regarding pertussis prevention.
Main Methods:
- Analysis of diverse data sources on pertussis incidence and vaccination status.
- Examination of clinical pertussis cases and severity in different age groups.
- Investigation into factors influencing vaccine hesitancy and uptake among healthcare providers and parents.
Main Results:
- Approximately 25% of Italian children contract pertussis by age five.
- Infants under one year face the highest risk, with 1 in 14 hospitalized and 1 in 850 dying.
- Pertussis incidence is rising in the 1-4 year age group, even with some vaccination efforts.
- Low vaccine coverage is attributed to pediatrician ambivalence, not parental safety concerns.
Conclusions:
- The current optional pertussis vaccination policy in Italy is insufficient to control the disease.
- Pediatrician attitudes significantly impact vaccine uptake and require targeted intervention.
- Mandatory pertussis vaccination legislation is being considered to improve public health outcomes.
Abstract:
In Italy pertussis vaccination is optional. Fewer than 40% of children younger than 5 years of age are vaccinated, and pertussis remains a common childhood disease. We use data from a variety of sources to examine trends and characteristics of Italian children with pertussis and reasons behind the low vaccine coverage. Approximately 25% of Italian children have experienced clinical pertussis by their fifth birthday. The disease is most severe in those less than 1 year of age; in this group an estimated 1 in 14 cases are hospitalized and 1 in 850 die. The incidence appears to be increasing in the 1- to 4-year age group despite increased vaccination coverage. The low vaccine coverage appears to be caused by the ambivalence of the Italian pediatric community about the vaccine rather than parental concerns about vaccine safety. Legislation is being considered to make pertussis vaccination mandatory.