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Varicella epidemiology and varicella vaccination strategies in Italy

Rome, March 18, 2005. Varicella epidemiology and varicella vaccination strategies in Italy. Luigi D. Notarangelo Department of Pediatrics University of Brescia – Italy notarang@med.unibs.it. Italy. Population: 57,321,070 inhabitants Northern Italy: 25,782,796 Central Italy: 10,980,912

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Varicella epidemiology and varicella vaccination strategies in Italy

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  1. Rome, March 18, 2005 Varicella epidemiology and varicella vaccination strategies in Italy Luigi D. Notarangelo Department of Pediatrics University of Brescia – Italy notarang@med.unibs.it

  2. Italy Population: 57,321,070 inhabitants Northern Italy: 25,782,796 Central Italy: 10,980,912 Southern Italy: 20,557,362 Newborns: 544,063 Northern Italy: 236,498 Central Italy: 99,501 Southern Italy: 208,064 Tot. Pazienti: 117 Dicembre 2002 ISTAT, December 2003

  3. Italy: Demographic data Thousands inhabitants

  4. Monthly incidence of diseases under active surveillance SPES, years 2000  2003 Mumps Pertussis Number of cases per 100,000 inhabitants Measles Rubella

  5. Notification SPES Population All ages Up to 14 years Entire country Population sample (4%) Period Regularly, since 1934 Regularly, since 2000 Case definition clinic only clinic only Data flow From doctor to ASL From pediatrician to ISS From ASL to Region From Region to Ministery, ISS, ISTAT Data reported by SIMI

  6. Notification (SIMI) vs sentinel-pediatricians surveillance (SPES)varicella in Italy – year 2000 • SPES: 20,513 cases reported 4.4% of individuals <14 years (470 primary-care pediatricians, 370,000 citizens) • SIMI: 90,540 cases notified 4,820/100,000 SPES 1,252/100,000 Ciofi degli Atti, Ann Ig 2002; ;14 (S6):11.

  7. Under-reporting rate of varicellainfection by age-group Children 014 years; Italy 2000 Age group Under-reporting rate 0 - 4 years 3.9 5 - 9 years 3.0 10 - 14 years 6.5 Total 3.8 Ciofi degli Atti, Ann Ig 2002;14(S6):11.

  8. Incidence of varicella in Italy among infants and children SPES (sentinel pediatricians) – years 2002 and 2003 year 2002 year 2003 Incidence (per 100,000)

  9. VZV seroprevalence by age-group and geographic area in Italy, 19961997 17.9% Reproduced from Gabutti, et al.Epidemiol Infect.2001;126:433-40, with permission from Cambridge University Press (http://.journals.cambridge.org)

  10. 1-6 months 7-11 months 1 2-4 5-9 10-14 15-19 20-39 > 40 Anti-VZV antibodies GMT by age-group in the Italian population, 1996-1997 mUI/ml 1000 750 500 250 0 Age-groups (years) Gabutti, et al. Epidemiol Infect. 2001;126:433-440

  11. Changes of seroprevalence between 12 and 18 years 561 children born in 1981, first studied in 1992, and then again in 2000 11.1% 22.8% 500 first infection booster 400 seroneg. seroconv. serorev (1) 300 increase dim 200 seropos. 100 0 199293 19982000 Romanò, Ann Ig 2002;14(S6):7

  12. The burden of varicella in Italia • complications reported in 3.5 – 4.8% • of infected children • hospitalization required in 0.18 – 0.34% • of infected children • skin infections • pneumonia • neurological complications Fornaro, et al. Pediatr Infect Dis J 1999;18:414-19 Giaquinto, et al. Ann Igiene 2002;14(S6):21-7

  13. The burden of varicella in Italia Varicella-related hospitalizations in Italy – 1999-2002 2.000 1.900 1.800 1.700 1.690 1.600 1.500 Nr. hospitalizations 1.628 1.400 1.538 1.300 1.432 1.200 1.100 1.000 1999 2000 2001 2002 Year Incidence of varicella-related hospitalizations (per 100,000) by age group – year 2000 50 39.27 40 30 Incidence ( per 100,000 ) 20.32 20 7.85 10 2.68 1.80 0.50 0.37 0.17 0 < 1 1-4 5-14 15-24 25-44 45-64 65-74 > 75 Age (years) Ministry of Health

  14. 25 20 15 10 5 0 <1 1 2 3 4 5-9 10-14 15-19 20-24 25-49 50-59 60-69 > 70 Deaths due to varicella, by age-group. Italy, 1981-2000  ISTAT 96 deaths in 20 years (4.8 deaths/year) Age (years)

  15. 500 450 400 350 300 250 N. cases 200 150 100 50 0 25-49 50-59 60-69 > 69 Age (years) Deaths due to/with herpes zoster, by age-group. Italy, 1981-2000  ISTAT 550 deaths in 20 years (27.5 deaths/year) due to zoster or with zoster?

  16. The economic burden of varicella in Italy • For the society • Work-loss • For the family • OTC medications • Loss of work • Private lessons • Home-care • Other costs • (telephone, transportation) • For the NHS • Consultations • Medications • Hospitalization • Lab testing

  17. The economic burden of varicella in Italy • For each pediatric patient • Fornaro et al. Coudeville et al. • <1 year 16 ys 717y • prescriptions 10.90 € 10.90 € 10.90 € • OTC medications 3.98 € 3.98 € 3.98 € • - hospitalizations 9.06 € 43.20 € 4.70 € 4.70 € • - consultations 19.02 € 37.80 € 37.80 € 35.60 € • complications 0.78 € • additional examinations 0.71 € 0.71 € 0.71 € • - work losses 81.24 € 84.50 € 84.50 € 84.50 € • - school losses 11.25 € • Total 129.24 € 181.09 € 142.59 € 140.39 € 7.89 € Fornaro, et al. Pediatr Infect Dis J 1999;18:414-19 Coudeville, et al., Pharmacoeconomics 2004; 22: 839-55.

  18. The economic burden of varicella in Italy For each adult patient • Zotti Coudeville • prescriptions 18.30 € • OTC medications 3.98 € • - hospitalizations 47.20 € 33.00 € • consultations 15.00 € 30.00 € • additional examinations 1.55 € • - work losses 710.00 € 681.40 € • Total 792.80 € 768.23 € 20.60 € Zotti, et al. Ann Igiene 2002;14:29-33. Coudeville, et al. Pharmacoeconomics 2004;22:839-55.

  19. Vaccination at 1 year, 20% coverage Vaccination at 1 year, 80% coverage 600000 w=0,003 600000 600000 w=0,003 reduction rate: 18% 500000 w=0,003 600000 reduction rate: 82% 500000 >24 years 500000 w=0,003 400000 numero di nuovi casi 500000 400000 400000 19-24 years number of new cases numero di nuovi casi number of new cases 300000 400000 numero di nuovi casi numero di nuovi casi 300000 5-18 years 300000 300000 200000 200000 200000 200000 0-4 years 100000 100000 100000 100000 0 years from vaccination 0 5 -5 25 30 35 10 15 20 40 45 -10 0 0 years from vaccination 0 0 0 5 5 -5 -5 10 15 20 25 30 35 40 45 20 30 45 10 15 25 35 40 -10 0 5 -10 -5 10 15 20 25 30 35 40 45 -10 anni dalla vaccinazione Vaccination at 1 year, 80% coverage and at 12 years, 50% coverage anni dalla vaccinazione anni dalla vaccinazione anni dalla vaccinazione Vaccination at 12 years, 80% coverage reduction rate: 26% reduction rate: 94% number of new cases years from vaccination years from vaccination Modelling of varicella vaccination in Italy (Salmaso) number of new cases Salmaso, et al. Epidemiol Prev 2003;27:154–60. Reproduced with permission.

  20. MMR vaccine coverage in ItalyICONA, years 1998 and 2003 1998 2003 < 50% 50-75% >75%

  21. Universal varicella vaccination in Sicily • identified as a priority by the Regional Health Authority (22.07.2002) • approved with a law by Regione Sicilia, 23.03.2004 • aims: • - immunize at least 80% of infants at 15 months • - immunize at least 50% of susceptible individuals at 12 years • - monitor vaccination coverage • - monitor adverse events (including identification of strain) • - monitor epidemiology of varicella in Sicily • officially started in March 2003

  22. State-Regions Conference March 2005 • universal varicella vaccination • (12 years) recommended for • those Regions able to reach • >80% coverage • varicella vaccination • recommended for susceptible • adolescents

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