Prevention of invasive diseases: strategies to increase vaccination coverage in children and adolescents.

INTRODUCTION Vaccines able to prevent invasive bacterial diseases have been introduced into national and/or regional immunization plans through different strategies. We evaluated Haemophilus influenzae type b, Pneumococcus and Meningococcus C vaccination coverage in the 5 Ligurian Local Health Agencies, in the Liguria Region, and in Italy in order to assess the efficacy of current immunisation policies concerning children at the 24th month and adolescents. Furthermore, we considered new strategies for increasing vaccination coverage. MATERIALS AND METHODS We estimated the vaccination coverage of Local Health Agency 4 by means of the "OASIS" software. The regional mean vaccination coverage was calculated from the data provided by the other four Local Health Agencies in Liguria. National data were obtained from the database of the Ministry of Health and from the last report of the ICONA Working Group. We used a questionnaire to evaluate the knowledge of Meningococcus C vaccination among the pediatricians and general practitioners operating in our Local Health Agency. RESULTS The regional vaccination coverage at the 24th month proved to be: > 95% for Haemophilus influenzae type b, 93% for Pneumococcus and 87% for Meningococcus C. The national mean is: > 95% for Haemophilus influenza type b, 55% for Pneumococcus and 37% for Meningococcus C. Meningococcus C vaccination coverage among adolescents is 49% in Liguria, while the national mean is 16%. The questionnaire administered to the physicians was composed of 5 questions, which were answered by 81% of pediatricians and only 22% of general practitioners. Reducing the incidence of invasive meningococcal diseases through large-scale vaccination was deemed very important by 92% of pediatricians and 81% of general practitioners. About 92% of pediatricians and 85% of general practitioners considered the vaccine safe and effective. All (100%) physicians expressed their agreement with the Ligurian immunization strategy. However, while all the pediatricians reported recommending this vaccination, only 76% of general practitioners did so. Finally, all the physicians interviewed stated their willingness to collaborate with the Department of Prevention to increase vaccination coverage. DISCUSSION VC against Hib at the 24th month, in both Liguria and Italy, proved excellent. Compliance with vaccination against Pneumococcus has been very high since its introduction in 2003 in Liguria, while the national mean is suboptimal. The regional vaccination coverage against Meningococcus C at the 24th month is good; the national value, however, is low because some Italian Regions have not yet introduced this vaccination into their immunization plans. Vaccination coverage in adolescents varies widely among the Ligurian Local Health Agencies and needs to be increased; the national figure is very low because few Regions have introduced this vaccination. However, achieving compliance with vaccinations in adolescents is difficult. The questionnaire indicated that general practitioners place less emphasis on vaccinations than pediatricians. Nevertheless, both general practitioners and pediatricians expressed their willingness to collaborate with the Department of Prevention of Local Health Agency 4 in improving the immunization strategies aimed at adolescents. CONCLUSIONS In conclusion, we consider it very important to create a network involving the Department of Prevention, pediatricians and general practitioners, in order to share the best immunization strategies.