Regional reports for the subnational monitoring of measles elimination in Italy and the identification of local barriers to the attainment of the elimination goal.

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PLoS One. 2018 Oct 24;13(10):e0205147. doi: 10.1371/journal.pone.0205147. eCollection 2018.

Regional reports for the subnational monitoring of measles elimination in Italy and the identification of local barriers to the attainment of the elimination goal.

Adamo G¹ Sturabotti G¹ Baccolini V¹ de Soccio P¹ Prencipe GP¹ Bella A² Magurano F³ Iannazzo S⁴ Villari P¹ Marzuillo C¹.

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Abstract

Although most countries in the WHO European Region were verified in 2017 as having interrupted endemic measles transmission nine countries were still endemic. Among these Italy accounted for the second highest number of measles cases reported in Europe in 2017. The elimination of measles is verified at national level by each countrys National Verification Committee (NVC) through the production of an Annual Status Update (ASU). Since in Italy decentralization has led to an inhomogeneous implementation of immunization strategies among the 21 administrative Regions the Italian NVC proposed that measles elimination should also be documented at the subnational level through regional ASUs and Synthetic Regional Reports (SRRs). The regional ASUs and the SRRs for 2014 2015 and 2016 were produced and appraised by the NVC to evaluate the Regions performances in each individual year as well as over the whole period. A specific analysis of vaccination coverage including official immunization data for 2017 was performed. Moreover the measles epidemic of 2017 was examined. Firstly in the period 2014-2016 low immunization rates were registered in most Regions. Sixty-three per cent of southern Regions reported rates below the national mean and an overall low-quality performance. The approval of Italys mandatory vaccination law in 2017 resulted in a marked increase in vaccination coverage; however this increase was not homogeneous among Regions. Secondly more than 50% of Regions did not report any supplemental immunization activity (SIA) for the period 2014-2016. Thirdly from 2014 to 2016 fewer than one-third of Regions improved their reporting of outbreaks. Finally over the study period only two Regions reached the target required by the WHO for measles laboratory investigations. In countries with decentralized health policies subnational monitoring can help identify local barriers to measles elimination. In Italy it has highlighted the need for further SIAs and a stronger surveillance system.

PMID: 30356247 DOI: 10.1371/journal.pone.0205147