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Vaccine. 2018 Mar 7;36(11):1435-1443. doi: 10.1016/j.vaccine.2018.01.065. Epub 2018 Feb 7.

The impact of immunization programs on 10 vaccine preventable diseases in Italy: 1900-2015.

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Department of Infectious Diseases, Istituto Superiore di Sanità (Italian National Institute of Health), Rome, Italy. Electronic address:
Department of Infectious Diseases, Istituto Superiore di Sanità (Italian National Institute of Health), Rome, Italy.
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
National Center of Health Technology Assessment, Istituto Superiore di Sanità, Rome, Italy.
Department of Economics, Roma Tre University, Rome, Italy.
Istituto Superiore di Sanità, Rome, Italy; Institute of Hygiene and Public Health, Catholic University of the Sacred Heart, Rome, Italy.



Vaccination has determined a dramatic decline in morbidity and mortality from infectious diseases over the last century. However, low perceived risk of the infectious threat and increased concern about vaccines' safety led to a reduction in vaccine coverage, with increased risk of disease outbreaks.


Annual surveillance data of nationally communicable infectious diseases in Italy between 1900 and 2015 were used to derive trends in morbidity and mortality rates before and after vaccine introduction, focusing particularly on the effect of vaccination programs. Autoregressive integrated moving average models were applied to ten vaccine-preventable diseases: diphtheria, tetanus, poliomyelitis, hepatitis B, pertussis, measles, mumps, rubella, chickenpox, and invasive meningococcal disease. Results of these models referring to data before the immunization programs were projected on the vaccination period to estimate expected cases. The difference between observed and projected cases provided estimates of cases avoided by vaccination.


The temporal trend for each disease started with high incidence rates, followed by a period of persisting reduction. After vaccine introduction, and particularly after the recommendation for universal use among children, the current rates were much lower than those forecasted without vaccination, both in the whole population and among the 0-to-4 year olds, which is, generally, the most susceptible age class. Assuming that the difference between incidence rates before and after vaccination programs was attributable only to vaccine, more than 4 million cases were prevented, and nearly 35% of them among children in the early years of life. Diphtheria was the disease with the highest number of prevented cases, followed by mumps, chickenpox and measles.


Universal vaccination programs represent the most effective prevention tool against infectious diseases, having a major impact on human health. Health authorities should make any effort to strengthen public confidence in vaccines, highlighting scientific evidence of vaccination benefits.


ARIMA models; Morbidity; Mortality; Prevention; Surveillance; Vaccines

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