[The importance of flu vaccination during CoViD time]. / L'importanza della vaccinazione anti influenzale ai tempi della CoViD.

In the next months, the risk of coinfection with f lu virus and Sars-CoV-2 is high. Despite the number of studies dealing with the consequences of the interaction between the two viruses, the impact of this coexistence on human health is still uncertain. However, achieving high f lu vaccination coverage would mean avoiding hospital overload due to hospitalizations for f lu complications and facilitating a timely differential diagnosis that allows a quick and appropriate treatment of CoViD-19 cases. These are two valid reasons for actively promoting f lu vaccination, particularly this year when the risk of a "twindemic" determined by f lu and CoViD-19 is high. In Italy this year, for the first time, f lu vaccination is offered free of charge also to people aged 60 to 64, expanding individuals entitled to free vaccination. Furthermore, it is strongly recommended to healthcare workers and to elderly who live in residential or long-term care facilities.

[Routine vaccinations during SARS-CoV-2 epidemics]. / Le vaccinazioni di routine ai tempi del SARS-CoV-2.

The circulation of SARS-CoV-2 required the deplacement of resources from routine preventive activities to pandemic-related interventions. The vaccination services have been adapted to the individual territorial realities on the basis of virus circulation and restrictive measures put in place. The reduction of coverage with the consequent accumulation of susceptible subjects increases the risk of vaccine-preventable diseases' epidemics. Catch-up programs and strategies to optimize sessions, such as carrying out co-administrations, are in place on the national territory in order to reduce the risk.

[Vaccines: from the identification of the microorganism to marketing. How long does it take?] / Vaccini: dall'identificazione del microrganismo alla commercializzazione. Quanto tempo ci vuole?

The development of a vaccine, particularly one that can help against the recent pandemic, is a topic that has recently attracted public opinion. More than ninety vaccines are currently being developed against Sars-Cov2 by universities and companies around the world. They are protein-based vaccines, viral vector vaccines, DNA or RNA vaccines and inactivated or attenuated viral vaccines. The development of a vaccine starts from the identification and characterization of the microorganism that causes the disease. The second step is the preclinical phase. Then, there is the phase of clinical experimentation, which allows to study the posology, efficacy and safety of the vaccine, on an increasingly larger sample. In the European Union, vaccines are authorized through two procedures (EU and national) based on the quality, safety and efficacy requirements defined by the European and international guidelines. Timing of realization, authorization and marketing of new vaccines can be shortened in cases of particular need, through an accelerated evaluation known as "Priority Medicines". In this period, it is crucial not to neglect current vaccinations. In fact, during the pandemic period, many countries postponed vaccination campaigns against many vaccine-preventable diseases, causing a marked decrease in routine immunizations in childhood.

Healthcare Workers Training Courses on Vaccinations: A Flexible Format Easily Adaptable to Different Healthcare Settings.

Since 2017, Italy has expanded the compulsory vaccination from 4 to 10 for those aged 0 to 16 years. Because of the great organizational effort required for the immunization services, minor attention was given to the vaccinations not included among the mandatory ones. This situation led to a real difficulty in harmonizing the vaccination procedures even inside a single region. In the Lazio region, the Laboratory of Vaccinology of the University of Rome Tor Vergata established a working group to create a new training model for healthcare professionals. The course program proposed an update of three vaccinations which are not mandatory but actively offered. It included the same part of scientific updating and a variable part based on local experiences. A specific anonymous questionnaire on knowledge and attitude was administered. The study aimed to propose a general format of training courses for vaccination centers adaptable to the individual local health units (ASLs) and to evaluate through questionnaires. The results show differences in knowledge and attitudes toward non-mandatory vaccinations among the ASLs of Lazio, confirming the usefulness of a support to make knowledge and procedures homogeneous. This model could be adapted to any healthcare setting and exported to other services.

[Tuberculosis: an ever present disease but difficult to prevent]. / Tubercolosi patologia sempre attuale e difficile da prevenire.

Tuberculosis (TB) is an infectious and contagious disease caused by Mycobacterium tuberculosis, commonly called Koch's bacillus. TB is spread by air and is present all over the world. Not everyone who become infected develop the disease; the immune system can cope with the infection and the bacterium can remain dormant for years. Despite advances in therapy and prevention, TB remains one of the top 10 causes of death worldwide. Over 9 million new cases and over 1 million deaths occur each year. Since 1921 BCG has been the only authorized vaccine. More than ten experimental vaccines are currently in different stages of development. Depending on the type, they are divided into vaccines consisting of: live attenuated, inactivated mycobacteria and subunits. According to their purpose they can be divided in: vaccines aimed at preventing infection, vaccines aimed at preventing disease, vaccines aimed at preventing recurrence and therapeutic vaccines. Hopefully, these numerous attempts to develop new vaccination approaches will lead to obtain products with greater immunogenicity and efficacy.

[Adverse reactions after repeated doses of anti-tetanus vaccine: scientific evidences]. / Reazioni avverse dopo dosi ravvicinate di vaccino anti-tetanico nell'adulto: una ricerca sulle evidenze scientifiche.

The possible risk of hyperimmunization after tetanus vaccination is currently discussed after the National Vaccine Prevention Plan 2017-2019 confirmed the recommendation of a booster dose every ten years. Due to the ubiquitous nature of tetanus spores and the inability to obtain herd-immunity through vaccination, efforts to reduce the incidence of tetanus aim at eliminating the disease. The only way to prevent infection is vaccination followed by recommended periodic booster doses. Between 2012 and 2016, Italy notified 45% (252/564) of all cases reported by the 26 EU Member States, most of them in the over 65 age group, generally women in the rural areas. The recommendation of the antipertussis vaccine, combined with anti-tetanus, in pregnancy and the indications for antitetanic prophylaxis by vaccination or specific immunoglobulins in emergency setting, gives rise to doubts about the risk of hyperimmunization. Studies generally agree on the safety of diphtheria-tetanus-pertussis combined vaccines during the third trimester of pregnancy, and the time elapsed since the previous tetanus vaccination seems not to be related to significant differences in the incidence of adverse events or obstetrical complications. In the emergency wards, given the relatively high incidence of tetanus in Italy, the risk/benefit ratio often leads to prefer vaccination to no-intervention. The administration of tetanus immunoglobulins in subjects not vaccinated in the last 10 years seems justified by the epidemiology of tetanus in Italy.

[Anti-pneumococcus, anti-herpes-zoster and anti-papillomavirus vaccinations: experience in programming continuing education courses in local health units in Rome]. / Vaccinazioni anti-pneumococco, anti-herpes-zoster e anti­ papillomavirus: esperienza nella programmazione di corsi di formazione nelle asl di Roma.

The National Vaccine Prevention Plan considers the recommendations for immune prophylaxis in all ages of life. However, compulsory vaccination introduced in 2017 focused the attention on improving global vaccination coverage in infants and children, giving less attention to adult/elderly vaccinations. The immunization of this population is necessary considering the change in the age structure of the population, whose average life expectancy is increasing. Aim of this work was the organization of continuing education courses about anti-Pneumococcus, anti-Herpes-Zoster and anti-Papillomavirus vaccinations to offer an update of knowledge and to discuss the attitudes of health professionals in vaccination centers of the Local Health Units in Rome.

[Anti-flu Vaccine: tailor made solutions in large-scale distribution]. / Vaccino anti-influenzale: scelte sartoriali nella grande distribuzione.

Influenza is a public health problem with a strong impact from an epidemiological, clinical and economic point of view. Many factors contribute: ubiquity and contagiousness of the disease, antigenic variability of the viruses and the possibility of serious complications. Influenza rarely causes complications in healthy subjects. On the contrary complications can occur and be severe in people with fragile conditions. More susceptible to infection are: children, elderly, pregnant women, people with chronic conditions or undergoing immunosuppressive therapies. Vaccine is an important preventive measure. It allows to protect both the vaccinated person and those at risk. Thanks to the presence of diversified vaccines, we can offer targeted prevention. Vaccine innovations also involved production methods, allowing GPs to choose a quadrivalent cell-derived in addition to the quadrivalent egg-derived and the trivalent vaccine. Age, existing pathologies and immune system reactivity are fundamental elements guiding the customized choice of GPs. Recent years innovations concerning the increased immunogenicity (adjuvated and high-dose vaccines) and the protection against a greater number of strains (quadrivalent vaccine) in addition to new production methods (cell derived vaccine) allow us to trust in further possibilities for the future.

[Old outbreaks and new vaccines: Italy facing Ebola]. / Vecchie epidemie e nuovi vaccini: l'Italia di fronte al problema Ebola.

Zaire is the name of the most deadly Ebola Virus (ZEBOV), which caused many outbreaks in past years and is the causative agent of the most recent one. In July 2019, Ebola was declared a public health emergency of international concern. After this declaration, the steps required to prequalify and approve the r VSV ZEBOV vaccine followed each other quickly. Nowadays in Europe the risk of an outbreak is low. However, secondary cases in USA and Spain have alerted public opinion. Italy is not involved except for the assistance to its citizens infected in countries at risk mainly in contexts of humanitarian aid. In epidemic areas the situation deserves close monitoring, as shown by the interest of the WHO, FDA and EMA. Last year the Italian Ministry of Health issued four circulars on this subject to update epidemic data and procedures and to remember precautions. The live attenuated vaccine in use now shows encouraging results; however, the need to evaluate further vaccines remains to guarantee efficacy, safety and adequate quantities.