The appropriateness of the use of influenza vaccines: Recommendations from the latest seasons in Italy.

Influenza is one of the major infectious causes of excess mortality, hospitalization, and an increase in healthcare expenditure in all countries. In an increasingly ageing population, many members are exposed to flu-related complications. Vaccination coverage rates for the elderly in most European countries, such as Italy, are not satisfactory, and have been decreasing with time due to a sense of skepticism toward vaccination. Nowadays, many types of vaccines are available on the Italian market to prevent influenza illness. Many studies have proven their effectiveness in preventing influenza-related complications in specific risk groups. Any vaccine can be crucial to avoid complications, hospitalizations and death, but use of the most appropriate vaccine could optimize the result at a very modest cost. General practitioners (GPs) should encourage their patients to take the influenza vaccination to prevent complications or deaths. Health authorities should give GPs the opportunity to choose the appropriate vaccines tailored to specific patients.

[Mortality of immigrants in Tuscany Region (Central Italy), 1997-2013]. / Mortalità della popolazione immigrata in Toscana dal 1997 al 2013.

OBJECTIVES: to evaluate mortality in immigrants dwelling in Tuscany Region (Central Italy) compared to mortality data relating to the Italian population residing in the same region. DESIGN: cross-sectional descriptive mortality study relying on a unique data source, i.e., the Regional Mortality Registry of Tuscany, for the period 1997-2013. SETTING AND PARTICIPANTS: in the analysis, immigrants residing in Tuscany were included; Italian residing in the same region were the comparison population. Immigrants were divided into two categories: immigrants from Countries at High Migration Rates (CHMRs) and immigrants from Developed Countries (DCs). MAIN OUTCOME MEASURES: proportional general and cause-specific mortality by age and gender for the period 1997-2013; trends of standardized truncated (age 20-64) mortality rates for the Italian population, and for immigrants from CHMRs and from DCs for the period 2002-2013; standardized mortality ratios (SMRs) in people from CHMRs with confidence interval at 95% (95%CI) for all causes and cause-specific mortality. RESULTS: during 1997-2013, 4,681 deaths were recorded among immigrants, 3,005 of which were in immigrants from a CHMR. Both cause-specific and general mortality trends in Italians and in immigrants from DCs are lowering, while general mortality of immigrants from CHMRs seems to have risen in the last 5 years. Mortality of people from CHMRs for all causes, cardiovascular causes, and cancer is permanently lower than Italian population's mortality in the examined period, but the gap seems to progressively reduce. On the other hand, child mortality among immigrants from CHMRs, despite a declining trend, is consistently higher than Italian population's mortality. Following the SMR analysis, the only exceeding cause of mortality in people from CHMRs - compared to the Italian population - is homicide among men (SMR: 3.46; 95%CI 1.55-5.59). CONCLUSIONS: this study updates our knowledge on immigrants' mortality - and, indirectly, on their health status - in Tuscany. The gap between mortality of Italians and immigrants from CHMRs is reducing: this could be partially explained by a successful ongoing integration process. For future analyses, it would be important to obtain more complete data relative to non-resident immigrants' mortality, as their number is constantly increasing.