Italian immunization calendar: rationale and schedule

Vaccines are a great scientific conquest of the modern era having made it possible to prevent many infectious diseases that previously had a significant impact on the population both in terms of morbidity and sequelae and/or lethality. They act respecting/enhancing physiological capabilities of the organism and have a very favorable pharmacoeconomic profile. The development and availability of a safe, well-tolerated and effective vaccine is the indispensable premise for the primary prevention through vaccination in the community. Then it is necessary to define the target to be pursued; this latter can be control, elimination and eradication. The choice of the target is influenced by several factors; however, it must be followed by the development of an appropriate strategy to achieve the necessary vaccine coverage rate. The vaccination schedule is therefore the instrument by which each vaccine strategy is planned, and should take into account some epidemiological, immunological and practical requirements (Table 1) [1]. The immunization schedule is therefore the chronological sequence of each vaccination; it is an essential tool to achieve established targets as well as a useful guide for any stakeholder (e.g. health care professionals, users, ect.). The current vaccine schedule results from a series of laws relating to compulsory vaccinations and has been integrated over time by including recommended immunizations [2]. A key point is that the schedule should be a flexible instrument and continuously updated. The Italian immunization schedule has many positive aspects as it is updated based on the availability of new vaccines, combines mandatory and recommended immunizations (stressing in this way the relevance of both types of vaccinations), is structured so that it can be integrated in case of new epidemiological requirements and covers all age groups. Besides, it includes vaccines considered of priority from the public health point of view and for this free of charge and actively offered.

Table 1 Immunizations schedule: main factors that should be taken into account

Concerning the paediatric age, particularly the first year of life, the definition of the schedule should take into account the development of the immune system, the clearance of maternal antibodies, the typical age of acquisition of infection, the possible age-related complications of a disease, the possible side effects of immunization according to age of immunization, the duration of elicited immune protection, the number of appointments for vaccination sessions and the accessibility to vaccination services. The scientific societies SItI and SIP, togheter with FIMP and FIMMG, has approved the “2014 Lifetime Immunization Schedule” (Table 2) [3].

Table 2 2014 Lifetime Immunization Schedule up to 15 months of age (SItI, SIP, FIMP, FIMMG) (modified from ref. 3)