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

Patrizio Pezzotti, Stefania Bellino, Francesca Prestinaci, Simone Iacchini, Francesca Lucaroni, Laura Camoni, Maria Maddalena Barbieri, Walter Ricciardi, Paola Stefanelli, Giovanni Rezza

Research output: Contribution to journalArticlepeer-review


Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish
Pages (from-to)1435-1443
Number of pages9
Issue number11
Publication statusPublished - Mar 7 2018


  • ARIMA models
  • Morbidity
  • Mortality
  • Prevention
  • Surveillance
  • Vaccines

ASJC Scopus subject areas

  • Molecular Medicine
  • Immunology and Microbiology(all)
  • veterinary(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


Dive into the research topics of 'The impact of immunization programs on 10 vaccine preventable diseases in Italy: 1900–2015'. Together they form a unique fingerprint.

Cite this