title: Impact on disease incidence of a routine universal and catch-up vaccination strategy against Neisseria meningitidis C in Tuscany, Italy.
abstract: BACKGROUND
  Invasive infections due to Neisseria meningitidis are still an important public health issue worldwide. In Europe, meningococcal meningitis is differently distributed in the EU countries, but most cases of meningococcal diseases are caused by serogroups B and C. In Italy, each year about 900 cases of bacterial meningitis occur, of whom one third are caused by N. meningitidis. In March 2005, the Regional Health Authority of Tuscany approved a policy of active offer of conjugate meningococcus C (MCC) vaccination with three doses to all newborns at 3, 5 and 13 months of age (subsequently turning to a single dose at 13 months as of 2008) and a catch-up until age 6 years with a single dose.
  
  
  OBJECTIVE
  The aim of the present study was to evaluate the effectiveness of the vaccination strategy adopted by Tuscany in preventing cases of invasive meningococcal C disease.
  
  
  METHODS
  Surveillance data for the calculation of disease incidence, immunization coverage with MCC vaccine and vaccination status of meningitis cases were collected from 2005 to 2011.
  
  
  RESULTS
  Incidence rates of meningococcal meningitis and septicemia decreased in all age groups involved in the immunization campaign, as a result of the progressively increasing vaccination coverage. Since 2006, no cases of invasive meningococcal C infection in vaccinated subjects were observed in Tuscany. A herd immunity effect was measured in unvaccinated age groups.
  
  
  CONCLUSIONS
  MCC vaccination implementation in Tuscany was successful in the prevention of meningococcal C disease. Our results should prompt all Italian Regions to consider introducing MCC vaccination in order to protect their population.
authors.affiliation: Department of Public Health, University of Florence, Viale Morgagni, 48, 50134 Florence, Italy. angela.bechini@unifi.it
authors.forename: Angela
authors.initials: A
authors.lastname: Bechini
authors.forename: Miriam
authors.initials: M
authors.lastname: Levi
authors.forename: Sara
authors.initials: S
authors.lastname: Boccalini
authors.forename: Emilia
authors.initials: E
authors.lastname: Tiscione
authors.forename: Emanuela
authors.initials: E
authors.lastname: Balocchini
authors.forename: Clementina
authors.initials: C
authors.lastname: Canessa
authors.forename: Chiara
authors.initials: C
authors.lastname: Azzari
authors.forename: Paolo
authors.initials: P
authors.lastname: Bonanni
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D006801:Humans; D017589:Immunization Programs / Q000379:methods*; D015994:Incidence; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008589:Meningococcal Infections / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D022401:Meningococcal Vaccines / Q000627:therapeutic use*; D008875:Middle Aged; D009345:Neisseria meningitidis / Q000276:immunology; D011159:Population Surveillance / Q000379:methods; D055815:Young Adult
chemical_list: D022401:Meningococcal Vaccines