Implementation of the Plan for Elimination of Measles and Congenital Rubella Infection in Tuscany: evidence of progress towards phase II of measles control

Tuscany was one of the first Italian regions to issue an own Regional Plan for the elimination of measles and congenital rubella infection The Plan is now at an intermediate stage of application. The goal of the present work is to highlight the first results which were reached in the Tuscany Region in 2004, when the immunization campaign took place in the primary schools (birth cohorts 1993-1997) in order to catch-up susceptible subjects. This work provides the results obtained by the twelve Local Health Agencies of the Tuscany Region regarding the monitoring of the immunization coverage with MMR (Measles – Mumps – Rubella) vaccine and the evaluation of the susceptibility to the infection. Methods. The process indicators defined inside the Plan for the measurement of the surveillance activities are the evaluation of the immunization coverage with respect to MMR within the 24th month of age and within the groups of age up to the 15th year of age, and the definition of a population risk indicator for measles infection; evaluation of the immunization campaign in primary schools updated to December 2004; the completion of a seroepidemiological investigation in order to assess the accumulation of susceptible persons towards measles infection; the establishment of a regional committee of technical experts in order to evaluate the serious adverse reactions following MMR immunization. Results. The level of measles control in Tuscany Region, corresponds to the first stage of “limited control”. This evidence was the same also at Italian national level. Regional immunization coverage from 1999 to 2003 showed a substantial increase and reached 87% in the last year registered. The lowest historical levels of measles notifications were recorded in the period 1997- 2001. The Regional risk indicator results always negative for the two considered years determining a clear improvement in terms of decreasing number of susceptibles. At the end of December 2004, the number of children contacted during the immunization campaign through the primary schools reached 70.5% of the target population. The more consistent increment was registered for second doses administered, but the level of refusals is also rather high. During the period from 1st January 2004 to 25th February 2005, the committee on the adverse effects following MMR immunization met three times for the evaluation of 21 notified cases. Discussions and Conclusions. At the end of the catch-up campaign in primary and secondary schools, a further seroepidemiological survey will be performed in order to reveal possible changes in the profile of the target population susceptibility and to evaluate the impact of immunization activities in Tuscany Region during the application of the Plan for measles and congenital rubella elimination. Many of the results obtained during the last years in Tuscany Region indicate that the achievement of the definite control stage of measles is next to come.