Sara Boccalini

Background: Despite sustained public-health efforts, measles continues to re-emerge in Europe. According to the ECDC, 1045 measles cases were reported in Italy in 2024. We describe epidemiological trends and characteristics of measles cases in the Tuscany Region from 2019 to 2024. Methods: We conducted a population-based retrospective study using cases reported through the national surveillance system (PREMAL). Incidence rates were calculated using demographic data from the Italian National Institute of Statistics (ISTAT). Cases were stratified by year, sex, age group, vaccination status (2024), and hospital admission; temporal, demographic, and clinical trends were analysed. Results: From 2019 to 2024, 204 cases were reported, corresponding to a mean annual incidence of 0.93 per 100,000 population (95% CI: 0.80–1.07) and a cumulative incidence of 5.58 per 100,000 (95% CI: 4.78–6.31). Females accounted for 63.2% of cases (n = 129). After a peak in 2019 (n = 116), with an incidence of 3.13 per 100,000 (95% CI: 2.56–3.71), cases sharply declined during 2020–2023, followed by a resurgence in 2024 (n = 75), with an incidence of 2.05 per 100,000 (95% CI: 1.59–2.51). Children aged 0–4 years represented 7.4% of cases but had the highest age-specific incidence (12.19 per 100,000). Adults aged 25–64 years accounted for 70.1% of all cases, indicating the greatest absolute burden. Incidence was higher among individuals aged 25–44 years (11.56 per 100,000) than among those aged 45–64 years (4.30 per 100,000). Overall, 41.7% of cases required hospitalization. In 2024, most cases occurred in unvaccinated individuals (n = 56), while vaccination status was unknown for five cases. Conclusions: The 2024 measles resurgence in Tuscany mainly affected unvaccinated adults. These findings highlight persistent immunity gaps among adults, suggesting that protection and prevention measures are also needed in the population (0–4 y).

Background: Human rhinoviruses (HRVs) exhibit a global circulation characterized by prolonged epidemics and a less concentrated seasonal distribution compared with other respiratory viruses. In this study, we describe the timing, amplitude and duration of HRV epidemics on a global scale, analyzing seasonal patterns in relation to geographic latitude. Methods: HRV surveillance data reported to WHO FluNet from 2016 to 2025 were analyzed. Epidemic peak timing, amplitude and duration were estimated as a function of geographic latitude using harmonic analyses, with a comparison between the pre-pandemic (2016–2019) and post-pandemic (2021–2025) periods. Results: During the study period, 432,399 HRV detections were reported to WHO FluNet across 50 countries. Among these, 24 countries met the predefined criteria for seasonal analysis. Epidemic peak timing showed differences consistent with latitude, with peaks occurring in late autumn and winter in the Northern Hemisphere, during the central months of the year in the Southern Hemisphere, and greater temporal variability in the intertropical belt. Peak amplitude showed marked heterogeneity across countries (median 68.2%, range 28.1–96.7%), while epidemic duration indicated prolonged circulation (median 31 weeks, range 5–48 weeks). A secondary seasonal peak was identifiable in most countries, further supporting the relatively diffuse seasonal profile of HRV circulation. Comparison between the pre- and post-pandemic periods showed largely stable peak timing in most countries, alongside heterogeneous changes in peak amplitude. Conclusions: HRV is characterized by prolonged and weakly concentrated seasonal activity, with epidemic circulation often extending over several months. Despite major epidemiological perturbations during the COVID-19 pandemic, the timing of seasonal peaks remained largely stable across countries, highlighting the epidemiological resilience of HRV and the need for continuous, pathogen-specific surveillance.

Pertussis, caused by Bordetella pertussis, remains a public health concern despite long-standing vaccination programs. After a marked decline during the COVID-19 pandemic, a resurgence was observed in Europe and Italy, with a sharp increase in 2024. This study describes pertussis epidemiological trends in the Tuscany Region (Italy) from 2019 to 2024 to identify high-risk groups and inform prevention strategies. A retrospective population-based analysis was conducted using cases reported to the national surveillance system (PREMAL). Incidence rates were calculated using ISTAT population data, and demographic, temporal, and clinical characteristics were analyzed. Overall, 669 cases were reported (mean annual incidence rate: 3.03/100,000 (IC 95% 2.47–3.59; period incidence rate: 18.2/100,000 (IC 95% 16.81–19.56)), with 89% occurring in 2024 (16.34/100,000 (IC 95% 15.03–17.65)). No sex differences were observed, and most cases were reported in Central Tuscany (64%). Children under 15 years accounted for 87% of cases. The highest incidence was observed among 10–14-year-olds, while infants < 1 year, particularly those under 4 months, showed the highest burden in narrower age strata. Hospitalizations occurred in 12.6% of cases, decreasing substantially in 2024. The 2024 resurgence likely reflects waning immunity, disruptions to routine vaccinations during the pandemic, and reduced pathogen circulation in previous years due to containment and isolation measures related to the pandemic. Strengthening surveillance and improving booster and maternal vaccination coverage are essential to protect vulnerable populations.

Background/Objectives: Herpes zoster (HZ), caused by varicella zoster virus (VZV) reactivation, significantly affects the functional status and quality of life of older adults and immunocompromised individuals. Vaccination represents an effective strategy to reduce the incidence of HZ. Methods: This review offers a cross-sectional assessment of the current landscape of adult herpes zoster vaccination strategies across the 27 EU member states, drawing on data available up to July 2025 from official sources such as the ECDC, the WHO, and national health authorities. Results: HZ vaccination is recommended in 17 EU countries (63%) according to the National Immunization Programs (NIPs) or by other institutional national health documents; in only 7 countries, vaccination is fully covered by the national healthcare system. HZ vaccination is recommended for healthy adults aged ≥50 years in 23.5% of countries (4/17), ≥60 years in 29.4% (5/17), and ≥65 years in 41.2% (7/17). At-risk groups are targeted in 94.1% of countries (16/17), predominantly from age 18 years (14 countries). Conclusions: An overall tendency toward broader HZ vaccination strategies, targeting both older adults and risk groups, is emerging. However, differences among national policies, together with the European Commission’s withdrawal of the live-attenuated Zostavax vaccine effective 1 June 2025, highlight the urgent need for comprehensive, harmonized immunization strategies to ensure adequate coverage of adult HZ vaccination across Europe.

Background/Objectives: The “TROVAILMIOVACCINO” platform was developed to help adults in Italy identify vaccines recommended for them based on individual characteristics, in line with the Italian National Immunization Plan (NIP). The website directs users to an anonymous online questionnaire addressing key factors such as age, sex, pregnancy status, travel history, medical conditions, and risky behaviors. It is intended for adults aged 18 and over and can be filled out either by individuals or by others on their behalf, such as healthcare professionals. The purpose of the study was to assess the platform’s reach, the health status of users, and its ability to inform users. Methods: Data were organized into tables and analyzed using frequencies, percentages, and statistical tests to assess user demographics and health conditions. Significant differences among sociodemographic groups were evaluated using the Chi-square and Fisher’s exact tests. Results: Over 30 months, the website was accessed 1897 times, with 1622 users (85.5%) completing the questionnaire for personal interest. The majority of users were aged 18–49 years (61.5%), with a nearly equal male–female distribution. Healthcare workers represented the most common professional group (29.2%) among users. Older individuals were more likely to have the questionnaire completed by someone else. Among respondents, 25.8% reported having a single medical condition, with cardiovascular diseases (11.9%), diabetes (6.7%), and respiratory diseases (4.8%) being the most frequent. The most common risk condition reported was potential contact with newborns. Conclusions: The findings highlight the value of the platform in reaching diverse user groups and offering tailored vaccine recommendations.

Introduction: Respiratory Syncytial Virus (RSV) is the leading cause of lower respiratory tract infections in infants and children, as well as hospitalizations for respiratory infections in the pediatric population, representing a significant public health concern. Nirsevimab, a long-acting anti-RSV monoclonal antibody, has recently been approved by the European Medicines Agency (EMA). The aim of this study is to assess the utility of certain parameters, such as the Number Needed to Immunize (NNI), in supporting decision-makers regarding the introduction of nirsevimab as a universal prophylactic measure. Methods: A literature review was conducted to identify the definition and application of the NNI in the context of infectious disease prevention. The following online databases were consulted: Scopus, MEDLINE, Google Scholar, Web of Science, and Cochrane Library. The search was restricted to English-language texts published between 1 January 2000 and 30 January 2025. Results: The NNI represents the number of individuals who need to be immunized to prevent clinical outcomes such as medical visits and hospitalizations caused by infectious diseases. Six studies were identified that utilized this parameter to outline the benefits of immunization and describe the advantages of using monoclonal antibodies for RSV disease. Finelli and colleagues report that to prevent one RSV-related hospitalization, 37–85 infants aged 0–5 months and 107–280 infants aged 6–11 months would need to be immunized with long-acting anti-RSV antibodies. A recent study by Mallah et al. on the efficacy of nirsevimab estimates that the NNI required to prevent one RSV-related hospitalization is 25 infants. Studies by Francisco and O’Leary report NNI values of 82 and 128 infants, respectively, to prevent one RSV-related hospitalization with nirsevimab. Mallah et al. describe NNI as a metric useful to quantify the immunization effort needed to prevent a single RSV hospitalization. A recent Italian study reports that 35 infants need to be immunized to prevent one hospitalization due to RSV-LRTI and 3 infants need to be immunized to prevent one primary care visit due to RSV-LRTI. The studies indicate that the NNI for anti-RSV monoclonal antibodies is lower than the corresponding Number Needed to Vaccinate (NNV) for vaccines already included in national immunization programs. The main limitations of using this parameter include the absence of a shared threshold for interpreting results and the lack of consideration for the indirect effects of immunization on the population. Conclusions: The NNI is an easily understandable tool that can be used to convey the value of an immunization intervention to a variety of stakeholders, thereby supporting public health decision-making processes when considered in association with the uptake of the preventative strategy. At the current status, the estimated NNI of monoclonal antibodies against RSV results favourable and confirms the use in the first year of life for the prevention of RSV disease.

Introduction: Vaccinations are one of the most impactful public health interventions, saving millions of lives annually and reducing the spread of infectious diseases. Numerous vaccines are expected to become available in the future. Decision-makers will have to thoroughly evaluate them. It is essential to fully comprehend the value of vaccinations to effectively and efficiently guide decisions. Methods: This work aims to highlight the multifaceted benefits of vaccination, extending beyond clinical outcomes to encompass profound economic and societal advantages. Results: Vaccinations should be considered an investment, not a cost. In comparison to other health expenditures, the vaccine costs can be considered moderate. Vaccinations can also reduce the fiscal burden by avoiding diseases, minimizing lost workdays and absenteeism, lowering disability claims, and increasing workforce productivity. The costs of non-vaccination represent a relevant issue. Vaccination also plays a key role in addressing the global challenge of antimicrobial resistance. Apart from quantifiable economic parameters, vaccines also have intangible benefits reducing pain and avoiding quality of life lost and deaths. Conclusions: Comprehensive Health Technology Assessments are required to understand the overall value of vaccinations.

Italy was one of the first countries to implement a hepatitis B (HBV) immunization strategy in 1991; since its introduction, the epidemiology of this disease has significantly changed. The aim of this retrospective study was to assess the seroprevalence of three HBV markers (anti-HBs, anti-HBc, and HBsAg) and describe the acquired immunity in a representative sample of the adult general population in the province of Florence (Italy) between April 2018 and December 2019. We conducted an enzyme-linked immunosorbent assay on 430 serum samples collected from the adult general population to quantify anti-HBs titers and assess the presence of anti-HBc and HBsAg. For the interpretation of hepatitis B serologic results, we referred to the US CDC guidelines. We conducted two multivariate logistic regression analyses (applied to the entire enrolled population and to the unvaccinated) to assess predictors of immunity against HBV using sex, age, and nationality as predictors. The overall anti-HBs prevalence was 30%, with a significant decreasing trend in seropositivity with increasing age. The overall anti-HBc prevalence was 11.6%, with seropositivity increasing with age. Only one subject tested positive for HBsAg (0.2%). Approximately 67.4% (290/430) of the study population was susceptible, 20.9% (90/430) was vaccinated, 9.1% (39/430) had naturally acquired immunity, and 0.2% (1/430) had an acute infection. Older age and foreign nationality were identified as risk factors in both multivariate logistic regression models. The comparison highlights a reduction in the circulation of HBV infection markers (anti-HBc and HBsAg) over 30 years in Tuscany, particularly in younger age groups. Our seroprevalence study demonstrated a good level of protection against hepatitis B, primarily among individuals under 40 years old, the target group of the vaccination strategy.