Effect of the mandatory vaccination law on measles and rubella incidence and vaccination coverage in Italy (2013-2019)

Figures & data

Table 1. Measles incidence (x 1,000,000) in Italy, by Regions

Region	2013	2014	2015	2016	2017	2018	2019
Piemonte	148.5	119.5	1.1	11.4	144.1	12.3	13.1
Val d’Aosta	39.0	7.8	0.0	0.0	7.9	23.8	23.9
Lombardia	71.2	14.7	8.6	16.4	78.4	16.3	41.1
P.A. Bolzano	208.7	21.3	44.4	3.8	42.0	13.3	11.3
P.A. Trento	9.4	11.2	0.0	27.9	35.3	3.7	7.4
Veneto	5.1	12.8	5.1	6.7	58.5	7.1	17.3
Friuli-Venezia Giulia	8.2	17.9	2.4	5.7	13.1	16.5	3.3
Liguria	150.8	123.7	4.4	3.8	35.1	36.0	11.6
Emilia-Romagna	22.9	47.0	1.8	18.2	20.7	22.2	35.0
Toscana	25.0	16.3	2.7	5.6	98.9	24.1	30.0
Umbria	1.1	1.1	6.7	28.1	92.2	5.7	10.2
Marche	31.0	25.1	0.0	3.9	39.7	19.6	9.2
Lazio	0.0	30.5	5.9	14.8	333.3	46.1	87.9
Abruzzo	126.2	13.5	0.0	0.0	190.6	68.4	9.1
Molise	9.6	3.2	0.0	0.0	6.4	0.0	19.6
Campania	5.2	2.2	3.9	28.7	18.8	53.7	11.5
Puglia	6.9	17.8	2.0	2.5	6.2	12.4	14.1
Basilicata	8.7	0.0	0.0	1.7	17.5	14.1	3.6
Calabria	1.5	6.1	1.5	61.9	51.9	90.5	4.6
Sicilia	5.5	1.0	1.0	12.6	92.2	238.9	12.8
Sardegna	1.8	63.7	3.6	2.4	28.4	4.9	4.9
ITALY	40.7	27.0	3.9	13.5	88.4	43.3	25.5

Table 2. Rubella incidence (x 1,000,000) in Italy, by Regions

Region	2013	2014	2015	2016	2017	2018	2019
Piemonte	0.5	1.4	0.2	1.6	2.3	0.7	0.2
Val d’Aosta	0.0	0.0	0.0	0.0	0.0	0.0	0.0
Lombardia	1.7	0.4	0.7	0.6	0.7	0.2	0.3
P.A. Bolzano	2.0	0.0	0.0	3.8	11.4	5.7	3.8
P.A. Trento	0.0	1.9	0.0	0.0	0.0	1.9	0.0
Veneto	0.0	0.2	0.4	0.0	0.6	0.0	0.2
Friuli-Venezia Giulia	4.1	1.6	0.0	0.0	1.6	0.0	0.0
Liguria	0.6	0.0	0.6	0.0	0.0	0.0	0.0
Emilia-Romagna	0.5	0.2	0.2	0.0	0.5	0.0	0.2
Toscana	0.8	0.0	0.0	0.0	0.3	0.0	0.8
Umbria	0.0	0.0	0.0	0.0	1.1	0.0	0.0
Marche	0.0	0.0	0.0	0.0	0.0	0.0	1.3
Lazio	0.0	0.2	0.2	0.3	2.7	0.7	1.4
Abruzzo	9.8	0.0	0.0	0.0	0.0	0.0	0.0
Molise	0.0	0.0	0.0	0.0	0.0	0.0	0.0
Campania	0.5	0.2	0.9	1.4	2.2	0.5	0.0
Puglia	0.0	0.0	0.0	0.5	0.0	0.0	0.0
Basilicata	1.7	1.7	0.0	0.0	0.0	0.0	1.8
Calabria	9.1	2.5	2.5	0.5	1.0	1.0	0.0
Sicilia	0.0	0.0	0.0	0.2	1.0	0.6	0.2
Sardegna	0.0	1.8	0.6	0.6	0.0	0.0	0.0
ITALY	1.2	0.4	0.4	0.5	1.1	0.3	0.3

Table 3. Percentage of vaccinated children against measles in Italy in 2016 and comparison with the following calendar years after the introduction of the Decree Law 119/2017

FIRST DOSE
Year	Cohort*	Vaccinated	p-value
2016	2014: 23553.38	87.3%	<0.001
2017	2015: 22700.14	91.8%
2016	2014: 23553.38	87.3%	<0.001
2018	2016: 22197.14	93.2%
2017	2015: 22700.14	91.8%	<0.001
2018	2016: 22197.14	93.2%
2016	2014: 23553.38	87.3%	<0.001
2019	2017: 21655.95	94.4%
2018	2016: 22197.14	93.2%	<0.001
2019	2017: 21655.95	94.4%
SECOND DOSE
Year	Cohort*	Vaccinated	p-value
2016	2009: 26794.38	82.2%	<0.001
2017	2010: 26483.90	85.7%
2016	2009: 26794.38	82.2%	<0.001
2018	2011: 25808.05	89.2%
2017	2010: 26483.90	85.7%	<0.001
2018	2011: 25808.05	89.2%
2016	2009: 26794.38	85.7%	<0.001
2019	2012: 25441.76	90.2%
2018	2011: 25808.05	89.2%	<0.001
2019	2012: 25441.76	90.2%

*Mean value.

Figure 1. Joinpoint analysis of the trend in vaccination rates for measles and rubella between 2013 and 2019 in Italy. a, trend in vaccination coverage for first dose of measles vaccine; b, trend in vaccination coverage for second dose of measles vaccine; c, trend in vaccination coverage for first dose of rubella vaccine; d, trend in vaccination coverage for second dose of rubella vaccine. The use of asterisks (*) indicates that the Slope is significantly different from zero at the alpha = 0.05 level. Final Selected Model: 1 Joinpoint.

Figure 2. Trends in coverage for first (a) and second (b) dose of measles vaccine (2013–2019) by Region. Each concentric circle represents one year, starting with 2013 in the center.

Table 4. Percentage of vaccinated children against rubella in Italy in 2016 and comparison with the following calendar years after the introduction of the Decree Law 119/2017

FIRST DOSE
Year	Cohort*	Vaccinated	p-value
2016	2014: 23553.38	87.2%	<0.001
2017	2015: 22700.14	91.8%
2016	2014: 23553.38	87.2%	<0.001
2018	2016: 22197.14	93.2%
2017	2015: 22700.14	91.8%	<0.001
2018	2016: 22197.14	93.2%
2016	2014: 23553.38	87.2%	<0.001
2019	2017: 21655.95	94.4%
2018 2019	2016: 22197.14 2017: 21655.95	93.2% 94.4%	<0.001
SECOND DOSE
Year	Cohort*	Vaccinated	p-value
2016	2009: 26794.38	82.0%	<0.001
2017	2010: 26483.90	85.6%
2016	2009: 26794.38	82.0%	<0.001
2018	2011: 25808.05	89.1%
2017	2010: 26483.90	85.6%	<0.001
2018	2011: 25808.05	89.1%
2016	2009: 26794.38	82.0%	<0.001
2019	2012: 25441.76	90.0%
2018 2019	2011: 25808.05 2012: 25441.76	89.1% 90.0%	<0.001

*Mean value.

Figure 3. Trends in vaccination coverage for first (a) and second (b) dose of rubella vaccine (2013–2019) by Region. Each concentric circle represents one year, starting with 2013 in the center.