Managing unexpected failure in vaccination coverage:2017 extraordinary vaccination campaign in Italy

Issue: On April 20th, 2017 an alert was issued by Veneto Region and forwarded to the Local Health Agency n.3 (AAS3) of Friuli Venezia Giulia Region. It stated that a nurse, in charge of vaccine administration in both regions, allegedly pretended to inoculate vaccines during 2009-2015, thus exposing several cohorts of children to vaccine preventable diseases (VPDs) outbreaks. We report what done by AAS3 to cope with such an unexpected and potentially risky situation. Description: A task force including experts in pediatrics, public health, immunology and infectious diseases as well as citizens and AAS3 area Majors’ delegates was created. Preliminary laboratory results from a sample of 200 children confirmed the lack of VDPs coverage and prompted the task force to rearrange resources for an extraordinary vaccination plan aimed to re-administer 20441 vaccine doses to 5444 children. They were distinguished according to the number of vaccine doses received from that nurse: every (high risk) or just one (low risk). Consistently with this, information release and families’ reassurance were organized and managed through ad-hoc channels: a toll free number, an email address and Whatsapp chats. Results: The high risk group included 2406 children (44%), 3038 being at low risk (56%). AAS3 invited parents to have their children re-vaccinated by phone (2249 answers) and by mail (4402 letters delivered), starting on May 2nd, 2017. 26 alternative vaccination schedules have been created and 11303 vaccines doses (55%) have been administered until the end of January 2018, for a total of 6644 outpatient consultations. Vaccinations are still ongoing. Lessons: The creation of the task force allowed AAS3 to cope with such an undesired situation in a quick and coherent manner. Actions implemented consistently by all stakeholders after the alert allowed an effective public health response, enabling AAS3 to recover more than 50% of missing vaccines in 9 months, in addition to routine activity. Key messages: The engagement of all stakeholders from the start is a fundamental step in dealing with both ordinary and extraordinary public health issues. The long-term effects on children vaccine coverage and herd immunity require a continuous monitoring of the extraordinary vaccination plan implementation.