lunedì 28 aprile 2014

Morbillo e rosolia: ci vuole chiarezza

Morbillo e rosolia persistono nelle aree europee malgrado la vaccinazione estremamente diffusa e che si somministra ormai da molti anni: parte da questa considerazione il dottor Mark Muscat, danese, in forze all’Organizzazione Mondiale della Sanità in una delle sezioni europee. Sulla rivista Clinical Microbiology and Infection, Muscat propone una lunga riflessione carente però di dati completi e di statistiche riguardo la situazione vaccinale, la storia clinica dei pazienti e le coperture medie e per singole categorie. Malgrado la mancanza di dati sostanziali, Muscat arriva a concludere che pietra angolare per la lotta a morbillo e rosolia continua a essere la vaccinazione di massa. A rispondergli è il presidente di Assis, il dottor Eugenio Serravalle che sottopone al responsabile Oms alcune osservazion (come riportato nel testo integrale della lettera che trovate di seguito e che è stata inviata al dottor Muscat e alla rivista che ne ha ospitato l’intervento):
-          Grande disomogeneità tra i casi denunciati e quelli confermati
-          Si ritengono desunti o presupposti dati che invece non vengono forniti, quali le coperture vaccinali nei diversi paesi e la realtà specifica dei gruppi suscettibili
-          Mancanza di valutazioni sull’efficacia della herd-immunity
-          Nessun dato sullo stato di salute precedente dei pazienti che si sono ammalati e sono morti
-          Vago cenno alla necessità di incrementare la vaccinovigilanza ma nessuna informazione su quanto e cosa sia stato fatto in proposito
       

Di seguito la lettera inviata dal dottor Serravalle.

Dr. M. Muscat, WHO Regional Office for Europe, Denmark
In copy: Clinical Microbiology and Infection, Didier Raoult, Editor-in-Chief
Dear Dr Muscat,
I read with great interest your article “The state of measles and rubella in the WHO European Region, 2013” and I would want to ask you some explanations; I’m confident about your gentle answer.
- How is it possible to explain the great differences between reported cases and confirmed cases? We move from one extreme to the other, from Georgia numbers (7830 reported cases and only 787 confirmed) to United Kingdom numbers (199 reported and confirmed cases).
- How to explain the so marked different age distribution between countries? In Italy the largest proportion of cases occurs in adults, aged > 20 years old, with vaccination coverage from 77% in 2001 to 90% in 2012, while in Turky the largest proportion of cases occurs in children aged < 4 years old, with a vaccination coverage fron 91% in 2001 to 98% in 2012. You wrote that is reasonable to assume that the age distribution of measles cases in different countries reflects the susceptible population by age. I read in your article: «Although we did not include national data on vaccination strategies and coverage, the accumulation of susceptible groups is most likely a result of fluctuating vaccination coverage levels over the years. Moreover, adults not targeted when measles vaccination programmes were first implemented in their countries >20 years ago are still susceptible if they never acquired the disease nor received the vaccine». I believe that the priority should be to have all datas about vaccination coverages and strategies to verify herd immunity. Isn’t it? Are you agree? Do you have those datas? If you, can you give me the information?
- You wrote that the vaccination status was known in 70% of cases. The 75% was unvaccinated. The 23% was too young to receive vaccination (< 1 years old), 20% was 1-4 years old, 14% was 5-9 years old, 22% 10-19 years old and 22% aged > 20 years. It would be extremely usefull and interesting to know the cases’ place of origin to evaluate the herd-immunity effectiveness? Are you agree? Do you know it? If you, is it possible for me to have this information?
- Is it possible to know the state of health of dead people? You wrote that a 36-year-old-man died in Spain in 2012 . Was he ill? Any chronic illnesses? And the seven measles-related-deaths in 2013 were a direct consequence of measle? Or measle was a complication of other chronic illnesses? Can we know anything about the social and Hygienic conditions?
- You wrote that despite high vaccination coverage at regional level and in most Member States, suboptimal coverage rates in some areas and immunity gaps in the population remain the primary cause of continued measles transmission in 2013 and you referred to point 7 of references. This reference give us the datas about measles immunization coverage among 1 year old children. Does exist any datas about MCV with 2 shots of measle vaccine?
- You wrote that health authorities should promptly investigate adverse effects following vaccination and disseminate the results quickly and effectively. What it has been done to riduce the under-reporting trend in different countries? What about the results?
I rely on your answers
Best regards
President of Assis
Eugenio Serravalle, MD
Pisa, 28th april 2014


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