Suspension of mandatory vaccination and public health preserving: Rovigo Local Health Unit experience after appliance of Veneto regional law 7/2007

The burden of infectious diseases preventable by vaccination decreased considerably over last decades in all countries pro- vided with effective immunization schedules. Implementation of these programs with new vaccines has started discussion on dual- ity between mandatory and recommended vaccinations. Regional autonomy has allowed the Veneto Region, with introduction of Law 7/2007, to experience suspension of all mandatory childhood vaccinations, replaced by an active and free offer of all vaccines recognized as safe and effective. Coverage?s trends and accept- ance of invitation are carefully monitored to avoid loss of com- pliance and reduction of immunized children. The evaluation, performed on population of Rovigo ULSS18 for 2002-2008 birth cohorts (2008 is the first concerned by the change), revealed no fall for previously mandatory vaccinations, but rather a slight increase. Percentage of non-vaccinated children was negligible. The leading cause of non-vaccination to polio was inability to deliver the letter of invitation due to wrong address. An informed dissent was expressed only by a minority (0.9% in 2008 birth cohort). Compliance to immunization offer was elevated both for previ- ously compulsory and recommended vaccinations. Experience of Rovigo ULSS 18 showed that, in a context of already high levels of coverage for recommended vaccinations with optimal organization of immunization services, coverage rates for ex- mandatory vaccines remain unchanged. Further research and reports are required to carefully assess the effect on coverage rates in next birth cohorts, but available data are encourag- ing. Similar legislative measures can be successfully adopted by other Regions with starting conditions comparable to Veneto Region