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 provided with effective immunization schedules. Implementation of these programs with new vaccines has started discussion on duality 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 acceptance of invitation are carefully monitored to avoid loss of compliance 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 previously 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 exmandatory 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 encouraging. Similar legislative measures can be successfully adopted by other Regions with starting conditions comparable to Veneto Region.