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. 2025 Jun 25;13(7):683.
doi: 10.3390/vaccines13070683.

Childhood Immunization Coverage Before, During and After the COVID-19 Pandemic in Italy

Flavia Pennisi  1   2 , Andrea Silenzi  3 , Alessia Mammone  4 , Andrea Siddu  5 , Anna Odone  6 , Michela Sabbatucci  4 , Riccardo Orioli  4 , Anna Carole D'Amelio  2 , Francesco Maraglino  4 , Giovanni Rezza  2 , Carlo Signorelli  2   7
Affiliations

Childhood Immunization Coverage Before, During and After the COVID-19 Pandemic in Italy

Flavia Pennisi et al. Vaccines (Basel). .

Abstract

Background/Objectives: Maintaining high childhood vaccination coverage is essential to prevent outbreaks of vaccine-preventable diseases. In Italy, Law No. 119/2017 introduced mandatory childhood immunizations, leading to significant improvements. However, the COVID-19 pandemic disrupted routine services, potentially jeopardizing these gains. This study aimed to evaluate national and regional trends in vaccine coverage across three phases: post-mandate (2015-2016 vs. 2017-2019), pandemic (2017-2019 vs. 2020-2021), and post-pandemic recovery (2020-2021 vs. 2022-2023). Methods: National and regional administrative data on vaccination coverage at 24 months of age were obtained from the Italian Ministry of Health. Temporal trends were analyzed using Joinpoint regression to estimate annual percent changes (APCs), and absolute changes in coverage (Δ) were calculated across defined periods. Pearson correlation coefficients were used to assess associations between baseline coverage and subsequent changes. Results: After the 2017 mandate, coverage increased significantly for varicella (APC = +28.6%), MenB (+22.6%), and measles (+3.4%). Regionally, varicella coverage rose by up to +58.4% in Emilia-Romagna and measles by +11.1% in Campania. During the pandemic, coverage declined for polio (-2.4% in the South) and measles (-6.2% in Abruzzo), while MenB increased in regions with lower initial uptake (r = -0.918, p < 0.001). Post-pandemic, coverage rebounded, with varicella improving by +20.1% in central regions and measles by +13.9% in Abruzzo. A strong inverse correlation between baseline coverage and improvement was observed for varicella across all periods (r from -0.877 to -0.915). Conclusions: Mandatory vaccination policies led to substantial coverage improvements, and despite the disruption caused by the pandemic, recovery trends were observed for most vaccines. The consistent association between low baseline coverage and stronger gains highlights the resilience of the system, but also the ongoing need for regionally tailored strategies to reduce geographic disparities and ensure equitable immunization across Italy.

Keywords: COVID-19 pandemic; mandatory vaccination; vaccination coverage; vaccination strategies; vaccines.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Trends in vaccination coverage with Joinpoint analysis for poliomyelitis, measles, and varicella (a), and MenB and pneumococcal vaccines (b) in Italy (birth cohorts 2014–2021). Dashed lines indicate joinpoints; slopes represent APCs.
Figure 2
Figure 2
Change in vaccination coverage (2015–2016 vs. 2017–2019). Variation at 24 months by region and vaccine following the implementation of mandatory vaccination (Law 119/2017).
Figure 3
Figure 3
Change in vaccination coverage (2017–2019 vs. 2020–2021). Regional variation by vaccine during the COVID-19 pandemic.
Figure 4
Figure 4
Change in vaccination coverage (2020–2021 vs. 2022–2023). Regional variation by vaccine during the post-pandemic recovery phase.
Figure 5
Figure 5
Correlation between baseline coverage and change across periods for varicella and MenB.
See this image and copyright information in PMC

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