Mazzilli Sara, Tavoschi Lara, Lopalco Pier Luigi
Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Front Public Health. 2020 Apr 22;8:120. doi: 10.3389/fpubh.2020.00120. eCollection 2020.
Whooping cough (pertussis) represents one of the most prevalent vaccine-preventable diseases in Western countries, capable of causing disease in infants, with a high risk of severe complications. To protect new-borns from pertussis, many countries have introduced the acellular pertussis adult vaccine in combination with tetanus and diphtheria toxoids for women in the third trimester of pregnancy. Thanks to the approval of the new National Immunization Prevention Plan 2017-2019: Italy is among those countries. The Italian health-care system is a regionally based National Health Service, therefore, regions organize and implement new vaccination strategy on their own. This study focuses on Tuscany's experience in implementing the maternal pertussis vaccination. The present study had a qualitative design: we obtained information about the implementation process through interviews with relevant stakeholders involved in the planning or implementation of vaccination programme at different levels. We noticed heterogeneous implementation's status between Tuscan Health Care Departments. The most frequently reported barriers influencing the success of the implementation process of this prevention strategy included: lack of accountability, lack of enabling instruments, financial constraints, logistics barriers, training deficiencies, attitudes of health care workers, and lack of communication experts. The implementation of new vaccination programs is complex and challenging. Often the importance of education and information activities targeting health professionals are underestimated and underfunded. These elements would need to be carefully considered and adequate provisions should be made to address them when designing and implementing effective vaccine interventions.
百日咳是西方国家最常见的可通过疫苗预防的疾病之一，可导致婴儿患病，且严重并发症风险高。为保护新生儿免受百日咳侵害，许多国家已为妊娠晚期妇女引入了与破伤风和白喉类毒素联合的无细胞百日咳成人疫苗。得益于新的《2017 - 2019年国家免疫预防计划》获批，意大利是这些国家之一。意大利医疗保健系统是基于地区的国家医疗服务体系，因此，各地区自行组织和实施新的疫苗接种策略。本研究聚焦托斯卡纳地区实施孕产妇百日咳疫苗接种的经验。本研究采用定性设计：我们通过采访参与不同层面疫苗接种计划规划或实施的相关利益攸关方，获取了有关实施过程的信息。我们注意到托斯卡纳各医疗保健部门的实施情况存在差异。影响这一预防策略实施过程成功的最常报告的障碍包括：缺乏问责制、缺乏支持工具、资金限制、后勤障碍、培训不足、医护人员态度以及缺乏沟通专家。新疫苗接种计划的实施复杂且具有挑战性。针对卫生专业人员的教育和信息活动的重要性往往被低估且资金不足。在设计和实施有效的疫苗干预措施时，需要仔细考虑这些因素并做出适当安排来应对它们。
