Among the main public health problems in Italy are deaths caused by tumors, equal to just under 500 people per day, with over 1,400 daily diagnoses. Compounding this picture is the lack of awareness of the preventive tools available against infectious diseases. For this reason, greater awareness is needed on the availability of vaccine protection against infections such as pneumococcus, Herpes zoster (Hz), Rsv (respiratory syncytial virus), as well as against Covid and influenza. Fragile patients, more exposed to these infections and to greater severity of symptoms, must be offered the opportunity to receive vaccinations in hospital and in the local area. These are the messages that emerged in the scientific-institutional meeting held today at the Ministry of Health, 'Vaccination protection in fragile and at-risk patients. Focus on cancer patients', organized by Aristea with the non-conditioning contribution of GSK.
The appeal launched by the scientific community and patient associations was aimed precisely at spreading awareness and “access to vaccinations both locally and in hospital”, in line with what has already been prescribed by the National Vaccine Prevention Plan which in the fifth point – recalls a note – promotes vaccination interventions in population groups at high risk for pathologies, favoring an approach centered on the needs of the patient. According to the WHO, vaccinations prevent 2-3 million deaths a year, but many deaths are still caused by infectious diseases preventable by vaccination, especially among immunocompromised patients and those with comorbidities. Among these, cancer patients represent one of the populations at greatest risk.
“It is necessary to bring vaccinations as close as possible to fragile patients – underlines Roberta Siliquini, president of Siti (Italian Society of Hygiene, Preventive Medicine and Public Health) – In fact, an infectious disease in immunocompromised patients or with chronic diseases such as tumors could aggravate the basic situation or, in some cases, force the interruption of life-saving treatments. It is also necessary that the privileged vaccination routes for these patients are correctly organised, the same throughout the national territory and have a governance supported by the prevention departments” .
“A survey of over 500 patients conducted by the Aiom Italian Association of Medical Oncology revealed that 20% of cancer patients have never discussed vaccinations with their specialist and only one in 10 patients is aware of the vaccination recommendation against Herpes zoster – highlights Giuseppe Tonini, Aiom delegate – Furthermore, 80% of patients do not know that vaccination protection can improve the results of anti-tumor therapies. This is why our scientific society has launched a new information campaign, also aimed at caregivers , which promotes awareness of the importance of vaccines, such as those against influenza, pneumococcal, Sars-CoV-2, Herpes zoster, respiratory syncytial virus. The Guidelines on vaccinations in cancer patients are about to be published. The effects of these pathologies can be particularly serious: Herpes zoster, for example, in cancer patients can also delay treatment of the underlying pathology; Frail individuals who contract RSV are at high risk of serious illness.”
The recommendations in support of prevention are further supported by the most recent achievements of scientific research, which has made new vaccines available for Hz and RSV, thus offering an important opportunity for cancer patients. The respiratory syncytial virus – the note reports – is a ubiquitous, very diffusive virus, which attacks the upper respiratory tract and subsequently, spreading into the lower respiratory tract, can cause bronchiolitis/pneumonia. It is one of the most common viruses in children and is now increasingly recognized as a pathogen in the elderly and immunocompromised population. In industrialized countries, in adults, it causes over 420 thousand hospitalizations every year and 29 thousand deaths. So far, no therapies and vaccinations have been available, but the first vaccine for adults has recently been available in Italy, with extraordinary efficacy – we read in the note – in subjects with concomitant pathologies: in the pivotal study it showed a reduction of 94.1% of severe RSV disease and an overall efficacy of 82.6%.
“Fragile subjects who contract RSV are at high risk of serious disease due to age-related decline in immunity and underlying conditions – remarks Roberto Parrella, president of Simit (Italian Society of Infectious and Tropical Diseases) – If in fact most people recover within a couple of weeks, the virus can cause serious expressions of illness in vulnerable people, in which it can lead to serious outcomes such as pneumonia, hospitalization and death. In general, those with previous pathologies risk a worsening of their conditions and experiences higher hospitalization rates. In fact, in adults/elderly RSV causes a 3-5 times increase in hospitalization rates compared to younger subjects. Recent American studies reveal that every year there are from 60 thousand to 120 thousand hospitalizations due to RSV, of which approximately 6-8 thousand deaths”. In Europe “at least 33 thousand RSV-related deaths in hospitalized patients are estimated. These data highlight the importance that a preventive tool such as the vaccine can have”.
Herpes zoster – it was reported during the meeting – has an incidence of approximately 8 cases per thousand inhabitants per year, but increases with age, so much so that at 80 years old there is a 50% greater chance of incurring in this pathology. And in those affected by hematological malignancies, the incidence is 31/thousand subject-years. Hz is very dangerous for fragile patients, because it often worsens the control of the disease, and even more so for immunocompromised ones, in particular those suffering from oncological or oncohematological pathologies. In fact, the risk of developing post-herpetic neuralgia in patients with haematological cancer varies between 6% and 40%. Oral, esophageal, stomach, colorectal, lung, breast, ovarian, prostate, kidney and bladder cancers are associated with an increased chance of developing the infection between 10-50%.
“The Herpes zoster virus is present in over 90% of the population and its reactivation is linked to age-related immunodeficiency or underlying disease – recalls Massimo Andreoni, Simit scientific director – It involves an annoying acute phase and sequelae , such as post-herpetic neuralgia, a pain that affects the area where the infection occurred and which can persist for months. The most recent scientific literature has also highlighted cardio and cerebro-vascular complications. The variety and severity of these consequences lead us to strongly recommend vaccination, especially since the new adjuvanted recombinant vaccine, unlike the previous one with an attenuated virus, can also be administered in immunocompromised subjects; furthermore it has demonstrated a clearly favorable risk/benefit ratio, as well as persistence of effect of 10 years”.
The scientific-institutional meeting opened with institutional greetings from Francesco Saverio Mennini, head of the Department of Programming, Medical Devices, Medicines and Policies in favor of the National Health Service of the Ministry of Health. Four round tables will follow. In the first, 'Investment in prevention as health protection and a form of public savings', speakers included, among others, senators Francesco Zaffini, President of the Daniele Manca and Elisa Pirro (5th Budget Commission, Senate); Luciano Ciocchetti (vice president XII Social Affairs Commission, Chamber); Gian Antonio Girelli and Simona Loizzo (XII Social Affairs Commission, Chamber); Nicola Ottaviani, secretary of the V Budget, Treasury and Planning Commission of the Chamber.
Guido Bertolaso, Councilor for Health, Lombardy Region, spoke in the session that compared the different regional models; Luca Coletto, councilor for health and social policies, Umbria region; Claudio D'Amario, director of the Health Department, Abruzzo Region; Roberto Ieraci, member of the Vaccination Strategies Working Group, Lazio Region. The scientific round table saw the participation of Simit's scientific director, Massimo Andreoni; Andrea Mandelli, president of Fofi; Roberto Parrella, president of Simit; Alessandro Rossi, president of Simg; Carlo Signorelli, president of Nitag; Roberta Siliquini, president of Siti; Giuseppe Tonini, Aiom delegate.
The patient associations part involved Adriana Bonifacino, president of the IncontraDonna Foundation; Stefano Giordani, scientific director of the Onconauti Association; Anna Maria Mancuso, president of Women's Health; Marce
lla Marletta, Favo Executive Committee; Giuseppe Tonini, coordinator of the Lilt national scientific committee.
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