Another vaccine victory. Eliminated rubella in Italy

On 7 June 2017, the decree law 74/2017 was published in our country, which extended the vaccination obligation beyond the 4 long-established conditions (poliomyelitis, diphtheria, tetanus and hepatitis B) to 12, including pertussis, Haemophilus influenzae type b, meningococcal B, meningococcal C, measles, rubella, mumps and varicella, for all those between 0 and 16 years old. The government was that of Gentiloni, and the health minister was Beatrice Lorenzin.

Today we measure an important result: WHO has declared the elimination of endemic rubella transmission, a disease that is transmitted by air or direct contact and which is dangerous in pregnant women. Indeed, in this segment of the population, in addition to the rare risk of serious effects that affects the whole population (encephalitis in one case out of 6000 and thrombocytopenic purpura in one case out of 3000), the rubella virus is able to cross the placental barrier and cause embryo-fetal anomalies. In particular, if the infection occurs shortly before conception or in the first 8-10 weeks of gestation, the estimated risk of consequences to the fetus is up to 90%; and the consequences are serious, involving malformations of various kinds.

There end of endemic transmission, of course, does not imply that no more cases will be observed in the future: it only means that, for at least 12 months, an efficient national surveillance system such as the Italian one has not detected more cases, so that the local transmission chains must be interrupted and the outbreaks gone; but, of course, the appearance of future cases due to importation of the virus cannot be excluded.

This has an important consequence: vaccination coverage still needs to be kept highbecause until rubella is definitively eradicated, the lowering of population immunity in our country would expose our nation to a new risk of endemization.

The result we have therefore obtained is the following: we have managed to throw this virus out of our country for which there is no specific therapy, and which causes serious conditions that are fully preventable by the vaccine, and we have created an immune wall that has proven itself well; but, despite the excellent goal achieved after all in a few years, it is essential that this wall is not allowed to fall into decay, allowing new layers susceptible to infection to form in the population and thus frustrating the effort made.

Furthermore, it is good to remember certain hypotheses circulated during the pandemic, regarding the sensational decrease in cases of measles and rubella attributed to the widespread use of masks.

Last year, some experts uncertain about the weight of this factor in rubella (and measles) vaccination, declared that “masks and social distancing have been shelved. Therefore, if for once Covid-19 has had a positive impact, it is easy to predict that these viruses will circulate again".

Fortunately, at least up to now the fears of these experts, who in any case already called for a further increase in vaccination coverage, have not come true, at least for the case of rubella, whose consistency has indeed diminished until today's WHO declaration .

Of course, it is quite possible that there has been an additional effect of the masks in the last two years, who have, so to speak, given the "final blow" to an already declining virus thanks to vaccination coverage; in any case, the level to which this virus was reduced was such that it did not cause any recovery after the abandonment of the measures to contrast Sars-Cov-2.

As stated by my friend Dr. Diego Pavesio, general practitioner, member of the Omceo Solidarity Commission of Turin and one of the most active in promoting vaccination against preventable diseases, today's excellent result derives from a precise fact: "In 2017, Politics (with a capital P ) imposed the vaccination obligation, unleashing waves of scoundrels, shameful no-vax doctors and a certain part of pitifully populist and ignorant politicians.

Of course, in epidemiology nothing is definitive until the complete eradication of a pathogen (and whether this is possible remains to be seen); but the effectiveness of at least the rubella vaccine, in the light of decades of experience, is indisputable, and even our country today can testify to it.