Compulsory and voluntary vaccinations. The calendar

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Compulsory and voluntary vaccinations

For a long time, there were four formally compulsory vaccinations in Del Paese: anti-diphtheria (Law no. 6 of 1939 June 891 - Law no. 27 of 1981 April 166); anti-tetanus (Law no. 20 of 1968 March 419); antipoliomyelitis (Law no. 4 of 1966 February 51); antihepatitisviral B (Law of May 27, 1991 No. 165).

All other vaccinations available for the pediatric age were voluntary. In fact, however, the formal distinction between Compulsory vaccines and optional came to fall. This on the one hand because since 1999 the lack of vaccination did not lead to problems for entry to school, nor were the fines provided for (however negligible) practically ever applied. On the other hand, because - through the national plans for vaccine prevention - the health system has always encouraged the use and guaranteed the free of charge of many other vaccinations available (measles, mumps, rubella, pneumococcus, meningococcus C etc.).

In the last 15 years, a cultural path has been undertaken that aimed at the conscious and voluntary participation of citizens in vaccinations. So let's see what the compulsory and optional vaccinations to do to the children.

In this article

  • The new mandatory vaccinations
  • Can multiple vaccines be made at the same time?
  • The schedule of vaccinations
  • Compulsory vaccines and school

The new mandatory vaccinations

The situation has changed with the new vaccine law finally approved in the summer of 2022. With the aim of raise vaccination coverage levels now too low for many vaccinations, he raised a 10 mandatory vaccines. It is about:

  • anti-poliomyelitis;
  • anti-diphtheriae;
  • anti-tetanica;
  • anti-hepatitis B;
  • whooping cough;
  • anti Haemophilusinfluenzae type B;
  • anti-measles;
  • anti-rubella;
  • anti-mumps;
  • anti-varicella.

They remain outside the obligation, but can be executed voluntarily, other vaccinations however very important for the pediatric age, namely:

  • anti-pneumococci;
  • anti-meningococcal C (in monovalent form, the tetravalent ACWY);
  • anti-meningococcal B;
  • anti-rotavirus;
  • anti-HPV.

All these vaccinations are offered in the way active and free by vaccination services and are highly recommended.

Influenza vaccine and children

In some countries, children are also actively offered free influenza vaccination. In Del Paese up to now this choice of public health has never been made.

As a COVID-19 pandemic situation remains, influenza vaccination is recommended in the 6 months - 6 years age group, also in order to reduce the circulation of the influenza virus between adults and the elderly.

Furthermore, in order to facilitate the differential diagnosis in the age groups of greatest risk of serious illness, the flu vaccination is strongly recommended and can be offered free of charge in the 60-64 age group.

For the 2022-2022 season, the flu vaccination can be carried out in the same session as the Covid-19 vaccination.

Can multiple vaccines be made at the same time?

In many cases, these vaccines are available in combined form: they are given to the child, with a single injection, multiple antigens at the same time, against various diseases. A system that reduces the discomfort of the sting and increases the effectiveness of the immune response itself. The most common combined formulations are:

  • hexavalent (diphtheria-tetanus-pertussis-hepatitis B-poliomyelitis-Haemophilus influenzae type B);
  • trivalent DTPa (diphtheria-tetanus-pertussis);
  • quadrivalent DTpaIPV (diphtheria-tetanus-pertussis-polio);
  • trivalent MMR (measles-mumps-rubella);
  • quadrivalent MPRV (measles-mumps-rubella-varicella);
  • quadrivalent meningococcus (ACWY).

If one of the diseases for which compulsory vaccination is foreseen has already been made, the new vaccine law specifies the possibility of requesting vaccines in single-component or combined formulation, but without the antigen in question. It should be noted, however, that these vaccines are not necessarily available - at the moment, for example, single-component vaccines against diphtheria, pertussis, measles, rubella and mumps are not authorized in the country - and that the Regions have actually purchased them (generally they cost Moreover).

Vaccination calendar

Three months

  • Mandatory: first dose diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B, Haemophilus influenzae type B (hexavalent).
  • Recommended: first dose meningococcus B; pneumococcal first dose.

Four months

  • Recommended: second dose meningococcus B.

Five months

  • Mandatory: second dose diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B, Haemophilus influenzae type B (hexavalent).
  • Recommended: second pneumococcal dose.

Six months

  • Recommended: third dose meningococcus B.

Between 3 and 7 months

  • Recommended: rotavirus (two or three doses depending on the type of vaccine).

11 months

  • Mandatory: third dose diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B, Haemophilus influenzae type B (hexavalent).
  • Recommended: third pneumococcal dose.

13 months

  • Recommended: fourth dose Meningococcus B.

Between 13 and 15 months

  • Mandatory: first dose measles, mumps and rubella (MMR); first dose chicken pox (or first dose tetravalent MPRV).
  • Recommended: first dose Meningococcus C.

Six years

  • Mandatory: diphtheria, tetanus, pertussis, polio (DTP + polio) recall; recall measles, mumps, rubella and chicken pox (MPR or MPRV).

Between 12 and 18 years

  • Mandatory: diphtheria, tetanus, pertussis, polio (DTP + polio) booster.
  • Recommended: HPV (two or three doses, for both females and males, depending on age and vaccine); recall meningococcus C, in the quadrivalent form ACWY.

What happens if a parent does not vaccinate their child?

For children and teenagers from 0 to 16 years, failure to carry out compulsory vaccinations involves the payment of a fine of between 100 and 500 euros. Furthermore, between 0 and 6 years of age, there is a ban on entering kindergartens and preschools.

For children and young people who attend compulsory school (primary, secondary and first two years of high school) there is no ban on access to school. Children who attend compulsory schools and cannot be vaccinated for documented health reasons will be placed in classes where there are no other unvaccinated minors.

According to the operational circular issued by the Ministry of Health in August 2022, the procedure that each ASL puts in place to recover children and families who are not in good standing is established at the local level. In general, however, the steps could be the following, as indicated by the circular itself:

  1. the ASL calls parents by sending them a written invitation to vaccinate, possibly accompanied by informative material;
  2. if the parents do not respond, the ASL calls them again, by registered letter, for an interview in which the reasons for the lack of vaccination will be addressed and correct information on the objective will be provided - possibly with the involvement of the pediatrician or general practitioner individual and collective vaccination practice and the risks of non-prevention;
  3. if the parents do not show up for the interview or do not agree to have their child vaccinated, the ASL formally disputes the non-fulfillment of the vaccination obligation.

Compulsory vaccines and school

As the Ministry of Health explains, compliance with vaccination obligations becomes a requirement for admission to nursery schools and schools of infancy (for children from 0 to 6 years), while from primary school (elementary school) onwards, children and young people can still access school and take exams, but, if the obligations have not been respected, activated by the ASL a vaccination recovery process and it is possible to incur administrative penalties from 100 to 500 euros.

Children who are already immunized as a result of a natural disease and children who have specific clinical conditions that represent a permanent and / or temporary contraindication to vaccinations are exempt from the obligation. 

  • vaccinations for children
  • optional vaccinations
  • first year
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