{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:27:49Z","timestamp":1791581269597,"version":"4.3.4"},"reference-count":58,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>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\u20132016 vs. 2017\u20132019), pandemic (2017\u20132019 vs. 2020\u20132021), and post-pandemic recovery (2020\u20132021 vs. 2022\u20132023). 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 (\u0394) 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 (\u22122.4% in the South) and measles (\u22126.2% in Abruzzo), while MenB increased in regions with lower initial uptake (r = \u22120.918, p &lt; 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 \u22120.877 to \u22120.915). 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.<\/jats:p>","DOI":"10.3390\/vaccines13070683","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T06:55:13Z","timestamp":1750920913000},"page":"683","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Childhood Immunization Coverage Before, During and After the COVID-19 Pandemic in Italy"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9185-9747","authenticated-orcid":false,"given":"Flavia","family":"Pennisi","sequence":"first","affiliation":[{"name":"National PhD Programme in One Health Approaches to Infectious Diseases and Life Science Research, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy"},{"name":"School of Medicine, Universit\u00e0 Vita-Salute San Raffaele, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Silenzi","sequence":"additional","affiliation":[{"name":"Center for Research and Studies on Leadership in Medicine, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2250-1247","authenticated-orcid":false,"given":"Alessia","family":"Mammone","sequence":"additional","affiliation":[{"name":"General Directorate of Health Prevention, Ministry of Health, 00153 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Siddu","sequence":"additional","affiliation":[{"name":"Health Promotion and Prevention, Regional Directorate for Health and Social-Health Integration, Lazio Region, 00193 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5657-9774","authenticated-orcid":false,"given":"Anna","family":"Odone","sequence":"additional","affiliation":[{"name":"Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5889-1780","authenticated-orcid":false,"given":"Michela","family":"Sabbatucci","sequence":"additional","affiliation":[{"name":"General Directorate of Health Prevention, Ministry of Health, 00153 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4767-3558","authenticated-orcid":false,"given":"Riccardo","family":"Orioli","sequence":"additional","affiliation":[{"name":"General Directorate of Health Prevention, Ministry of Health, 00153 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0636-7199","authenticated-orcid":false,"given":"Anna Carole","family":"D\u2019Amelio","sequence":"additional","affiliation":[{"name":"School of Medicine, Universit\u00e0 Vita-Salute San Raffaele, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Maraglino","sequence":"additional","affiliation":[{"name":"General Directorate of Health Prevention, Ministry of Health, 00153 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Rezza","sequence":"additional","affiliation":[{"name":"School of Medicine, Universit\u00e0 Vita-Salute San Raffaele, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9710-4962","authenticated-orcid":false,"given":"Carlo","family":"Signorelli","sequence":"additional","affiliation":[{"name":"School of Medicine, Universit\u00e0 Vita-Salute San Raffaele, 20132 Milan, Italy"},{"name":"Italian National Immunization Technical Advisory Group (NITAG), Ministry of Health, 00153 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/S0140-6736(21)01337-4","article-title":"Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: A modelling study","volume":"398","author":"Causey","year":"2021","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2529","DOI":"10.1111\/apa.15949","article-title":"Impact that the COVID-19 pandemic on routine childhood vaccinations and challenges ahead: A narrative review","volume":"110","author":"Chiappini","year":"2021","journal-title":"Acta Paediatr."},{"key":"ref_3","unstructured":"WHO (2020). 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