{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T06:02:08Z","timestamp":1767852128928,"version":"3.49.0"},"reference-count":41,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,1,30]],"date-time":"2020-01-30T00:00:00Z","timestamp":1580342400000},"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: Vaccine hesitancy has increased worldwide, leading to reduction in vaccination coverage rates. In particular, reduction in the coverage for the trivalent Measles-Mumps-Rubella vaccine has led to an increase of measles cases. The aim of this study is to analyze the coverage rates for the MMR vaccine in the Emilia-Romagna Region (RER) and Sicily Region (SR) between 2009 and 2018, and to correlate any significant change to index events which could have modified the trend of vaccination rates. Methods: Official aggregate data on vaccination coverage at 24 months provided by the RER and the SR were analyzed through trend analysis and related to important index events. Results: The two regions showed similar results; both achieved the lowest coverage rates in 2015 and both showed an increase in the rates after the introduction of mandatory vaccinations for access to schools. In 2018, both reached the starting point before the decrease. Conclusions: Our results confirm the effectiveness of legislative coercive measures in favor of vaccination. A potential decrease in the coverage rates may be observed as a result of an attenuation of the positive effects of coercive measures over time. It is thus necessary to combine these measures together with information campaigns and political initiatives at different levels (i.e., national, regional).<\/jats:p>","DOI":"10.3390\/vaccines8010057","type":"journal-article","created":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T01:25:51Z","timestamp":1580693151000},"page":"57","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["The Impact of Mandatory Vaccination Law in Italy on MMR Coverage Rates in Two of the Largest Italian Regions (Emilia-Romagna and Sicily): An Effective Strategy to Contrast Vaccine Hesitancy"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4954-9419","authenticated-orcid":false,"given":"Davide","family":"Gori","sequence":"first","affiliation":[{"name":"Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3397-7331","authenticated-orcid":false,"given":"Claudio","family":"Costantino","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Odone","sequence":"additional","affiliation":[{"name":"School of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatrice","family":"Ricci","sequence":"additional","affiliation":[{"name":"School of Hygiene and Preventive Medicine, University of Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magda","family":"Ialonardi","sequence":"additional","affiliation":[{"name":"School of Hygiene and Preventive Medicine, University of Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Signorelli","sequence":"additional","affiliation":[{"name":"School of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Vitale","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Pia","family":"Fantini","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,1,30]]},"reference":[{"key":"ref_1","unstructured":"Strategic Advisory Group of Experts on Immunization (2020, January 15). The Global Vaccine Action Plan 2011\u20132020. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/329097\/WHO-IVB-19.07-eng.pdf?ua=1."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1080\/21645515.2015.1019980","article-title":"The future of immunization policies in Italy and in the European Union: the declaration of Erice","volume":"11","author":"Odone","year":"2015","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1056\/NEJMp1010594","article-title":"The age-old struggle against the antivaccinationists","volume":"364","author":"Poland","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/j.vaccine.2015.11.051","article-title":"When vaccine hesitancy makes headlines","volume":"35","author":"Odone","year":"2017","journal-title":"Vaccine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.vaccine.2017.12.043","article-title":"The vaccine hesitancy scale: psychometric properties and validation","volume":"36","author":"Shapiro","year":"2018","journal-title":"Vaccine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4161","DOI":"10.1016\/j.vaccine.2015.04.036","article-title":"Vaccine hesitancy: definition, scope and determinants","volume":"33","author":"MacDonald","year":"2015","journal-title":"Vaccine"},{"key":"ref_7","unstructured":"(2019, December 02). Ten Threats to Global Health in 2019. Available online: https:\/\/www.who.int\/emergencies\/ten-threats-to-global-health-in-2019."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Demicheli, V., Rivetti, A., Debalini, M.G., and di Pietrantonj, C. (2012). Vaccines for measles, mumps and rubella in children. Cochrane Database Syst. Rev., 15.","DOI":"10.1002\/14651858.CD004407.pub3"},{"key":"ref_9","unstructured":"World Health Organization (WHO) (2019, November 14). Measles. Geneva: WHO. Available online: http:\/\/www.who.int\/mediacentre\/factsheets\/fs286\/en\/."},{"key":"ref_10","unstructured":"(2019, November 13). Vaccinations at Paediatric and Adolescent Age\u2014Vaccination Coverage, Available online: http:\/\/www.salute.gov.it\/portale\/documentazione\/p6_2_8_3_1.jsp?id=20."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1177\/003335490512000306","article-title":"Vaccine beliefs of parents who oppose compulsory vaccination","volume":"120","author":"Kennedy","year":"2005","journal-title":"Public Health Rep."},{"key":"ref_12","unstructured":"(2019, December 02). Vaccinazioni. Available online: http:\/\/salute.regione.emilia-romagna.it\/sanita-pubblica\/vaccinazioni."},{"key":"ref_13","unstructured":"(2019, November 20). Piano Nazionale Prevenzione Vaccinale (PNPV) 2017-2019, Available online: http:\/\/www.salute.gov.it\/imgs\/C_17_pubblicazioni_2571_allegato.pdf."},{"key":"ref_14","unstructured":"(2019, November 20). Legge 31 Luglio 2017, N. 119. Available online: http:\/\/www.gazzettaufficiale.it\/eli\/id\/2017\/08\/5\/17G00132\/sg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4057","DOI":"10.1016\/j.vaccine.2017.06.011","article-title":"Italy\u2019s response to vaccine hesitancy: an innovative and cost effective National Immunization Plan based on scientific evidence","volume":"35","author":"Signorelli","year":"2017","journal-title":"Vaccine"},{"key":"ref_16","unstructured":"(2020, January 15). ISTAT. Available online: http:\/\/dati.istat.it\/Index.aspx."},{"key":"ref_17","unstructured":"(2019, January 15). Statistica Self Service. Available online: http:\/\/statistica.regione.emilia-romagna.it\/servizi-online\/statistica-self-service."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z","article-title":"Permutation tests for joinpoint regression with applications to cancer rates","volume":"19","author":"Kim","year":"2000","journal-title":"Stat. Med."},{"key":"ref_19","unstructured":"Tribunale di Rimini, sentenza n. 2010\\148, Ruolo n\u00b02010\\0474; Cron. N\u00b02012\\886."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1080\/21645515.2017.1264738","article-title":"The \u2018Fluad Case\u2019 in Italy: could it have been dealt differently?","volume":"13","author":"Levi","year":"2017","journal-title":"Hum. Vaccin. Immunother."},{"key":"#cr-split#-ref_21.1","unstructured":"Corte di appello di Bologna, sentenza n. 1767 \/2014 pubblicata il 13\/2\/2015"},{"key":"#cr-split#-ref_21.2","unstructured":"Ruolo n. 803\/2012. Cronologico 2014\/868."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5962","DOI":"10.1016\/j.vaccine.2018.08.050","article-title":"Invasive meningococcal disease due to group C N. meningitidis ST11 (cc11): the tuscany cluster 2015\u20132016","volume":"36","author":"Menichetti","year":"2018","journal-title":"Vaccine"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Costantino, C., Restivo, V., Ventura, G., D\u2019Angelo, C., Randazzo, M.A., Casuccio, N., Palermo, M., Casuccio, A., and Vitale, F. (2018). Increased vaccination coverage among adolescents and young adults in the district of Palermo as a result of a public health strategy to counteract an \u2018Epidemic Panic\u2019. Int. J. Environ. Res. Public Health, 15.","DOI":"10.20944\/preprints201802.0191.v1"},{"key":"ref_24","first-page":"231","article-title":"Infant immunization coverage in Italy (2000\u20132016)","volume":"53","author":"Signorelli","year":"2017","journal-title":"Ann. Ist. Super. San."},{"key":"ref_25","first-page":"1909","article-title":"Determinants of European parents\u2019 decision on the vaccination of their children against measles, mumps and rubella: A systematic review and meta-analysis","volume":"12","author":"Tabacchi","year":"2016","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2533","DOI":"10.1080\/21645515.2018.1486156","article-title":"Immunization and media coverage in Italy: An eleven-year analysis (2007\u201317)","volume":"14","author":"Odone","year":"2018","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_27","first-page":"146","article-title":"Vaccine coverage in Italy and assessment of the 2012\u20132014 National Immunization Prevention Plan","volume":"39","author":"Bonanni","year":"2015","journal-title":"Epidemiol. Prev."},{"key":"ref_28","first-page":"1","article-title":"Childhood vaccine coverage in Italy after the new law on mandatory immunization","volume":"30","author":"Signorelli","year":"2018","journal-title":"Ann. Ig."},{"key":"ref_29","first-page":"3727","article-title":"Opportunities and challenges of Web 2","volume":"30","author":"Betsch","year":"2012","journal-title":"0 for vaccination decisions. Vaccine"},{"key":"ref_30","first-page":"394","article-title":"Vaccine hesitancy and mandatory immunizations in Emilia-Romagna Region: the case of MMR vaccine","volume":"90","author":"Gori","year":"2019","journal-title":"Acta. Biomed."},{"key":"ref_31","first-page":"21","article-title":"On field vaccine effectiveness in three periods of 2018\/2019 influenza season in Emilia-Romagna Region","volume":"90","author":"Colucci","year":"2019","journal-title":"Acta. Biomed."},{"key":"ref_32","unstructured":"(2019, October 22). I \u2018No-Vax\u2019 in un Partito, Movimento Punta a Regionali E-R. Available online: http:\/\/www.ansa.it\/emiliaromagna\/notizie\/2019\/03\/27\/regionali-in-e-r-nasce-movimento-no-vax_959b4329-46a0-42bf-aaef-1b677380dd4b.html."},{"key":"ref_33","unstructured":"Italian Ministry of Health (2019, October 25). Available online: http:\/\/www.salute.gov.it\/portale\/news\/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=dalministero&id=1960."},{"key":"ref_34","unstructured":"La Repubblica (2019, October 22). Muore dopo il vaccino, il figlio: \"Voglio sapere cosa lo ha ucciso\". Available online: https:\/\/palermo.repubblica.it\/cronaca\/2014\/11\/29\/news\/muore_dopo_il_vaccino_il_figlio_voglio_sapere_cosa_lo_ha_ucciso-101704244\/]."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/d41586-018-02267-9","article-title":"Lessons from Italy\u2019s policy shift on immunization","volume":"555","author":"Burioni","year":"2018","journal-title":"Nature"},{"key":"ref_36","unstructured":"(2020, January 15). Vaccinazioni in Et\u00e0 Pediatrica: Impatto Dell\u2019obbligo Sullecoperture Vaccinali in Italia. Available online: www.gimbe.org\/osservatorio\/Report_Osservatorio_GIMBE_2019.03_Coperture_vaccinali_2018.pdf."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/S1473-3099(17)30696-5","article-title":"The imperative of vaccination put into practice","volume":"18","author":"Signorelli","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_38","unstructured":"(2020, January 15). Il Definanziamento 2010\u20132019 Del Servizio Sanitario Nazionale. Available online: www.gimbe.org\/osservatorio\/Report_Osservatorio_GIMBE_2019.07_Definanziamento_SSN.pdf."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2984","DOI":"10.1080\/21645515.2016.1198456","article-title":"Communication about vaccination: a shared responsibility","volume":"12","author":"Biasio","year":"2016","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_40","first-page":"88","article-title":"Monitoring the web to support vaccine coverage: results of two years of the portal vaccinarSi\u0300","volume":"39","author":"Ferro","year":"2015","journal-title":"Epidemiol. Prev."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/8\/1\/57\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T08:53:08Z","timestamp":1760172788000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/8\/1\/57"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,30]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,3]]}},"alternative-id":["vaccines8010057"],"URL":"https:\/\/doi.org\/10.3390\/vaccines8010057","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,30]]}}}