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Children and Adolescents: Preventable Infectious Diseases

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Adolescents".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 45798

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Special Issue Editors

Dr. Alberto Villani

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Guest Editor

1. The Italian Pediatric Society, via Gioberti 60, 00185 Roma, Italy
2. Pediatric Department, Bambino Gesù Children Hospital, 00165 Roma, Italy
Interests: pediatric; infectious diseases; adolescence; children; communication
Special Issues, Collections and Topics in MDPI journals

Dr. Elena Bozzola

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Guest Editor

Pediatric Unit, IRCCS Bambino Gesù Children Hospital, 00165 Roma, Italy
Interests: pediatric; infectious diseases; adolescence; children; communication
Special Issues, Collections and Topics in MDPI journals

Dr. Paolo Palma

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Guest Editor

1. Department of Public Health, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
2. Academic Department of Pediatrics, Bambino Gesù Children Hospital, 00165 Rome, Italy
Interests: pediatrics; infectious diseases; adolescence; children

Special Issue Information

Dear Colleagues,

Preventable infectious diseases are among the major cause of disability and death in the world. Substantial global progress has been made in reducing child death for preventable, common infectious diseases; however, globally, infectious diseases remain the leading causes of death for children under five. The World Health Organization supports national governments to organize and implement programs aimed at strengthening ongoing control of infectious diseases, reducing transmission, mortality, morbidity and human suffering and aiming at eliminating preventable infectious diseases. To address infectious disease circulation, updated epidemiology evaluations are essential for the implementation of appropriate immunization recommendations and implement public health policy programs. Vaccination is a useful strategy to avoid the significant burden of preventable infectious disease incidence and complications and should be encouraged from both a medical and economic viewpoint. Communication strategies are also important to set and spread effective health messages to families to address the perceptions of the individual risk of the disease, recommending immunization strategies according to the intended audience. Reaching culturally diverse groups with messages vital to disease prevention and trying to convince families to modify habits may sometimes require integrated communication strategies, which may provide new opportunities and challenges for the effective spread of messages.

Dr. Alberto Villani
Dr. Elena Bozzola
Dr. Paolo Palma
Guest Editors

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Keywords

Children
Adolescents
Infectious disease
Prevention
Communication
Immunization strategy
Public health programs

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Published Papers (13 papers)

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Editorial

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3 pages, 254 KiB

Open AccessEditorial

Respiratory Syncytial Virus Resurgence in Italy: The Need to Protect All Neonates and Young Infants

by Elena Bozzola

Int. J. Environ. Res. Public Health 2022, 19(1), 380; https://doi.org/10.3390/ijerph19010380 - 30 Dec 2021

Cited by 14 | Viewed by 2151

Abstract

Respiratory syncytial virus (RSV) is the most prevalent cause of viral respiratory infections in children up to the age of 2 years and causes a wide range of clinical manifestations [...] Full article

(This article belongs to the Special Issue Children and Adolescents: Preventable Infectious Diseases)

Research

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11 pages, 1471 KiB

Open AccessArticle

Disease Progression, Clinical Features, and Risk Factors for Pneumonia in Unvaccinated Children and Adolescents with Measles: A Re-Emerging Disease in Romania

by Mirela Turaiche, Mirela Loredana Grigoras, Felix Bratosin, Iulia Bogdan, Adrian Vasile Bota, Bianca Cerbu, Camelia Vidita Gurban, Prima Hapsari Wulandari, Srivathsava Gurumurthy, Kakarla Hemaswini, Cosmin Citu and Iosif Marincu

Int. J. Environ. Res. Public Health 2022, 19(20), 13165; https://doi.org/10.3390/ijerph192013165 - 13 Oct 2022

Cited by 8 | Viewed by 3023

Abstract

Measles causes in vaccinated children, with some exceptions, a mild disease, while the unvaccinated can suffer complications that result in serious consequences and even death. Although the introduction of the measles vaccine has reduced the number of cases and the viral spread, the current downward vaccination trend has resulted in the resurgence of the disease. Currently, Romania has a measles vaccination coverage below the 95% safety threshold. Thus, an outbreak started in 2016 and still ongoing in Romania, many cases being identified in the Western region in the pediatric population. Our objective was to conduct a thorough examination of clinical characteristics, evolution, and risk factors in vaccinated and unvaccinated children in this region. To reach our objectives we used a retrospective cohort analysis. The authors reviewed clinical and laboratory data from patients hospitalized at “Victor Babes” Hospital for Infectious Diseases and Pulmonology in Timisoara. We found a total of 136 qualifying cases of measles among the children admitted to this facility. The two comparison groups consisted of 104 children under 10 years and 32 patients between 10 and 18 years. An important characteristic of both study groups was the high prevalence of patients from the Roma ethnicity, which, although represents a minority in Romania, the prevalence was over 40% in the current study. The infection source was in 40.4% of children under 10 years inside the family, while 71.9% of infections in the group of adolescents were isolated (p-value = 0.047). The multivariate risk factor analysis identified as independent risk factors for the development of pneumonia the older age of patients (OR = 1.62), poor nutritional status (OR = 1.25), Roma ethnicity (OR = 2.44), presence of anemia (OR = 1.58), and procalcitonin (OR = 3.09). It is essential to handle these risk factors in a patient with measles, especially in conjunction with an unknown vaccination status. To achieve a vaccination rate greater than 95 percent for Romanian children, measles vaccination awareness must be promoted, moreover in the Roma population. More comprehensive preventative methods must be developed promptly with the objective of eradicating measles in Romania via a vigorous vaccination campaign. Full article

(This article belongs to the Special Issue Children and Adolescents: Preventable Infectious Diseases)

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14 pages, 365 KiB

Open AccessArticle

HPV Vaccination in Young Males: A Glimpse of Coverage, Parental Attitude and Need of Additional Information from Lombardy Region, Italy

by Alessandra Mari, Laura Gianolio, Valeria Edefonti, Dariush Khaleghi Hashemian, Francesca Casini, Francesco Bergamaschi, Anna Sala, Elvira Verduci, Valeria Calcaterra, Gian Vincenzo Zuccotti and Valentina Fabiano

Int. J. Environ. Res. Public Health 2022, 19(13), 7763; https://doi.org/10.3390/ijerph19137763 - 24 Jun 2022

Cited by 3 | Viewed by 2413

Abstract

Background: In the Lombardy Region, Italy, HPV vaccination is recommended and offered free of charge to 12-years-old males since 2017. The expected vaccination thresholds are still far to be reached. Methods: A cross-sectional survey to investigate parents’ attitudes towards the HPV vaccine and knowledge about HPV was administered to parents of boys aged 6 to 18 years attending a large pediatric hospital for outpatient specialistic evaluations. Two parallel multiple logistic regression analyses were conducted to estimate the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) for attitude towards HPV vaccination and perceived need for more information about HPV vaccination. Results: A positive attitude towards HPV vaccination was found in 74% of interviewed parents. Knowledge of HPV, having a generally positive attitude toward vaccination, and mothers filling in the survey were positively associated with a positive attitude to the HPV vaccine. Parents’ perceived need for more information about HPV vaccination was positively associated with the child’s age, general positive attitude toward vaccination, Christian religion, and positive attitude toward HPV vaccination; knowing that HPV vaccination is free of charge significantly reduced the risk of asking for more information on HPV vaccination. Conclusions: The majority of parents of male children and adolescents in our study have a positive attitude toward HPV vaccination. Attitude toward HPV vaccination and perceived need for more information on HPV vaccination were directly related to a positive attitude toward vaccines in general. In addition, knowledge of HPV and related pathologies favors a positive attitude toward HPV vaccination. Future health programs should target an even wider diffusion of evidence-based information on vaccines in general and on the HPV vaccine in young males, to support a positive attitude toward vaccines in the general population. Full article

(This article belongs to the Special Issue Children and Adolescents: Preventable Infectious Diseases)

16 pages, 375 KiB

Open AccessArticle

Meningococcal Disease in Pediatric Age: A Focus on Epidemiology and Prevention

by Giada Maria Di Pietro, Giulia Biffi, Massimo Luca Castellazzi, Claudia Tagliabue, Raffaella Pinzani, Samantha Bosis and Paola Giovanna Marchisio

Int. J. Environ. Res. Public Health 2022, 19(7), 4035; https://doi.org/10.3390/ijerph19074035 - 29 Mar 2022

Cited by 7 | Viewed by 3687

Abstract

Meningococcal disease is caused by Neisseria meningitidis; 13 serogroups have been identified and differentiated from each other through their capsular polysaccharide. Serotypes A, B, C, W, X, and Y are responsible for nearly all infections worldwide. The most common clinical manifestations are meningitis and invasive meningococcal disease, both characterized by high mortality and long-term sequelae. The infection rate is higher in children younger than 1 year and in adolescents, who are frequently asymptomatic carriers. Vaccination is the most effective method of preventing infection and transmission. Currently, both monovalent meningococcal vaccines (against A, B, and C serotypes) and quadrivalent meningococcal vaccines (against serogroups ACYW) are available and recommended according to local epidemiology. The purpose of this article is to describe the meningococcal vaccines and to identify instruments that are useful for reducing transmission and implementing the vaccination coverage. This aim could be reached by switching from the monovalent to the quadrivalent vaccine in the first year of life, increasing vaccine promotion against ACYW serotypes among adolescents, and extending the free offer of the anti-meningococcal B vaccine to teens, co-administering it with others proposed in the same age group. Greater awareness of the severity of the disease and increased health education through web and social networks could represent the best strategies for promoting adhesion and active participation in the vaccination campaign. Finally, the development of a licensed universal meningococcal vaccine should be another important objective. Full article

(This article belongs to the Special Issue Children and Adolescents: Preventable Infectious Diseases)

8 pages, 893 KiB

Open AccessArticle

The Disappearance of Respiratory Viruses in Children during the COVID-19 Pandemic

by Anna Chiara Vittucci, Livia Piccioni, Luana Coltella, Claudia Ciarlitto, Livia Antilici, Elena Bozzola, Fabio Midulla, Paolo Palma, Carlo Federico Perno and Alberto Villani

Int. J. Environ. Res. Public Health 2021, 18(18), 9550; https://doi.org/10.3390/ijerph18189550 - 10 Sep 2021

Cited by 73 | Viewed by 4232

Abstract

Background: Social distancing measures are used to reduce the spreading of COVID-19. The aim of this study was to assess the impact of local restrictions on the transmission of respiratory virus infections. Methods: we retrospectively analyzed the nasopharyngeal samples of all patients (0–18 years old) admitted with respiratory symptoms in a large Italian tertiary hospital during the last three seasons from 2018 to 2021. Results: A strong reduction in all viral respiratory infections was observed in the last season (2020–2021) compared to the two previous seasons (−79.69% and −80.66%, respectively). In particular, we found that during the epidemic period 2018–2019 and 2019–2020, the total number of Respiratory Syncytial Virus (RSV) cases was, respectively 726 and 689, while in the last season a total of five cases was detected. In the first months of 2018–2019 and 2019–2020, the total flu infections were 240 and 354, respectively, while in the last season we did not detect any influenza virus. As other viruses, the presence of Rhinovirus declined, but to a lesser extent: a total of 488 cases were assessed compared to the 1030 and 1165 cases of the two previous respective epidemic seasons. Conclusions: Public health interventions and distancing (including continuous use of face masks) settled to counter the pandemic spread of COVID-19 had a macroscopic impact on all respiratory virus transmission and related diseases, with a partial exception of Rhinovirus. The absence of viruses’ circulation could result in a lack of immunity and increased susceptibility to serious infections in the next seasons. Full article

(This article belongs to the Special Issue Children and Adolescents: Preventable Infectious Diseases)

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12 pages, 519 KiB

Open AccessArticle

COVID-19: A Cross-Sectional Study of Healthcare Students’ Perceptions of Life during the Pandemic in the United States and Brazil

by Laura A. Geer, Rachel Radigan, Guilherme de Lima Bruneli, Lucas Sampaio Leite and Rosalie Barreto Belian

Int. J. Environ. Res. Public Health 2021, 18(17), 9217; https://doi.org/10.3390/ijerph18179217 - 1 Sep 2021

Cited by 1 | Viewed by 4598

Abstract

Societal influences, such as beliefs and behaviors, and their increasing complexity add to the challenges of interactivity promoted by globalization. This study was developed during a virtual global educational exchange experience and designed for research and educational purposes to assess personal social and cultural risk factors for students’ COVID-19 personal prevention behavior and perceptions about life during the pandemic, and to inform future educational efforts in intercultural learning for healthcare students. We designed and implemented a cross-sectional anonymous online survey intended to assess social and cultural risk factors for COVID-19 personal prevention behavior and students’ perceptions about life during the pandemic in public health and healthcare students in two public universities (United States n = 53; Brazil n = 55). Statistically significant differences existed between the United States and Brazil students in degree type, employment, risk behavior, personal prevention procedures, sanitization perceptions, and views of governmental policies. Cultural and social differences, risk messaging, and lifestyle factors may contribute to disparities in perceptions and behaviors of students around the novel infectious disease, with implications for future global infectious disease control. Full article

(This article belongs to the Special Issue Children and Adolescents: Preventable Infectious Diseases)

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11 pages, 318 KiB

Open AccessArticle

Utilization of Health Care Services and Common Disease Diagnoses among University Students: An Analysis of 35,249 Students from Thailand

by Suphawita Pliannuom, Kanokporn Pinyopornpanish, Chaisiri Angkurawaranon, Kanokwan Pinyopornpanish, Anawat Wisetborisut, Surinporn Likhitsathian and Wichuda Jiraporncharoen

Int. J. Environ. Res. Public Health 2021, 18(13), 7148; https://doi.org/10.3390/ijerph18137148 - 4 Jul 2021

Cited by 1 | Viewed by 3570

Abstract

The health care services for university students are important to improve student health and well-being. Analyzing the database of health conditions in the health service system will identify common health problems, which could be useful in further appropriate and specific health service planning. This study aims to investigate the utilization of health care services and common disease diagnoses among university students enrolled at Chiang Mai University during the academic year of 2018. A retrospective study was carried out using health data from the electronic health records (EHR) database of the university hospital. Ethical procedures were followed. Out of the overall 35,249 students in the academic year 2018, 17,284 students (49.03%) had visited an outpatient department (65,150 outpatient department visits), and 407 students (1.15%) had been admitted to the hospital (458 inpatient department admissions). The proportions of utilization between each field of education and training were similar across both groups. The top five categories of diagnosis, for both outpatient department visits and inpatient department admissions, differed between gender. Some of the most common diseases included trauma and injury conditions, respiratory diseases, and mental health. The conclusion of the study is that integration of a health promotion program with preventive methods, especially regarding traffic injury, transmitted diseases, mental health support, and safe environments are essential for university students. A general overview of utilization and common diseases among university students, which is still lacking in the literature, could be useful as a platform to enhance health care services for common diseases. Full article

(This article belongs to the Special Issue Children and Adolescents: Preventable Infectious Diseases)

Review

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9 pages, 525 KiB

Open AccessReview

Respiratory Syncytial Virus Pediatric Hospitalization in the COVID-19 Era

by Elena Bozzola, Sarah Barni and Alberto Villani

Int. J. Environ. Res. Public Health 2022, 19(23), 15455; https://doi.org/10.3390/ijerph192315455 - 22 Nov 2022

Cited by 17 | Viewed by 2936

Abstract

Respiratory syncytial virus (RSV) globally affects the population, mainly young children, potentially causing hospitalization. During the COVID-19 pandemic, non-pharmacological measures interfered with the circulation of most respiratory viruses. Then, with the discontinuation of restrictive measures, a new scenario appeared. With this scoping review, we want to globally explore whether the RSV paediatric hospitalization rate was influenced by COVID-19. This scoping review was performed according to PRISMA guidelines on PubMed using the Mesh terms “Respiratory Syncytial Viruses”[Mesh] AND “COVID-19”[Mesh] OR “SARS-CoV-2”[Mesh]. Among them, we identified studies pertaining to children and adolescents up to 18 years old hospitalized for RSV, including 18 records in the revision. With the onset of the COVID-19 pandemic, a drastic reduction in RSV hospitalization among the pediatric population in 2020–2021 season has been observed in the Northern and Southern hemispheres. After the relaxing of restrictive measures, unexpected outbreaks happened, leading to increased hospitalization and occupation of pediatric intensive care units. Full article

(This article belongs to the Special Issue Children and Adolescents: Preventable Infectious Diseases)

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29 pages, 491 KiB

Open AccessReview

Exclusive Breastfeeding and Vitamin D Supplementation: A Positive Synergistic Effect on Prevention of Childhood Infections?

by Raffaele Domenici and Francesco Vierucci

Int. J. Environ. Res. Public Health 2022, 19(5), 2973; https://doi.org/10.3390/ijerph19052973 - 3 Mar 2022

Cited by 14 | Viewed by 5974

Abstract

Human milk is the best food for infants. Breastfeeding has been associated with a reduced risk of viral and bacterial infections. Breast milk contains the perfect amount of nutrients needed to promote infant growth, except for vitamin D. Vitamin D is crucial for calcium metabolism and bone health, and it also has extra-skeletal actions, involving innate and adaptive immunity. As exclusive breastfeeding is a risk factor for vitamin D deficiency, infants should be supplemented with vitamin D at least during the first year. The promotion of breastfeeding and vitamin D supplementation represents an important objective of public health. Full article

(This article belongs to the Special Issue Children and Adolescents: Preventable Infectious Diseases)

Other

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11 pages, 327 KiB

Open AccessCommentary

Cascading Risks for Preventable Infectious Diseases in Children and Adolescents during the 2022 Invasion of Ukraine

by Andrea Maggioni, Jose A. Gonzales-Zamora, Alessandra Maggioni, Lori Peek, Samantha A. McLaughlin, Ulrich von Both, Marieke Emonts, Zelde Espinel and James M. Shultz

Int. J. Environ. Res. Public Health 2022, 19(12), 7005; https://doi.org/10.3390/ijerph19127005 - 8 Jun 2022

Cited by 18 | Viewed by 4452

Abstract

Russia’s military incursion into Ukraine triggered the mass displacement of two-thirds of Ukrainian children and adolescents, creating a cascade of population health consequences and producing extraordinary challenges for monitoring and controlling preventable pediatric infectious diseases. From the onset of the war, infectious disease surveillance and healthcare systems were severely disrupted. Prior to the reestablishment of dependable infectious disease surveillance systems, and during the early months of the conflict, our international team of pediatricians, infectious disease specialists, and population health scientists assessed the health implications for child and adolescent populations. The invasion occurred just as the COVID-19 Omicron surge was peaking throughout Europe and Ukrainian children had not received COVID-19 vaccines. In addition, vaccine coverage for multiple vaccine-preventable diseases, most notably measles, was alarmingly low as Ukrainian children and adolescents were forced to migrate from their home communities, living precariously as internally displaced persons inside Ukraine or streaming into European border nations as refugees. The incursion created immediate impediments in accessing HIV treatment services, aimed at preventing serial transmission from HIV-positive persons to adolescent sexual or drug-injection partners and to prevent vertical transmission from HIV-positive pregnant women to their newborns. The war also led to new-onset, conflict-associated, preventable infectious diseases in children and adolescents. First, children and adolescents were at risk of wound infections from medical trauma sustained during bombardment and other acts of war. Second, young people were at risk of sexually transmitted infections resulting from sexual assault perpetrated by invading Russian military personnel on youth trapped in occupied territories or from sexual assault perpetrated on vulnerable youth attempting to migrate to safety. Given the cascading risks that Ukrainian children and adolescents faced in the early months of the war—and will likely continue to face—infectious disease specialists and pediatricians are using their international networks to assist refugee-receiving host nations to improve infectious disease screening and interventions. Full article

(This article belongs to the Special Issue Children and Adolescents: Preventable Infectious Diseases)

6 pages, 979 KiB

Open AccessCase Report

MRSA Femoral Osteomyelitis from Superinfected Scabies Lesions: A Pediatric Case Report

by Marco Ugo Andrea Sartorio, Alice Marianna Munari, Patrizia Carlucci, Paola Erba, Valeria Calcaterra and Valentina Fabiano

Int. J. Environ. Res. Public Health 2022, 19(2), 1007; https://doi.org/10.3390/ijerph19021007 - 17 Jan 2022

Cited by 3 | Viewed by 2695

Abstract

Scabies is a skin infestation from the Sarcoptes scabiei. It is considered a public health issue causing concern in developing countries and is considered a “neglected tropical disease” by the World Health Organization (WHO). Scabies skin lesions may cause severe itching and can be the portal of entry for opportunistic and pathogenic bacteria, which can cause serious systemic infections. We report the case of a 3-year-old boy with recurrent scabies infections who presented to the emergency department because of a fever and refusal to walk. Blood tests showed neutrophilic leukocytosis and significantly increased C reactive protein (CRP) and procalcitonin. Upon medical examination, his right thigh was extremely painful upon palpation, knee flexion was lost and he was unable to stand, so magnetic resonance imaging (MRI) was performed. MRI showed osteomyelitis of metaphysis and distal diaphysis of the right femur with associated subperiosteal purulent collection and concomitant pyomyositis and fasciitis of the distal right thigh. Blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). The patient received a long course of intravenous antibiotic therapy and his condition slowly improved. Follow-up femur X-ray showed a mixed pattern of erosion and sclerosis at the meta-diaphyseal region and periosteal reaction at the diaphyseal region. This case highlights the importance of early scabies diagnosis even in Western countries where poverty and household overcrowding are uncommon. Early diagnosis, timely initiation of proper treatment and evidence of clinical resolution are important elements to prevent recurrence of infection and serious systemic superinfections even from multi-drug resistant bacteria. Clinical consequences from unrecognized disease or inadequate eradication are preventable. Full article

(This article belongs to the Special Issue Children and Adolescents: Preventable Infectious Diseases)

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9 pages, 3318 KiB

Open AccessCase Report

Severe COVID-19 Complicated by Cerebral Venous Thrombosis in a Newborn Successfully Treated with Remdesivir, Glucocorticoids, and Hyperimmune Plasma

by Laura Cursi, Francesca Ippolita Calo Carducci, Sara Chiurchiu, Lorenza Romani, Francesca Stoppa, Giulia Lucignani, Cristina Russo, Daniela Longo, Carlo Federico Perno, Corrado Cecchetti, Mary Haywood Lombardi, Patrizia D’Argenio, Laura Lancella, Stefania Bernardi and Paolo Rossi

Int. J. Environ. Res. Public Health 2021, 18(24), 13201; https://doi.org/10.3390/ijerph182413201 - 15 Dec 2021

Cited by 8 | Viewed by 2233

Abstract

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic, affecting all age groups with a wide spectrum of clinical presentation ranging from asymptomatic to severe interstitial pneumonia, hyperinflammation, and death. Children and infants generally show a mild course of the disease, although infants have been observed to have a higher risk of hospitalization and severe outcomes. Here, we report the case of a preterm infant with a severe form of SARS-CoV-2 infection complicated by cerebral venous thrombosis successfully treated with steroids, hyperimmune plasma, and remdesivir. Full article

(This article belongs to the Special Issue Children and Adolescents: Preventable Infectious Diseases)

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6 pages, 642 KiB

Open AccessBrief Report

Pediatric Hospitalization for Varicella in an Italian Pediatric Hospital: How Much Does It Cost?

by Elena Bozzola, Giulia Spina, Maria Rosaria Marchili, Carla Brusco, Stefano Guolo, Chiara Rossetti, Giuseppe Logrieco, Francesca Pignatelli, Massimiliano Raponi and Alberto Villani

Int. J. Environ. Res. Public Health 2021, 18(22), 12053; https://doi.org/10.3390/ijerph182212053 - 17 Nov 2021

Cited by 2 | Viewed by 2008

Abstract

Background: Varicella is a common pediatric infection. Even if it generally has a benign course, it may complicate and require hospitalization. The aim of our study was to estimate the acute hospitalization cost (AHC) for varicella in the acute phase in a pediatric population. Methods: We calculated the AHC of pediatric patients admitted for varicella at Bambino Gesù Children Hospital, Rome, Italy, from 1 November 2005 to 1 November 2020. Results: In the study period, 825 pediatric patients affected by varicella were hospitalized. The mean hospitalization cost was EUR 4015.35 (range from EUR 558.44 to EUR 42,608.00). Among patients, 55% were unvaccinable due to either their age or their immunosuppression status. They would benefit from herd immunity, reducing the overall AHC by EUR 182,196,506. Since the introduction of the compulsory vaccination against varicella in Italy, we observed a significant reduction in AHC cost of 60.6% in 2019 and of 93.5% in 2020. Finally, from the beginning of the COVID-19 pandemic, we documented a decline of 81.2% and 76.9% in varicella hospitalization, compared to 2018 and 2019, respectively. Conclusions: Varicella AHC is an important economic and health assessment point and can be useful for improving preventive strategies. Full article

(This article belongs to the Special Issue Children and Adolescents: Preventable Infectious Diseases)

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