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HPV vaccines currently marketed in Italy (bivalent and quadrivalent against HPV 16-18 and HPV and 6,11,16,18 respectively) are an extraordinary tool for the primary prevention of HPV related diseases, particularly of the cervical cancer. Although the implementation of the organized vaccination programs has already translated (for some endpoint) in confirmation of clinical efficacy, remains excluded a significant proportion of the diseases linked to non-vaccine HPV types. The new nonavalent vaccine (HPV9), of impending commercialization, represents an evolution of the quadrivalent, the composition of which are added five high-risk HPV types (HPV 31,33,45,52,58). The high clinical-immunological efficacy in experimental trials against the new genotypes (96% for CIN2 +), and the equivalence immunogenic to the four already present in the previous vaccine, will render the use of HPV9 a tool able to control in an even more effective HPV disease. The potential of the new vaccine is linked to the reduction of the HPV cancer burden by 2-20% according to anatomical site, with major benefits for cervical cancer, vulvo-vaginal, penile and more limited benefits for anal tumours. Moreover, the potential benefits could be also linked to the reduction of incidence of pre-neoplastic lesions arising in the lower-genital tract, especially in the cervix (CIN2-3), so often cause lengthy and expensive diagnostic and therapeutic procedures. In the face of this broad provision of benefit from HPV9 vaccine, we have also to consider all the variables related to its introduction in the vaccination calendars: the market price, the schedule of administration (currently in three doses) and data regarding the cost-effectiveness. The authors recognize the new vaccine (currently registered only in the US) a lot of potential in the prevention of HPV-related diseases.

Medical meetings should be an occasion for common reflection on specific topics, rather than help to spread information which, especially for experts on the subject, are often easily accessible. Paediatricians have approached the subject “vaccination” with great caution due to the scarce skills training offered today by most post-graduate Specialty Schools. Since 2001 the FIMP (Federazione Italiana Medici Pediatri) has created a regional network of Referents capable of spreading “Good Vaccination Practice” among General Paediatricians; this activity resulted with the prepa- ration of (vaccine) scheduled recommendations first in 2003, until approval of (vaccination) schedules with other scientific societies in 2010. Certainly the role of the clinician is consistently enriched with the related scientific literature to better understand the diseases in terms of surveillance, epidemiology and etiology but for the paediatrician, “disease” means above all an ill child and the diseases caused by pneumococcus have a wide spectrum of pathological manifestations. In the pre-vaccination period [1], the pneumococcal bac- teremia in children were almost 90%, 55% meningitis, pneumonians more than 70% between the bacterials ones for childrens under 5 years old of age and middle ear otitis exceed 40%. The Ligurian experience [2] shows that pneumococcal vaccination, which has reached sizeable levels of cover- age in the region, allows significant reduction of these diseases, in fact there has been a decrease of 15% for childhood pneumonia from all causes, 70 % for pneumococcal pneumonia and a reduction of 36% for acute middle ear otitis. The otologic disease, certainly not the primary goal of vaccination, is a daily vocational commitment for pae- diatricians. The vaccine efficacy is demonstrated by many studies: among others, the study in Greece [3] show that cases in A&E Departments for otorrhea (signal of particularly virulence of the disease) have decreased by 38% dur- ing the observation period compared to the pre-vaccine period and by 48% for ear infections caused by pneu- mococcus, even though the need Startup monitoring demonstrates an increased incidence of serotype 19A (a rise from 2% up to 25%) and resistance to amoxicillin growth from 4% up to 13%. Translated into numerical terms, the term “discrete re- ductions” of Cochrane review about vaccination impact on acute middle ear infections [4], we can say that in Italy, (we) Paediatricians , have to treat approximately 60-70,000 less cases every year. The reported increase in mastoiditis also relative to the recent Guide Line of SIP, which would decline the an- tibiotic therapy in certain conditions, increase often due to the serotype 19A not included in the Heptavalent Pnu- mococcal Vaccine, in reality [5], appears mainly as a result of complications due to previous middle ear prob- lems, being wrongly diagnosed and poorly treated. Would point out that these publications are related to a reality that does not provide a General Paediatric Assist- ance as in Italy., Journal of Preventive Medicine and Hygiene, Vol 53, No 2 (2012)

Medical scientific societies have the core mission of producing, pooling and disseminating solid and updated scientific information. We report the successful experience of the partnership of four national Medical Scientific Societies active in Italy in producing scientific advice on vaccines and vaccination. In particular, i) the Italian Society of Hygiene, Preventive Medicine and Public Health; SitI, ii) the Italian Society of Paediatrics; SIP, iii) the “Italian Federation of General Practitioners”; FIMP, and iv) the Italian Federation of General Medicine FIMMG) have worked together since 2012 to produce shared evidence-based recommendations on vaccination schedules, namely the “Lifetime Immunization Schedule” which introduced for the first time in Italy a life-course approach to vaccination. The 2014 edition of the “Lifetime Immunization Schedule” was used as a basis to develop the 2017–2019 Italian National Prevention Plan, approved by The Italian Ministry of Health in February 2017. In this report, we present the structure, content and supporting evidence of the new 2016 “Lifetime Immunization Schedule” and we expand on the influential role of medical scientific societies in researching and advocating for effective and safe vaccination programmes’ implementation at the national level.