Respiratory infections: Italy is above the European average in terms of number of cases.

Influenza, but not only that. Also lurking are COVID-19, respiratory syncytial virus, pneumococcus, and dozens of other pathogens. Ready to strike in the winter months, they can cause pneumonia and serious respiratory infections, whose health and economic burden is becoming increasingly significant. And vaccines, the only truly effective weapons to protect at-risk populations, still fail to reach the coverage recommended by the international scientific community. This was discussed during the meeting "Respiratory Infections: Impact on Healthy Aging and Costs of the National Health System," organized by The European House – Ambrosetti with the unconditional contribution of Pfizer.

A growing phenomenon

As discussed during the meeting, Italy experiences approximately 188,300 cases of respiratory infections per 100,000 inhabitants each year, higher than the European average. This represents nearly two episodes of illness per citizen, with a particularly high incidence among children (323,000 cases per 100,000) and those over 50 (140,000 cases per 100,000). Over the past year, flu-like illnesses (caused not only by actual influenza viruses) have affected 27.7% of the population, an increase compared to the previous season.

Mortality is also on the rise: between 2012 and 2019, it increased by 57.8%, and with the pandemic, the overall increase exceeded 560%. In 2022, 9.1% of deaths in Italy were attributable to respiratory infections, a higher rate than in France, Germany, and Spain. Hospitalizations also highlight the scale of the problem: in 2020-2021, over 179,000 hospitalizations were recorded annually, and the level remains 82% higher than in 2019.

Patients at risk

The danger posed by respiratory infections is not the same for everyone. An aging immune system exposes older adults to greater risks: 88% of influenza deaths in Europe occur in this population group. Respiratory syncytial virus (RSV), often underestimated, causes over 26,000 hospitalizations and 1,800 deaths each year, primarily among the elderly.

"Every year, during the influenza season—which includes influenza, COVID-19, respiratory syncytial virus, parainfluenza, and rhinovirus—Italy records between 5,000 and 15,000 excess deaths, with the elderly and vulnerable among the most affected," emphasized Massimo Andreoni , Scientific Director of SIMIT and Full Professor of Infectious Diseases at Tor Vergata University in Rome. "These numbers alone would be enough to confirm that respiratory infections represent a genuine public health priority, not limited to the winter period alone, as demonstrated by the COVID data from recent weeks. In this context, vaccines prove to be a crucial tool: not only do they reduce the risk of contracting and transmitting the infection, but they also prevent thousands of hospitalizations and deaths, while also easing the pressure on the healthcare system."

Push for vaccinations

The most powerful weapon we have against these respiratory pathogens is vaccination. But as experts emphasized during the meeting, vaccination coverage rates in Italy remain dramatically low. For the flu vaccine among those over 65, we have dropped to 52.5%, far from the minimum target of 75% set by the WHO. Regarding COVID, the 2024-2025 season recorded coverage of just 4.5%. For pneumococcus, estimates indicate coverage of less than 30%, compared to a target of 75%. For RSV, despite the availability of the vaccine, structured national campaigns for adults are still lacking.

In this context, it is important to emphasize that vaccines, in addition to improving the health of individuals and the community, also significantly contribute to the sustainability of the National Health System: achieving 50% vaccination coverage for influenza, pneumococcus, COVID-19, and RSV would generate savings of €1 billion per year, which would rise to over €2 billion with coverage close to 95%.

"A few months ago, the Vaccine Calendar for Life updated its 'ideal' vaccination offerings for all ages," explained Paolo Bonanni, Coordinator of the Calendar for Life Board and Professor of Hygiene at the University of Florence. "The main new features include the request to finally offer the meningococcal B vaccination to adolescents, the request for actions to increase HPV vaccine coverage, the emphasis on the new, highly effective pneumococcal vaccines for children and adults, and two new chapters on COVID and RSV, whose vaccinations, respectively, remain and must become crucial for maintaining the health of the adult population. They are essential for extending, in addition to the flu shot, protection against highly dangerous diseases, especially for the elderly and chronically ill of all ages."