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Background: Influenza is the infectious disease with the highest impact on population health in the European Union in terms of disability-adjusted life years. Reliable country-specific influenza- associated burden estimates play a crucial role in informing prevention and control measures to minimize the health and economic burden of the disease. Our purpose was to provide a comprehensive summary of available scientific literature on the burden of seasonal influenza on the Italian population. Methods: We performed a systematic literature review of articles published until 31 July 2020. PubMed, Embase and Web of Science were searched. The search strategy included a combination of search terms related to burden, influenza and Italian population. We included studies investigating seasonal influenza-related complications and/or mortality in Italy. A meta-analysis of data was not pre-planned because of the expected heterogeneity in study populations and outcomes. Results: A total of 16 studies were included in the qualitative synthesis, out of an original yield of 9,268 articles. Ten (62.5%) and 8 (50%) studies analyzed influenza-related complications and hospitalizations, respectively, while 8 (50%) assessed influenzarelated deaths. Only 3 studies (19.7%) concerned pediatric age. The synthesis of results showed that patients with chronic conditions might have an increased risk for complications up to almost 3 times as compared to healthy people. Hospitalization due to influenza can occur from less than 1% to more than 5% according to the study setting (general practice or emergency room). Excess deaths rates were estimated to be over 6-fold higher for the elderly than for the rest of population. Conclusions: Although there are still gaps in existing data, there is evidence of the significant burden that influenza places each year especially on high-risk groups. Summaries of the available data may inform decision-making in regard to vaccine strategies and public health policies. Key messages: • Existing data show evidence of significant burden of influenza on Italian population, especially on high-risk groups. • Summaries of country-specific influenza-related burden are crucial in informing vaccine strategies. [ABSTRACT FROM AUTHOR]

Issue/problem: Vaccinations are one of the most successful public health measures and contribute to the achievement of Sustainable Development Goals. Despite this, there are still several challenges, such as poor resources, unequal access, and vaccine hesitancy. An exploitation of the full value of vaccinations could help contrasting them. Description of the problem: A dual approach was followed to exploit full value of vaccinations. First, the four pillars of value pinpointed by the Expert Panel on Effective Ways of Investing in Health of the European Commission, namely personal, societal, allocative, and technical value, were considered to carry out a systematic review of available papers addressing the value of vaccinations. The synthesis of data was the submitted to a panel of international experts in vaccinations who gave inputs on recommendations to drive a value-based decision-making. Results: Overall, 54 papers published from 2010 onwards addressed at least one pillar of value with most of them (83.3%) assessing a single one. Two-thirds of papers addressed the technical pillar, namely the economic value, in most cases without catching the broad economic implications. Very few studies addressed allocative and societal value highlighting the need to generate evidence to support the application of these pillars. Furthermore, some aspects of the allocative pillar, such as equity, accessibility, and appropriate use, were not addressed so far. Recommendations on research on full value of vaccinations, decision-making process and public engagement were eventually issued. Lessons: The project allowed to apply for the first the value-based approach to vaccinations. This led to the identification of current gaps in the assessment of full value of vaccinations and to recommendations to foster a value-based decision-making. These results have international relevance because of the growing attention to the value-based approach for sustainable health systems. Key messages: The full value of vaccinations need to be further investigated according to the four pillars pinpointed by the Expert Panel on Effective Ways of Investing in Health. Different actions could be promoted with respect to research, decision-making process and public engagement in order to exploit the full value of vaccination and drive a value-based decision-making. [ABSTRACT FROM AUTHOR]