Incidence data on pertussis cases in Italy do not show pertussis resurgence as recently described in other European countries. The aim of this study was to determine the seroprevalence of IgG ...antibodies to pertussis toxin (PT-IgG) in selected adult age groups, who can serve as a reservoir of Bordetella pertussis and be responsible for onward transmission to vulnerable infants. The seroprevalence of PT-IgG was studied in sera collected in 2012-2013 in three age groups: 20-29 years and 30-39 years (reproductive age), and ≥60 years. These data were compared to those from sera collected in similar age groups in 1996-1997. More than 80 % of the adult population analysed in the 2012-2013 group presented detectable levels of PT-IgG (>5 IU ml
). PT-IgG titres of 50-99 IU ml
, considered indicative of infection in the last few years, and PT-IgG titres of ≥100 IU ml
, considered indicative of recent infection (i.e.within the last year), reached 9.1 % 95 % confidence interval (CI) 6.9-11.3 %; 58/639 and 5 % (95 % CI 3.3-6.7 %; 32/639) seroprevalence, respectively. Notably, the proportion of subjects with a seroprevalence indicative of recent infection increased significantly from 9.3 % (95 % CI 7.5-11.1 %; 96/1037) in 1996-1997 to 14.1 % (95 % CI 11.4-16.8 %; 90/639) in 2012-2013. Overall, our data clearly indicate a significant increase in the circulation of B. pertussis in adults in Italy; therefore, it is likely that the statutory notification system underestimates the real incidence of the disease. These findings have implications for preventive strategies.
Although most countries in the WHO European Region were verified in 2017 as having interrupted endemic measles transmission, nine countries were still endemic. Among these, Italy accounted for the ...second highest number of measles cases reported in Europe in 2017. The elimination of measles is verified at national level by each country's National Verification Committee (NVC) through the production of an Annual Status Update (ASU). Since in Italy decentralization has led to an inhomogeneous implementation of immunization strategies among the 21 administrative Regions, the Italian NVC proposed that measles elimination should also be documented at the subnational level through regional ASUs and Synthetic Regional Reports (SRRs). The regional ASUs and the SRRs for 2014, 2015 and 2016 were produced and appraised by the NVC to evaluate the Regions' performances in each individual year as well as over the whole period. A specific analysis of vaccination coverage, including official immunization data for 2017, was performed. Moreover, the measles epidemic of 2017 was examined. Firstly, in the period 2014-2016, low immunization rates were registered in most Regions. Sixty-three per cent of southern Regions reported rates below the national mean and an overall low-quality performance. The approval of Italy's mandatory vaccination law in 2017 resulted in a marked increase in vaccination coverage; however, this increase was not homogeneous among Regions. Secondly, more than 50% of Regions did not report any supplemental immunization activity (SIA) for the period 2014-2016. Thirdly, from 2014 to 2016, fewer than one-third of Regions improved their reporting of outbreaks. Finally, over the study period, only two Regions reached the target required by the WHO for measles laboratory investigations. In countries with decentralized health policies, subnational monitoring can help identify local barriers to measles elimination. In Italy it has highlighted the need for further SIAs and a stronger surveillance system.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Identifying healthcare workers (HCW) who have less awareness and knowledge on antibiotic use and resistance represents a challenge for public health, since it might help the development of novel ...educational and training initiatives tailored on specific subgroups of professionals. This work aims to compare knowledge, attitudes and behaviors on antibiotic use and resistance across different groups of Italian HCW.
We used data from the multi-country and multi-professional survey launched by the European Centre for Disease Prevention and Control between 28 January to 4 March 2019 to assess knowledge, attitude and behaviors of HCW on antibiotics, antibiotic use and resistance. We distinguished three clusters of HCW using the Two-Step Cluster analysis, based on their personal and professional characteristics (i.e. profession, role, activity as prescriber, setting, and activity as antibiotic use advisor).
In general, cluster 1 consisted mostly of allied healthcare workers, while clusters 2 and 3 were made up almost completely of pharmacists and medical doctors, respectively. Interestingly, healthcare workers in cluster 3 had the highest knowledge on antibiotic use and resistance. Workers in cluster 1, instead, were those reporting the highest awareness of the importance and role of hand hygiene as an infection prevention and control measure. However, HCW in cluster 2 were those who recognized more their role of advisors on prudent antibiotic use.
Italian HCW exhibited different knowledge, attitudes, and behaviors on antibiotic use and resistance. These findings raised the need for educational and training interventions targeting specific professional groups.
In the WHO European Region, endemic transmission of measles and rubella had been interrupted by 37 and 42 of the 53 member states (MSs), respectively, by 2018. Sixteen MSs are still endemic for ...measles, 11 for rubella and nine for both diseases, the latter including Italy. Elimination is documented by each country's National Verification Committee (NVC) through an annual status update (ASU).
By analysing data used to produce the ASUs, we aimed to describe the advances made by Italy towards elimination of measles and rubella. Moreover, we propose a set of major interventions that could facilitate the elimination process.
A total of 28 indicators were identified within the six core sections of the ASU form and these were evaluated for the period 2013-2018. These indicators relate to the incidence of measles/rubella; epidemiological investigation of cases; investigation of outbreaks; performance of the surveillance system; population immunity levels; and implementation of supplemental immunization activities (SIAs).
From 2013 to 2018, epidemiological and laboratory analyses of measles cases in Italy improved substantially, allowing timely investigation in 2017 and 2018 of most outbreak and sporadic cases and identification of the majority of genotypic variants. Moreover, since 2017, vaccination coverage has increased significantly. Despite these improvements, several areas of concern emerged, prompting the following recommendations: i) improve outbreak monitoring; ii) strengthen the MoRoNet network; iii) increase the number of SIAs; iv) reinforce vaccination services; v) maintain regional monitoring; vi) design effective communication strategies; vii) foster the role of general practitioners and family paediatricians.
The review of national ASUs is a crucial step to provide the NVC with useful insights into the elimination process and to guide the development of targeted interventions. Against this background, the seven recommendations proposed by the NVC have been shared with the Italian Ministry of Health and the Technical Advisory Group on measles and rubella elimination and have been incorporated into the new Italian Elimination Plan 2019-2023 as a technical aid to facilitate the achievement of disease elimination goals.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•Virological surveillance needs to be further strengthened in Italy.•Timely and accurate laboratory diagnosis: priorities for reaching measles elimination.•MoRoNet: the Italian network of ...WHO-accredited laboratory for measles and rubella.
In accordance with the goal of the World Health Organization Regional Office for Europe, the Italian National Measles and Rubella Elimination Plan aimed to interrupt indigenous measles transmission in Italy by the end of 2015. However, from 2013 to 2015, Italy experienced high measles burden with 4902 measles cases (49.3% laboratory-confirmed) reported to the enhanced measles surveillance system (cumulative incidence in the triennium reference period: 2.4/100,000 population). The measles elimination goal was not reached.
Laboratory surveillance of measles circulating genotypes is performed by the Measles and Rubella National Reference Laboratory (NRL) at the Italian National Institute of Health (Istituto Superiore di Sanità − ISS), in Rome. Samples received from 1 January 2013–31 December 2015 were analysed. Those positive for measles genome by molecular tests were sequenced and phylogenetically analysed. Phylogenetic analysis performed by NRL identified that genotypes D4 and D8 were endemic and co-circulated in 2011–2013: study results show that genotype D4 disappeared during 2013. Sporadic cases were associated to genotype B3 during 2011–2013, which became endemic in Italy during 2014 and co-circulated with D8 until 2015. Sporadic cases were found belonging to genotypes D9 and H1 all over the period in exam. Similar trend has been observed in European WHO Region.
Herpes Zoster (HZ) and its main complication, post-herpetic neuralgia (PHN), represent important public health issues because of their relevant burden among older adults. However, data on the ...epidemiology of HZ and PHN in Italy are very limited.
A population-based study was performed by seeking for cases of HZ and PHN, occurred in the period 2013-2015, in the clinical charts of 56 General Practitioners working in 4 Italian Regions (Liguria, Puglia, Toscana and Veneto). The main objective of the study was to estimate the incidence of HZ and the proportion of PHN (at 1 and 3 mo from the onset of HZ; PHN1 and PHN3) among people aged ≥ 50 y.
Overall, 598 cases of HZ were identified over 93,146 person-years of observation, thus corresponding to an overall incidence of 6.42 (IC95%: 5.93 - 6.95) HZ cases per 1,000 person-years. The incidence of HZ increased with age and was higher in female than in male. In total, 22.7%, 12.7%, and 2.4% of HZ cases suffered PHN at 1 and 3 mo and 1 y from the onset of acute episode. The proportions of these complications significantly increased with age, with the peak occurring in people aged ≥ 85 y. Four per cent of patients suffered ophthalmic zoster.
The study provided an update of the epidemiological burden of HZ and PHN in Italy, confirming the relevant burden of the disease in the elderly population.
The study was funded by the Italian Ministry of Health, Center for Disease Prevention and Control (CCM) in 2013.
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Despite extensive efforts to monitor the diffusion of COVID-19, the actual wave of infection is worldwide characterized by the presence of emerging SARS-CoV-2 variants. The present ...study aims to describe the presence of yet undiscovered SARS-CoV-2 variants in Italy.
Next Generation Sequencing was performed on 16 respiratory samples from occasionally employed within the Bangladeshi community present in Ostia and Fiumicino towns. Computational strategy was used to identify all potential epitopes for reference and mutated Spike proteins. A simulation of proteasome activity and the identification of possible cleavage sites along the protein guided to a combined score involving binding affinity, peptide stability and T-cell propensity.
Retrospective sequencing analysis revealed a double Spike D614G/S939F mutation in COVID-19 positive subjects present in Ostia while D614G mutation was evidenced in those based in Fiumicino. Unlike D614G, S939F mutation affects immune response by the slight but significant modulation of T-cell propensity and the selective enrichment of potential binding epitopes for some HLA alleles.
Collectively, our findings mirror further the importance of deep sequencing of SARS-CoV-2 genome as a unique approach to monitor the appearance of specific mutations as for those herein reported for Spike protein. This might have implications on both the type of immune response triggered by the viral infection and the severity of the related illness.
The imperative of vaccination put into practice Signorelli, Carlo; Iannazzo, Stefania; Odone, Anna
Lancet. Infectious diseases/The Lancet. Infectious diseases,
January 2018, 2018-01-00, 20180101, Letnik:
18, Številka:
1
Journal Article
Recenzirano
Odprti dostop
...despite having a strong tradition of protection of personal freedoms, in 2015, California approved Senate Bill 277, which removed personal belief exemptions to vaccination requirements for school ...entry; this bill resulted in a 5·2% increase in vaccine coverage over the 2 years after the new law was enforced.6 The law is, indeed, a powerful tool. Compared with 2016, this catch-up vaccination resulted in a vaccine coverage increase from June to October, 2017 of 1·0% for the hexavalent vaccine against diphtheria, tetanus, pertussis, poliomyelitis, H influenzae type b, and hepatitis B and of 2·9% for the measles, mumps, and rubella vaccine (unpublished). Australia and compulsory vaccination, Lancet Infect Dis, Vol. 17, 2017, 903 3 J Kennedy, D Michailidou, Divergent policy responses to increasing vaccine scepticism in southern Europe, Lancet Infect Dis, Vol. 17, 2017, 900 4 C Signorelli, A Odone, P Cella, S Iannazzo, R Guerra, Infant immunization coverage in Italy (2000-2016), Ann Ist Super Sanita, Vol. 53, 2017, 231-237 5 P Bonanni, A Ferro, R Guerra, Vaccine coverage in Italy and assessment of the 2012-2014 National Immunization Prevention Plan, Epidemiol Prev, Vol. 39, Iss. 4 suppl 1, 2015, 146-158 6 California Department of Public Health, Immunization Branch, 2016-2017 kindergarten immunization assessment-executive summary, (accessed Aug 9, 2017).
Vaccine-preventable diseases among high-risk patients are a public health priority in high-income countries. Most national immunization programs have included vaccination recommendations for these ...population groups but they remain hard-to-reach and coverage data are poorly available. In a pilot study, we developed and tested an automated approach for identifying individuals with underlying medical conditions to feed an immunization information system (IIS).
We reviewed published recommendations on medical conditions that indicate vaccination against influenza, pneumococcal disease, meningococcal disease, hepatitis A, and hepatitis B. For each medical condition, we identified the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes, the user fee exempt codes and the Anatomical Therapeutic Chemical Classification System codes and we reported these data in correspondence tables. Using these tables, we extracted three lists of patients recorded in three current data sources between 2001 and 2010 in the Apulia region of Italy: the hospital discharge registry, the user fee exempt registry, and the drug prescription registry. Using a unique personal identification number, we linked these three lists of patients with the regional IIS (2012 database), obtaining a list of patients with chronic diseases eligible for vaccination. We tested completeness, sensitivity, and positive predictive value (PPV) of this approach by asking a sample of 28 general practitioners (GPs) to evaluate the matching between a sublist of patients with clinical recommendations for influenza vaccination and the GPs individual subjects medical records.
We included a total of 1,204,496 subjects with underlying medical conditions eligible to receive any of the aforementioned vaccinations. Of these, 9% were identified in all three data sources, 18% in two sources, and 73% in one source. The completeness of this automated process in identifying GPs high-risk patients eligible for influenza vaccination was 88.9% 95% confidence intervals (95% CI): 88.1-89.8%, with a sensitivity of 69.2% (95% CI: 67.7-70.6%) and a PPV of 85.7% (95% CI: 84.4-86.8%).
The high completeness of the methodology used for identifying high-risk patients in current data sources encouraged us to apply this approach for feeding the regional IIS.
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