Congenital Cytomegalovirus (cCMV) is a serious global public health issue that can cause irreversible fetal and neonatal congenital defects in symptomatic or asymptomatic newborns at birth. In ...absence of universal cCMV screening, the retrospective diagnosis of cCMV infection in children is only possible by examining Dried Blood Spot (DBS) samples routinely collected at birth and stored for different time spans depending on the newborn screening regulations in force in different countries. In this article, we summarize the arguments in favor of long-term DBS sample storage for detecting cCMV infection.
CMV infection is the most common cause of congenital infection resulting in severe defects and anomalies that can be apparent at birth or develop in early childhood. Sensorineural hearing loss is the most frequent consequence of cCMV infection and may have a late onset and progress in the first years of life. The virological diagnosis of cCMV is essential for clinical research and public health practices. In fact, in order to assess the natural history of CMV infection and distinguish between congenital or acquired infection, children should be diagnosed early by analyzing biological samples collected in the first weeks of life (3 weeks by using viral culture and 2 weeks by molecular assays), which, unfortunately, are not always available for asymptomatic or mildly symptomatic children. It now seems possible to overcome this problem since the CMV-DNA present in the blood of congenitally infected newborns can be easily retrieved from the DBS samples on the Guthrie cards routinely collected and stored within 3 days from birth in the neonatal screening program for genetic and congenital diseases. Early collection and long-term storage are inexpensive methods for long-term bio-banking and are the key points of DBS testing for the detection of cCMV.
DBS sampling is a reliable and inexpensive method for long-term bio-banking, which enables to diagnose known infectious diseases - including cCMV - as well as diseases not jet recognized, therefore their storage sites and long-term storage conditions and durations should be the subject of political decision-making.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
BACKGROUND:Human parechovirus (HPeV) and enterovirus (EV) infections are widespread and can lead to a broad range of symptoms, from the common cold to severe disease (SD). Because of the lack of ...Italian data, this 4-year retrospective cross-sectional study aimed to investigate the frequency, seasonality and molecular characteristics of EV and HPeV circulating in children younger than 5 years.
METHODS:A total of 812 samples were collected from children ≤5 years (56.5% males; median age20.6 months; interquartile range30.1 months) from September 2010 to August 2014. Two real-time RT-PCR assays were used for EV/HPeV and EV-D68 detection. Phylogenetic analysis was performed on the EV-VP1 gene and the HPeV–VP3/VP1 junction.
RESULTS:16.1% and 5.2% of samples were EV- and HPeV-positive, respectively. One sample was EV-D68-positive. The majority (nearly 80%) of EV/HPeV-positive samples was detected in children ≤3 years, during the summer/autumn seasons. The risk of EV infection was higher in children presenting with SD, whereas the risk of infection from HPeV was higher in infants ≤1 year. Most (61.7%) of molecularly characterized EVs belonged to species B, followed by A (29.4%). The majority (66.7%) of characterized HPeVs were type 1, followed by types 3 (20%) and 6 (13.3%).
CONCLUSIONS:This study shows the significant impact of EV/HPeV circulation in children, particularly among those ≤3 years and during and early autumn, with different pattern of viral strains. The implementation of a national surveillance system could clarify the epidemiologic and clinical characteristics of these viruses in the general population.
Congenital CMV (cCMV) infection is a serious public health issue due to both its worldwide prevalence and the severe and permanent impairments it causes. However, awareness of this infection is low ...in the general population and among pregnant women, and it also seems to be generally disregarded by healthcare providers. The identification of factors behind this inadequate level of knowledge could provide a basis for future preventive measures. This study aimed at evaluating awareness of CMV and cCMV infection and its correlation with socio-demographic variables in a general population.
The survey was carried out by computer-assisted web interviewing (CAWI). A questionnaire was sent via e-mail to the 70,975 individuals who comprised the whole population (students, administrative staff, teaching staff) of Milan University, Italy in 2015.
Out of the 10,190 respondents, 5,351 (52.5 %) had already heard of CMV but only 3,216 (31.8 %) knew that this virus could be implicated in congenital infection. Urine and breastfeeding were the least recognized transmission routes for CMV infection; less than half of respondents accurately identified the right symptoms and sequelae caused by cCMV infection. The correct hygienic measures against cCMV infection were identified in percentages ranging from 55.6 to 75 % depending on the measures proposed but about one in three of interviewees deemed those measures unnecessary in the event of a pregnant woman already being CMV seropositive. From the mean knowledge scores the most complete quality of awareness of CMV turned out to be linked to childbearing-age (25-40 year) and with not having children, even if results for non-parents showed less of them having heard of cCMV than parents.
Our results indicate a limited and confused awareness of cCMV infection in a large, fairly young and well-educated Italian population.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•AFPS monitors the progress towards polio eradication.•AFPS is a useful tool for assessing the contribution of NPEV in AFP cases.•AFPS is able to link the molecular-epidemiological features of ...emerging NPEV.•In absence of NPEV-based surveillance systems, AFPS recognized emerging AFM cases.
Acute Flaccid Paralyses Surveillance (AFPS) monitors the emergence of polioviruses and can track Non-Polio Enteroviruses (NPEVs). We report AFPS activity in the Lombardy region (Northern Italy) from 2016 to 2018.
Fecal and respiratory samples were collected from children <15 years who met the WHO definition of an AFP case, analyzed by virus isolation in cell cultures (RD/L20B) and by a one-step real-time RT-PCR assay specific for the 5′-noncoding-region of NPEV. NPEV-positive specimens were further analyzed by sequencing a fragment of the VP1 gene.
36 AFP cases (89 stool and 32 respiratory samples) were reported with an incidence of 1.1/100’000, 0.9/100’000, 0.6/100’000 children <15 years in 2016, 2017, 2018, respectively. Poliovirus was not identified, whereas NPEVs were detected in 19.4% (7/36) of AFP cases. The presence of one Echovirus-25 (2016), two EV- and D68 (2016 and 2018), one EV-A71 (2016), and one Echovirus-30 (2016) sharing high nucleotide identity with NPEVs detected in Europe was identified.
The absence of polio was confirmed. The unpredicted detection of emerging EV-D68, EV-A71, and E-30 sharing high sequence nucleotide similarity with viruses involved in the latest outbreaks, provided valuable and up-to-date information, emphasizing the importance of monitoring NPEVs through AFPS.
This paper outlines the role of Lombardy's regional influenza reference laboratory (Northern Italy) in the surveillance of influenza-like illnesses (ILIs) in monitoring SARS-CoV-2 circulation by ...analyzing 631 consecutive nasopharyngeal swabs (NPSs) collected from ILI outpatients by sentinel physicians during the 2019-2020 season. The samples were tested by specific real-time RT-PCRs targeting SARS-CoV-2, influenza viruses, and RSVs. Results: Of these NPSs, 31% tested positive for influenza viruses, 10% for SARS-CoV-2, and 7% for RSV. No coinfections were detected. Influenza viruses and RSVs circulated throughout the surveillance period until the end of February (week 9-2020), when they suddenly ceased to circulate seven weeks earlier than during the previous five influenza seasons. After the first detection of SARS-CoV-2 in our ILI outpatients at the beginning of March (week 10-2020), SARS-CoV-2 remained the only virus identified throughout the surveillance period. Patients ≥ 65 years had a 3.2-fold greater risk of being infected with SARS-CoV-2, while school-age children (5-14 years) and children < 5 years proved to be the age groups most at risk of contracting influenza viruses and RSV, respectively. Our experience demonstrates that laboratory-based ILI surveillance networks are essential for identifying SARS-CoV-2 cases that would otherwise remain undetected, in order to stop their spread within our communities.
The quantification and molecular characterization of the AdV genome in urban wastewater samples (WWSs) collected weekly at a wastewater treatment plant (WWTP) in Milan from 1 January 2021 (week ...2021-01) to 1 May 2022 (week 2022-17) were performed. The concentration of the AdV genome was graphically compared with the AdV positive rate observed in the respiratory/gastrointestinal specimens from individuals hospitalized with acute respiratory/gastrointestinal infections collected from one of the major hospitals in Milan in the same time series. An increase in the AdV circulation in WWSs was seen from November 2021, peaking in March 2022 and overlapped with an increase in the AdV positive rate in respiratory/fecal samples from individuals hospitalized with acute respiratory/gastrointestinal infections. The molecular characterization of the hexon hypervariable region of loop 1 of AdV revealed the presence of the species F type 41 in WWSs collected from February 2022 to April 2022. The wastewater surveillance of AdV can provide crucial epidemiological characteristics regarding AdV, particularly where no clinical surveillance is ongoing. The increase in the AdV circulation in Milan both in WWSs and clinical samples temporally overlapped with the outbreak of severe acute pediatric hepatitis observed in Europe and needs to be better investigated.
(1) Background. Exploring the evolution of SARS-CoV-2 load and clearance from the upper respiratory tract samples is important to improving COVID-19 control. Data were collected retrospectively from ...a laboratory dataset on SARS-CoV-2 load quantified in leftover nasal pharyngeal swabs (NPSs) collected from symptomatic/asymptomatic individuals who tested positive to SARS-CoV-2 RNA detection in the framework of testing activities for diagnostic/screening purpose during the 2020 and 2021 winter epidemic waves. (2) Methods. A Statistical approach (quantile regression and survival models for interval-censored data), novel for this kind of data, was applied. We included in the analysis SARS-CoV-2-positive adults >18 years old for whom at least two serial NPSs were collected. A total of 262 SARS-CoV-2-positive individuals and 784 NPSs were included: 193 (593 NPSs) during the 2020 winter wave (before COVID-19 vaccine introduction) and 69 (191 NPSs) during the 2021 winter wave (all COVID-19 vaccinated). We estimated the trend of the median value, as well as the 25th and 75th centiles of the viral load, from the index episode (i.e., first SARS-CoV-2-positive test) until the sixth week (2020 wave) and the third week (2021 wave). Interval censoring methods were used to evaluate the time to SARS-CoV-2 clearance (defined as Ct < 35). (3) Results. At the index episode, the median value of viral load in the 2021 winter wave was 6.25 log copies/mL (95% CI: 5.50–6.70), and the median value in the 2020 winter wave was 5.42 log copies/mL (95% CI: 4.95–5.90). In contrast, 14 days after the index episode, the median value of viral load was 3.40 log copies/mL (95% CI: 3.26–3.54) for individuals during the 2020 winter wave and 2.93 Log copies/mL (95% CI: 2.80–3.19) for those of the 2021 winter wave. A significant difference in viral load shapes was observed among age classes (p = 0.0302) and between symptomatic and asymptomatic participants (p = 0.0187) for the first wave only; the median viral load value is higher at the day of episode index for the youngest (18–39 years) as compared to the older (40–64 years and >64 years) individuals. In the 2021 epidemic, the estimated proportion of individuals who can be considered infectious (Ct < 35) was approximately half that of the 2020 wave. (4) Conclusions. In case of the emergence of new SARS-CoV-2 variants, the application of these statistical methods to the analysis of virological laboratory data may provide evidence with which to inform and promptly support public health decision-makers in the modification of COVID-19 control measures.
In developed countries, congenital cytomegalovirus (cCMV) infection is the most common congenital viral infection, representing the leading non-genetic cause of sensorineural hearing loss (HL). ...Diagnosis of cCMV infection can be performed by detection of CMV DNA in urine or saliva within 2-3 weeks after birth, or later in dried blood samples on the Guthrie card. Currently, there are many controversies regarding the preventive, diagnostic, and therapeutic approaches to cCMV infection. HL secondary to cCMV is highly variable in onset, side, degree, audiometric configuration, and threshold changes over time. Therefore, it is of paramount importance to perform a long and thorough audiological follow-up in children with cCMV infection to ensure early identification and prompt treatment of progressive and/or late-onset HL. Early cochlear implantation appears to be a valid solution not only for children with bilateral profound HL, but also for those with single-sided deafness, improving localization ability and understanding speech in noisy environments. Moreover, the decision to apply a unilateral cochlear implant in children with cCMV is strengthened by the non-negligible possibility of hearing deterioration of the contralateral ear over time.
•Laboratory-based enterovirus surveillance detected an outbreak of echovirus 11.•Echovirus 11 only infected children; neonates were the most severely affected.•Echovirus 11 strains belonged to the D5 ...genogroup.•Echovirus 11 strains were related to the lineage circulating in Europe in 2022-23.
Following the alert of echovirus 11 (E-11) infection in neonates in EU/EEA Member States, we conducted an investigation of E-11 circulation by gathering data from community and hospital surveillance of enterovirus (EV) in northern Italy from 01 August 2021 to 30 June 2023.
Virological results of EVs were obtained from the regional sentinel surveillance database for influenza-like illness (ILI) in outpatients, and from the laboratory database of ten hospitals for inpatients with either respiratory or neurological symptoms. Molecular characterization of EVs was performed by sequence analysis of the VP1 gene.
In our ILI series, the rate of EV-positive specimens showed an upward trend from the end of May 2023, culminating at the end of June, coinciding with an increase in EV-positive hospital cases. The E-11 identified belonged to the D5 genogroup and the majority (83%) were closely associated with the novel E-11 variant, first identified in severe neonatal infections in France since 2022. E-11 was identified sporadically in community cases until February 2023, when it was also found in hospitalized cases with a range of clinical manifestations. All E-11 cases were children, with 14 out of 24 cases identified through hospital surveillance. Of these cases, 60% were neonates, and 71% had severe clinical manifestations.
Baseline epidemiological data collected since 2021 through EV laboratory-based surveillance have rapidly tracked the E-11 variant since November 2022, alongside its transmission during the late spring of 2023.
Between September and October 2018, an enterovirus D68 (EV-D68) outbreak occurred in patients hospitalised with severe acute respiratory infection in northern Italy; 21 laboratory-confirmed cases ...were reported. Phylogenetic analysis revealed that 16/20 of the EV-D68 sequences belonged to a divergent group within the sub-clade D1. Since its upsurge, EV-D68 has undergone rapid evolution with the emergence of new viral variants, emphasising the need for molecular surveillance that include outpatients with respiratory illness.
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