Anti-varicella-zoster vaccination in contacts of children receiving antineoplastic chemotherapy: a prospective pilot study.

Varicella may be a severe infection in children with malignancy. Varicella vaccination is either not recommended for immunocompromised children or it requires temporary discontinuation of immunosuppression. We prospectively evaluated the feasibility of a varicella vaccination programme of household contacts of varicella-negative children receiving antineoplastic chemotherapy. From April 2004 to April 2005, 207 children were evaluated; in 49 (24 percent) the attending physicians collected no history about previous varicella and performed no serological evaluation before any transfusion. Among the 158 patients with complete history and/or a screening test, 51 (32 percent) were negative, with a total of 110 household contacts eligible for the study. Of these, 13 (12 percent) subjects resulted negative for varicella. In three of them vaccination was not performed due to parental refusal. This study demonstrates the difficulties in implementing a varicella vaccination programme targeting negative household contacts of immunocompromised children. The attitude of paediatric oncologists and parental refusal currently represent the main challenges against the complete success of this strategy in countries where VZV vaccination is not inserted in the general vaccination programme.

[Difficulty in diagnosing pediatric tuberculosis]. / Tubercolosi pediatrica una diagnosi difficile.

Tuberculosis (TB) in children is an important warning sign in a community, as it could signal recent infection of a cavitary form in an adult. Thus, while early diagnosis is crucial for effective treatment in children, it is also imperative for the control of tuberculosis at the public health level since it allows rapid identification of contagious adult cases. Here we report four cases of difficult and delayed diagnosis of TB in children. From this experience we highlight the need for an extensive medical history of the patient during diagnostic work-up. This includes: the positive history for contact with infected adults, especially for immigrant children; exclusion of TB diagnosis for persistent respiratory symptoms (2-3 weeks) after antibiotic therapy; and the need for high-definition CT scan when the radiological picture is not specific, especially for children under 5 years of age.

Varicella and its complications as cause of hospitalization.

Varicella is an acute contagious disease that most commonly occurs in childhood. Although normally benign, varicella can occasionally develop into a more serious illness. Moreover, the infection can lead to serious complications, such as Staphylococcus aureus infections, otitis media, endocarditis, pneumonia, and rare central nervous system (CNS) events like cerebellar ataxia and encephalitis. This study was conducted to analyze the hospitalization rate due to varicella or its complications in a tertiary care hospital in Italy, where varicella vaccination has not yet been implemented. The review was carried out on cases of children with varicella identified by ICD9 and ICD9-CM diagnostic codes and admitted to the Giannina Gaslini Children's Research Hospital of Genoa, Italy, from January 1st, 1995 to December 31st, 2004. For each case reporting complications, the clinical report form was extracted and the events recorded. Varicella was recorded in 346 (0,16%) out of 212,647 total hospital discharges. Chickenpox with detailed complications and cerebrovascular diseases accounted for 56 discharges (12.14%), for a total of 728 days. Fifteen patients needed more than one hospitalization because of severe sequelae as result of CNS involvement. We reported three particular cases of invasive infections and four children affected with cerebrovascular diseases following varicella. Our retrospective data regarding a single tertiary care pediatric hospital shows that hospitalization due to varicella or its sequelae may present an important medical and indirect economic problem.

Correlation between meteorological conditions and Parietaria pollen concentration in Alassio, north-west Italy.

The pollen grains in the atmosphere in different geographical areas differ according to the species present, the pollination seasons and pollen grain concentrations, but possibly the greatest contributors to this variability are the meteorological conditions. The aim of our research is to establish a possible correlation between Parietaria pollen concentration and meteorological conditions during the period from 1991 to 1995 in the town of Alassio (north-west Italy). As far as vegetation is concerned, the Mediterranean climatic conditions support the blooming of extensive grasslands in the environment surrounding the town; these grasslands mainly comprise Urticaceae and shrubs. The study demonstrates that the most influential parameters affecting the Urticaceae grain concentration upsurge are the absence of rainfall, a maximum daily temperature of about 21 degrees C, and a diurnal temperature range of about 5 degrees C. Moreover, our aeropalinological study indicates that this last parameter has the greatest influence on Urticaceae pollination. In fact, an increase in diurnal temperature range could be responsible for a dehydration of pollens resulting in a loss in mass. This grain lightness and volatility would ultimately permit atmospheric dispersion if there is a significant wind speed. On the other hand, days with rain or high relative humidity make pollens heavier, preventing them from flying long distances and therefore partially explaining the decline in airbone pollen concentration.

[The surveillance of the aeraulic and hydraulic system reduce environmental Aspergillus contamination in hospital]. / Utilità della sorveglianza degli impianti aeraulici e idraulici ai fini di ridurre la contaminazione aspergillare degli ambienti ospedalieri.

The aim of this work was to value the evolution of environmental Aspergillus contamination in hospital with respect to aeraulic system and bathrooms works. An analysis on levels of air and surface Aspergillus contamination were determined in patient's rooms and various common sites in a ward of an hospital in Genoa in 1999. As high contamination levels were found, in summer 1999 a radical disinfection and revision of the aeraulic system was settled. In spite of these interventions some samples maintained an high contamination level, even if from only two rooms, so a further disinfection of bathrooms and surfaces became necessary. A period of sampling was conducted after this last intervention until November 2002. At the beginning of our surveillance 59% positive samples and about 50% of them with high contamination level (>1000 CFU/m3) were found. After the revision of the aeraulic system the reduction of positive samples was significative (14.2%), besides all the positive samples regarded only two rooms. In the last valuation period, after a further disinfection of bathrooms and surfaces of the above mentioned rooms, all the samples taken resulted with a contamination level lower than 10 CFU/m3. This findings underlines the importance of environmental surveillance looking for all the contaminated sources; in particular the aeraulic and hydraulic system as well as the proximity hospital building yard not sufficiently protected.