Outbreak of a new measles B3 variant in the Roma/Sinti population with transmission in the nosocomial setting, Italy, November 2015 to April 2016.

A measles outbreak occurred from November 2015 to April 2016 in two northern Italian regions, affecting the Roma/Sinti ethnic population and nosocomial setting. Overall, 67 cases were reported. Median age of 43 cases in three Roma/Sinti camps was four years, nosocomial cases were mainly adults. The outbreak was caused by a new measles virus B3.1 variant. Immunisation resources and strategies should be directed at groups with gaps in vaccine coverage, e.g. Roma/Sinti and healthcare workers.

[Tuberculosis among children and young adults in Emilia-Romagna Region (Northern Italy): surveillance system and integration with socioeconomic data]. / La tubercolosi nei bambini e nei giovani adulti in Emilia-Romagna: sistema di sorveglianza e integrazione con dati socioeconomici.

OBJECTIVES: to characterise the cases of tuberculosis (TB) aged 0-24 years reported in Emilia-Romagna (Northern Italy) Region between 2001 and 2010 through an ecological approach and from a sociodemographic perspective. DESIGN: observational study on notified TB cases, with data integration and subsequent location through geocoding and ecological deprivation index. SETTING AND PARTICIPANTS: notification records of TB cases identified by the current surveillance system. Cases were geocoded where address details were available and, through spatial intersection with census block polygons, the related deprivation index (DI) was attributed to them. MAIN OUTCOME MEASURES: deprivation index distribution of the observed cases. RESULTS: in the considered decade, 686 cases of tuberculosis in the age group 0-24 years were reported, 14.5% of the overall number of cases in the Emilia-Romagna Region. The DI was attributed to the 90.4% of cases. Notified TB cases were more frequently located in the most deprived areas. CONCLUSIONS: as other TB international surveillance systems, this study shows that it is possible to locate TB cases, to link them with census data and, therefore, to characterise with socioeconomic information. Looking ahead, the extension of the analysis to all age classes, the updating of socioeconomic data and the use of qualitative methodologies can integrate surveillance system data to better describe the social disadvantage among TB cases.

Impact of meningococcal C conjugate vaccination campaign in Emilia-Romagna, Italy.

The incidence of reported meningococcal disease in Italy is among the lowest in Europe. The trend of the disease was increasing up to 2005 and then declined after the gradual introduction of a universal Men C vaccination program in 17/21 Italian regions. Since 2006, in Emilia-Romagna region vaccination against Neisseria meningitidis serogroup C was actively offered free of charge in a single dose to the age groups 12-15 months and 14-15 years, in addition to people with defined epidemiological risk. Our aim was to measure the impact of vaccination on the incidence of meningococcal disease caused by different serogroups among the population of Emilia Romagna Region, Northern Italy (approximately 4.5 million inhabitants) subdivided by age. Using surveillance data, we computed the incidence rates of Neisseria meninigitidis related invasive disease per 100.000 inhabitants for the years 2000 to 2012. In addition, the percentage change in incidence and the mortality rates were calculated. Results indicate a 70.1% decrease in the incidence of meningococcus C-related invasive disease after the introduction of MenC universal vaccination. No case of serogroup C related infection was observed since 2006 in children aged 1-4 years. These findings suggest that the single-dose vaccination strategy against serogroup C N.meningitidis targeted to the age groups 12-15 months and 14-15 years was effective in the Emilia-Romagna population. However, the occurrence of two cases of meningiditis in a 5-month child and in a 9-years child suggests caution and careful consideration in surveillance for the next years.

Epidemiology of tuberculosis in a low-incidence Italian region with high immigration rates: differences between not Italy-born and Italy-born TB cases.

BACKGROUND: Emilia Romagna, a northern Italian region, has a population of 4.27 million, of which 9.7% are immigrants. The objective of this study was to investigate the epidemiology of tuberculosis (TB) during the period 1996-2006 in not Italy-born compared to Italy-born cases. METHODS: Data was obtained from the Regional TB surveillance system, from where personal data, clinical features and risk factors of all notified TB cases were extracted. RESULTS: 5377 TB cases were reported. The proportion of immigrants with TB, over the total number of TB cases had progressively increased over the years, from 19.1% to 53.3%. In the not Italy-born population, TB incidence was higher than in Italians (in 2006: 100.7 cases per 100,000 registered not Italy-born subjects and 83.9/100,000 adding 20% of estimated irregular presences to the denominators. TB incidence among Italians was 6.5/100,000 Italians). A progressive rise in the not Italy-born incident cases was observed but associated with a decline in TB incidence. Not Italy-born cases were younger compared to the Italy-born cases, and more frequently classified as "new cases" (OR 2.0 95%CI 1.61-2.49 for age group 20-39); 60.7% had pulmonary TB, 31.6% extra pulmonary and 7.6% disseminated TB. Risk factors for TB in this population group were connected to lower income status (homeless: OR 149.9 95%CI 20.7-1083.3 for age group 40-59). CONCLUSIONS: In low-incidence regions, prevention and control of TB among sub-groups at risk such as the foreign-born population is a matter of public health concern. In addition, increasing immigration rates may affect TB epidemiology. TB among immigrants is characterized by particular clinical features and risk factors, which should be analyzed in order to plan effective action.

Dry mouth as an initial sign of food-borne botulism: a case report and review of the literature.

Botulism is a rare neuroparalytic disease caused by a potent neurotoxin produced by Clostridium botulinum. There are different clinical types of botulism. Early diagnosis of the condition is essential for effective treatment. We report a case of food-borne botulism in identical twins characterized by severe initial oral involvement and a review of the literature about the condition.

Acute hepatitis B 14 years after the implementation of universal vaccination in Italy: areas of improvement and emerging challenges.

BACKGROUND: Italy had intermediate-level endemicity for hepatitis B virus (HBV) infection in the 1970s and 1980s. In 1991, vaccination of infants and adolescents became mandatory. We report the impact of universal vaccination 14 years after its beginning. METHODS: We performed a case-control study within a population-based surveillance for acute viral hepatitis. The incidence of acute hepatitis B (AHB) was estimated for the time since 1991, and the association between AHB and the considered risk factors was analyzed for the period 2001-2005. RESULTS: The incidence of AHB progressively decreased from 1991 to 2005, mainly for persons in the age groups targeted by the universal vaccination campaign: there was a 24-fold and 50-fold decrease in the 15-24-year and 0-14-year age groups, respectively; for the > or =25-year age group, the incidence halved. Owing to the persons' ages, approximately 3% of total AHB cases should have been the target of vaccination campaign. In 2004-2005, foreigners accounted for 14% of total cases and for 57% of persons who should have been targets for vaccination. Missed opportunities for immunization were documented for approximately 50% of patients with AHB who reported cohabitation with HBV carriers and for 70% of those who reported injection drug use. The strongest associations with AHB were found for blood transfusion (adjusted odds ratio [OR(adj)], 8.4; 95% confidence interval [CI], 2.7-26), cohabitation with HBV carriers (OR(adj), 5.3; 95% CI, 3.6-7.7), injection drug use (OR(adj), 3.8; 95% CI, 2.5-5.8), and unsafe sexual practices (OR(adj), 2.8; 95% CI, 1.9-4.2). CONCLUSION: Universal vaccination has contributed to a decreasing AHB incidence in Italy, especially by reducing the risk of infection among persons aged 15-24 years. Most infections occur in persons aged > or =25 years in association with injection drug use, unsafe sexual activity, percutaneous treatment, and iatrogenic exposure. Improvement of vaccine coverage in high-risk groups and adherence to infection control measures during surgery and percutaneous treatment are needed. The high risk still associated with blood transfusion needs to be further investigated, with consideration of occult HBV infection in blood donors. The potential spread of HBV infection from the immigrant population deserves adequate health policy prevention programs.

[Chikungunya emergency in Emilia-Romagna: learning through experience]. / L'emergenza Chikungunya in Emilia-Romagna: apprendere dall'esperienza.

This paper summarizes the Emilia-Romagna strategy to face the 2007 emergency, caused by a Chikungunya epidemic outbreak with local virus transmission by Ae. albopictus. The paper describes the trend of epidemic and the interventions adopted to face toward the event. The first cases were in Ravenna and Cervia and then the outbreak spread toward other areas: the Provinces of Forlì-Cesena, Rimini and Bologna. Last case was notified 2007 28th September; Health Ministry declared over the outbreak on 2007 20th November. Emilia-Romagna Region did not consider over the trouble and prepared a Plan for the fight against the asian tiger mosquito and the prevention of Chikungunya and Dengue fever for 2008, activating an health surveillance system and optimizing the entomological control of the territory.

[Diagnostic delay in patients with pulmonary tuberculosis]. / Ritardo diagnostico in pazienti con tubercolosi polmonare.

Delay in pulmonary tuberculosis diagnosis prolongs the period of time in which a patient is infectious, promoting tuberculosis transmission. We quantified diagnostic delay and examined delay associated factors in a regional wide case-control study set in Emilia-Romagna. A total 55 days median delay, with no significant difference between native and foreign-born patients, was observed in this study. Longer delay was observed when a general practitioner was consulted as first provider and when clinical picture was not fully manifest. This study points out the need of improving physicians' awareness of tuberculosis disease especially when they care for elderly people and foreign-born patients.