Impact of influenza during the post-pandemic season: epidemiological picture from syndromic and virological surveillance.

INTRODUCTION: Following the observation that 1 or 2 pandemic peak due to the circulation ofAHINlv had occurred in most countries and in most World Health Organization (WHO) Regions, WHO declared on August 10"h, 2010 that the world was moving into the post-pandemic period, whose surveillance presents considerable interest both from epidemiological and clinical point of view. We described the epidemiological picture emerged from syndromic and virological surveillance during the post-pandemic season in Liguria, Italy. MATERIALS AND METHODS: An Emergency Department Syndrome surveillance system, based on data collected at "San Martino" and IRCCS "G. Gaslini" Liguria Regional Reference University Hospitals for adults and children is active since July 2007. Monitored syndromes include "Influenza-Like Illness" (ILl) and "Low Respiratory Tract Infections" (LRTI). The Ligurian Regional Reference laboratory for Influenza virological surveillance and diagnosis offers rapid detection of influenza viruses by real-time and block RT-PCR, viral culture and genetic characterization by entire sequence analysis of haemagglutinin- and neuraminidase-coding regions in accordance with the international standards established by the global laboratory network. RESULTS AND DISCUSSION: The integration of syndromic surveillance system and laboratory surveillance for rapid detection and characterization of the disease responsible agent represented a specific and sensitive tool for influenza surveillance. The post-pandemic season was characterized by early onset and by the heaviest impacts for ILI and LRTI among the recent epidemic seasons. In contrast to the picture observed during the pandemic season, the 2010/11 winter was characterized by the intensive circulation of pandemic AH1N1v coupled with sustained activity due to influenza B and Respiratory Syncytial Virus (RSV). Antigenic and molecular characterization of influenza strains confirmed the good matching between circulating and 2010/11 vaccine viruses.

Evaluation of microbial contamination of air in two haematology departments equipped with ventilation systems with different filtration devices.

BACKGROUND: Nosocomial infections (NI) are above all due to health-care workers practices, but also the contamination of the environment could lead to their rise in health-care facilities. Introduction. In the last years, the incidence of NI has increased due to a substantial rise in the number of immuno-compromised patients. These patients are often gathered in hospital areas declared at "high risk" of infection such as Hematology and Bone Marrow Transplant ward. In this study, we evaluated microbial contamination of the air in two divisions with high risk patients, focusing on the validity of the air system with correlation to the presence or not of the HEPA absolute filters. METHODS: An environmental surveillance study has been carried out in two Divisions of Haematology, in two different Hospitals. Investigations have been performed by sampling air and by analyzing bacterial and fungal growth on microbiology plates after an incubation period. RESULTS: Unit A, without HEPA filters in the ventilation systems, showed a gradual increase in the bacterial load 20 and 60 days after cleaning of the ventilation system. Mycetes and Aspergilli were not present in basal conditions, at 20 or 60 days after decontamination. Unit B, equipped with HEPA filters placed at the inlet vents, showed extremely low values of the bacterial load either in basal conditions or upon inspection 60 days after cleaning. No mycetes were present. DISCUSSION: From the results obtained, it was evident that following the cleaning operation, the quality of the air is excellent in both types of equipment, since no mycetes were present and the bacterial load was < 20 CFU/mc in all the sites tested. However, although in subsequent controls mycetes were absent in both types of equipment, a great difference in the suspended bacterial load was found: Unit B was close to sterility whereas in Unit A a progressive increase was observed.

Microbiological surveillance of hospital ventilation systems in departments at high risk of nosocomial infections.

The air in hospital wards with patients at high risk (Surgeries, Intensive Care Units and Bone Marrow Transplant Centers) has been surveyed less than the one in Operating Rooms. Therefore in this study we considered useful to verify the microbic contamination of the air of those wards evaluating the consistency of ventilation systems in relation also to the presence and location of HEPA absolute filters. Seven departments of Genoese San Martino Hospital at high risk of infection were taken into account. In there, environmental investigations have been performed by air samplings and by analyzing bacterial and fungal growth on plates after an incubation period. Almost 60% of all samples taken in wards yielded a positive result and the average values of bacterial and aspergillar charges measured at air flow emission openings decisively exceed the ones considered standard in operating rooms. Still, the average values of airborne bacterial charges were significantly higher in those wards equipped with central filters (p < 0.001), while as far as the aspergillar charge is concerned, no statistically relevant differences were noticed. In wards with ventilation system, the bacterial charge value raises from the emission grids to the middle of the room and to the aspiration grids, while the ward not equipped with a ventilation system presents in the middle of the room an average bacterial charge 2 to 10 times higher than the one in other wards. The average values regarding bacterial and aspergillar charges resulted quite high in all the departments surveyed. Nevertheless, if we take into account ventilation systems equipped with absolute filters HEPA located centrally or peripherally, it can be outlined that the air quality from the point of view of both microbic and aspergillar contamination turns out to be decisively better in systems with peripheral filters. Moreover, a compared analysis of the three Hematology wards allows us to infer that the presence of artificial ventilation systems can lower the bacterial and fungal compared with a ward with natural ventilation.

[Reduction of the incidence of nosocomial infections after assessing and revising the quality of assistance in a thoracic surgery unit]. / Riduzione del tasso d'incidenza delle infezioni ospedaliere in una U.O. di Chirurgia Toracica mediante verifica e revisione della qualità assistenziale.

An active surveillance for nosocomial infections has been lead in a Thoracic Surgery with the intention, first to point out their frequency and characteristics, and then to outline all the measures to remove the main risk factors checking the results obtained. A prospective incidence study has been promoted in a Thoracic Surgery in the years 2000, 2001, 2002. The analysis has been lead weekly gathering all necessary data from the health records and making laboratory tests to look for microbes growth in the air of Thoracic Surgery Operating Rooms. A nosocomial infections incidence of 13.3% among surgically treated patients has been registered in 2000. Deep surgical site infections were the most frequent localizations, and microbes isolated were Staphylococcus aureus and coagulase negative Staphylococcus with an high oxacillin resistance (70.6%-76.5%). From the observation of the risk factors the sterilization system has been modified and the assistance and environmental protocols have been improved. In the further evaluation period, a global reduction of nosocomial infections incidence (7.1%), of surgical site infections (from 10.1% to 4.5%) (p = 0.007), of Staphylococcus aureus and coagulase negative Staphylococcus isolations have been obtained even if short results in antibiotic resistances have been registered. Thoracic Surgery has to be considered an area at medium-high risk of nosocomial infections. The quite high incidence of nosocomial infections recorded at the beginning of the study in presence of prevalent deep surgical site infections from staphylococci with an high oxacillin resistance compelled to promote corrections. These lead to a remarkable decrease in incidence of nosocomial infections even if the same results can not be reached in antibiotic resistances.

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.