[Analysis of occupational diseases in Lazio region: a comparison between Italian and foreign workers]. / Analisi delle malattie professionali nel Lazio. Confronto tra lavoratori italiani e stranieri.

In 2000-2009 in Lazio Region (Italy), 3% of reported occupational diseases occurred among foreign workers. Compared with foreigners, Italian workers more frequently reported Neoplasia (2.2% vs. 0.9%), Asbestosis (1.9% vs. 0.2%), Silicosis (1.5% vs. 0.2), while Skin Diseases were less frequently reported (1.2 vs. 2.5). Compared with foreigners, Italian workers reported more frequently occupational diseases in division "Transport" (11.1% vs. 4.6%), "Energy-Water" (6.4% vs. 1.8%), "Health System" (3.3% vs. 2.3%), "Chemical Industry" (2.0% vs. 0.2%). Compared with foreigners, Italian more frequently were acknowledged as affected by an occupational disease (27.6% vs. 14.6%). All these finding were substantially expected.

[Epidemiology of work-related accidents in the Lazio Region of Italy]. / Epidemiologia degli infortuni sul lavoro nella Regione Lazio.

BACKGROUND: Prevention of work-related accidents requires an in-depth epidemiological assessment of the issue. In Italy the most used databases are from the national insurance (INAIL) and research (ISPESL) institutes. However, these data are only available several years after the time of accident. OBJECTIVES: To describe the characteristics of accidents and evaluate factors potentially associated with hospitalization using the Information System of Hospital Emergency Departments (SIES). METHODS: We analyzed 51.705 Emergency Department (ED) work-related accident admissions in the Lazio Region of Italy in 2008 among workers aged 16-65 years. Information on socio-demographics, diagnosis, triage codes, and outcome of ED admissions were gathered. We performed a logistic regression model to estimate association between these factors and risk of hospitalization after ED admission. RESULTS: The subjects' mean age was 39.1 (SD 11.0); 71.5% woere men, 12.7% were foreigners, 5.9% arrived by ambulance, 4.5% with triage red/yellow tags, 2.7% were hospitalized. Diagnosis was trauma in 85.1%, orthopaedic lesions in 8.3%. We found a higher risk of hospitalization in subjects with: one year of age increase (OR=1.02; 95% CIs: 1.01-1.03), males (OR=1.68; 95% CIs: 1.44-1.97), foreigners coming from countries with high emigration rates (OR=1.55; 95% CIs: 1.31-1.82), ED triage red/yellow tags (OR=84.47; 95% CIs: 47.06-151.60). CONCLUSIONS: It was confirmed that data fr-om an emergency health care information system can be a useful complement to information gathered by national insurance and research institutes, thus resolving the limit posed by the delay in availability for analysis of these data after the occurrence of accidents. We also identified some factors potentially associated with more serious accidents, which constitute a basis for planning and implementing specific public health preventive interventions.

Description of two measles outbreaks in the Lazio Region, Italy (2006-2007). Importance of pockets of low vaccine coverage in sustaining the infection.

BACKGROUND: Despite the launch of the national plan for measles elimination, in Italy, immunization coverage remains suboptimal and outbreaks continue to occur. Two measles outbreaks, occurred in Lazio region during 2006-2007, were investigated to identify sources of infection, transmission routes, and assess operational implications for elimination of the disease. METHODS: Data were obtained from several sources, the routine infectious diseases surveillance system, field epidemiological investigations, and molecular genotyping of virus by the national reference laboratory. RESULTS: Overall 449 cases were reported, sustained by two different stereotypes overlapping for few months. Serotype D4 was likely imported from Romania by a Roma/Sinti family and subsequently spread to the rest of the population. Serotype B3 was responsible for the second outbreak which started in a secondary school. Pockets of low vaccine coverage individuals (Roma/Sinti communities, high school students) facilitated the reintroduction of serotypes not endemic in Italy and facilitated the measles infection to spread. CONCLUSIONS: Communities with low vaccine coverage represent a more serious public health threat than do sporadic susceptible individuals. The successful elimination of measles will require additional efforts to immunize low vaccine coverage population groups, including hard-to-reach individuals, adolescents, and young adults. An enhanced surveillance systems, which includes viral genotyping to document chains of transmission, is an essential tool for evaluating strategy to control and eliminate measles.

Incidence and risk factors of hospitalization for bronchiolitis in preterm children: a retrospective longitudinal study in Italy.

BACKGROUND: Bronchiolitis is a distressing, potentially life-threatening respiratory condition that affects infants. We evaluated the incidence and risk factors of hospitalization for broncholitis in preterm infants (i.e., a gestational age of <36 weeks) born between 2000 and 2006, and the use and impact of Palivizumab, a monoclonal antibody that in randomized clinical trials has been shown to lessen the severity of RSV-related bronchiolitis. METHODS: Retrospective cohort study that linked data from four health administrative databases in the Lazio region (a region of central Italy): the birth register, the hospital discharge register, and two ad-hoc databases that record the doses of Palivizumab administered at two local health units. RESULTS: Among 2407 preterm infants, 137 had at least one hospitalization for bronchiolitis in the first 18 months of life, an overall incidence rate of 4.70 per 100 person-years (95%CI: 3.98-5.56); similar incidence rates were observed by calendar year. A multiple Poisson model showed that the following characteristics were associated with higher incidence: younger age of the infant, the period between October-April, male gender, low Apgar score at birth, low birth weight, and low maternal educational level. At least one dose of Palivizumab was administered to 324 (13.5%) children; a dramatic increase from 2000 (2.8%) to 2006 (19.1%) (p < 0.01) was observed. Other factors independently associated with more frequent Palivizumab use were older maternal age, Italian-born mothers, female gender, low Apgar score, low birth weight, shorter gestational age, a diagnosis of broncho-dysplasia, and the month of birth. It is of note that none of the 34 children with congenital heart disease were prescribed Palivizumab. Performing several multiple Poisson models that also considered Palivizumab use as covariate, although the point estimates were in agreement with previous clinical trial results, we did not find in most of them a significant reduction for immunized children to be hospitalized for bronchiolitis. CONCLUSION: In Italy the incidence of hospitalization for bronchiolitis, and its associated risk factors, are similar to that found in other countries. Although Palivizumab use is associated with the most important characteristics of severe prematurity, other aspects of its non-use in children with congenital heart disease, the age and the birth country of the mother suggest the need for public health measures that can reduce these health disparities. Finally, the estimated effectiveness of Palivizumab in routine practice, although not significant, confirms the results of previous clinical trials, but its impact on modifying the temporal trend in this population is still negligible.

Incidence of bacterial meningitis (2001-2005) in Lazio, Italy: the results of a integrated surveillance system.

BACKGROUND: Monitoring the incidence of bacterial meningitis is important to plan and evaluate preventive policies. The study's aim was to estimate the incidence of bacterial meningitis by aetiological agent in the period 2001-2005, in Lazio Italy (5.3 mln inhabitants). METHODS: Data collected from four sources--hospital surveillance of bacterial meningitis, laboratory information system, the mandatory infectious diseases notifications, and hospital information system--were combined into a single archive. RESULTS: 944 cases were reported, 89% were classified as community acquired. S. pneumoniae was the most frequent aetiological agent in Lazio, followed by N. meningitis. Incidence of H. influenzae decreased during the period. 17% of the cases had an unknown aetiology and 13% unspecified bacteria. The overall incidence was 3.7/100,000. Children under 1 year were most affected (50.3/100,000), followed by 1-4 year olds (12.5/100,000). The percentage of meningitis due to aetiological agents included in the vaccine targets, not considering age, is 31%. Streptococcus spp. was the primary cause of meningitis in the first three months of life. The capture-recapture model estimated underreporting at 17.2% of the overall incidence. CONCLUSION: Vaccine policies should be planned and monitored based on these results. The integrated surveillance system allowed us to observe a drop in H. influenzae b meningitis incidence consequent to the implementation of a mass vaccination of newborns.

Treatment outcomes and relapses of pulmonary tuberculosis in Lazio, Italy, 1999-2001: a six-year follow-up study.

OBJECTIVES: The aim of this study was to enhance tuberculosis (TB) treatment outcome monitoring by linking diverse surveillance systems and estimating treatment outcomes including relapse. METHODS: Tuberculosis treatment was surveyed in the Lazio region (Italy) from 1999 to 2001; a six-year follow-up of notified cases was undertaken to detect relapses. The results were analyzed as a population-based case-control study comparing each unsuccessful outcome and relapse with eligible controls. RESULTS: Of the 974 patients who entered the survey, 805 (82.6%) had complete treatment evaluations; 398 (49.4%) had a successful outcome, 401 (49.8%) had an unsuccessful outcome, and six developed chronic TB. Death was associated with age >64 years (OR 5.9; 95% CI 3.1-11.2), male gender (OR 2.1; 95% CI 1.0-4.4), and using second-line drugs (OR 2.3; 95% CI 1.0-5.4). Treatment failure was associated with previous treatment (OR 3.0; 95% CI 1.4-6.7) and being male, being foreign born (OR 6.6; 95% CI 2.1-21.2), receiving second-line drugs (OR 7.4; 95% CI 1.8-29.5), and receiving modified therapy (OR 5.1; 95% CI 1.7-14.9). Relapses after successful outcomes were detected in 5.5%, for which the strongest predictor was having extrapulmonary lesions (OR 22.8; 95% CI 1.8-287.3). CONCLUSIONS: Linking our survey data to other surveillance systems improved the mortality estimates and detected a high rate of relapse. Having received previous treatment and being a foreigner were independent determinants of treatment failure, suggesting that both acquired and primary drug resistance affect TB patients in Lazio.

Cost-effectiveness of vaccinating for invasive pneumococcal disease in the elderly in the Lazio region of Italy.

Pneumococcal vaccination among the elderly is currently recommended in several western countries. We estimated the cost-effectiveness of a hypothetical vaccination campaign of 65+ year olds in the Lazio region (Italy). Baseline net costs per event averted and life-year gained, at 2001 prices, were euro 34,681 (95%CI: euro 28,699 to euro 42,929) and euro 23,361, respectively (95%CI: euro 16,419 to euro 38,297). Lower bacteraemic pneumonia incidence and vaccine effectiveness increased the net cost per life-year gained (ICER) to euro 53,899 and euro 74,313, respectively; in the best-case scenario the ICER was euro 4249. The case definition of invasive pneumococcal disease and, consequently, vaccine effectiveness are major uncertainties in countries with low incidence of pneumonia.