[Tuberculosis in Prato (Tuscany Region, Central Italy) in the period 2007-2014]. / La tubercolosi a Prato nel periodo 2007-2014.

OBJECTIVES: a description of the epidemiology of tuberculosis in the province of Prato (Tuscany Region, Central Italy) during the period 2007-2014 and verify the latency time between the onset of symptoms and the start of therapy. DESIGN: descriptive, observational study. SETTING AND PARTICIPANTS: tuberculosis cases were identified for the period 2007-2014 through an analysis of the notification files available at the Hygiene and Public Health Service of the Local Health Unit of Prato and through the Information System on Infectious Diseases database. RESULTS: in the years 2007-2014, 619 cases of tuberculosis were reported in the province of Prato, of which 465 (75.12%) were cases of pulmonary TB. The annual rate ranges from 35.2 cases per 100.00 inhabitants in 2010 to 18.5 cases per 100.000 inhabitants in 2012. The median age of foreign-born patients was significantly lower than the one of Italian-born subjects (34 years; interquartile range - IQR: 28-41 vs. 63 years; IQR: 45-77; <0.0001). The rate of cases in patients above 64 years and below 64 years was significantly different between Italian and foreign subjects (<0.01); this dissimilarity remained significant even after stratification by gender. Males were the most affected, in line with regional and national data. The average delay between the date of onset of symptoms and the initiation of therapy was 59 days (IQR: 28-104). CONCLUSIONS: tuberculosis is a complex disease both from an epidemiological and a clinical point of view. This complexity is more relevant in areas where different ethnic groups live together. The data presented in this paper show the necessity of an intervention to improve access to healthcare facilities through a deep collaboration among who works in public health, in general medicine, and in the multidisciplinary integrated care of the considered area.

Assessment of the effectiveness of the universal varicella vaccination program in Toscana (Italy), in the period 2010-2013.

OBJECTIVE: To assess the effectiveness of the varicella vaccination program in Toscana after one dose of vaccine, in the birth cohorts 2008-2011. DESIGN: Varicella vaccine effectiveness (VE) was calculated using the "screening method", based on vaccine coverage (VC) at 24 months and proportion of vaccinated subjects among varicella notified cases (PVC), verified through the Local Health Units' (LHUs) immunization registries. Breakthrough varicella (BV) was defined as a case of varicella occurring in a child vaccinated ≥42 days before the date of disease onset. SETTING AND PARTICIPANTS: The study was conducted in the 12 Tuscan LHUs and included all varicella cases notified in 2010-2013 in children of the birth cohorts 2008-2011. MAIN OUTCOME MEASURES: BV cases; VE after one dose of varicella vaccine; time interval between varicella vaccination and symptom onset. RESULTS: VC was 79.8%, VE reached 90.8%(95%CI 89.5%-92.0%) and the proportion of BV among notified cases was 26.6%. The median time interval between vaccination and symptom onset was 25 months. CONCLUSIONS: The very low rate of BV cases among vaccinated children confirms the high effectiveness even of a single dose of varicella vaccine and does not support a change of the current immunization schedule.