Food-borne botulism in Apulia region, Italy: an expert witness testimony.

We report the epidemiology of food-borne botulism in Puglia, Italy, between 1977-2017, using surveillance data and Experts' personal observations. As the disease is rare, the diagnosis is often missed or delayed, and cases are initially misdiagnosed. This was the case of a family outbreak of botulism in the 1970s.

Evaluation of measles and rubella integrated surveillance system in Apulia region, Italy, 3 years after its introduction.

This study aimed at evaluating the integrated measles and rubella surveillance system (IMRSS) in Apulia region, Italy, from its introduction in 2013 to 30 June 2016. Measles and rubella case reports were extracted from IMRSS. We estimated system sensitivity at the level of case reporting, using the capture-recapture method for three data sources. Data quality was described as the completeness of variables and timeliness of notification as the median-time interval from symptoms onset to initial alert. The proportion of suspected cases with laboratory investigation, the rate of discarded cases and the origin of infection were also computed. A total of 127 measles and four rubella suspected cases were reported to IMRSS and 82 were laboratory confirmed. Focusing our analysis on measles, IMRSS sensitivity was 82% (95% CI: 75-87). Completeness was >98% for mandatory variables and 57% for 'genotyping'. The median-time interval from symptoms onset to initial alert was 4.5 days, with a timeliness of notification of 33% (41 cases reported ⩽48 h). The proportion of laboratory investigation was 87%. The rate of discarded cases was 0.1 per 100 000 inhabitants per year. The origin of infection was identified for 85% of cases. It is concluded that IMRSS provides good quality data and has good sensitivity; still efforts should be made to improve the completeness of laboratory-related variables, timeliness and to increase the rate of discarded cases.

Incidence of Type 1 Diabetes among Children and Adolescents in Italy between 2009 and 2013: The Role of a Regional Childhood Diabetes Registry.

BACKGROUND: Surveillance represents a key strategy to control type 1 diabetes mellitus (T1DM). In Italy, national data are missing. This study aimed at evaluating the incidence of T1DM in subjects <18 year olds in Apulia (a large southeastern region, about 4,000,000 inhabitants) and assessing the sensitivity of the regional Registry of Childhood-Onset Diabetes (RCOD) in the 2009-2013 period. METHODS: We performed a retrospective study matching records from regional Hospital Discharge Registry (HDR), User Fee Exempt Registry (UFER), and Drugs Prescription Registry (DPR) and calculated T1DM incidence; completeness of each data source was also estimated. In order to assess the RCOD sensitivity we compared cases from the registry to those extracted from HDR-UFER-DPR matching. RESULTS: During 2009-2013, a total of 917 cases (about 184/year) in at least one of the three sources and an annual incidence of 25.2 per 100,000 were recorded, lower in infant, increasing with age and peaked in 5- to 9-year-olds. The completeness of DPR was 78.7%, higher than that of UFER (64.3%) and of HDR (59.6%). The RCOD's sensitivity was 39.05% (360/922; 95% CI: 34.01%-44.09%). CONCLUSIONS: Apulia appeared as a high-incidence region. A full, active involvement of physicians working in paediatric diabetes clinics would be desirable to improve the RCOD performance.

Proceedings of the Consensus Day Meeting: Implications for Rotavirus Vaccination in the 2014 Apulian Lifetime Immunization Schedule. Foggia, 17 April 2015.

Recommendations for vaccination against rotavirus (RV) were issued in Apulia in 2006; the vaccine was free of charge to children who entered day care or nursery school by 1 year of age or those affected by chronic diseases for which diarrhea caused by rotavirus can increase the risk of complications and hospitalization. In 2014, vaccination became available to all healthy children with only a copayment. However, there has not been a significant increase in vaccination coverage. On April 17, 2015, Apulian public health physicians and paediatricians met to share strategies to promote the RV vaccine indications provided in the regional immunization schedule. During the meeting, presentation of data reports were interspersed with discussions that were led with a "bottom-up" approach. The discussants responded to pre-planned questions raised by the participants and encouraged by the discussion.

A seroprevalence survey on varicella among adults in the vaccination era in Apulia (Italy).

In 2006, the Apulia Region (Italy) introduced universal routine vaccination (URV) against varicella disease. The coverage for one dose of varicella vaccine at 24 month of age reached 91.1% in 2010 birth-cohort. Vaccination coverage for the second dose at 5-6 years was 64.8% for the cohort 2005, and 28.8% for adolescents born in 1997. The aim of the present study is to evaluate the pattern of immunity/susceptibility to varicella in Apulian adults by a seroprevalence survey carried out 6 years after the introduction of URV. The study was carried out from May 2011 to June 2012 among blood donors of the Department of Transfusion Medicine of Policlinico General Hospital in Bari. Subjects were enrolled by a convenience sample. For each enrolled patient we collected a sample of serum of 5 ml. Anti-VZV IgG in collected sera were analyzed by chemiluminescence (CLIA). We enrolled 1769 subject; 1365 (77.2%) were male with a mean age of 38.4 ± 11.7 years. 93% (95% CI=91.7-94.1) of enrolled subject presented a titre of anti-VZV IgG >164 mIU/mL. GMT of anti-VZV IgG titre was 1063.4 mIU/ml and no difference was observed between different age group. According to our data, URV did not seem to have any impact on susceptibility among adults and in particular we did not note any cluster of susceptible subjects among young adults. Also in the vaccination era, we did not note that the average age of infection shifts among adults and then we could exclude an increase of case of complicated varicella related to the URV.

Addressing the anti-vaccination movement and the role of HCWs.

Over the last two decades, growing numbers of parents in the industrialized world are choosing not to have their children vaccinated. Trying to explain why this is occurring, public health commentators refer to the activities of an anti-vaccination movement. The aim of this paper is to review the literature about the anti-vaccination movements and to highlight the knowledge and the skills needed for HCWs to fight against their ideas. The main theoretical structures of anti-vaccination ideology in the 19th and 20th centuries are: vaccines cause idiopathic illness; opponents against vaccines accused vaccine partisans to be afraid of the "search after truth," they fear unveiling errors; the vaccination law not only insults every subject of the realm, but also it insults every human being; vaccine immunity is temporary; an alternative healthy lifestyle, personal hygiene and diet stop diseases. Proponents against vaccination now have additional means to communicate their positions to the general public, the Internet in particular. Doctors and HCWs constantly have to face parents and patients who search information about vaccination. A lot of these people have previously found data about vaccinations from a lot of sources, such as papers, media or in websites and in these sources most contents come from anti-vaccine movements. For these reasons doctors and HCWs need to have updated knowledge about the vaccinations and to know the contents proposed by vaccine sceptics. Educating the general public cannot be fully effective unless there is a corresponding provision, enthusiasm and commitment by trained HCWs.