Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.

[Vaccines for the treatment of drug addiction]. / Vaccini contro la dipendenza da sostanze psicoattive.

The treatment of drug addiction is a very wide-ranging sector within modern medicine. The use of immunotherapy in this context represents an innovative approach. The purpose of this paper is to illustrate, through a literature review, the main avenues of research and the results obtained with immunotherapy in the treatment of drug addiction.

[General practitioner's role in immunization practice: prevention, counseling and protection of patients at risk]. / Il Medico di Medicina Generale e le vaccinazioni: prevenzione, counseling e protezione dei soggetti a rischio.

In Italy, General Practitioner (GP) plays a key role in directing patients in immunization practice, especially those at risk, who might benefit most from vaccine protection. The numerous GP's specific activities in this field include vaccine administration, reporting of adverse reactions, check of vaccination status, counseling, identification of at-risk patients, recommendation for post-exposure prophylaxis, self and ambulatory staff immunization. GP is one the main health professionals in charge of patients care and has the task to ensure both diseases prevention and health care costs restraint.

[Immunotherapeutic approach for the prevention and treatment of chronic diseases]. / Approccio immunoterapeutico per la prevenzione e la terapia delle malattie cronico-degenerative.

Alzheimer disease, diabetes and cardiovascular diseases are among the leading causes of morbidity and mortality worldwide. Different immunotherapeutic approaches for prevention and treatment of these diseases are currently object of several researches. In this paper, recent trials describing active and passive immunotherapy for the management of these pathologies are discussed. The recent immunotherapeutic and preventive approaches for the treatment of Alzheimer's disease are based on the use of ß-amyloid peptides and to tau-based immunization strategies but new possibility are explored. Immunotherapeutic vaccine against angiotensin II showed promising results for the management of hypertension. Heath shock proteins and ß2-glycoprotein I have been tested to reduce atherosclerosis. Insulin agonists were used for preventing type 1 diabetes in mouse; IL-1ß was effective in experimental type 2 diabetes. Research in the field of immunological approach to treatment and prevention of chronic diseases is promising even if the present results have been obtained mainly in animal models.

The effect of physician's recommendation on seasonal influenza immunization in children with chronic diseases.

BACKGROUND: Despite recommendations by Health Authorities, influenza immunization coverage remains low in children with chronic diseases. Different medical providers involved in the management of children with chronic conditions may affect the pattern of influenza vaccine recommendations and coverage. The likelihood of vaccination by type of provider in children with chronic conditions is poorly understood. Therefore, the objectives of this study were to analyze the pattern and the effect of recommendations for seasonal influenza immunization provided by different physician profiles to families of children with chronic diseases and to measure the frequency of immunization in the study population. METHODS: We recruited children with chronic diseases aged 6 months-18 years who subsequently presented to specialty clinics for routine follow-up visits, during spring 2009, in three Italian Regions Families of children with chronic diseases were interviewed during routine visits at reference centers through a face-to-face interview. We analyzed the following immunization predictors: having received a recommendation toward influenza immunization by a health provider; child's sex and age; mothers and fathers' age; parental education and employment; underlying child's disease; number of contacts with health providers in the previous year. Influenza immunization coverage was calculated as the proportion of children who received at least one dose of seasonal influenza vaccine in the previous season. We calculated prevalence ratios and we used a generalized linear model with Poisson family, log link and robust error variance to assess the effect of socio-demographic variables, underlying diseases, and recommendations provided by physicians on influenza immunization. RESULTS: We enrolled 275 families of children with chronic diseases. Overall influenza coverage was 57.5%, with a low of 25% in children with neurological diseases and a high of 91.2% in those with cystic fibrosis. While 10.6% of children who did not receive any recommendation toward influenza immunization were immunized, among those who received a recommendation 87.5-94.7% did, depending on the health professional providing the recommendation. Receiving a recommendation by any provider is a strong predictor of immunization (PR = 8.5 95% CI 4.6;15.6) Most children received an immunization recommendation by a specialty (25.8%) or a family pediatrician (23.3%) and were immunized by a family pediatrician (58.7%) or a community vaccinator (55.2%). CONCLUSIONS: Receiving a specific recommendation by a physician is a strong determinant of being immunized against seasonal influenza in children with chronic diseases independently of other factors. Heterogeneity exists among children with different chronic diseases regarding influenza recommendation despite international guidelines. Increasing the frequency of appropriate recommendations toward influenza immunization by physicians is a single powerful intervention that may increase coverage in children with chronic conditions.

[Therapeutic cancer vaccines: only hope or concrete opportunity for the future?]. / Vaccini terapeutici contro il cancro: solo speranza o concreta prospettiva per il futuro?

In the recent years, research in the field of anti-tumour therapeutic vaccines showed a rapid development. Many studies regarding different types of cancers are presently on going. In the trials various immunological approaches are applied and studied in combination with standard therapies. Results are controversial and anti-tumor vaccines are not licensed in the European Union and only one is commercialized in US. Before these vaccines can be considered a valid therapeutic alternative it is necessary that the characteristics of the candidate patients are clearly identified and that clinical efficacy, length of protection and safety are well documented. Moreover a correct evaluation of socio-economic and public health aspects should be available.

Hepatitis B: Epidemiology and prevention in developing countries.

Hepatitis B virus (HBV) infection is a serious global public health problem. The infection may be transmitted through sexual intercourse, parenteral contact or from an infected mother to the baby at birth and, if contracted early in life, may lead to chronic liver disease, including cirrhosis and hepatocellular carcinoma. On the basis of the HBV carrier rate, the world can be divided in 3 regions of high, medium and low endemicity. The major concern is about high endemicity countries, where the most common route of infection remains vertical transmission from mother to child. Screening of all pregnant women and passive immunization with human hepatitis B immunoglobulin are not affordable for many developing countries. The infection rate can be reduced by modifying behavior, improving individual education, testing all blood donations, assuring asepsis in clinical practice and screening all pregnant women. However, availability of a safe and efficacious vaccine and adoption of appropriate immunization strategies are the most effective means to prevent HBV infection and its consequences. The unsolved problem for poorest countries, where the number of people currently infected is high, is the cost of the vaccine. A future challenge is to overcome the social and economic hurdles of maintaining and improving a prevention policy worldwide to reduce the global burden of the disease.

Seasonal and pandemic influenza vaccine: recommendations to families of at-risk children during the 2009-10 season.

We performed a study in three Italian regions to evaluate the association between provided recommendations and immunization uptake of the two influenza vaccines in children with chronic diseases. We interviewed families of 119 at-risk children, collecting information regarding recommendations and immunizations against pandemic and seasonal influenza. In total 60.5% of children had received seasonal influenza vaccine, 38.7% had received pandemic influenza vaccine and 33.6% had not been vaccinated. The majority of immunized children had received specific recommendations by a physician. Physicians involved in the management of children with chronic diseases should actively recommend influenza immunization.

[Epidemiology and prevention of hepatitis A and B in developing countries]. / Attualità in epidemiologia e prevenzione delle epatiti A e B nei Paesi in via di sviluppo.

Viral hepatitis A and B are serious public health problems all over the world. Effective prophylactic measures and improvement in the hygienic and sanitary conditions have considerably modified the diseases trend, characterized by high prevalence levels in developing countries. In this paper the epidemiology of hepatitis A and B is reviewed, focused on endemic areas, on the basis of data collected from local and international studies in order to evaluate prevention strategies for both local population and travelers.

Epidemiologic determinants affecting cigarette smoking cessation: a retrospective study in a National Health System (SSN) treatment service in Rome (Italy).

This retrospective study aims to evaluate epidemiologic characteristics of patients attending stop smoking courses, based on group therapy, testing their influence on smoking cessation in univariate and multivariate model. A total of 123 patients were included in this study. Mean age was 53 (+/-11). Sixty-seven percent were women. At the end of the courses 66% of patients stopped smoking, after 12 months only 39% remained abstinent. Patients younger than 50 years statistically tended to continue smoking 6 months (P = .02-R.R. = 1.49, C.I. 95%: 1.06-2.44) and 12 months (P = .03-R.R. = 1.37, C.I. 95%: 1.02-2.52) after the end of the courses. A low self-confidence in quitting smoking was significantly related to continuing tobacco consumption after 6 months (P = .016-R.R. = 1.84, C.I. 95%: 1.14-2.99). Low adherence to therapeutic program was statistically associated to maintenance of tobacco use at 6 months (P = .006-R.R. = 1.76, C.I. 95%: 1.32-2.35) and 12 months (P = .050-R.R. = 1.45, C.I. 95%: 1.11-1.88). This association was confirmed at 6 months in the analysis performed on logistic regression model (P = .013).

[Active immunoprophylaxis to reduce clinical impact of Herpes Zoster and its complications]. / Prospettive dell'immunoprofilassi attiva nella riduzione dell'impatto dell'Herpes Zoster e delle sue complicanze.

Herpes Zoster is a painful cutaneous eruption caused by reactivation of Varicella Zoster Virus, years after primary infection. Approximately one third of the population, and more than 50% of persons older than 80, will present zoster in their lifetime. Zoster complications, particularly postherpetic neuralgia, are common and result in worsening health status and quality of life, with high direct and indirect costs. Licensed zoster vaccine, available in Italy in a next future, is efficacious in preventing virus reactivation and particularly in reducing complications.

[V+: strategies improving vaccination coverage among children with chronic diseases]. / V+: strategie per il miglioramento della copertura vaccinale nei bambini con patologia cronica.

Despite widespread recommendations, vaccination coverage in high-risk groups is generally low. Various interventions have shown to be effective in improving immunization rates, especially in the healthy population. In this paper, we present a project supported by the Italian Centre for Disease Control, whose aim is to study determinants of vaccine administration to children with chronic diseases and to study the effect of experimental multilevel interventions to increase vaccination coverage in these patients.

[Persistence of protection induced by hepatitis B vaccine.]. / Persistenza della protezione indotta dal vaccino anti-epatite B.

Universal mass vaccination against hepatitis B virus in infants and adolescents, together with targeted prophylaxis for risk groups, is recommended since almost twenty years all over the world to prevent infection and related diseases. Safety and effectiveness of the vaccine have been clearly demonstrated while unambiguous data about long term protection and need of booster administration are not yet available, especially for high risk subjects like health care workers and dialysis patients. By means of new vaccines and new adjuvants better results could be obtained in a next future.

[Immunization in the 3rd, 5th and 11th month of age: an Italian intuition]. / Vaccinazioni al 3 degrees , 5 degrees e 11 degrees mese di vita: un'intuizione italiana.

In Italy a vaccination schedule with three doses in the 3rd, 5th and 11th month of age is currently used. Often 1968, or even earlier, is considered as the year of the introduction of this schema. In 1966, antipolio vaccine become compulsory for all infants in the 1st year of life and in 1968 tetanus vaccine, together with diphtheria, in the 2nd year. In 1972 trivalent polio vaccine was proposed in the 3rd, 5th and 11th month of age, but only in 1981 the official schedule was stated by law. In Europe there are many different vaccination schedules and now efforts are made to find possible integration. Italian schedule allows to combine good immunogenicity with less administrations for better compliance and coverage.

[Invasive pneumococcal diseases in children and surveillance systems in Italy]. / Malattie invasive da pneumococco nell'infanzia e sistemi di sorveglianza in Italia.

Streptococcus pneumoniae is the causative agent of invasive diseases and of localized infections in children and older people. World and European epidemiological data show differences in disease incidences and in prevalences of pathogenic serotypes. Epidemiology changed after the introduction of conjugate vaccines for infants even if the still inadequate surveillance systems do not allow a comparison of the data. In this paper the Italian available epidemiological data and surveillance systems are rewied considering problems related to the emergence of new or drug-resistant strains and the advantages awaited from the new vaccines.

[Hepatitis A and Hepatitis B: present immunization strategies]. / Epatiti A e B: quali aggiornamenti sulle strategie vaccinali?

The most recent data on the epidemiology of hepatitis A and B and on the immunization strategies are presented and discussed. In Italy Hepatitis A vaccine is recommended for risk groups, while a wide strategy is implemented against hepatitis B in order to reach the elimination of the disease.