Mumps: a current epidemiologic pattern as a necessary background for the choice of a vaccination strategy.

Before the measles mumps rubella (MMR) vaccination was widely offered, the epidemiologic data about mumps (morbidity, immunization level, vaccine coverage) were analyzed in Piedmont region (Italy). The disease had a 3- to 5-year epidemic recurrence with morbidity rate between 40 and 150/100,000; the surveillance conducted by 'sentinel' pediatricians showed that the notifications underestimated the real data by about 5- to 7-fold. The 12-year-old subjects showed an immunization level (reached by the disease or the vaccination) of about 50% and their parents tended to refuse the MMR vaccination. Only 54% of the 3- to 5-year-old children received the MMR vaccine in the second year of life and the frequency of the vaccination failure was about 10%. The strategy of vaccination should take into account this epidemiologic pattern, to program an offer adequate to reach mumps control/elimination; the strategy of our region should include the active offer in the second year of life to reach higher coverage, a second offer at 4-6 and/or 12 years of life, when other vaccinations are given and the choice of a highly efficacious vaccine. The improvement of the notification system could also allow a more sensitive surveillance of epidemiologic patterns.

Moderate alcohol consumption and spontaneous abortion.

A prospective study was carried out on 546 women interviewed during pregnancy about their drinking habits, in order to evaluate the association between alcohol consumption during pregnancy and spontaneous abortion. Pregnancy outcome (normal or abortion) was analysed as a dependent variable in a multivariate model where different levels of drinking were taken into consideration as independent-effect variables. A significant increase in the risk of abortion was observed in the 30+ age category and in the higher parity category; no significant trend was evidenced for alcoholic variables, even after controlling for the other potentially confounding variables. The possible underestimation of alcohol consumption, due to reluctance in declaring real consumption by the women interviewed, is discussed. It is concluded that, on the basis of these and other data reported in the literature, a low level of alcohol consumption during pregnancy does not appear to be a significant risk for abortion.

Compulsory and non-compulsory immunizations: contraindications perceived by medical practitioners.

A total of 284 general practitioners (GPs), paediatricians and doctors of public vaccination centres (DPVC) were interviewed to investigate their willingness to immunize children with compulsory (diphtheria-tetanus, oral polio) and non-compulsory (measles, pertussis) vaccines in the presence of 19 different medical histories. We observed a reluctance to immunize in the case of false contraindications, a lack of information mainly about non-compulsory immunizations, and doubts about the real contraindications to polio, measles and pertussis vaccines. The frequency of correct answers to the question posed was significantly higher in the group with less than 20 years of experience, and the DPVCs proved better informed about immunization. However, the crucial role played by the GPs and paediatricians' advice can prejudice the correct use of active immunization.

[Reliability and completeness of an integrated epidemiologic system of acute viral hepatitis]. / Attendibilità e completezza del sistema epidemiologico integrato dell'epatite virale acuta.

An integrated epidemiological system for the surveillance of acute viral hepatitis (Seiva) has been performed in Italy. Aim of the present work is to evaluate diagnostic completeness and reliability of the surveillance system in the Piedmont Region. Results show that 15% of Acute Viral Hepatitis are not reported by the system and that the potential diagnostic errors are 7.3% of the cases.

[Immune response to toxoplasma infection]. / La risposta immunitaria in corso di infezione toxoplasmica.

The Authors studied the response of 49 subjects (23 affected by toxoplasmosis, 6 with systemic lymphopaties, and 20 apparently healthy controls) to the stimulation of lymphocytes both with an aspecific mitogen (PHA) and a specific one (toxoplasma antigen). No difference was found in the response to PHA, but when the specific antigen was used, patients with toxoplasmosis showed a significant increase of the lymphocytes stimulation index when compared to patients with systemic lymphopaties and to controls.