Impact of vaccination programs against measles, varicella and meningococcus C in Italy and in Tuscany and public health policies in the last decades.

The World Health Organization (WHO) has established specific targets for control, elimination or eradication of some vaccine preventable infectious diseases, which were periodically updated. In Italy, WHO recommendations have been endorsed and implemented over time, through the national and regional health prevention plans. The aim of the study was to assess the impact of the immunization practices against measles, varicella and Neisseria meningitidis type C (Men C) in Italy and in Tuscany Region, during the last decades, by analyzing national and regional surveillance databases. Benefits of vaccination strategies were discussed from different points of view (clinical, epidemiological, economic, ethical, social and communicative). The implementation of measles, varicella and Men C vaccination, caused a considerable decrease of incidence rates over the years in Italy and in Tuscany too. However, in the last years, notifications of measles and Men C cases in subjects not targeted by immunization campaigns, in Italy and in Tuscany, are a cause for concern for public health and for the achievement of the elimination goals. Achieving and maintaining high vaccine coverage guarantees a decrease in the incidence of serious diseases and their clinical and economic consequences, but it is necessary to strengthen surveillance system of infectious diseases in order to monitor epidemiological trends. Moreover, outreach campaigns are necessary to raise awareness in the general population and create the culture of prevention with the same nationwide health goals for all.

The role of the general practitioner in the screening and clinical management of chronic viral hepatitis in six EU countries.

INTRODUCTION: Chronic viral hepatitis is still a major public health concern in the EU. In order to halt the progression of the disease and to prevent onward transmission, timely recognition and accurate clinical management are crucial. The aim of the present study was to investigate the role of the general practitioner (GP) in the screening of persons at risk and in the clinical management of chronic viral hepatitis patients in six EU countries. METHODS: An online survey among GPs and secondary-care specialists was conducted in the UK, Germany, the Netherlands, Hungary, Italy and Spain. In the GP survey, we used a four-point Likert scale to find out how commonly risk groups are screened. In both surveys, we measured GPs involvement in monitoring clinical indicators in patients undergoing antiviral treatment, and explored whether patients in four clinical scenarios are referred back to primary care. RESULTS: Between five and 10 experts per professional group were surveyed, except for Spain (GPs: n = 2; Specialists: n = 4) and, in the case of the GP survey, Hungary (GPs: n = 1) and Germany (GPs: n = 4). Migrants are variably or not routinely screened for hepatitis B/C in the majority of cases. The majority of GPs reported that hepatitis B/C screening was routinely offered to people who inject drugs. In Hungary, Italy and in the Netherlands, screening sex workers is not a regular practice. As to whether GPs offer screening to men who have sex with men, responses varied; in Germany, the Netherlands and Italy, screening was "variably" or "commonly" implemented, while in Hungary the practice seems to be sporadic. In the UK, screening for hepatitis B seems to be common practice among GPs, while hepatitis C testing is only occasionally offered to this risk group. Most GPs (> 44%) in all countries except Hungary reported that hepatitis B/C screening was very commonly offered to HIV patients. The role of GPs in monitoring hepatitis cases and the referral of cases back to GPs by specialists varied both within and between countries. GPs are unlikely to monitor clinical outcomes other than side effects in patients undergoing treatment. Patients who have had a sustained virological response are usually referred back to GPs, whereas patients undergoing antiviral treatment and those who do not respond to treatment are rarely referred back. CONCLUSIONS: The GP's decision to offer screening to risk groups often seems to be an individual choice of the healthcare professional. Raising GPs' awareness of the disease, for example through the adoption of effective strategies for the dissemination and implementation of the existing guidelines for general practice, is strongly needed. The role of GPs and specialists involved in the management of chronically infected patients should also be clarified, as opinions sometimes differ markedly even within each professional group.

Present situation and new perspectives for vaccination against Neisseria meningitidis in Tuscany, Central Italy.

BACKGROUND: In Italy one third of bacterial meningitis are caused by Neisseria meningitidis. In March 2005, the Regional Health Authority of Tuscany included the meningococcal serogroup C conjugate (MCC) vaccine in the recommended vaccination program with a schedule of three doses to all newborns at 3, 5 and 13 months of age (from 2008 amended to a single dose at 13 months) and a single catch-up dose until age 6. OBJECTIVE: To evaluate the impact of the current national and regional immunization strategies against N. meningitidis and to highlight new perspectives for meningococcal disease prevention with the existing tetravalent meningococcal vaccine (ACWY) and with the future incoming meningococcal B vaccines. METHODS: Meningitis incidence rates in Italy and in Tuscany were calculated for the period 1994-2011 and 2005-2011,respectively. Immunization coverage with MCC vaccine in Tuscany and vaccination status of meningitis cases were reported. Literature review on meningococcal conjugate vaccine use and recommendation was performed. RESULTS: A decrease in incidence rates of meningococcal meningitis was observed in all age groups involved in the immunization campaign. Immunization coverage with MCC increased progressively year by year in Tuscany. A herd immunity effect was measured in unvaccinated age groups. Since 2006 no cases of invasive meningococcal C infection in vaccinated subjects were observed in Tuscany. CONCLUSIONS: Implementation of MCC vaccination in Tuscany was effective in preventing meningococcal C disease, confirming the effectiveness of the vaccine. A new tetravalent (ACWY) conjugate vaccine is now available and its use in all Italian Regions should be considered.

[Mass communication during the "H1N1 flu"]. / La comunicazione di massa durante l'evento "influenza H1N1".

Nowadays communication plays a key role in healthcare, especially when a detailed risk analysis is important for correct information, as in the case of the H1N1 flu virus A. Through our study we have analyzed how the event "H1N1 flu" was addressed by the media, considering the period April 2009-June 2010. We collected the information from "Il Corriere della Sera", "La Repubblica" and "City", in addition to an online site for general information such as "TGCOM". The analyzed peak of daily news was seen a few weeks before the pandemic peak; in addition, after the peak of the pandemic, the interest of the press has completely collapsed, and eventually disappeared altogether. The media can influence the thought and consequentially how the recipients act, leading to a misperception of risk ('risk') and danger ('hazard'). Moreover the institutions and health professionals are not always able to communicate effectively to meet the needs for correct information. It is desirable in the future a greater degree of collaboration between media and authorities to have a clearer simpler and less misleading communication in the health field, helping recipients to act properly.

Sexual behavior, use of contraceptive methods and risk factors for HPV infections of students living in central Italy: implications for vaccination strategies.

The most frequent risk factors related to the infection/persistence of HPV in the population are an early start of sexual activity, the number of sexual partners, smoking, and the utilization of some contraceptive methods. In Italy, HPV vaccine is offered free of charge to all 12-year-old female adolescents, with a possible extension to other age groups according to Regional policies. In order to value the suitability of the current HPV vaccination strategies in Italy, an epidemiological study on sexual habits in adolescents and young adults was organized. An anonymous questionnaire on sexual behavior and risk factors for HPV infection was administered to 2300 students aged 13-24 years attending secondary schools and universities in Tuscany during 2008-09. About 12% of the sample declared to be foreign citizen. The results highlight the early start of sexual activity among young students. Particularly, more than half of the interviewed students declared to be already sexually active. The mean and the median age of the first sexual intercourse was 15.4 +/- 1.4 years and 15 years (25th and 75th percentiles = 14-16), respectively. More than 77% of students at age 16 years declared they already had the first sexual intercourse, compared with 0.3% of those <12 years. Generally, females aged 13-16-years, if sexually active, had sexual contacts with a single partner. Most students declared to know common contraceptive methods (male condom and contraceptive pill). However, only half of them declared a regular use of male condom. These data confirm the importance of vaccination against HPV for young females before their sexual debut. In addition, the current multi-cohort strategy of HPV vaccination in Tuscany (free of charge in the age range 12-16 years) allows also to catch up those girls that have not yet had their first sexual experiences before 16 years (21.5% according to our study) but also to those girls already sexually active, who very rarely are already infected by all vaccine types at 16 years. Our results also show the importance of sexual health education and of promotion of correct behaviours in schools.

Performance of horizontal subsurface-flow treatment wetlands in fecal bacteria removal.

This work evaluated sub-surface flow (SSF) constructed wetlands and activated sludge plant efficiency in pathogen removal. The two were also compared. The removal of fecal bacteria (total coliforms, fecal coliforms, fecal streptococci) was evaluated. Analysis was carried out during one year by determining the amount of bacteria in the inflow and the outflow of four systems: three SSF systems (two were pilot plants and one a fully operating plant) and an activated sludge plant. MPN techniques were used to determine the quantity-value of the microorganisms. Percentages of fecal bacteria removal in wetlands systems were as good as (and sometimes better than) those recorded in the activated sludge plant. Optimal values of these bacteria were obtained in the outflow of the post-treatment pilot plant: very high bacterial removal percentages (>99%) were recorded. SFS constructed wetlands are a valid solution for the final treatment of the outflow of existing plants.

Prevalence of hepatitis A virus infection in sewage plant workers of Central Italy: is indication for vaccination justified?

Prevalence of antibodies to hepatitis A virus (HAV) was studied in a group of 65 sewage plant workers living in Tuscany, Central Italy. In order to evaluate the effect of several confounders (age, place of birth, income, educational degree, sea-food consumption, etc.), subjects under study were matched with 160 other workers residing in the same area. Anti-HAV was detected in about 51% of sewage workers and 44% of other employees. The difference was not statistically significant. Both univariate and multivariate analysis showed that the main variables related to previous HAV infection were increasing age (P<0.001), birth in Southern Italy (P<0.01) and lower educational degree (P<0.001). Although other studies in Northern and Central Europe showed a slightly higher risk of infection in sewage workers versus general population, lack of evidence of occupational risk in Italy might be explained by the relative importance of a higher degree of viral circulation in the past. The changing epidemiology of HAV infection in Italy with increasing numbers of susceptibles in adults and the potential occupational risk suggest that the present indication to immunize sewage plant workers against hepatitis A should be maintained.

Impact of routine infant and adolescent hepatitis B vaccination in Tuscany, Central Italy.

BACKGROUND: In Italy routine infant and adolescent immunization against hepatitis B was introduced in 1991. OBJECTIVE: Evaluation of (1) coverage with three doses of hepatitis B vaccine in infants and adolescents; (2) seroconversion to anti-hepatitis B surface antigen antibody (anti-HBs) in adolescents receiving three doses of vaccine; (3) concordance of coverage rates in infants with prevalence of neutralizing antibodies in sera from anonymous children; (4) trend of notified cases of acute hepatitis B. METHODS: A sample of infants and adolescents living in Tuscany was studied during 6 years (1992 through 1997) by matching birth records and immunization certificates. Sera from 139 adolescents who completed the vaccination course and from 159 anonymous children belonging to immunized cohorts (1 to 5 years) were tested with a quantitative anti-HBs assay. Incidence of acute hepatitis B by age was calculated from regional statistics on notified infectious diseases between 1992 and 1996. RESULTS: Overall 10,606/11,164 (95%) infants and 10,599/11,100 (95%) adolescents received 3 doses of vaccine. Seroconversion to anti-HBs was detected in 98% of adolescent vaccinees. Anti-HBs titers > or =10 IU/l were detected in 87% of children. A 49% decline of acute hepatitis B cases was registered between 1992 and 1996 in 15- to 24-year-olds living in Tuscany. No case occurred in vaccinated adolescents. CONCLUSIONS: Coverage against hepatitis B is excellent in cohorts subject to mandatory immunization. If efforts to vaccinate are maintained at these levels, elimination of hepatitis B virus transmission could occur within few decades in Italy.

Experience of hepatitis A vaccination during an outbreak in a nursery school of Tuscany, Italy.

An outbreak of hepatitis A started in late October 1996 in a nursery school in Tuscany, Italy. A programme of hepatitis A vaccination without the use of immunoglobulin started at the beginning of December 1996 and included 33 children, 21 household contacts and 6 adults working in the school. Overall, 11 cases occurred in children attending the school (attack rate 27%) and 10 among their household contacts (attack rate 9 %). The latter also included parents, and, in two cases, grandmothers. The data indicate that susceptibility to HAV has increased over recent decades in central Italy. Past and recent experience shows that the usual duration of hepatitis A epidemics in the absence of immune prophylaxis is longer than that described here. The use of hepatitis A vaccine probably contributed to the early extinction of the outbreak, because no further cases were notified in the area after 7 February 1997.

In vivo plaque formation on cast ceramic (Dicor) and conventional ceramic.

This study compared plaque accumulation on glazed and nonglazed metal ceramic porcelain surfaces with shaded and nonshaded Dicor cast ceramic surfaces. Plaque accumulation on natural teeth was also measured at 4, 12, 24, and 48 hours. Bacterial cultures were prepared from each sample to establish the aerobic and anaerobic charge. Plaque accumulation between 12 and 24 hours was measured on different materials. No significant differences were discovered between the plaque-retaining capacities of metal ceramic porcelain and Dicor ceramic surfaces. There was less plaque accumulation on glazed surfaces than on nonglazed surfaces.

Low prevalence of diphtheria immunity in the population of Florence, Italy.

A seroepidemiological study was conducted in 1994 on a representative sample of the population of Florence in order to verify the immunity coverage against diphtheria. Subjects were divided according to sex and age class. Sera from each selected class were at least 1.5/1000 of the residing population. Diphtheria antitoxin was titrated using a quantitative ELISA test. The results show an overall adjusted prevalence of diphtheria immunity (> or = 0.01 IU/ml) equal to 63.7%. Subjects of younger age classes have good protection levels (85.5% immune under 30 years), while only half individuals aged > or = 50 years have antibody titres > or = 0.01 IU/ml. Full protection (antibody titre > or = 0.1 IU/ml) was detected only in a very small proportion of those aged > or = 40 years. Our data show (1) how a recrudescence of diphtheria could theoretically take place in older subjects living in Italy, and (2) stress the importance of periodical re-vaccination of adults.

Studies on 1,2,3-triazole derivatives as in vitro inhibitors of prostaglandin synthesis.

This paper reports some new structural modifications (branching and lengthening of alkanoic substituent, increase of heterocycle-carboxylate distance) on 1,2,3-triazole derivative 1, a potent in vitro inhibitor of prostaglandin synthesis, and their influence on enzyme activity. Regarding the structural relationship between 1 and Dazoxiben, a selective thromboxane-synthetase inhibitor, the preparation and activity of some Dazoxiben analogs bearing different heterocycles, are also described.

[Prevalence of antibodies against Coxiella burnetii in 2 geographical zones of Tuscany]. / Prevalenza di anticorpi anti-Coxiella burnetii in due zone geografiche della Toscana.

Q Fever, caused by Coxiella burneti, was first identified as a separate syndrome in 1937 in Australia. Usually it takes the form of an acute atypic lung pneumonia disease, but subclinic or non-typical forms are also known. Q Fever is a zoonoses. The most important source of infection is represented by sheep; the transmission to man occurs by vectors (ticks), or more often by carriers as aerosol, non-pasteurized milk and dairy products. In Italy the first outbreaks of Q Fever date back to the end of World War II and lated until the beginning of the sixties. Since the seventies only a few sporadic cases have been notified, suggesting a low endemic situation. In Tuscany Q Fever presented the same epidemiological characteristics as in Italy. The causes of this particular epidemiological evolution are not clear. We suspect that it might be partly an illusion, caused by an inaccurate evaluation of the real number of cases, due to both the high frequency of atipic clinic forms and the lack of attention of doctors. On the other hand, a reduction in the circulation of C. burneti in the environment could be explained by a limitation of infection to man caused by changed sheep-breeding systems and a consequence of socio-economic evolution. To evaluate the actual reduction in the incidence of Q Fever in general, it is necessary: 1 - to make a careful research of Q Fever cases in man 2 - to evaluate the frequency of C. burneti antibodies in man and sheep. In this light, the Authors carried out a seroepidemiological study in individuals living in two different geographic areas of Tuscany. A total of 130 serum samples were tested. Half of them were collected from people professionally in contact with ovines, the other half from urban people presumably not in contact with animals. The antibody response to C. burneti was tested by indirect immunofluorescence test (IIT), a method known to be sensitive, specific, practical and economic. Antibodies titers indicating previous infection (greater than 1:20) were more frequently found in subjects belonging to the rural group (49.1%) than in those belonging to the urban group (6.1%). The seropositive subjects presented a negative clinic anamnesis. These results suggest a persistent circulation of C. burneti in man, linked to contacts with sheep. Also there appear, however, to be a good number of unnotified or subclinic Q Fever forms. Young people appear to be slightly less frequently infected, which suggest that the infection may be in fact becoming rarer.(ABSTRACT TRUNCATED AT 400 WORDS)

New imidazole-5-carbohydroxamic acids with biological activity.

A series of 1-benzyl-2-arylthio (or heteroarylthio)-5-imidazolecarbohydroxamic acids (Va-e) was prepared starting from the corresponding imidazole-5-carboxylic acids IIIa-e via acid chlorides IVa-e. Tests of biological activity showed that compounds Va-e are fairly active against Escherichia coli and Candida albicans.