Surveillance of perceptions, knowledge, attitudes and behaviors of the Italian adult population (18-69 years) during the 2009-2010 A/H1N1 influenza pandemic

Monitoring perceptions, knowledge, attitudes and behaviors of populations during pandemic flu outbreaks is important as it allows communication strategies to be adjusted to meet emerging needs and assessment to be made of the effects of recommendations for prevention. The ongoing Italian Behavioral Risk Factor Surveillance System (PASSI) offered the setting for investigating people's opinions and behaviors regarding the A/H1N1 pandemic. PASSI surveillance is carried out in 126/148 Italian Local Health Units (LHU) through monthly telephone interviews administered by public health staff to a random sample of the resident population 18-69 years. In fall 2009 additional questions exploring issues related to the A/H1N1 flu were added to the standard questionnaire. The pandemic module was administered on a voluntary basis by the 70 participating LHUs from November 2nd, 2009 to February 7th, 2010; 4 047 interviews were collected. Overall 33% of respondents considered it likely that they would catch flu, 26% stated they were worried, 16% reported having limited some daily activities out of home and 22% said they would accept vaccination if offered. All these indicators showed a decreasing trend across the four-month period of observation. The most trusted sources of information were family doctors (81%). Willingness to be vaccinated was associated with worry about pandemic, age, sex, having a chronic disease and timing of the interview. The surveillance allowed us to gather relevant information, crucial for devising appropriate public health interventions. In future disease outbreaks, systems monitoring people's perceptions and behaviors should be included in the preparedness and response plans.

Personality Disorders in a Sample of Inpatients Alcoholics Entering Detoxification Treatment in Italy: Prevalence and Gender Differences

Introduction

Alcohol abuse and dependence are frequently associated with psychiatric disorders and Personality Disorders, with differences among genders. However, only few studies investigated gender differences in personality disorders among alcoholics.

Aims

The aim of our study is to investigate personality disorders in a sample of inpatient alcoholics applying Millon Clinical Multiaxial Inventory - III, and to describe gender differences in prevalence and comorbidity of personality disorders.

Methods

The study population consist of 206 alcohol dependent patients entering detoxification treatment in a specialized clinic in Italy. At enrollment, patients filled in the Millon Clinical Multiaxial Inventory - III for the assessment of personality disorders and the AUDIT Test for the evaluation of alcohol consumption.

Results

The sample consisted of 150 men and 56 women. According to Millon assessment, 25% percent of men vs 12% of women had one PDs, 16% vs 23% had two PDs, and 46% vs 48% had more than three PDs. A statistically significant higher proportion of women got high scores on Avoidant (21.4% vs 9.3%, p = 0.020), Self-Defeating (50.0% vs 24.0%, p < 0.001), and Borderline scale (42.9% vs 25.3%, p = 0.015). Associations among PD are sporadic among men whilst are very frequent among women. Depressive, Self-Defeating and Borderline PDs are frequently associated both to other PDs and among each other, suggesting a possible female pattern.

Conclusions

Borderline PD is confirmed to be more frequent among alcoholic women than among men. More studies are needed to clarify prevalence and associations of PDs, prognosis, and gender differences in alcoholics patients.

Sudden unexpected deaths and vaccinations during the first two years of life in Italy: a case series study

BACKGROUND

The signal of an association between vaccination in the second year of life with a hexavalent vaccine and sudden unexpected deaths (SUD) in the two days following vaccination was reported in Germany in 2003. A study to establish whether the immunisation with hexavalent vaccines increased the short term risk of SUD in infants was conducted in Italy.

METHODOLOGY/PRINCIPAL FINDINGS

The reference population comprises around 3 million infants vaccinated in Italy in the study period 1999-2004 (1.5 million received hexavalent vaccines). Events of SUD in infants aged 1-23 months were identified through the death certificates. Vaccination history was retrieved from immunisation registries. Association between immunisation and death was assessed adopting a case series design focusing on the risk periods 0-1, 0-7, and 0-14 days after immunisation. Among the 604 infants who died of SUD, 244 (40%) had received at least one vaccination. Four deaths occurred within two days from vaccination with the hexavalent vaccines (RR = 1.5; 95% CI 0.6 to 4.2). The RRs for the risk periods 0-7 and 0-14 were 2.0 (95% CI 1.2 to 3.5) and 1.5 (95% CI 0.9 to 2.4). The increased risk was limited to the first dose (RR = 2.2; 95% CI 1.1 to 4.4), whereas no increase was observed for the second and third doses combined.

CONCLUSIONS

The RRs of SUD for any vaccines and any risk periods, even when greater than 1, were almost an order of magnitude lower than the estimates in Germany. The limited increase in RRs found in Italy appears confined to the first dose and may be partly explained by a residual uncontrolled confounding effect of age.

Features and initial assessment of the Italian Behavioral Risk Factor Surveillance System (PASSI), 2007-2008

INTRODUCTION

Surveillance systems for health status and behaviors of populations are fundamental for planning, implementing, and monitoring preventive interventions. In 2006, the Italian Ministry of Health provided funding to the National Institute of Public Health to develop an ongoing surveillance system for adult behavioral risk factors. We describe the main features of the system (known as PASSI) and provide a preliminary assessment of its activity.

METHODS

PASSI is conducted by participating local health units, which use a common questionnaire and methods. Each month, local health unit staff conduct telephone interviews of a random sample of resident adults aged 18 to 69 years. Data are transmitted to the national coordinating center, where they are cleaned, managed, and made available for local, regional, and national analysis. Training, data analysis, and communications are centrally supervised, and data quality is routinely monitored.

RESULTS

In 2007 and 2008, nearly 60,000 interviews were completed. The demographic characteristics of survey participants closely corresponded to census data in the surveyed areas. The response rate was 82%; the refusal rate was 10% or less. Communications activities have been conducted to disseminate the results and encourage their use.

CONCLUSION

PASSI is administered by the public health system with limited human and financial resources. In the first 2 years of activity, the data quality was good, and information collected was useful. The organizational model of PASSI may be of interest to countries that are developing surveillance systems as well as those with systems already in place.

Response to the 2009 influenza A(H1N1) pandemic in Italy

Binary file ES_Abstracts_Final_ECDC.txt matches

Differences in national influenza vaccination policies across the European Union, Norway and Iceland 2008-2009

In 2009 the second cross-sectional web-based survey was undertaken by the Vaccine European New Integrated Collaboration Effort (VENICE) project across 27 European Union (EU) member states (MS), Norway and Iceland (n=29) to determine changes in official national seasonal influenza vaccination policies since a survey undertaken in 2008 and to compare the estimates of vaccination coverage between countries using data obtained from both surveys. Of 27 responding countries, all recommended vaccination against seasonal influenza to the older adult population. Six countries recommended vaccination of children aged between six months and <18 years old. Most countries recommended influenza vaccination for those individuals with chronic medical conditions. Recommendations for vaccination of healthcare workers (HCW) in various settings existed in most, but not all countries. Staff in hospitals and long-term care facilities were recommended vaccination in 23 countries, and staff in out-patient clinics in 22 countries. In the 2009 survey, the reported national estimates on vaccine coverage varied by country and risk group, ranging from 1.1% - 82.6% for the older adult population; to between 32.9% -71.7% for clinical risk groups; and from 13.4% -89.4% for HCW. Many countries that recommend the influenza vaccination do not monitor the coverage in risk groups. In 2008 and 2009 most countries recommended influenza vaccination for the main risk groups. Hovewer, despite general consensus and recommendations for vaccination of high risk groups many countries do not achieve high coverage in these groups. The reported vaccination coverage still needs to be improved in order to achieve EU and World Health Organization goals.

Cross-reactive antibody responses to the 2009 A/H1N1v influenza virus in the Italian population in the pre-pandemic period

To assess in Italy the pre-pandemic susceptibility of the general population to the 2009 A/H1N1v influenza virus, 587 serum samples collected in 2004 were analyzed using haemagglutination-inhibition (HI), single-radial-haemolysis (SRH) and microneutralisation (MN) assays. Serum samples were stratified by age group, gender, and geographic area. Overall, using HI assay, the proportion of subjects showing antibodies cross-reacting with 2009 A/H1N1v virus at seroprotection level (>or=1:40) was estimated to be 6.7%, 12.4%, and 22.4% in individuals born between 2004 and 1949, 1948 and 1939, 1938 and 1909, respectively. With a HI antibody titre of >or=1:10, in the same birth cohort, the seroprotection levels were 13.5%, 19.2%, and 58.2%, respectively. The results suggest that the Italian population was not fully naïf to the current pandemic virus and that the possible previous exposure and immune response increases with age.

[Food-borne illnesses: a survey of regional reference laboratories in Italy.]

Many problems exist in the surveillance of human food-borne illnesses, and one of the most important is identifying the responsible microorganisms. For this reason, a survey was carried out to identify regional reference laboratories and laboratories with the capacities necessary for identification of pathogenic microorganisms in Italy. All 21 Italian regions and autonomous provinces completed the survey except three (Basilicata, Tuscany and Sardinia).Only 6% of the identified laboratories were found to have been formally designated as regional reference laboratories. Seventy-one percent of all laboratories reported having the capacity to diagnose over half (>7/13) of the listed bacteria, 69% over half of the listed parasites (> 4/8) and 51% over half of the listed viruses (>2/4). No differences were found in the capability to diagnose bacterial and parasitic infections, between laboratories in northern, central and southern Italy, while a significant difference was found in the capability to diagnose viral infections between laboratories in the three geographical areas (p <0.01). This study clearly shows that there is a need to improve diagnostic capacities of regional reference laboratories and laboratories involved in the surveillance of food-borne illnesses in Italy.

West Nile virus transmission with human cases in Italy, August - September 2009

In 2009, to date 16 human cases of West Nile neuroinvasive disease (WNND) have been reported in Italy, in three regions: Veneto, Emilia-Romagna and Lombardia. The number of cases is higher compared with last year when nine cases were identified (eight cases of WNND and one case of West Nile fever) and the geographical distribution indicates spread from east to west.

West Nile virus transmission with human cases in Italy, August - September 2009

In 2009, to date 16 human cases of West Nile neuroinvasive disease (WNND) have been reported in Italy, in three regions: Veneto, Emilia-Romagna and Lombardia. The number of cases is higher compared with last year when nine cases were identified (eight cases of WNND and one case of West Nile fever) and the geographical distribution indicates spread from east to west.

Enhanced epidemiological surveillance of influenza A(H1N1)v in Italy

As of 7 July 2009, a total of 158 laboratory-confirmed cases of influenza A(H1N1)v were reported in Italy, from half of the 21 Italian regions. To date all cases have had symptoms consistent with seasonal influenza and no severe or fatal cases have been reported. An active surveillance of cases has been set up in Italy in order to undertake appropriate measures to slow down the spread of the new virus. This report describes the routine and enhanced surveillance currently ongoing in Italy.

Characterisation of Neisseria meningitidis C strains causing two clusters in the north of Italy in 2007 and 2008

Two clusters of invasive meningococcal disease in the north of Italy both due to serogroup C/ST-11 clonal complex are here described. The objective of the investigation was to analyse the phenotype and the genotype of meningococci involved in the two clusters which were of national relevance due to the fatal outcome of the majority of cases (six of the total of 10 cases). All the strains were C:2a:P1.5 ST-11/ET-37 clonal complex. Two pulsed field gel electrophoresis (PFGE) and variable number tandem repeats (VNTR) profiles were identified, one for each cluster. VNTRs were different from those detected in Italy for C/ST-11 strains isolated from sporadic cases in the same period. This laboratory surveillance report highlights the importance and the crucial role of molecular characterisation to confirm the relatedness among meningococci responsible for clusters of cases.

Characterisation of Neisseria meningitidis C strains causing two clusters in the north of Italy in 2007 and 2008

Two clusters of invasive meningococcal disease in the north of Italy both due to serogroup C/ST-11 clonal complex are here described. The objective of the investigation was to analyse the phenotype and the genotype of meningococci involved in the two clusters which were of national relevance due to the fatal outcome of the majority of cases (six of the total of 10 cases). All the strains were C:2a:P1.5 ST-11/ET-37 clonal complex. Two pulsed field gel electrophoresis (PFGE) and variable number tandem repeats (VNTR) profiles were identified, one for each cluster. VNTRs were different from those detected in Italy for C/ST-11 strains isolated from sporadic cases in the same period. This laboratory surveillance report highlights the importance and the crucial role of molecular characterisation to confirm the relatedness among meningococci responsible for clusters of cases.

Neuropsychological performance 10 years after immunization in infancy with thimerosal-containing vaccines

OBJECTIVE

Thimerosal, a mercury compound used as a preservative in vaccines administered during infancy, has been suspected to affect neuropsychological development. We compared the neuropsychological performance, 10 years after vaccination, of 2 groups of children exposed randomly to different amounts of thimerosal through immunization.

METHODS

Children who were enrolled in an efficacy trial of pertussis vaccines in 1992-1993 were contacted in 2003. Two groups of children were identified, according to thimerosal content in vaccines assigned randomly in the first year of life (cumulative ethylmercury intake of 62.5 or 137.5 microg), and were compared with respect to neuropsychological outcomes. Eleven standardized neuropsychological tests, for a total of 24 outcomes, were administered to children during school hours. Mean scores of neuropsychological tests in the domains of memory and learning, attention, executive functions, visuospatial functions, language, and motor skills were compared according to thimerosal exposure and gender. Standard regression coefficients obtained through multivariate linear regression analyses were used as a measure of effect.

RESULTS

Nearly 70% of the invited subjects participated in the neuropsychological assessment (N = 1403). Among the 24 neuropsychological outcomes that were evaluated, only 2 were significantly associated with thimerosal exposure. Girls with higher thimerosal intake had lower mean scores in the finger-tapping test with the dominant hand and in the Boston Naming Test.

CONCLUSIONS

Given the large number of statistical comparisons performed, the few associations found between thimerosal exposure and neuropsychological development might be attributable to chance. The associations found, although statistically significant, were based on small differences in mean test scores, and their clinical relevance remains to be determined.

National seasonal influenza vaccination survey in Europe, 2008

A cross-sectional survey was undertaken with the European Union (EU) Member States and Norway and Iceland to describe seasonal influenza immunisation in the 2006-7 season, in particular to identify country-specific recommendations for risk groups, obtain vaccine uptake information and allow comparison with global recommendations. A standardised questionnaire was completed electronically by each country's project gatekeeper. Of the 29 countries surveyed, 28 recommended seasonal influenza vaccination for older age groups (22 for those aged > 65 years), and in one country vaccine was recommended for all age groups. All countries recommended vaccinating patients with chronic pulmonary and cardiovascular diseases and most countries advised to immunise patients with haematologic or metabolic disorders (n=28), immunologic disorders (n=27) and renal disease (n=27), as well as residents of long-term care facilities (n=24). Most countries recommended vaccination for staff in hospitals (n=25), long-term care facilities (n=25) and outpatient clinics (n=23), and one-third had such recommendations for workers in essential (n=10), military (n=10) and veterinary services (n=10) and poultry industry (n=13). Eight countries recommended vaccine for pregnant women; and five advised to vaccinate children (with age limits ranging from 6 months to 5 years). Twenty countries measured influenza vaccine uptake among those aged > 65 years (range 1.8%-82.1%), seven reported uptake in healthcare workers (range 14%-48%) and seven assessed coverage in persons with underlying medical conditions (range 27.6%-75.2%). The data provided by this study can assist EU states to assess and compare their influenza vaccination programme performance with other countries. The information provides a comprehensive overview of policies and programmes and their outcomes and can be used to inform joint discussions on how the national policies in the EU might be standardised in the future to achieve optimal coverage. Annual surveys could be used to monitor changes in these national policies.

Low coverage of seasonal influenza vaccination in the elderly in many European countries

In May 2003, the 56th World Health Assembly (WHA) recommended influenza vaccination for all people at high risk defined as the elderly and persons with underlying diseases [1]. The WHA countries, including all European Union (EU) Member States, also committed to the goal of attaining vaccination coverage of the elderly population of at least 50% by 2006 and 75% by 2010 and to having mechanisms for monitoring the uptake [1]. To date there has been no published survey on how successful European countries have been in implementing this WHA resolution.

Introduction of human papillomavirus (HPV) vaccination into national immunisation schedules in Europe: Results of the VENICE 2007 survey

The European Union Member States are simultaneously considering introducing HPV vaccination into their national immunisation schedules. The Vaccine European New Integrated Collaboration Effort (VENICE) project aims to develop a collaborative European vaccination network. A survey was undertaken to describe the decision status and the decision-making process regarding the potential introduction of human papillomavirus (HPV) vaccination into their national immunisation schedules. A web-based questionnaire was developed and completed online in 2007 by 28 countries participating in VENICE. As of 31 October 2007, five countries had decided to introduce HPV vaccination into the national immunisation schedule, while another seven had started the decision-making process with a recommendation favouring introduction. Varying target populations were selected by the five countries which had introduced the vaccination. Half of the surveyed countries had undertaken at least one ad hoc study to support the decision-making process. According to an update of the decision-status from January 2008, the number of countries which had made a decision or recommendation changed to 10 and 5 respectively. This survey demonstrates the rapidly evolving nature of HPV vaccine introduction in Europe and the existence of expertise and experience among EU Member States. The VENICE network is capable of following this process and supporting countries in making vaccine introduction decisions. A VENICE collaborative web-space is being developed as a European resource for the decision-making process for vaccine introduction.

Measles resurges in Italy: preliminary data from September 2007 to May 2008

Following an incidence rate of 1/100,000 inhabitants in 2006 [1], Italy has been facing an upsurge of measles cases since September 2007, with outbreaks being reported in various regions. In Italy, measles vaccination is currently offered free of charge as combined measles-mumps-rubella (MMR) vaccine. The current national vaccination schedule recommends two doses of MMR vaccine, given respectively at 11-12 months and 5-6 years of age. Although childhood vaccination coverage has increased in recent years, reaching the national average of 88% in 2006 (source: Ministry of Health), with some regional variability (Figure 1), it is still below the target of 95% set by the National Measles Elimination Plan (MEP) launched in 2003 [2], and outbreaks continue to occur.

Social contacts and mixing patterns relevant to the spread of infectious diseases

BACKGROUND

Mathematical modelling of infectious diseases transmitted by the respiratory or close-contact route (e.g., pandemic influenza) is increasingly being used to determine the impact of possible interventions. Although mixing patterns are known to be crucial determinants for model outcome, researchers often rely on a priori contact assumptions with little or no empirical basis. We conducted a population-based prospective survey of mixing patterns in eight European countries using a common paper-diary methodology.

METHODS AND FINDINGS

7,290 participants recorded characteristics of 97,904 contacts with different individuals during one day, including age, sex, location, duration, frequency, and occurrence of physical contact. We found that mixing patterns and contact characteristics were remarkably similar across different European countries. Contact patterns were highly assortative with age: schoolchildren and young adults in particular tended to mix with people of the same age. Contacts lasting at least one hour or occurring on a daily basis mostly involved physical contact, while short duration and infrequent contacts tended to be nonphysical. Contacts at home, school, or leisure were more likely to be physical than contacts at the workplace or while travelling. Preliminary modelling indicates that 5- to 19-year-olds are expected to suffer the highest incidence during the initial epidemic phase of an emerging infection transmitted through social contacts measured here when the population is completely susceptible.

CONCLUSIONS

To our knowledge, our study provides the first large-scale quantitative approach to contact patterns relevant for infections transmitted by the respiratory or close-contact route, and the results should lead to improved parameterisation of mathematical models used to design control strategies.

Autochthonous chikungunya virus transmission may have occurred in Bologna, Italy, during the summer 2007 outbreak

In Italy, a national surveillance system for chikungunya fever coordinated by the National Public Health Institute has been in place since August 2006. In summer 2007, an outbreak of chikungunya fever affected the Italian provinces of Ravenna, Cesena-Forli and Rimini [1-3]. As of 16 December 2007, health authorities identified 214 laboratory-confirmed cases with date of onset from 15 July to 28 September 2007. Most cases (161) occurred in the two neighbouring villages of Castiglione di Cervia and Castiglione di Ravenna, but limited local transmission also took place in the cities of Ravenna, Cesena, Cervia, and Rimini. In September 2007, two confirmed cases (two women aged 68 and 70) were reported among residents of the city of Bologna (373,026 inhabitants). Both had a history of travel in the affected areas (municipality of Cervia). No unusual increase in the density of Aedes albopictus mosquitoes in the Bologna area was noted at that time (September).

Trends for influenza-related deaths during pandemic and epidemic seasons, Italy, 1969-2001

During epidemics, excess deaths were similar in amplitude and time across 3 regions.

Age-specific patterns of death from influenza vary, depending on whether the influenza season is epidemic or pandemic. We assessed age patterns and geographic trends in monthly influenza-related deaths in Italy from 1969 through 2001, focusing on differences between epidemic and pandemic seasons. We evaluated age-standardized excess deaths from pneumonia and influenza and from all causes, using a modified version of a cyclical Serfling model. Excess deaths were highest for elderly persons in all seasons except the influenza A (H3N2) pandemic season (1969–70), when rates were greater for younger persons, confirming a shift toward death of younger persons during pandemic seasons. When comparing northern, central, and southern Italy, we found a high level of synchrony in the amplitude of peaks of influenza-related deaths.

The current status of HPV and rotavirus vaccines in national immunisation schedules in the EU – preliminary results of a VENICE survey

In the second half of 2006, two vaccines against rotavirus infections and one against human papillomavirus (HPV) infection were granted licensing authorisations by the European Medicines Agency (EMEA).

Progress in Italy in control and elimination of measles and congenital rubella

After a long period of inadequate vaccination coverage, Italy implemented a National Elimination Plan for Measles and Congenital Rubella in 2003, in order to reach the objective by 2010, according to the goals of World Health Organization (WHO) in the European Region. Concerted efforts have been made in the last years in all Italian Regions, leading to substantial increase of coverage both at 24 months of age and in older children, also thanks to a special campaign addressed to school-age subjects. Measles and rubella are at historical lows, although several limited outbreaks occurred in 2006. However, such outbreaks gave the opportunity to show that lab surveillance of cases, identification of contacts and their rapid immunisation are feasible and able to stop further spread of infection. The re-introduction in 2005 of compulsory notification for congenital rubella and rubella during pregnancy has a key role in the evaluation of needs for women at fertile age and to address efforts of vaccination to risk groups, like immigrant women. Although further actions need to be pursued, the increase of vaccination coverage and the strong commitment of the Italian public health service in the Elimination Plan suggest that phase II of measles control is approaching and that final elimination of measles and congenital rubella can be reached in Italy.

Venice: Europe's new network for vaccination

Vaccination is an extremely effective tool in reducing the burden of infectious diseases. There are many vaccine products currently available in Europe. Vaccines developed recently have been introduced according to common European Union (EU)-wide regulatory procedures since 2003, which implies that they are licensed for common indications and population groups across the EU.

Comparison of pertussis surveillance systems in Europe

We compared pertussis surveillance systems of 16 European countries in the period 1998-2002. In twelve out of sixteen countries the system covered the general population. Ten countries relied on WHO case definition for surveillance of pertussis. Eleven countries applied laboratory tests, and eight of them used PCR for case confirmation. The proportion of hospitalised rates in children<1 year varied between 33.1 and 100%, while case fatality in the same age group varied between 0 and 21.3 per 1000. The adoption of WHO case definition, standardisation of laboratory diagnosis, and integration of information on deaths from alternative sources should be supported.

"SMART" drug delivery systems: double-targeted pH-responsive pharmaceutical nanocarriers

To develop targeted pharmaceutical carriers additionally capable of responding to certain local stimuli, such as decreased pH values in tumors or infarcts, targeted long-circulating PEGylated liposomes and PEG-phosphatidylethanolamine (PEG-PE)-based micelles have been prepared with several functions. First, they are capable of targeting a specific cell or organ by attaching the monoclonal antimyosin antibody 2G4 to their surface via pNP-PEG-PE moieties. Second, these liposomes and micelles were additionally modified with biotin or TAT peptide (TATp) moieties attached to the surface of the nanocarrier by using biotin-PE or TATp-PE or TATp-short PEG-PE derivatives. PEG-PE used for liposome surface modification or for micelle preparation was made degradable by inserting the pH-sensitive hydrazone bond between PEG and PE (PEG-Hz-PE). Under normal pH values, biotin and TATp functions on the surface of nanocarriers were "shielded" by long protecting PEG chains (pH-degradable PEG(2000)-PE or PEG(5000)-PE) or by even longer pNP-PEG-PE moieties used to attach antibodies to the nanocarrier (non-pH-degradable PEG(3400)-PE or PEG(5000)-PE). At pH 7.4-8.0, both liposomes and micelles demonstrated high specific binding with 2G4 antibody substrate, myosin, but very limited binding on an avidin column (biotin-containing nanocarriers) or internalization by NIH/3T3 or U-87 cells (TATp-containing nanocarriers). However, upon brief incubation (15-30 min) at lower pH values (pH 5.0-6.0), nanocarriers lost their protective PEG shell because of acidic hydrolysis of PEG-Hz-PE and acquired the ability to become strongly retained on an avidin column (biotin-containing nanocarriers) or effectively internalized by cells via TATp moieties (TATp-containing nanocarriers). We consider this result as the first step in the development of multifunctional stimuli-sensitive pharmaceutical nanocarriers.

Clinical, social and relational determinants of paediatric ambulatory drug prescriptions due to respiratory tract infections in Italy

OBJECTIVES

Collecting information on patterns of drug prescriptions and on factors influencing prescribing decisions is fundamental for supporting the rational use of drugs. This study was aimed at investigating patterns of drug prescription in paediatric outpatients and at evaluating determinants of prescriptions for respiratory tract infections (RTIs).

METHODS

We conducted a national cross-sectional survey involving primary care paediatricians and parents. Diagnoses and prescriptions made at each consultation were described. Poisson regression models were used to analyse determinants of drug and antibiotic prescriptions for visits due to RTIs.

RESULTS

A total of 4,302 physician and parent questionnaires were analysed. These corresponded to 2,151 visits, 792 of which were due to RTIs. Drugs were prescribed in 83.4% of RTI visits, while antibiotics were prescribed in 40.4%. According to paediatricians' perceptions, 84.2% of parents of children with a RTI expected to receive a drug prescription. Paediatricians' perception of parental expectations was the strongest determinant for prescription of drugs and specifically of antibiotics [adjusted relative risk (RR): 1.7 and 3.6, respectively; P < 0.001]. However, in 77.1% of RTI visits, paediatricians judged themselves as not being influenced at all by parents' expectations in their decision to prescribe.

CONCLUSIONS

This study underscores that relational factors, in particular perceived parental expectations, are one of the leading factors of drug prescriptions in paediatric ambulatory care settings, reinforcing the opinion that communication between physicians and parents can affect prescription patterns.

Assessment of measles incidence, measles-related complications and hospitalisations during an outbreak in a southern Italian region

A large measles epidemic occurred in 2002 in Campania, a region of southern Italy with inadequate vaccination coverage. We evaluated the burden of the outbreak in children <15 years of age using different data sources. The measles standardized incidence rate was 5,757/100,000, corresponding to 63,368 estimated cases (95% CI: 59,544--67,373). Measles virus strains were identified as belonging to the D7 genotype. The estimated complication rate was 7.6%. A total of 972 measles hospitalisations were detected, giving a hospitalisation rate of 88.3/100,000. Three deaths occurred. These results show that measles can still represent a serious health threat even in industrialized countries.

Legionnaires' disease outbreak in Rome, Italy

Between August and October 2003, 15 cases of Legionnaires' disease were detected in the 9th district of Rome. To identify possible sources of Legionella exposure, a matched case-control study was conducted and environmental samples were collected. Hospital discharge records were also retrospectively analysed for the period July-November 2003, and results were compared with the same period during the previous 3 years. The case-control study revealed a significantly increased risk of disease among those frequenting a specific department store in the district (OR 9.8, 95% CI 2.1-46.0), and Legionella pneumophila was isolated from the store's cooling tower. Genotypic and phenotypic analysis of human and environmental isolates demonstrated that the cluster was caused by a single strain of L. pneumophila serogroup 1, and that the cooling tower of the store was the source of infection. The increased number of hospital admissions for microbiologically undiagnosed pneumonia during the study period may indicate that some legionellosis cases were not identified.

How increased pertussis vaccination coverage is changing the epidemiology of pertussis in Italy

The epidemiology of pertussis in Italy is described by using data from the statutory notification system and from seroepidemiology studies. Starting from the 1990s, the incidence of pertussis in Italy has shown a sharp decline and is now at the lowest level ever reached. During this time period vaccination coverage has increased from 88% in 1998 to 95% in 2003. In 1996-97, the prevalence of subjects with levels of IgG antibodies against PT greater than 2EU/ml was 77.6%. The increase in vaccination coverage will probably change the pattern of disease transmission and increase the number of susceptible adults, unless administration of booster doses to adolescents and adults is considered.

Different seroprevalence and molecular epidemiology patterns of hepatitis C virus infection in Italy

The epidemiological picture of hepatitis C virus (HCV) infection in the general population is largely unknown, even in developed countries. The aim of this study was to estimate the prevalence and genotype distribution of HCV amongst a large sample of the Italian general population. A total of 3,577 serum samples were collected and screened for anti-HCV antibodies. ELISA and RIBA tests were used to assess the presence of anti-HCV. NS5b region sequencing was performed for molecular characterization. Of 3,577 tested sera, 95 (2.7%) were anti-HCV positive and a genome was detected and sequenced in 50 sera. The age-adjusted prevalence was 4.4%. Seroprevalence increased with age, following a North-South gradient, and increased steeply between the 15 and 30 and 31-45 age groups. Subtype 1b showed the highest prevalence in all geographical areas and age groups, followed by subtypes 2c (detected mainly in the elderly population in Southern Italy), 4a/d, and 3a (detected exclusively in adults) and 1a. These findings confirm that Central and Southern Italy are hyperendemic areas. The high prevalence observed in adults over age 30 is mainly attributable to an increase in 1b-prevalence but also to subtypes 2c- and 3/4-infections. Age-specific prevalence data and molecular characterization of the virus suggest that two transmission patterns co-exist in Italy: one characterized by subtype 1b and 2c infections, mainly in adults older than 60 years, and the other by subtype 3 and 4 infections, mainly in the 31-60 year age group, and consistent with intravenous drug use and immigration.

Resurgence of pertussis in Europe

BACKGROUND

A resurgence of pertussis has been observed in Canada, the United States and Australia since the 1980s, but inconsistent data are currently available for Europe. The objective of this paper is to describe the epidemiology of pertussis in Western European countries to discuss future vaccination strategies.

METHODS

The European Community funded a network for the epidemiologic surveillance of measles and pertussis in 1998. Sixteen European countries provided national surveillance data for pertussis for the period 1998-2002 in a standard format. Data were pooled and analyzed to describe incidence rates by age group, seasonality, proportion of hospitalized patients and deaths among notified cases.

RESULTS

Children younger than 1 year had the highest incidence during the entire period. Rates in the older than 14 years age group increased by 115% during the study period. Northern countries showed the highest incidence figures in all age groups. Among children younger than 1 year, 70% were admitted into hospital. Children younger than 6 months of age and those not vaccinated were most likely to be hospitalized. Thirty-two deaths were reported, 87% of which were in children younger than 6 months of age.

CONCLUSIONS

Pertussis is far from being controlled in Europe. Whereas the incidence in children younger than 1 year was high but remained stable, rates in adults doubled in 5 years.

Pneumococcal vaccination policy in Europe

Infection due to Streptococcus pneumoniae (Pneumococcus) (Pnc) is an important cause of invasive clinical manifestations such as meningitis, septicaemia and pneumonia, particularly in young children and the elderly. A 23-valent polysaccharide Pnc vaccine (PPV) has been available for many years and a 7-valent conjugate Pnc vaccine (PCV) has been licensed since 2001 in Europe. As part of a European Union (EU) funded project on pneumococcal disease (Pnc-EURO), a questionnaire was distributed to all 15 EU member states, Switzerland, Norway and the 10 accession countries in 2003 to ascertain current pneumococcal vaccination policy. Twenty three of the 27 target countries, constituting the current European Union (plus Norway and Switzerland), completed the questionnaire. PPV was licensed in 22 of the 23 responding countries and was in the official recommendations of 21. In all the 20/21 countries for which information was available, risk groups at higher risk of infection were targeted. The number of risk groups targeted ranged from one to 12. At least 17 countries recommend that PPV be administered to all those &gt;65 years of age (in three countries, to those over 60 years of age). Thirteen countries had developed national recommendations for PCV in 2003. No country recommended mass infant immunisation at that time, but rather targeted specific risk groups (between 1 and 11), particularly children with asplenia (n=13) and HIV infection (n=12). PCV use was restricted to children under two years of age in seven countries, and in four countries to children under five years of age. Future decisions on use of pneumococcal vaccines in Europe will be decided on the basis of several factors including: local disease burden; the predicted impact of any universal programme, particularly the importance of serotype replacement and herd immunity (indirect protection to the unvaccinated population); the effectiveness of reduced dose schedules, and vaccine cost. Indeed, at least one country, Luxembourg, has since implemented a universal infant PCV immunisation policy.

Pneumococcal vaccination policy in Europe

Infection due to Streptococcus pneumoniae (Pneumococcus) (Pnc) is an important cause of invasive clinical manifestations such as meningitis, septicaemia and pneumonia, particularly in young children and the elderly. A 23-valent polysaccharide Pnc vaccine (PPV) has been available for many years and a 7-valent conjugate Pnc vaccine (PCV) has been licensed since 2001 in Europe. As part of a European Union (EU) funded project on pneumococcal disease (Pnc-EURO), a questionnaire was distributed to all 15 EU member states, Switzerland, Norway and the 10 accession countries in 2003 to ascertain current pneumococcal vaccination policy. Twenty three of the 27 target countries, constituting the current European Union (plus Norway and Switzerland), completed the questionnaire. PPV was licensed in 22 of the 23 responding countries and was in the official recommendations of 21. In all the 20/21 countries for which information was available, risk groups at higher risk of infection were targeted. The number of risk groups targeted ranged from one to 12. At least 17 countries recommend that PPV be administered to all those >65 years of age (in three countries, to those over 60 years of age). Thirteen countries had developed national recommendations for PCV in 2003. No country recommended mass infant immunisation at that time, but rather targeted specific risk groups (between 1 and 11), particularly children with asplenia (n=13) and HIV infection (n=12). PCV use was restricted to children under two years of age in seven countries, and in four countries to children under five years of age. Future decisions on use of pneumococcal vaccines in Europe will be decided on the basis of several factors including: local disease burden; the predicted impact of any universal programme, particularly the importance of serotype replacement and herd immunity (indirect protection to the unvaccinated population); the effectiveness of reduced dose schedules, and vaccine cost. Indeed, at least one country, Luxembourg, has since implemented a universal infant PCV immunisation policy.