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Ferdinands JM, Gaglani M, Ghamande S, Martin ET, Middleton D, Monto AS, Silveira F, Talbot HK, Zimmerman R, Smith ER, Patel M. Vaccine Effectiveness Against Influenza-Associated Hospitalizations Among Adults, 2018-2019, US Hospitalized Adult Influenza Vaccine Effectiveness Network. J Infect Dis 2020; 224:151-163. [PMID: 33336702 DOI: 10.1093/infdis/jiaa772] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/14/2020] [Indexed: 01/18/2023] Open
Abstract
We estimated vaccine effectiveness (VE) for prevention of influenza-associated hospitalizations among adults during the 2018-2019 influenza season. Adults admitted with acute respiratory illness to 14 hospitals of the US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN) and testing positive for influenza were cases; patients testing negative were controls. VE was estimated using logistic regression and inverse probability of treatment weighting. We analyzed data from 2863 patients with a mean age of 63 years. Adjusted VE against influenza A(H1N1)pdm09-associated hospitalization was 51% (95% confidence interval [CI], 25%-68%). Adjusted VE against influenza A(H3N2) virus-associated hospitalization was -2% (95% CI, -65% to 37%) and differed significantly by age, with VE of -130% (95% CI, -374% to -27%) among adults 18 to ≤56 years of age. Although vaccination halved the risk of influenza A(H1N1)pdm09-associated hospitalizations, it conferred no protection against influenza A(H3N2)-associated hospitalizations. We observed negative VE for young and middle-aged adults but cannot exclude residual confounding as a potential explanation.
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Affiliation(s)
- Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Donald Middleton
- University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania, USA
| | - Arnold S Monto
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Fernanda Silveira
- University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania, USA
| | - Helen K Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard Zimmerman
- University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania, USA
| | - Emily R Smith
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manish Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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2
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Odone A, Bucci D, Croci R, Riccò M, Affanni P, Signorelli C. Vaccine hesitancy in COVID-19 times. An update from Italy before flu season starts. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020031. [PMID: 32921733 PMCID: PMC7716975 DOI: 10.23750/abm.v91i3.10549] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic and response caused a worrying decline in vaccine uptake around the world. In Italy, the immunization coverage targets set in the 2017-19 National Immunization Prevention Plan (PNPV) have been met only partially. The current public health emergency is likely to have negatively impacted on immunization , with the risk of re-occurrence of Vaccine-Preventable Diseases (VPDs) outbreaks. As flu season approaches, both National Health Institutions and the scientific community in Italy have taken action. Well in advance as compared to previous years, the Ministry of Health released the Circular to launch the 2020-2021 influenza immunization campaign which this year is longer (starting on October 2020) and extends flu vaccine recommendations to more "at risk" subgroups, offered the vaccine free of charge. In addition, some Italian Regions have recently tried to make flu vaccination compulsory for all Healthcare Workers (HCWs). Since 2017, when the law on childhood vaccination in Italy was passed, compulsory vaccination has proved to be a successful strategy towards coverage increase.
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Affiliation(s)
- Anna Odone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Daria Bucci
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Roberto Croci
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | | | | | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; University of Parma, Parma, Italy.
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3
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Veronesi L, Colucci ME, Pasquarella C, Caruso L, Mohieldin Mahgoub Ibrahim M, Zoni R, Pergreffi M, Arcuri C, Seidenari C, Viani I, Capobianco E, Mezzetta S, Affanni P. Virological surveillance of SARS-CoV-2 in an Italian northern area: comparison of Real Time RT PCR cycle threshold (Ct) values in three epidemic periods. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:19-21. [PMID: 32701912 PMCID: PMC8023099 DOI: 10.23750/abm.v91i9-s.10138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 12/31/2022]
Abstract
Aim of the study was to investigate the differences in Ct values in nasopharingeal swabs collected in three SARS-CoV-2 epidemic periods: first one from February 23 to March 25 (14 days from lockdown started on March 11); the second one from March 26 to May 18 (14 days from the end of strict lockdown on May 4) and the third one from May 19 until June 15. Viral RNA was detected in nasopharyngeal swabs obtained both from inpatients and outpatients. COVID-19 infection was confirmed according to the Ct values for N1 and N2 genes ascertained by Real-Time RT-PCR assay as described by the CDC. We calculated the prevalence of nasopharyngeal swabs tested positive for SARS-CoV-2, the mean and median of the Cts and the percentage of samples equal or below the Ct value of 25 in the 3 periods considered. The average value of Ct increased, going from 24.80 in the first epidemic period to 26.64 in the second period to 28.50 in the third period (p <0.001). The percentage of samples with Ct lower than or equal to 25 also decreased sharply from 54.7% to 20.0%. These findings need to be integrated with epidemiological and clinical data.
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Affiliation(s)
| | | | | | - Luca Caruso
- Department of Medicine and Surgery, University of Parma, Italy.
| | | | - Roberta Zoni
- Department of Medicine and Surgery, University of Parma, Italy.
| | | | - Carlo Arcuri
- Department of Medicine and Surgery, University of Parma, Italy.
| | | | - Isabella Viani
- Department of Medicine and Surgery, University of Parma, Italy.
| | | | - Sandra Mezzetta
- Department of Medicine and Surgery, University of Parma, Italy.
| | - Paola Affanni
- Department of Medicine and Surgery, University of Parma, Italy.
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4
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Rossi D, Croci R, Affanni P, Odone A, Signorelli C. [Influenza vaccination coverage in Lombardy Region: a twenty-year trend analysis (1999-2019)]. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:141-145. [PMID: 32275279 PMCID: PMC7975897 DOI: 10.23750/abm.v91i3-s.9455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022]
Abstract
Influenza vaccination coverage in Lombardy Region: a twenty-year trend analysis (1999-2019). Recent events and phenomena, such as A(H1N1) pandemic in 2009, “Fluad case” (2014-2015) and the spread of vaccine hesitancy, affected influenza vaccination coverage rates in Italy. In this study, the annual coverage rates in Lombardy Region and in Italy (from 1999-2000 season) have been critically described and compared. Regarding both the general population and the elderly over-65s, Lombardy’s coverages always remained consistently below the national average. However, declines and peaks occurred simultaneously. The current slight recovery, both at national and regional level, is not sufficient. Coverages are still widely below the recommended thresholds.
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Affiliation(s)
| | | | | | - Anna Odone
- Università Vita-Salute San Raffaele, Milano.
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5
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Colucci ME, Affanni P, Cantarelli A, Caruso L, Bracchi MT, Capobianco E, Zoni R, Paini G, Odone A, Mohieldin Mahgoub Ibrahim MM, Veronesi L. Influenza vaccine effectiveness in children: a retrospective study on eight post-pandemic seasons with trivalent inactivated vaccine. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:63-70. [PMID: 32275269 PMCID: PMC7975907 DOI: 10.23750/abm.v91i3-s.9424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 01/12/2023]
Abstract
Background and aim of the work: The global burden of disease attributable to seasonal influenza virus in children is difficult to quantify. Children with chronic medical conditions and healthy children may experience severe or fatal complications. Aim of the study was to estimate the influenza vaccine effectiveness (VE) in a cohort of outpatient children. Methods: From 2010 to 2018, a Pediatrician of Parma from the InfluNet network of Emilia-Romagna Region, performed nasal/throat swabs on every child with Influenza-like illness at least 14 days from the vaccination with trivalent vaccine. VE estimates against influenza season, virus type and subtype and age group were evaluated using a test-negative design. Results: 2,480 swabs were performed. The 57.6% of the analyzed swabs were positive for influenza viruses. Type A (57%) and type B viruses (43%) co-circulated. The 37.1% of type A viruses belonged to subtype A(H3N2), 19.4% to subtype A(H1N1)pdm09. The subtype A(H3N2) was prevalent among children up to 23 months (42.4%) while the type B in the 2-4 (40.7%) and 5-16 year old age groups (49.4%). Overall, 19.9% of the children were vaccinated. The highest prevalence of vaccinated subjects was found in children aged 5-16 (30.5%). The VE against subtype A(H1N1)pdm09 was 63% (95%CI 42.6-76.0), against type B 27.5% (95%CI 7.9-42.9) and against subtype A(H3N2) -14.3% (95%CI - 46.0-10.7). Conclusions: Our findings represent a useful contribution to the ongoing debate about the appropriateness of including influenza vaccination for healthy children, 6 months and older, in the updating National Vaccine Prevention Plan (PNPV).
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Affiliation(s)
| | - Paola Affanni
- Department of Medicine and Surgery, University of Parma.
| | | | - Luca Caruso
- Department of Medicine and Surgery, University of Parma.
| | | | | | - Roberta Zoni
- Department of Medicine and Surgery, University of Parma.
| | - Giulia Paini
- Department of Medicine and Surgery, University of Parma.
| | - Anna Odone
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, Milan.
| | | | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma.
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Affanni P, Colucci ME, Capobianco E, Bracchi MT, Zoni R, Viani I, Caruso L, Carlone L, Arcuri C, Veronesi L. Immunity status against tetanus in young migrants: a seroprevalence study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:77-84. [PMID: 32275271 PMCID: PMC7975914 DOI: 10.23750/abm.v91i3-s.9438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Thanks to the highly effective vaccine, tetanus became sporadic in high-income countries with well-established primary childhood immunization programs, but it is common in low-income countries. The migrants, leaving countries with poor immunization programs or where vaccinations have been interrupted, may represent a new risk group for tetanus in host countries. A seroprevalence study was conducted to estimate the immunological status against tetanus in young migrants without vaccination documentation. METHODS After a careful assessment by vaccination services of the Local Health Authority, all migrants recently arrived in Italy were included in the serosurvey. Titers of anti-tetanus toxoid were measured using a commercial ELISA kit. Subjects were stratified by age and by WHO region. Antibody titers <0.10 IU/ml were considered to be seronegative, between 0.10 and 1.00 IU/ml as intermediate protection, and >1.00 IU/ml high protection. RESULTS From January 2004 to December 2019, 2,326 blood samples were collected. Mean age was 13.9 years with no differences between WHO regions. The percentage of the subjects without protective antibodies was 22.3%, with an intermediate level was 45.2%, with high titer was 32.5%. Among migrant coming from African and Eastern Mediterranean WHO regions, the highest percentages of seronegative titers and, at the same time, the low percentages of high protective levels were found. Titers decreased with age. CONCLUSIONS The significant proportion of seronegative migrants and the decrease of protective titers increasing age, confirm the importance of the evaluation of the immunological status to employ the appropriate vaccination strategy.
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Affiliation(s)
| | | | | | | | - Roberta Zoni
- Department of Medicine and Surgery, University of Parma, Italy.
| | - Isabella Viani
- Department of Medicine and Surgery, University of Parma, Italy.
| | - Luca Caruso
- Department of Medicine and Surgery, University of Parma, Italy.
| | | | - Carlo Arcuri
- Department of Medicine and Surgery, University of Parma, Italy.
| | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma, Italy.
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Panatto D, Lai PL, Mosca S, Lecini E, Orsi A, Signori A, Castaldi S, Pariani E, Pellegrinelli L, Galli C, Anselmi G, Icardi G. Influenza Vaccination in Italian Healthcare Workers (2018-2019 Season): Strengths and Weaknesses. Results of a Cohort Study in Two Large Italian Hospitals. Vaccines (Basel) 2020; 8:E119. [PMID: 32150801 PMCID: PMC7157508 DOI: 10.3390/vaccines8010119] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Annual vaccination is the most effective way to combat influenza. As influenza viruses evolve, seasonal vaccines are updated annually. Within the European project Development of Robust and Innovative Vaccine Effectiveness (DRIVE), a cohort study involving Italian healthcare workers (HCWs) was carried out during the 2018-2019 season. Two aims were defined: to measure influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza cases and to conduct an awareness-raising campaign to increase vaccination coverage. METHODS Each subject enrolled was followed up from enrollment to the end of the study. Each HCW who developed ILI was swabbed for laboratory confirmation of influenza. Influenza viruses were identified by molecular assays. A Cox regression analysis, crude and adjusted for confounding variables, was performed to estimate the IVE. RESULTS Among the 4483 HCWs enrolled, vaccination coverage was 32.5%, and 308 ILI cases were collected: 23.4% were positive for influenza (54.2% A(H1N1) pdm09; 45.8% A(H3N2)). No influenza B viruses were detected. No overall IVE was observed. Analyzing the subtypes of influenza A viruses, the IVE was estimated as 45% (95% CI: -59 to 81) for A(H1N1) pdm09. CONCLUSIONS Vaccination coverage among HCWs increased. Study difficulties and the circulation of drifted variants of A(H3N2) could partly explain the observed IVE.
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Affiliation(s)
- Donatella Panatto
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy; (S.M.); (E.P.)
| | - Piero Luigi Lai
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy; (S.M.); (E.P.)
| | - Stefano Mosca
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy; (S.M.); (E.P.)
| | - Elvina Lecini
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy; (S.M.); (E.P.)
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milano, Italy; (S.C.); (L.P.); (C.G.); (G.A.)
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Via F. Sforza 28, 20122 Milano, Italy
| | - Elena Pariani
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy; (S.M.); (E.P.)
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milano, Italy; (S.C.); (L.P.); (C.G.); (G.A.)
| | - Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milano, Italy; (S.C.); (L.P.); (C.G.); (G.A.)
| | - Cristina Galli
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milano, Italy; (S.C.); (L.P.); (C.G.); (G.A.)
| | - Giovanni Anselmi
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milano, Italy; (S.C.); (L.P.); (C.G.); (G.A.)
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy; (S.M.); (E.P.)
| | - CIRI-IT Team
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milano, Italy; (S.C.); (L.P.); (C.G.); (G.A.)
- Ospedale Policlinico San Martino IRCCS, Largo R. Benzi 10, 16132 Genoa, Italy
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Gori D, Costantino C, Odone A, Ricci B, Ialonardi M, Signorelli C, Vitale F, Fantini MP. The Impact of Mandatory Vaccination Law in Italy on MMR Coverage Rates in Two of the Largest Italian Regions (Emilia-Romagna and Sicily): An Effective Strategy to Contrast Vaccine Hesitancy. Vaccines (Basel) 2020; 8:vaccines8010057. [PMID: 32019092 PMCID: PMC7158674 DOI: 10.3390/vaccines8010057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/18/2020] [Accepted: 01/23/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Vaccine hesitancy has increased worldwide, leading to reduction in vaccination coverage rates. In particular, reduction in the coverage for the trivalent Measles-Mumps-Rubella vaccine has led to an increase of measles cases. The aim of this study is to analyze the coverage rates for the MMR vaccine in the Emilia-Romagna Region (RER) and Sicily Region (SR) between 2009 and 2018, and to correlate any significant change to index events which could have modified the trend of vaccination rates. Methods: Official aggregate data on vaccination coverage at 24 months provided by the RER and the SR were analyzed through trend analysis and related to important index events. Results: The two regions showed similar results; both achieved the lowest coverage rates in 2015 and both showed an increase in the rates after the introduction of mandatory vaccinations for access to schools. In 2018, both reached the starting point before the decrease. Conclusions: Our results confirm the effectiveness of legislative coercive measures in favor of vaccination. A potential decrease in the coverage rates may be observed as a result of an attenuation of the positive effects of coercive measures over time. It is thus necessary to combine these measures together with information campaigns and political initiatives at different levels (i.e., national, regional).
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Affiliation(s)
- Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy;
- Correspondence:
| | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (C.C.); (F.V.)
| | - Anna Odone
- School of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy; (A.O.); (C.S.)
| | - Beatrice Ricci
- School of Hygiene and Preventive Medicine, University of Bologna, 40138 Bologna, Italy; (B.R.); (M.I.)
| | - Magda Ialonardi
- School of Hygiene and Preventive Medicine, University of Bologna, 40138 Bologna, Italy; (B.R.); (M.I.)
| | - Carlo Signorelli
- School of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy; (A.O.); (C.S.)
| | - Francesco Vitale
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (C.C.); (F.V.)
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy;
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