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Merdrignac L, Aït El Belghiti F, Pandolfi E, Acosta L, Fabiánová K, Habington A, García Cenoz M, Bøås H, Toubiana J, Tozzi AE, Jordan I, Zavadilová J, O'Sullivan N, Navascués A, Flem E, Croci I, Jané M, Křížová P, Cotter S, Fernandino L, Bekkevold T, Muñoz-Almagro C, Bacci S, Kramarz P, Kissling E, Savulescu C. Effectiveness of one and two doses of acellular pertussis vaccines against laboratory-confirmed pertussis requiring hospitalisation in infants: Results of the PERTINENT sentinel surveillance system in six EU/EEA countries, December 2015 - December 2019. Vaccine 2024; 42:2370-2379. [PMID: 38472070 PMCID: PMC11007387 DOI: 10.1016/j.vaccine.2024.02.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Monitoring effectiveness of pertussis vaccines is necessary to adapt vaccination strategies. PERTINENT, Pertussis in Infants European Network, is an active sentinel surveillance system implemented in 35 hospitals across six EU/EEA countries. We aim to measure pertussis vaccines effectiveness (VE) by dose against hospitalisation in infants aged <1 year. METHODS From December 2015 to December 2019, participating hospitals recruited all infants with pertussis-like symptoms. Cases were vaccine-eligible infants testing positive for Bordetella pertussis by PCR or culture; controls were those testing negative to all Bordetella spp. For each vaccine dose, we defined an infant as vaccinated if she/he received the corresponding dose >14 days before symptoms. Unvaccinated were those who did not receive any dose. We calculated (one-stage model) pooled VE as 100*(1-odds ratio of vaccination) adjusted for country, onset date (in 3-month categories) and age-group (when sample allowed it). RESULTS Of 1,393 infants eligible for vaccination, we included 259 cases and 746 controls. Median age was 16 weeks for cases and 19 weeks for controls (p < 0.001). Median birth weight and gestational age were 3,235 g and week 39 for cases, 3,113 g and week 39 for controls. Among cases, 119 (46 %) were vaccinated: 74 with one dose, 37 two doses, 8 three doses. Among controls, 469 (63 %) were vaccinated: 233 with one dose, 206 two doses, 30 three doses. Adjusted VE after at least one dose was 59 % (95 %CI: 36-73). Adjusted VE was 48 % (95 %CI: 5-71) for dose one (416 eligible infants) and 76 % (95 %CI: 43-90) for dose two (258 eligible infants). Only 42 infants were eligible for the third dose. CONCLUSIONS Our results suggest moderate one-dose and two-dose VE in infants. Larger sample size would allow more precise estimates for dose one, two and three.
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Affiliation(s)
| | | | - Elisabetta Pandolfi
- Preventive and Predictive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Lesly Acosta
- Public Health Agency of Catalonia (ASPCAT), Barcelona, Spain; Departament d'Estadística i Investigació Operativa, Universitat Politècnica de Catalunya- BarcelonaTech (UPC), Barcelona, Spain
| | | | | | - Manuel García Cenoz
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Håkon Bøås
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Julie Toubiana
- Biodiversité et Epidémiologie des bactéries et pathogènes, Institut Pasteur, Paris, France; National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France
| | - Alberto E Tozzi
- Preventive and Predictive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Iolanda Jordan
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | | | | | | | - Elmira Flem
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Ilena Croci
- Preventive and Predictive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Mireia Jané
- Public Health Agency of Catalonia (ASPCAT), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Pavla Křížová
- National Institute of Public Health, Prague, Czech Republic
| | | | - Leticia Fernandino
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Terese Bekkevold
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Carmen Muñoz-Almagro
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Sabrina Bacci
- European Centre for Diseases Control and Prevention, Stockholm, Sweden
| | - Piotr Kramarz
- European Centre for Diseases Control and Prevention, Stockholm, Sweden
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Bucci LM, Lamprianou S, Gesualdo F, Tozzi AE, Ghalayini T, Sahinovic I, Pal S. A social media intervention for communicating vaccine safety in low- and middle-income countries: protocol for a pilot study. Front Public Health 2023; 11:1248949. [PMID: 38145079 PMCID: PMC10748494 DOI: 10.3389/fpubh.2023.1248949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/06/2023] [Indexed: 12/26/2023] Open
Abstract
Vaccine safety is a concern that continues to drive hesitancy and refusal in populations in low-and-middle income countries (LMICs). Communicating about vaccine safety is a strategy that can successfully change personal and community perceptions and behaviors toward vaccination. The COVID-19 infodemic emergency with the rapid rollout of new vaccines and new technology, demonstrated the need for good and effective vaccine safety communication. The Vaccine Safety Net (VSN), a WHO-led global network of websites that provide reliable information on vaccine safety offers the ideal environment for gathering web and social media analytics for measuring impact of vaccine safety messages. Its members work with a wide range of populations, in different geographic locations and at many levels including national, regional, and local. We propose to undertake a pilot study to evaluate the feasibility of implementing COVID-19 vaccine safety communications with VSN members working in LMICs and to assess the impact of communications on public knowledge, attitudes, and perceptions.
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Affiliation(s)
| | | | - Francesco Gesualdo
- Predictive and Preventive Research Unit, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alberto E. Tozzi
- Predictive and Preventive Research Unit, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Tala Ghalayini
- Accenture Health and Public Service, London, United Kingdom
| | | | - Shanthi Pal
- World Health Organization, Geneva, Switzerland
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Beresniak A, Napoli C, Oxford J, Daruich A, Niddam L, Duru G, Tozzi AE, Atti MCD, Dupont D, Rizzo C, Bremond-Gignac D. The FLURESP European commission project: cost-effectiveness assessment of ten public health measures against influenza in Italy: is there an interest in COVID-19 pandemic? Cost Eff Resour Alloc 2023; 21:30. [PMID: 37189126 DOI: 10.1186/s12962-023-00432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 03/13/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND The FLURESP project is a public health research funded by the European Commission, with the objective to design a methodological framework to assess the cost-effectiveness of existing public health measures against human influenza pandemics. A dataset has been specifically collected in the frame of the Italian health system. As most of interventions against human influenza are relavant against other respiratory diseases pandemics, potential interests in COVID-19 are discussed. METHODS Ten public health measures against human influenza pandemics pandemic were selected to be also relevant to other respiratory virus pandemics such as COVID 19: individual (hand washing, using masks), border control (quarantine, fever screening, border closure), community infection (school closure, class dismissal, social distancing, limitation of public transport), reduction of secondary infections (implementation of antibiotic therapy guidelines), pneumococcal vaccination for at-risk people, development of Intensive Care Unit (ICU) capacity, implementation of life support equipments in ICU, screening interventions, vaccination programs targeting health professional and targeting general population. RESULTS Using mortality reduction as effectiveness criteria, the most cost-effective strategies are "reduction of secondary infections" and "implementation of life support equipment in ICU". The least cost-effective option whatever the level of pandemic events are screening interventions and mass vaccination. CONCLUSIONS A number of intervention strategies against human influenza pandemics appears relevant against every respiratory virus, including the COVID-19 event. Measures against pandemics should be considered according to their expected effectiveness but also their costs for the society because they impose substantial burden to the population, confirming the interest of considering cost-effectiveness of public health measures to enlighten decision making.
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Affiliation(s)
- Ariel Beresniak
- Data Mining International, Geneva Business Terminal, Route de Pré-Bois, 14, 1216, Geneva, Switzerland.
| | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Alejandra Daruich
- University Hospital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, AP-HP, Paris University, Paris, France
- Research Centre Cordeliers, INSERM, UMRS1138, Team 17, Sorbonne Paris Cité University, Paris, France
| | | | - Gérard Duru
- Data Mining International, Geneva Business Terminal, Route de Pré-Bois, 14, 1216, Geneva, Switzerland
| | | | | | - Danielle Dupont
- Data Mining International, Geneva Business Terminal, Route de Pré-Bois, 14, 1216, Geneva, Switzerland
| | | | - Dominique Bremond-Gignac
- University Hospital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, AP-HP, Paris University, Paris, France
- Research Centre Cordeliers, INSERM, UMRS1138, Team 17, Sorbonne Paris Cité University, Paris, France
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Borro L, Raponi M, Del Fattore A, Zanini F, di Lillo F, Contillo A, Bordonaro V, Di Piazza E, Tozzi AE, Secinaro A. Reusability of P3 Facial Filter in a Pandemic Emergency: A 3D Analysis of Filter Microstructure with X-ray Microtomography Images after Dry Heat and UV Sterilization Procedures. Int J Environ Res Public Health 2022; 19:ijerph19063435. [PMID: 35329123 PMCID: PMC8952298 DOI: 10.3390/ijerph19063435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 01/27/2023]
Abstract
Objective: Our goal is to evaluate the effects of heat and ultraviolet (UV) irradiation on P3 facial respirator microstructure. Intervention: P3 facial filters were exposed to dry heat and UV sterilization procedures. Methods: P3 facial filter samples underwent a standardized sterilization process based on dry heat and UV irradiation techniques. We analyzed critical parameters of internal microstructure, such as fiber thickness and porosity, before and after sterilization, using 3D data obtained with synchrotron radiation-based X-ray computed microtomography (micro-CT). The analyzed filter has two inner layers called the “finer” and “coarser” layers. The “finer” layer consists of a dense fiber network, while the “coarser” layer has a less compact fiber network. Results: Analysis of 3D images showed no statistically significant differences between the P3 filter of the controls and the dry heat/UV sterilized samples. In particular, averages fiber thickness in the finer layer of the control and the 60° dry heated and UV-irradiated sample groups was almost identical. Average fiber thickness for the coarser layer of the control and the 60° dry heated and UV-irradiated sample groups was very similar, measuring 19.33 µm (±0.47), 18.33 µm (±0.47), and 18.66 µm (±0.47), respectively. There was no substantial difference in maximum fiber thickness in the finer layers and coarser layers. For the control group samples, maximum thickness was on average 11.43 µm (±1.24) in the finer layer and 59.33 µm (±6.79) in the coarser layer. Similarly, the 60° dry heated group samples were thickened 12.2 µm (±0.21) in the finer layer and 57.33 µm (±1.24) in the coarser layer, while for the UV-irradiated group, the mean max thickness was 12.23 µm (±0.90) in the finer layer and 58.00 µm (±6.68) in the coarser layer. Theoretical porosity analysis resulted in 74% and 88% for the finer and coarser layers. The finer layers’ theoretical porosity tended to decrease in dry heat and UV-irradiated samples compared with the respective control samples. Conclusions: Dry heat and UV sterilization processes do not substantially alter the morphometry of the P3 filter samples’ internal microstructure, as studied with micro-CT. The current study suggests that safe P3 filter facepiece reusability is theoretically feasible and should be further investigated.
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Affiliation(s)
- Luca Borro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.B.); (A.S.)
- Correspondence: ; Tel.: +39-06-6859-2193
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Andrea Del Fattore
- Bone Physiopathology Research Unit, Genetics and Rare Diseases Research Area, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Franco Zanini
- Elettra-Sincrotrone Trieste, 34149 Trieste, Italy; (F.Z.); (F.d.L.); (A.C.)
| | - Francesca di Lillo
- Elettra-Sincrotrone Trieste, 34149 Trieste, Italy; (F.Z.); (F.d.L.); (A.C.)
| | - Adriano Contillo
- Elettra-Sincrotrone Trieste, 34149 Trieste, Italy; (F.Z.); (F.d.L.); (A.C.)
| | - Veronica Bordonaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.B.); (A.S.)
| | - Eleonora Di Piazza
- UOC Endocrinologia e Diabetologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli–IRCCS, 00168 Rome, Italy;
| | - Alberto E. Tozzi
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.B.); (A.S.)
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Pandolfi E, Gesualdo F, Rizzo C, Russo L, Campagna I, Carloni E, Concato C, Linardos G, Villani A, Ciampini S, Reale A, Boccuzzi E, Midulla F, Tozzi AE. The impact of pertussis in infants: insights from a hospital-based enhanced surveillance system, Lazio region, Italy, 2016 to 2019. ACTA ACUST UNITED AC 2021; 26. [PMID: 34142648 PMCID: PMC8212589 DOI: 10.2807/1560-7917.es.2021.26.24.2000562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Routine surveillance systems for pertussis often suffer from under-recognition and under-reporting. Aim Our aim was to describe the epidemiology and the clinical features of pertussis in children younger than 1 year in an Italian region, detected through an enhanced hospital surveillance system. Methods From 2016 to 2019, we monitored the incidence and the clinical characteristics of hospitalised pertussis cases younger than 1 year in two paediatric hospitals involved in the PERTINENT project. Results We detected 141 pertussis cases, corresponding to an estimated incidence of 105.8 per 100.000 in 2016, 91.7 per 100.000 in 2017, 64.5 per 100.000 in 2018 and 40.9 per 100.000 in 2019, based on the hospitals’ catchment area, roughly corresponding to the Lazio region. A total of 101 cases (77.1%) had a household member with cough or other respiratory symptoms. The most frequent combination of symptoms was paroxysmal cough with apnoea in the absence of fever. Almost 40% had been prescribed an antibiotic treatment before hospitalisation, and the median time from symptom onset to contact with the hospital was 8 days. Thirty-one (22.0%) had complications. Conclusion An enhanced surveillance system showed a high incidence of pertussis among infants in the Lazio region, where the impact of this disease may still be underestimated. Increasing the coverage of pertussis immunisation among pregnant women and improving the capacity for early detection in primary care may contribute to reducing the impact of pertussis among infants.
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Affiliation(s)
- Elisabetta Pandolfi
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Francesco Gesualdo
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Caterina Rizzo
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Luisa Russo
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Ilaria Campagna
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Emanuela Carloni
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Carlo Concato
- Bambino Gesù Children's Hospital, IRCCS, Virology Unit, Rome, Italy
| | - Giulia Linardos
- Bambino Gesù Children's Hospital, IRCCS, Virology Unit, Rome, Italy
| | - Alberto Villani
- Bambino Gesù Children's Hospital, IRCCS, Paediatric and Infectious Diseases Unit, Rome, Italy
| | - Sara Ciampini
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Antonino Reale
- Bambino Gesù Children's Hospital, IRCCS, Emergency Department, Rome, Italy
| | - Elena Boccuzzi
- Bambino Gesù Children's Hospital, IRCCS, Emergency Department, Rome, Italy
| | - Fabio Midulla
- Sapienza University, Department of Paediatrics, Rome, Italy
| | - Alberto E Tozzi
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
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Merdrignac L, Aït El Belghiti F, Pandolfi E, Jané M, Murphy J, Fabiánová K, García Cenoz M, Flem E, Guillot S, Tozzi AE, Carmona G, Habington A, Zavadilová J, Navasués A, Bøås H, Lévy-Brühl D, Ferretti B, Lanaspa M, O'Sullivan N, Křížová P, Fernandino L, Bekkevold T, Hanslik T, Muñoz-Almagro C, Bacci S, Spiteri G, Valenciano M, Moren A. Incidence and severity of pertussis hospitalisations in infants aged less than 1 year in 37 hospitals of six EU/EEA countries, results of PERTINENT sentinel pilot surveillance system, December 2015 to December 2018. ACTA ACUST UNITED AC 2021; 26. [PMID: 33509338 PMCID: PMC7848786 DOI: 10.2807/1560-7917.es.2021.26.4.1900762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction PERTINENT is a pilot active surveillance system of infants hospitalised with pertussis in six European Union/European Economic Area countries (37 hospitals, seven sites). Aim This observational study aimed to estimate annual pertussis incidence per site from 2016 to 2018 and respective trends between 2017 and 2018. Pertussis cases were described, including their severity. Methods We developed a generic protocol and laboratory guidelines to harmonise practices across sites. Cases were hospitalised infants testing positive for Bordetella pertussis by PCR or culture. Sites collected demographic, clinical, laboratory data, vaccination status, and risk/protective factors. We estimated sites’ annual incidences by dividing case numbers by the catchment populations. Results From December 2015 to December 2018, we identified 469 cases (247 males; 53%). The median age, birthweight and gestational age were 2.5 months (range: 0–11.6; interquartile range (IQR): 2.5), 3,280 g (range: 700–4,925; IQR: 720) and 39 weeks (range: 25–42; IQR: 2), respectively. Thirty cases (6%) had atypical presentation either with cough or cyanosis only or with absence of pertussis-like symptoms. Of 330 cases with information, 83 (25%) were admitted to intensive care units including five deceased infants too young to be vaccinated. Incidence rate ratios between 2018 and 2017 were 1.43 in Czech Republic (p = 0.468), 0.25 in Catalonia (p = 0.002), 0.71 in France (p = 0.034), 0.14 in Ireland (p = 0.002), 0.63 in Italy (p = 0.053), 0.21 in Navarra (p = 0.148) and zero in Norway. Conclusions Incidence appeared to decrease between 2017 and 2018 in all but one site. Enhanced surveillance of hospitalised pertussis in Europe is essential to monitor pertussis epidemiology and disease burden.
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Affiliation(s)
| | | | - Elisabetta Pandolfi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital, Rome, Italy
| | - Mireia Jané
- Epidemiological surveillance and response, Public Health Agency of Catalonia, Barcelona, Spain
| | - Jane Murphy
- Research, Temple Street Children's University Hospital, Dublin, Ireland
| | | | - Manuel García Cenoz
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Elmira Flem
- Infectious Disease Epidemiology and Modeling, Norwegian Institute of Public Health, Oslo, Norway
| | - Sophie Guillot
- Biodiversité et Epidémiologie des bactéries et pathogènes, Institut Pasteur, Paris, France
| | - Alberto E Tozzi
- Chief Innovation Unit and Clinical Trials, Bambino Gesù Children Hospital, Rome, Italy
| | - Gloria Carmona
- Epidemiological surveillance and response, Public Health Agency of Catalonia, Barcelona, Spain
| | - Adele Habington
- Microbiology, Our Lady's Children's hospital Crumlin, Dublin, Ireland
| | | | - Ana Navasués
- Clinical Microbiology Service, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Håkon Bøås
- Infectious Disease Epidemiology and Modeling, Norwegian Institute of Public Health, Oslo, Norway
| | - Daniel Lévy-Brühl
- Direction des maladies infectieuses, Santé Publique France, Paris, France
| | - Beatrice Ferretti
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital, Rome, Italy
| | - Miguel Lanaspa
- Instituto de Recerca Pediatrica Hospital Sant Joan de Deu, Barcelona, Spain
| | - Niam O'Sullivan
- Microbiology, Our Lady's Children's hospital Crumlin, Dublin, Ireland
| | - Pavla Křížová
- National Institute of Public Health, Prague, Czech Republic
| | - Leticia Fernandino
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Terese Bekkevold
- Infectious Disease Epidemiology and Modeling, Norwegian Institute of Public Health, Oslo, Norway
| | - Thomas Hanslik
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Carmen Muñoz-Almagro
- CIBER of Epidemiology and Public Health CIBERESP, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain.,Instituto de Recerca Pediatrica Hospital Sant Joan de Deu, Barcelona, Spain
| | - Sabrina Bacci
- European Centre for Diseases Prevention and Control, Stockholm, Sweden
| | | | | | - Alain Moren
- Epidemiology Department, Epiconcept, Paris, France
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- The members of the network are listed at the end of the article
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Gesualdo F, Bucci LM, Rizzo C, Tozzi AE. Digital tools, multidisciplinarity and innovation for communicating vaccine safety in the COVID-19 era. Hum Vaccin Immunother 2021; 18:1865048. [PMID: 33764272 PMCID: PMC8920147 DOI: 10.1080/21645515.2020.1865048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The research on the anti-SARS-CoV-2 vaccines and their commercialization is an opportunity to test and consolidate the current knowledge along with the diverse available tools related to vaccine communication. In this paper we explore the value of a multidisciplinary approach in this field: vaccine communication activities can be combined with insights from data science, risk communication, behavior change, design thinking and digital marketing. Methodologies derived from innovation and human-centered design can contribute to the development and testing of vaccine promotion campaigns, speeding up processes and streamlining the production of evidence in this area. The multiple activities involving the anti-SARS-CoV-2 vaccine could be the fertile ground in which to develop, test and refine effective frameworks to transfer data acquired through listening strategies into effective vaccine promotion campaigns. The World Health Organization’s Vaccine Safety Net is an interesting example of trusted information sources that aim toward using digital tools and innovative methodologies for communicating science-based information on vaccine safety at the global level.
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Affiliation(s)
- Francesco Gesualdo
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lucie M Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, Canada
| | - Caterina Rizzo
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alberto E Tozzi
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital, Rome, Italy
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Grimsholm O, Piano Mortari E, Davydov AN, Shugay M, Obraztsova AS, Bocci C, Marasco E, Marcellini V, Aranburu A, Farroni C, Silvestris DA, Cristofoletti C, Giorda E, Scarsella M, Cascioli S, Barresi S, Lougaris V, Plebani A, Cancrini C, Finocchi A, Moschese V, Valentini D, Vallone C, Signore F, de Vincentiis G, Zaffina S, Russo G, Gallo A, Locatelli F, Tozzi AE, Tartaglia M, Chudakov DM, Carsetti R. The Interplay between CD27 dull and CD27 bright B Cells Ensures the Flexibility, Stability, and Resilience of Human B Cell Memory. Cell Rep 2021; 30:2963-2977.e6. [PMID: 32130900 DOI: 10.1016/j.celrep.2020.02.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/23/2019] [Accepted: 02/05/2020] [Indexed: 10/24/2022] Open
Abstract
Memory B cells (MBCs) epitomize the adaptation of the immune system to the environment. We identify two MBC subsets in peripheral blood, CD27dull and CD27bright MBCs, whose frequency changes with age. Heavy chain variable region (VH) usage, somatic mutation frequency replacement-to-silent ratio, and CDR3 property changes, reflecting consecutive selection of highly antigen-specific, low cross-reactive antibody variants, all demonstrate that CD27dull and CD27bright MBCs represent sequential MBC developmental stages, and stringent antigen-driven pressure selects CD27dull into the CD27bright MBC pool. Dynamics of human MBCs are exploited in pregnancy, when 50% of maternal MBCs are lost and CD27dull MBCs transit to the more differentiated CD27bright stage. In the postpartum period, the maternal MBC pool is replenished by the expansion of persistent CD27dull clones. Thus, the stability and flexibility of human B cell memory is ensured by CD27dull MBCs that expand and differentiate in response to change.
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Affiliation(s)
- Ola Grimsholm
- B Cell Pathophysiology Unit, Immunology Research Area, Bambino Gesù Children's Hospital IRCCS, 00146 Rome, Italy; Department of Rheumatology and Inflammation Research, University of Gothenburg, Box 480, 405 30 Gothenburg, Sweden
| | - Eva Piano Mortari
- B Cell Pathophysiology Unit, Immunology Research Area, Bambino Gesù Children's Hospital IRCCS, 00146 Rome, Italy
| | - Alexey N Davydov
- Central European Institute of Technology, 625 00 Brno, Czech Republic
| | - Mikhail Shugay
- Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, 117997 Moscow, Russia; Institute of Translational Medicine, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; Center of Life Sciences, Skolkovo Institute of Science and Technology, 101000 Moscow, Russia
| | - Anna S Obraztsova
- Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, 117997 Moscow, Russia; Center of Life Sciences, Skolkovo Institute of Science and Technology, 101000 Moscow, Russia
| | - Chiara Bocci
- B Cell Pathophysiology Unit, Immunology Research Area, Bambino Gesù Children's Hospital IRCCS, 00146 Rome, Italy
| | - Emiliano Marasco
- Division of Rheumatology, Bambino Gesù Children's Hospital IRCCS, 00146 Roma, Italy
| | - Valentina Marcellini
- B Cell Pathophysiology Unit, Immunology Research Area, Bambino Gesù Children's Hospital IRCCS, 00146 Rome, Italy
| | - Alaitz Aranburu
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Box 480, 405 30 Gothenburg, Sweden
| | - Chiara Farroni
- B Cell Pathophysiology Unit, Immunology Research Area, Bambino Gesù Children's Hospital IRCCS, 00146 Rome, Italy
| | | | | | - Ezio Giorda
- B Cell Pathophysiology Unit, Immunology Research Area, Bambino Gesù Children's Hospital IRCCS, 00146 Rome, Italy
| | - Marco Scarsella
- B Cell Pathophysiology Unit, Immunology Research Area, Bambino Gesù Children's Hospital IRCCS, 00146 Rome, Italy
| | - Simona Cascioli
- B Cell Pathophysiology Unit, Immunology Research Area, Bambino Gesù Children's Hospital IRCCS, 00146 Rome, Italy
| | - Sabina Barresi
- Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, 00146 Rome, Italy
| | - Vassilios Lougaris
- Department of Experimental and Clinical Sciences, University of Brescia, 25121 Brescia, Italy
| | - Alessandro Plebani
- DPUO, Division of Immuno-Infectivology, University Department of Pediatrics, 00146 Bambino Gesù Children's Hospital, Rome, Italy
| | - Caterina Cancrini
- DPUO, Division of Immuno-Infectivology, University Department of Pediatrics, 00146 Bambino Gesù Children's Hospital, Rome, Italy; School of Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Andrea Finocchi
- DPUO, Division of Immuno-Infectivology, University Department of Pediatrics, 00146 Bambino Gesù Children's Hospital, Rome, Italy; School of Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Viviana Moschese
- Pediatric Immunology Unit, Policlinico Tor Vergata, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Diletta Valentini
- Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, 00146 Rome, Italy
| | - Cristina Vallone
- Department of Obstetrics and Gynaecology, Misericordia Hospital Grosseto, Usl Toscana Sud-est, 58100 Grosseto, Italy
| | - Fabrizio Signore
- Department of Obstetrics and Gynaecology, Misericordia Hospital Grosseto, Usl Toscana Sud-est, 58100 Grosseto, Italy
| | | | - Salvatore Zaffina
- Occupational Medicine/Health Technology Assessment and Safety Research Unit, Clinical-Technological Innovations Research Area, Bambino Gesù Children's Hospital, IRCCS, 00146 Rome, Italy
| | | | - Angela Gallo
- Oncohaematology Department, Bambino Gesù Children's Hospital IRCCS, 00146 Rome, Italy
| | - Franco Locatelli
- Oncohaematology Department, Bambino Gesù Children's Hospital IRCCS, 00146 Rome, Italy; Department of Pediatrics, Sapienza, University of Rome, 00161 Rome, Italy
| | - Alberto E Tozzi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital, IRCSS, 00146 Rome, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, 00146 Rome, Italy
| | - Dmitriy M Chudakov
- Central European Institute of Technology, 625 00 Brno, Czech Republic; Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, 117997 Moscow, Russia; Institute of Translational Medicine, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; Center of Life Sciences, Skolkovo Institute of Science and Technology, 101000 Moscow, Russia
| | - Rita Carsetti
- B Cell Pathophysiology Unit, Immunology Research Area, Bambino Gesù Children's Hospital IRCCS, 00146 Rome, Italy; Diagnostic Immunology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, 00146 Rome, Italy.
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9
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Jackson SM, Daverio M, Perez SL, Gesualdo F, Tozzi AE. Improving Informed Consent for Novel Vaccine Research in a Pediatric Hospital Setting Using a Blended Research-Design Approach. Front Pediatr 2021; 8:520803. [PMID: 33511090 PMCID: PMC7835206 DOI: 10.3389/fped.2020.520803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 09/22/2020] [Indexed: 02/02/2023] Open
Abstract
It is necessary to conduct Clinical Trials in children, including for novel vaccines. Children cannot legally provide valid consent, but can assent to research participation. Informed consent and assent communications are frequently criticized for their lack of comprehensibility and often, researchers do not involve patients in informed consent design. We tested a blended research-design approach to co-design multimedia informed consent prototypes for experimental vaccine studies targeted at the pediatric population. We report details on the methodology utilized, and the insights, ideas, and prototype solutions we generated using social media data analysis, a survey, and workshops. A survey of clinical trial researchers indicated that while the most did not use technology for informed consent, they considered its utilization favorable. Social media analysis enabled researchers to quickly understand where community perspectives were concordant and discordant and build their understanding of the types of topics that they may want to focus on during the design workshops. Participatory design workshops for children and their families reaped insights, ideas, and prototypes for a range of tools including apps and websites. Participants felt that the prototypes were better able to communicate necessary content than the original text document format. We propose using a participatory, mixed-methods approach to design informed consent so that it is better adapted to patients' needs. Such an approach would be helpful in better addressing the needs of different segments of the populations involved in clinical trials. Further evidence should be gained about the impact of this strategy in improving recruitment, decreasing withdrawals and litigations, and improving patient satisfaction during clinical trials.
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Affiliation(s)
- Sally M. Jackson
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | | | - Francesco Gesualdo
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alberto E. Tozzi
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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10
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Montagnoli C, Ruggeri S, Cinelli G, Tozzi AE, Bovo C, Bortolus R, Zanconato G. Anything New about Paternal Contribution to Reproductive Outcomes? A Review of the Evidence. World J Mens Health 2021; 39:626-644. [PMID: 33474842 PMCID: PMC8443996 DOI: 10.5534/wjmh.200147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/13/2020] [Accepted: 11/08/2020] [Indexed: 11/15/2022] Open
Abstract
Paternal health and behavioral lifestyles affect reproductive and neonatal outcomes and yet the magnitude of these effects remain underestimated. Even though these impacts have been formally recognized as a central aspect of reproductive health, health care services in Europe often neglect the involvement of fathers in their reproductive programs. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews, a literature search was carried out to assess the possible impact of paternal health on reproductive outcomes. The comprehensive strategy included cohort studies and meta-analysis available on PubMed, Web of Science, CINAHL, and Google scholar. Cross-referencing of bibliographies of the selected papers ensured wider study capture. Paternal factors were grouped into two categories respectively identified with the terms "Biological Paternal Factors" and "Lifestyle Paternal Factors". Advanced age may impair male fertility and affect early pregnancy stages. Increased body mass index, smoking, alcohol and recreational drugs, all alter seminal fluid parameters. Hazardous alcohol use correlates with low birthweight in pregnancy and harmful behavioral lifestyles have been linked to congenital heart defects, metabolic and neurodevelopmental disorders in the offspring. Measures targeting paternal health and lifestyle within the first 1,000 days' timeframe need to be implemented in couples undergoing reproductive decisions. Health professionals, as well as future fathers, must be aware of the benefits for the offspring associated with correct paternal behaviors. More research is needed to build guidelines and to implement specific programs aiming at reproductive health promotion.
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Affiliation(s)
- Caterina Montagnoli
- Department of Medical Direction, Verona University Hospital, Verona, Italy.,Department of Midwifery, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland
| | | | - Giulia Cinelli
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto E Tozzi
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Chiara Bovo
- Department of Medical Direction, Verona University Hospital, Verona, Italy
| | - Renata Bortolus
- Directorate General for Preventive Health - Office 9, Ministry of Health, Rome, Italy
| | - Giovanni Zanconato
- Department of Surgery, Odontostomatology and Maternal and Child Health, University of Verona, Verona, Italy
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11
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Tozzi AE. [Engagement, technology, and innovation.]. Recenti Prog Med 2020; 111:675-677. [PMID: 33205769 DOI: 10.1701/3474.34572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The journey of chronic and of complex patients is full of hurdles which the available technologies may help to overcome. The scarce application of technologic innovations is mainly a cultural problem. However, innovations should be guided by the analysis of clinical needs and of the potential solutions involving directly doctors and patients in a participatory model.
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12
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Gesualdo F, Marino F, Mantero J, Spadoni A, Sambucini L, Quaglia G, Rizzo C, Sahinovic I, Zuber PLF, Tozzi AE. The use of web analytics combined with other data streams for tailoring online vaccine safety information at global level: The Vaccine Safety Net's web analytics project. Vaccine 2020; 38:6418-6426. [PMID: 32788137 DOI: 10.1016/j.vaccine.2020.07.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 07/22/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
The Vaccine Safety Net's Web Analytics Project (VSN-WAP) was launched in October 2017 to monitor the behavior of users visiting websites belonging to the VSN, a global network of websites providing science-based information on vaccine safety. Participating websites could provide web metrics in two ways: through a Google Analytics (GA) script, which automatically forwarded metrics to a central account and through manual input (MI) of a reduced subset of metrics (Sessions, Page Views, New Users, Bounce Rate, Views/Session and Average Session Duration), which were pooled with the metrics obtained through GA. Additional metrics were obtained from websites providing data through Google Analytics (Country, Age, Sex, Device). We report results from February 2018 to March 2019. In March 2019, 32 websites were participating in the project (21 through GA, 11 through MI). From February 2018 to March 2019 we recorded 22,471,535 sessions, with 38,307,349 page views. Sessions, New Users and Page views progressively increased, Views/Session, Bounce Rate and Average Session Duration remained stable. Most users were female (68%) and belonged to the 25-34 age range (37%), followed by 35-44 (22%) and 18-24 (19%). Fifty-four percent of users connected from a mobile device, 42% from a desktop and 4% from a tablet. Digital media monitoring techniques can provide insights on the characteristics of users with a specific interest in vaccines. These data can be exploited to improve the performance of websites providing information on vaccines to the general public.
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Affiliation(s)
| | | | - Jas Mantero
- Bambino Gesù Children's Hospital, Rome, Italy
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13
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Gesualdo F, D'Ambrosio A, Agricola E, Russo L, Campagna I, Ferretti B, Pandolfi E, Cristoforetti M, Tozzi AE, Rizzo C. How do Twitter users react to TV broadcasts dedicated to vaccines in Italy? Eur J Public Health 2020; 30:510-515. [PMID: 32073598 PMCID: PMC7292342 DOI: 10.1093/eurpub/ckaa022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Social media monitoring during TV broadcasts dedicated to vaccines can provide information on vaccine confidence. We analyzed the sentiment of tweets published in reaction to two TV broadcasts in Italy dedicated to vaccines, one based on scientific evidence [Presadiretta (PD)] and one including anti-vaccine personalities [Virus (VS)]. METHODS Tweets about vaccines published in an 8-day period centred on each of the two TV broadcasts were classified by sentiment. Differences in tweets' and users' characteristics between the two broadcasts were tested through Poisson, quasi-Poisson or logistic univariate regression. We investigated the association between users' characteristics and sentiment through univariate quasi-binomial logistic regression. RESULTS We downloaded 12 180 tweets pertinent to vaccines, published by 5447 users; 276 users tweeted during both broadcasts. Sentiment was positive in 50.4% of tweets, negative in 37.7% and neutral in 10.1% (remaining tweets were unclear or questions). The positive/negative ratio was higher for VS compared to PD (6.96 vs. 4.24, P<0.001). Positive sentiment was associated to the user's number of followers (OR 1.68, P<0.001), friends (OR 1.83, P<0.001) and published tweets (OR 1.46, P<0.001) and to being a recurrent user (OR 3.26, P<0.001). CONCLUSIONS Twitter users were highly reactive to TV broadcasts dedicated to vaccines. Sentiment was mainly positive, especially among very active users. Displaying anti-vaccine positions on TV elicited a positive sentiment on Twitter. Listening to social media during TV shows dedicated to vaccines can provide a diverse set of data that can be exploited by public health institutions to inform tailored vaccine communication initiatives.
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Affiliation(s)
- Francesco Gesualdo
- Predictive and Preventive Medicine Research Unit, Multifactorial and Complex Disease Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angelo D'Ambrosio
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Eleonora Agricola
- Predictive and Preventive Medicine Research Unit, Multifactorial and Complex Disease Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luisa Russo
- Predictive and Preventive Medicine Research Unit, Multifactorial and Complex Disease Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ilaria Campagna
- Predictive and Preventive Medicine Research Unit, Multifactorial and Complex Disease Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Beatrice Ferretti
- Predictive and Preventive Medicine Research Unit, Multifactorial and Complex Disease Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elisabetta Pandolfi
- Predictive and Preventive Medicine Research Unit, Multifactorial and Complex Disease Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Cristoforetti
- Information and Communication Technology Department, Fondazione Bruno Kessler, Trento, Italy
| | - Alberto E Tozzi
- Predictive and Preventive Medicine Research Unit, Multifactorial and Complex Disease Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Caterina Rizzo
- Predictive and Preventive Medicine Research Unit, Multifactorial and Complex Disease Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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14
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Ceradini J, Tozzi AE, Agati S, De Zorzi A, Capolupo I, Iannace E, Manuri L, Pirti C, Di Iorio F, Brusco C, Raponi M. Teleconsultation and second opinions to promote high specialization in pediatrics. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky213.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Ceradini
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - AE Tozzi
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - S Agati
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - A De Zorzi
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - I Capolupo
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - E Iannace
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - L Manuri
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - C Pirti
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - F Di Iorio
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - C Brusco
- IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - M Raponi
- IRCCS Ospedale Bambino Gesù, Roma, Italy
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15
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Gesualdo F, Zamperini N, Tozzi AE. To talk better about vaccines, we should talk less about vaccines. Vaccine 2018; 36:5107-5108. [PMID: 30033116 DOI: 10.1016/j.vaccine.2018.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 11/16/2022]
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16
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Pandolfi E, Gesualdo F, Rizzo C, Bella A, Agricola E, Mastroiacovo P, Tozzi AE. Global seroprevalence of rubella among pregnant and childbearing age women: a meta-analysis. Eur J Public Health 2018; 27:530-537. [PMID: 28204465 DOI: 10.1093/eurpub/ckw259] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background We conducted a meta-analysis of articles published between January 2000 and July 2016 with the aim of defining the proportion of rubella seronegative women of childbearing age (WCBA), providing the best information available on the seroprevalence of rubella in this population. We selected articles published in the time period between 2000 and 2016. The pooled prevalence of rubella seronegative women was calculated by a fixed effect model and a random effect model, according to the heterogeneity among studies. Studies were sub-grouped by population type (pregnant women and WCBA with no mention of ongoing pregnancy) and by geographic area [World Health Organization (WHO) region]. Sensitivity analysis was performed to assess the stability of results. We found important differences in rubella seronegativity prevalence estimates by WHO Region. About 88% of the studies conducted on pregnant women reported a seronegativity rate >5%. The pooled rubella seronegativity prevalence was 9.3%. When considering population groups, we obtained a seronegativity pooled estimate of 9.4% for pregnant women and of 9.5% for WCBA with no mention of ongoing pregnancy. This meta-analysis shows that the proportion of WCBA who are susceptible to rubella is still high. The figures are worrisome, taking into account that the WHO set at 5% the rubella susceptibility threshold for WCBA.
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Affiliation(s)
- E Pandolfi
- Bambino Gesù Children's Hospital IRCCS, Multifactorial and Complex Diseases Research Area, Piazza S. Onofrio 4, Rome 00165, Italy
| | - F Gesualdo
- Bambino Gesù Children's Hospital IRCCS, Multifactorial and Complex Diseases Research Area, Piazza S. Onofrio 4, Rome 00165, Italy
| | - C Rizzo
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - A Bella
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - E Agricola
- Bambino Gesù Children's Hospital IRCCS, Multifactorial and Complex Diseases Research Area, Piazza S. Onofrio 4, Rome 00165, Italy
| | - P Mastroiacovo
- Alessandra Lisi International Centre on Birth Defects and Prematurity, Via Carlo Mirabello 14, Rome 00192, Italy
| | - A E Tozzi
- Bambino Gesù Children's Hospital IRCCS, Multifactorial and Complex Diseases Research Area, Piazza S. Onofrio 4, Rome 00165, Italy
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17
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Agricola E, Gesualdo F, Alimenti L, Pandolfi E, Carloni E, D'Ambrosio A, Russo L, Campagna I, Ferretti B, Tozzi AE. Knowledge attitude and practice toward pertussis vaccination during pregnancy among pregnant and postpartum Italian women. Hum Vaccin Immunother 2017; 12:1982-1988. [PMID: 27712242 DOI: 10.1080/21645515.2016.1188242] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In Italy, no specific recommendation toward maternal pertussis immunization during pregnancy has been issued. However, vaccination during pregnancy will be likely integrated in the Italian immunization program in the future. In order to identify barriers to achieving a sufficient vaccination coverage during pregnancy, we investigated knowledge, attitude and practice toward pertussis vaccination during pregnancy through a web-based survey. A total of 343 Italian pregnant women (N = 164) and women in the postpartum period (N = 183) completed the online questionnaire. More than a half of the study population was uncertain regarding the benefits of the vaccination during pregnancy. Only 1.7% of women in the postpartum had received the vaccination during pregnancy, and 21% of pregnant women declared the intention to be vaccinated in pregnancy. Only 34% would accept the vaccination in the current or in a future pregnancy, if recommended by a physician, and a half would remain uncertain. Perceiving the vaccine as harmful for the fetus' development is associated to a decreased willingness to be vaccinated if recommended by a HCP, both in pregnant women (OR 0.25 p = 0.010 95% CI 0.09-0.72) and in women in the postpartum period (OR 0.32 p = 0.006 95% CI 0.15-0.72). Our study suggests that the vaccination recommendation by physicians might not be sufficient to adequately raise vaccination coverage against pertussis among Italian pregnant women. A combination of educational interventions and tailored communi-cation campaigns could be implemented to promote maternal immunization.
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Affiliation(s)
- Eleonora Agricola
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Francesco Gesualdo
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Lia Alimenti
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Elisabetta Pandolfi
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Emanuela Carloni
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Angelo D'Ambrosio
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Luisa Russo
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Ilaria Campagna
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Beatrice Ferretti
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Alberto E Tozzi
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
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18
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Frassanito A, Nenna R, Nicolai A, Pierangeli A, Tozzi AE, Stefanelli P, Carsetti R, Concato C, Schiavoni I, Midulla F. Infants hospitalized for Bordetella pertussis infection commonly have respiratory viral coinfections. BMC Infect Dis 2017; 17:492. [PMID: 28701160 PMCID: PMC5506634 DOI: 10.1186/s12879-017-2567-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/26/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- A Frassanito
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - R Nenna
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - A Nicolai
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - A Pierangeli
- Molecular Medicine Department, "Sapienza" University of Rome, Rome, Italy
| | - A E Tozzi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - P Stefanelli
- Department of Infectious, Parasitic & Immunomediated Disease, Istituto Superiore di Sanità, Rome, Italy
| | - R Carsetti
- Immunology Unit, Immunology and Pharmacal Therapy Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - C Concato
- Virology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - I Schiavoni
- Department of Infectious, Parasitic & Immunomediated Disease, Istituto Superiore di Sanità, Rome, Italy
| | - F Midulla
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy.
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19
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Stefanelli P, Buttinelli G, Vacca P, Tozzi AE, Midulla F, Carsetti R, Fedele G, Villani A, Concato C. Severe pertussis infection in infants less than 6 months of age: Clinical manifestations and molecular characterization. Hum Vaccin Immunother 2017; 13:1073-1077. [PMID: 28129036 PMCID: PMC5443365 DOI: 10.1080/21645515.2016.1276139] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We conducted a study to determine the main traits of pertussis among unimmunized infants less than 6 months of age. From August 2012 to March 2015, 141 nasopharyngeal aspirates (NPAs) were collected from infants with respiratory symptoms attending 2 major hospitals in Rome. Clinical data were recorded and analyzed. Lab-confirmation was performed by culture and realtime PCR. B. pertussis virulence-associated genes (ptxP, ptxA and prn), together with multilocus variable-number tandem repeat analysis (MLVA), were also investigated by the sequence-based analysis on the DNAs extracted from positive samples. Antibiotic susceptibility with Etest was defined on 18 viable B. pertussis isolates. Samples from 73 infants resulted positives for B. pertussis. The median age of the patients was 45 d (range 7–165); 21 infants were treated with macrolides before hospital admission. Cough was reported for a median of 10 d before admission and 18 d after hospital discharge among infected infants, 84% of whom showed paroxysmal cough. No resistance to macrolides was detected. Molecular analysis identified MT27 as the predominant MLVA profile, combined with ptxP3-ptxA1-prn2 associated virulence genes. Although our data may not be generalized to the whole country, they provide evidence of disease severity among infants not vaccinated against pertussis. Moreover, genetically related B. pertussis strains, comprising allelic variants of virulence associated genes, were identified.
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Affiliation(s)
- Paola Stefanelli
- a Department of Infectious Diseases , Istituto Superiore di Sanità , Rome , Italy
| | - Gabriele Buttinelli
- a Department of Infectious Diseases , Istituto Superiore di Sanità , Rome , Italy
| | - Paola Vacca
- a Department of Infectious Diseases , Istituto Superiore di Sanità , Rome , Italy
| | - Alberto E Tozzi
- b Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Fabio Midulla
- c Departments of Pediatrics . "Sapienza" University of Rome , Rome , Italy
| | - Rita Carsetti
- d Immunology Unit, Immunology and Pharmacotherapy Area, Bambino Gesù Children Hospital IRCSS , Rome , Italy
| | - Giorgio Fedele
- a Department of Infectious Diseases , Istituto Superiore di Sanità , Rome , Italy
| | - Alberto Villani
- e Department of Pediatrics and Infectious Disease , Bambino Gesù Children Hospital IRCSS , Rome , Italy
| | - Carlo Concato
- f Virology Unit, Bambino Gesù Children Hospital IRCCS , Rome , Italy
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Marchetti G, Vittori A, Tortora V, Bishop M, Lofino G, Pardi V, De Marco EA, Manca G, Inserra A, Caruso R, Ciaralli I, Locatelli F, Bella S, Tozzi AE, Picardo S. Prevalence of pain in the departments of surgery and oncohematology of a paediatric hospital that has joined the project "Towards pain free hospital". Clin Ter 2017; 167:156-160. [PMID: 27845483 DOI: 10.7417/ct.2016.1948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Among hospitalized adults and children pain is undertreated. This study wants to assess the effectiveness of pain therapy in two departments of a large children's hospital. MATERIALS AND METHODS During a single day work three committees, administering a questionnaire to patients or parents, have evaluated the adherence to international recommendations (JCI and WHO) in the management of analgesic therapy. Patient demographics, prevalence and intensity (moderate and/or severe) of pain (during hospitalization, 24 hours before and at the time of the interview), analgesia (type, route, duration and frequency of administration) and Pain Management Index (=analgesic score-pain score) were recorded. RESULTS 75 patients participated in the study (age: 2 months up to 24 years, mean 7.8 ± 6). During hospitalization 43 children (57%) had no pain while 32 (43%) have experienced pain. 22 children (29 %) had pain 24 hours before and 12 (16%) at the time of the interview. The average value of the PMI was -0.8±1.3 with a minimum of -3 and a maximum of +2: 60% (19) of the children had a PMI less than 0 (undertreated pain) while 40% (13) had a value=or>0. Out of 32 patients who needed an analgesic therapy 14 (44%) received an around-the-clock dosing, 8 (25%) an intermittent therapy and 10 (31%) no treatment.17 (77 %) were the single drug therapy and 5 (23%) the multimodal ones. CONCLUSIONS The prevalence of pain in the two departments is high. The main cause is that knowledge is not still well translated into clinical practice.
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Affiliation(s)
- G Marchetti
- Paediatric Hospital Bambino Gesù, Rome; Department of Emergency, Anesthesiology and Intensive Care
| | - A Vittori
- Paediatric Hospital Bambino Gesù, Rome; Department of Emergency, Anesthesiology and Intensive Care
| | - V Tortora
- Paediatric Hospital Bambino Gesù, Rome; Department of Emergency, Anesthesiology and Intensive Care
| | - M Bishop
- Paediatric Hospital Bambino Gesù, Rome; Department of Emergency, Anesthesiology and Intensive Care
| | - G Lofino
- Paediatric Hospital Bambino Gesù, Rome; Department of Emergency, Anesthesiology and Intensive Care
| | - V Pardi
- Paediatric Hospital Bambino Gesù, Rome; Department of Surgery
| | - E A De Marco
- Paediatric Hospital Bambino Gesù, Rome; Department of Surgery
| | - G Manca
- Paediatric Hospital Bambino Gesù, Rome; Department of Surgery
| | - A Inserra
- Paediatric Hospital Bambino Gesù, Rome; Department of Surgery
| | - R Caruso
- Paediatric Hospital Bambino Gesù, Rome; Department of Oncology and Hematology
| | - I Ciaralli
- Paediatric Hospital Bambino Gesù, Rome; Department of Oncology and Hematology
| | - F Locatelli
- Paediatric Hospital Bambino Gesù, Rome; Department of Oncology and Hematology
| | - S Bella
- Paediatric Hospital Bambino Gesù, Rome; Department of Pediatrics
| | - A E Tozzi
- Paediatric Hospital Bambino Gesù, Rome; Telemedicine
| | - S Picardo
- Paediatric Hospital Bambino Gesù, Rome; Department of Emergency, Anesthesiology and Intensive Care
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Russo L, Campagna I, Ferretti B, Agricola E, Pandolfi E, Carloni E, D'Ambrosio A, Gesualdo F, Tozzi AE. What drives attitude towards telemedicine among families of pediatric patients? A survey. BMC Pediatr 2017; 17:21. [PMID: 28095894 PMCID: PMC5240275 DOI: 10.1186/s12887-016-0756-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Telemedicine has been recognized as a way to improve accessibility, quality, and efficiency of care. In view of the introduction of new telemedicine services, we conducted a survey through a self-administered questionnaire among families of children attending the Bambino Gesù Children's Hospital IRCCS, a tertiary care children's hospital located in Rome, Italy. METHODS We investigated sociodemographic data, clinical information, technological profile, attitude towards telemedicine, perceived advantages of telemedicine, fears regarding telemedicine, willingness to use a smartphone app providing telemedicine services and willingness to use a televisit service. Through logistic regression, we explored the effect of sociodemographic and clinical variables and technological profile on willingness of using a telemedicine app and a televisit service. RESULTS We enrolled a total of 751 families. Most patients had a high technological profile, 81% had at least one account on a social network. Whatsapp was the most popular messaging service (76%). Seventy-two percent of patients would use an app for telemedicine services and 65% would perform a televisit. Owning a tablet was associated with both outcome variables - respectively: OR 2.216, 95% CI 1.358-3.616 (app) and OR 2.117, 95% CI 1.415-3.168 (televisit). Kind of hospitalization, diagnosis of a chronic disease, disease severity and distance from the health care center were not associated with the outcome variables. CONCLUSION Families of pediatric patients with different clinical problems are keen to embark in telemedicine programs, independently from severity of disease or chronicity, and of distance from the hospital.
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Affiliation(s)
- Luisa Russo
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Ilaria Campagna
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Beatrice Ferretti
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Eleonora Agricola
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Elisabetta Pandolfi
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Emanuela Carloni
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Angelo D'Ambrosio
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Francesco Gesualdo
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Alberto E Tozzi
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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Bortolus R, Oprandi NC, Rech Morassutti F, Marchetto L, Filippini F, Agricola E, Tozzi AE, Castellani C, Lalatta F, Rusticali B, Mastroiacovo P. Why women do not ask for information on preconception health? A qualitative study. BMC Pregnancy Childbirth 2017; 17:5. [PMID: 28056865 PMCID: PMC5217233 DOI: 10.1186/s12884-016-1198-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 12/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preconception care involves health promotion to reduce risk factors that might affect women and couples of childbearing age. The risk factors of adverse reproductive outcomes include recognized genetic diseases in the family or the individual, previous congenital diseases, miscarriage, prematurity, fetal growth restriction, infertility, chronic maternal diseases, lifestyle, and occupational or environmental factors. Effective preconception care involves a range of preventive, therapeutic and behavioural interventions. Although in Italy there are national preconception care recommendations concerning the general population, they are usually encouraged informally and only for single risk factors. At present there is increasing interest in offering a global intervention in this field. The aim of this study was to investigate attitudes and behaviours of Italian women of childbearing age and healthcare professionals regarding preconception health. METHODS We conducted a qualitative study among women of childbearing age and healthcare professionals between February 2014 and February 2015. Five focus groups were held: 2 with non-pregnant women aged 22 to 44 years and 3 with healthcare professionals. Discussion topics included women's questions about preconception health, worries and barriers regarding preconception care interventions, attitudes and behaviours of women and healthcare professionals towards preconception health, women's information sources. In the analysis of the focus groups priority was given to what was said by the women, supplemented by information from the healthcare professionals' focus groups. RESULTS Fourteen women of childbearing age (8 nulliparae and 6 multiparae) and 12 healthcare professionals (3 nurses, 4 midwives, 5 doctors) participated in the focus groups. The results indicate the presence of many barriers and a lack of awareness of preconception health relating to women, healthcare professionals and policies. Women's knowledge and attitudes towards primary preconception care information are described. The main reference source of information in this field for Italian women seems to be their obstetric-gynaecologist. CONCLUSIONS The study indicates that several barriers influence preconception care in Italy. Moreover, a lack of awareness of preconception health and care among Italian women of childbearing age and healthcare professionals emerges. The findings might contribute to strategies for the implementation of preconception care guidelines.
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Affiliation(s)
- Renata Bortolus
- Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy.
| | - Nadia C Oprandi
- Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy
| | - Francesca Rech Morassutti
- Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy
| | - Luca Marchetto
- Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy
| | - Francesca Filippini
- Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy
| | - Eleonora Agricola
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alberto E Tozzi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Carlo Castellani
- Cystic Fibrosis Centre, Verona University Hospital, Verona, Italy
| | - Faustina Lalatta
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Pierpaolo Mastroiacovo
- Alessandra Lisi International Centre on Birth Defects and Prematurity - ICBD, Rome, Italy
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Ciofi Degli Atti ML, Serino L, Piga S, Tozzi AE, Raponi M. Incidence of surgical site infections in children: active surveillance in an Italian academic children's hospital. Ann Ig 2017; 29:46-53. [PMID: 28067937 DOI: 10.7416/ai.2017.2131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Surgical Site Infections (SSIs) account for 16-34% of all health-care associated infections. This study aimed to assess the incidence rate of SSIs in children who underwent surgical procedures in an academic children's hospital in Italy. STUDY DESIGN Prospective cohort study. METHODS We actively followed-up 0-17 year old children at 30 days of surgical procedures without implants conducted during one index week per quarter, from the second quarter of 2014, to the first quarter of 2016 (8 index weeks in total). Follow up data were collected by telephone interview, or derived by clinical records if patients were still hospitalized. SSIs were defined according to case definitions of Centers for Diseases Control, Atlanta, USA. We calculated cumulative incidence of SSIs per 100 surgical procedures, by patient characteristics, procedure characteristics, and quarter. To investigate variables associated with SSIs, we compared characteristics of procedures with SSIs with those of procedures without SSIs. RESULTS Over the study period, SSI incidence was 1.0% (19 cases/1,830 surgical procedures). SSI incidence was significantly lower after ear, nose and throat procedures compared to all other procedures, and significantly decreased over time. Duration of surgery was a risk factor for SSIs; patients with SSIs had a significantly longer total length of stay (LOS), due to a prolonged post-operative LOS. CONCLUSION As reported in adults, this study confirms that SSIs are associated with longer hospitalizations in children. Active surveillance of SSIs is an important component of the overall strategy to reduce the incidence of these infections in children.
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Affiliation(s)
- M L Ciofi Degli Atti
- Unit of Clinical Epidemiology, Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy
| | - L Serino
- Unit of Clinical Epidemiology, Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy
| | - S Piga
- Unit of Clinical Epidemiology, Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy
| | - A E Tozzi
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - M Raponi
- Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy
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24
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Agricola E, Gesualdo F, Carloni E, D'Ambrosio A, Russo L, Campagna I, Pandolfi E, Tozzi AE. Investigating paternal preconception risk factors for adverse pregnancy outcomes in a population of internet users. Reprod Health 2016; 13:37. [PMID: 27080860 PMCID: PMC4832499 DOI: 10.1186/s12978-016-0156-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 03/31/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Paternal preconception risk factors such as smoking, exposure to environmental substances, medication use, overweight and advanced age correlate with the occurrence of malformations and birth defects in the offspring. Nonetheless, the prevalence of risk factors for adverse pregnancy outcomes in the male population has been scarcely investigated and no report on preconception interventions targeting prospective fathers is available. We conducted a web-based survey to measure the prevalence of paternal preconception risk factors for adverse pregnancy outcomes in an Italian population of Internet users. METHODS Prospective or expectant fathers were enrolled during a four-week period through two of the main Italian web-sites dedicated to preconception, pregnancy, childhood and family care. Participants filled in a web questionnaire regarding preconception risk factors for adverse pregnancy outcomes. Logistic regression analysis was used to explore the predictors of paternal preconception risk factors. RESULTS We enrolled 131 prospective and 205 expectant fathers. More than half of the total participants used medications during the preconception period, 35% were smokers and 8% were obese. Exposure to environmental substances was declared by almost 20% of the participants, with the group including pesticides/herbicides/professional paints being the most prevalent. More than a half of the study sample included men aged over 35 years. According to the multivariate analysis, smoking and exposure to environmental toxics were less frequent among individuals with a university degree (respectively: OR = 0.52; 95% CI 0.32-0.84; OR = 0.52; 95% CI 0.29-0.93). Paternal obesity and medication use in the preconception period were not associated with any of the independent variables. CONCLUSIONS The prevalence of preconception risk factors among male population should not be neglected when planning preconception interventions, confirming that preconception health must be focused on the couple, rather than on women only.
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Affiliation(s)
- Eleonora Agricola
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Francesco Gesualdo
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Emanuela Carloni
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Angelo D'Ambrosio
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Luisa Russo
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Ilaria Campagna
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Elisabetta Pandolfi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Alberto E Tozzi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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Tozzi AE, Gesualdo F, D'Ambrosio A, Pandolfi E, Agricola E, Lopalco P. Can Digital Tools Be Used for Improving Immunization Programs? Front Public Health 2016; 4:36. [PMID: 27014673 PMCID: PMC4782280 DOI: 10.3389/fpubh.2016.00036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 02/19/2016] [Indexed: 02/04/2023] Open
Abstract
In order to successfully control and eliminate vaccine-preventable infectious diseases, an appropriate vaccine coverage has to be achieved and maintained. This task requires a high level of effort as it may be compromised by a number of barriers. Public health agencies have issued specific recommendations to address these barriers and therefore improve immunization programs. In the present review, we characterize issues and challenges of immunization programs for which digital tools are a potential solution. In particular, we explore previously published research on the use of digital tools in the following vaccine-related areas: immunization registries, dose tracking, and decision support systems; vaccine-preventable diseases surveillance; surveillance of adverse events following immunizations; vaccine confidence monitoring; and delivery of information on vaccines to the public. Subsequently, we analyze the limits of the use of digital tools in such contexts and envision future possibilities and challenges.
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Affiliation(s)
- Alberto E Tozzi
- Unit of Telemedicine, IRCCS, Bambino Gesù Children's Hospital , Rome , Italy
| | - Francesco Gesualdo
- Unit of Telemedicine, IRCCS, Bambino Gesù Children's Hospital , Rome , Italy
| | - Angelo D'Ambrosio
- Unit of Telemedicine, IRCCS, Bambino Gesù Children's Hospital , Rome , Italy
| | - Elisabetta Pandolfi
- Unit of Telemedicine, IRCCS, Bambino Gesù Children's Hospital , Rome , Italy
| | - Eleonora Agricola
- Unit of Telemedicine, IRCCS, Bambino Gesù Children's Hospital , Rome , Italy
| | - Pierluigi Lopalco
- European Centre for Disease Prevention and Control , Stockholm , Sweden
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Nicolai R, Cortis E, Ravà L, Bracaglia C, Pardeo M, Insalaco A, Buonuomo PS, Tozzi AE, De Benedetti F. Herpes Virus Infections During Treatment With Etanercept in Juvenile Idiopathic Arthritis. J Pediatric Infect Dis Soc 2016; 5:76-9. [PMID: 26908493 DOI: 10.1093/jpids/piu078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/18/2014] [Indexed: 11/14/2022]
Abstract
Incidence rates for varicella and herpes zoster were similar in patients with juvenile idiopathic arthritis receiving etanercept/methotrexate (n = 85, 184.9 patient-years [PY]) or methotrexate alone (n = 71, 199.4 PY); no complicated varicella or herpes zoster cases were reported; herpes labialis incidence was higher in patients receiving etanercept/methotrexate versus methotrexate alone (0.38 vs. 0.24 PY).
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Affiliation(s)
| | - E Cortis
- Division of Pediatrics, Ospedale Santa Maria della Stella, Orvieto, Italy
| | - L Ravà
- Division of Epidemiology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | | | | | | | - P S Buonuomo
- Division of Rare Diseases, Department of Pediatric Medicine
| | - A E Tozzi
- Division of Epidemiology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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27
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Palazzo R, Carollo M, Bianco M, Fedele G, Schiavoni I, Pandolfi E, Villani A, Tozzi AE, Mascart F, Ausiello CM. Persistence of T-cell immune response induced by two acellular pertussis vaccines in children five years after primary vaccination. New Microbiol 2016; 39:35-47. [PMID: 26922984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/06/2015] [Indexed: 06/05/2023]
Abstract
The resurgence of pertussis suggests the need for greater efforts to understand the long-lasting protective responses induced by vaccination. In this paper we dissect the persistence of T memory responses induced by primary vaccination with two different acellular pertussis (aP) vaccines, hexavalent Hexavac® vaccine (Hexavac) (Sanofi Pasteur MSD) and Infanrix hexa® (Infanrix) (Glaxo-SmithKline Biologicals). We evaluated magnitude and duration of T-cell responses to pertussis toxin (PT) by measuring T-cell proliferation, cytokines (IL-2 and IFNγ) production and memory subsets in two groups of children 5 years after primary vaccination. Some of the enrolled children received only primary vaccination, while others had the pre-school boost dose. Positive T-cell responses to PT were detected in 36% of children. Percentage of responsive children, T-cell proliferation and CD4IL-2+ cells were significantly higher in the children primed with Hexavac than in those who received Infanrix vaccine. No major effects of the boost on PT-specific proliferation were observed. Overall, our data documented a persistence of T-cell memory against PT in a minor fraction of children 5 years after primary vaccination. The different responses induced by Hexavac and Infanrix vaccine could rely on differences in PT inactivation process or excipients/adjuvants formulations.
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Affiliation(s)
- Raffaella Palazzo
- Anti-Infectious Immunity Unit, Department of Infectious, Parasitic and immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Carollo
- Anti-Infectious Immunity Unit, Department of Infectious, Parasitic and immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Manuela Bianco
- Anti-Infectious Immunity Unit, Department of Infectious, Parasitic and immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giorgio Fedele
- Anti-Infectious Immunity Unit, Department of Infectious, Parasitic and immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Ilaria Schiavoni
- Anti-Infectious Immunity Unit, Department of Infectious, Parasitic and immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Elisabetta Pandolfi
- Epidemiology Unit, Research Center, Ospedale Pediatrico Bambino Gesù, IRCSS, Roma, Italy
| | - Alberto Villani
- Paediatric Department, Ospedale Pediatrico Bambino Gesù, IRCSS, Roma, Italy
| | - Alberto E Tozzi
- Epidemiology Unit, Research Center, Ospedale Pediatrico Bambino Gesù, IRCSS, Roma, Italy
| | - Françoise Mascart
- Laboratory of Vaccinology and Mucosal Immunity and Immunobiology Clinic- Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Clara M Ausiello
- Anti-Infectious Immunity Unit, Department of Infectious, Parasitic and immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
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de Ville de Goyet J, di Francesco F, Sottani V, Grimaldi C, Tozzi AE, Monti L, Muiesan P. Splitting livers: Trans-hilar or trans-umbilical division? Technical aspects and comparative outcomes. Pediatr Transplant 2015; 19:517-26. [PMID: 26059061 DOI: 10.1111/petr.12534] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2015] [Indexed: 12/11/2022]
Abstract
UNLABELLED Controversy remains about the best line of division for liver splitting, through Segment IV or through the umbilical fissure. Both techniques are currently used, with the choice varying between surgical teams in the absence of an evidence-based choice. We conducted a single-center retrospective analysis of 47 left split liver grafts that were procured with two different division techniques: "classical" (N = 28, Group A) or through the umbilical fissure and plate (N = 19, Group B). The allocation of recipients to each group was at random; a single transplant team performed all transplantations. Demographics, characteristics, technical aspects, and outcomes were similar in both groups. The grafts in Group A, prepared with the classical technique, were procured more often with a single BD orifice compared with the grafts in Group B; however, this was not associated with a higher incidence of biliary problems in this series of transplants (96% actual graft survival rate [median ± s.d. FOLLOW-UP 26 ± 20 months]). Both techniques provide good quality split grafts and an excellent outcome; surgical expertise with a given technique is more relevant than the technique itself. The classical technique, however, seems to be more flexible in various ways, and surgeons may find it to be preferable.
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Affiliation(s)
- J de Ville de Goyet
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.,Pediatric Surgery Chair, Università di Roma Tor Vergata, Rome, Italy
| | - F di Francesco
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - V Sottani
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - C Grimaldi
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - A E Tozzi
- Telemedicine Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - L Monti
- Hepato-Biliary Radiological Unit, Department of Imaging, Bambino Gesù Children's Hospital, Rome, Italy
| | - P Muiesan
- Liver Transplantation and HPB Surgery, Queen Elizabeth Hospital NHS, Birmingham, UK
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Gesualdo F, Stilo G, D’Ambrosio A, Carloni E, Pandolfi E, Velardi P, Fiocchi A, Tozzi AE. Can Twitter Be a Source of Information on Allergy? Correlation of Pollen Counts with Tweets Reporting Symptoms of Allergic Rhinoconjunctivitis and Names of Antihistamine Drugs. PLoS One 2015. [PMID: 26197474 PMCID: PMC4510127 DOI: 10.1371/journal.pone.0133706] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Pollen forecasts are in use everywhere to inform therapeutic decisions for patients with allergic rhinoconjunctivitis (ARC). We exploited data derived from Twitter in order to identify tweets reporting a combination of symptoms consistent with a case definition of ARC and those reporting the name of an antihistamine drug. In order to increase the sensitivity of the system, we applied an algorithm aimed at automatically identifying jargon expressions related to medical terms. We compared weekly Twitter trends with National Allergy Bureau weekly pollen counts derived from US stations, and found a high correlation of the sum of the total pollen counts from each stations with tweets reporting ARC symptoms (Pearson’s correlation coefficient: 0.95) and with tweets reporting antihistamine drug names (Pearson’s correlation coefficient: 0.93). Longitude and latitude of the pollen stations affected the strength of the correlation. Twitter and other social networks may play a role in allergic disease surveillance and in signaling drug consumptions trends.
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Affiliation(s)
- Francesco Gesualdo
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- * E-mail:
| | - Giovanni Stilo
- Department of Informatics, “Sapienza” University of Rome, Rome, Italy
| | - Angelo D’Ambrosio
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Emanuela Carloni
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Elisabetta Pandolfi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Paola Velardi
- Department of Informatics, “Sapienza” University of Rome, Rome, Italy
| | - Alessandro Fiocchi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Alberto E. Tozzi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
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Nadalin S, Monti L, Grimaldi C, di Francesco F, Tozzi AE, de Ville de Goyet J. Roux-en-Y hepatico-jejunostomy for a left segmental graft: Do not twist the loop, stick it! Pediatr Transplant 2015; 19:358-65. [PMID: 25879299 DOI: 10.1111/petr.12474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 12/31/2022]
Abstract
Biliary complications remain a major challenge for long-term success after LT, as it is, as a rule, the most common technical - early and late - complication that occurs, and because these complications contribute to a significant number of late graft losses and retransplantations. In the pediatric age group, both biliary atresia, as the patient's condition, and the use of a left liver graft, obtained by a liver division technique, make it necessary for the use of a Roux-en-Y jejunal loop for the biliary reconstruction in the majority of cases. A slight modification of the technique is presented, consisting of a straight positioning along the cut surface (rather than the conventional position that results in a harpoon shape). A favorable outcome in terms of a technical complication and graft survival was observed. This way of doing this is an interesting variation and adds to the surgical armamentarium.
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Affiliation(s)
- S Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
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Tozzi AE, Carloni E, Gesualdo F, Russo L, Raponi M. Attitude of families of patients with genetic diseases to use m-health technologies. Telemed J E Health 2014; 21:86-9. [PMID: 25469727 DOI: 10.1089/tmj.2014.0080] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dealing with complex chronic disease may take great advantage of mobile health (m-health) technologies. We performed an online survey on the perception of use of m-health technologies among families of patients affected with Down's syndrome, Williams' syndrome, and 22q11 deletion syndrome. MATERIALS AND METHODS The survey included questions on sociodemographic characteristics, availability of a connection to the Internet on different devices, interest in m-health technologies, and functions to be implemented in order to meet family needs. Through multivariate analysis we studied the association between characteristics of enrolled families and interest in m-health. RESULTS In total, 166 people completed the questionnaire. Forty-seven percent connected to the Internet through a mobile phone, versus 34% through a tablet. Eighty percent were interested in m-health solutions for their child's disease; the main reasons of interest were saving time (49%) and being more involved in the disease management (49%). Desired m-health services were aimed at rapid consultation with a physician (68%) and at retrieving updated information on research and on ongoing clinical studies (66%). Interest in m-health services was associated with availability of a mobile Internet connection, whereas no association was found with living in a remote area. CONCLUSIONS Families of patients with Down's syndrome, Williams' syndrome, and 22q11 deletion syndrome show a positive attitude toward m-health technologies. Such syndromes represent a good model for translating published recommendations into m-health applications, which may improve compliance. Expectations regarding m-health lead to patient empowerment, and m-health applications are perceived as useful not only for people living far away from healthcare centers.
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Affiliation(s)
- Alberto E Tozzi
- IRCCS, Telemedicine Unit, Bambino Gesù Children's Hospital , Rome, Italy
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Abstract
Pertussis continues to be an important public-health issue. The high immunization coverage rates achieved, mainly in industrialized countries, have certainly decreased the spread of the pathogen. However, as immunity wanes, adolescents and adults play an important role in the dynamics of the infection. The surveillance system has several limitations and the underestimation of pertussis in adolescents, young adults and adults is mainly related to the atypical clinical characteristics of cases and the lack of lab confirmation. The real epidemiological impact of pertussis is not always perceived. The unavailability of comprehensive data should not hamper the adoption of active prophylactic measures designed to avoid the impact of waning immunity against pertussis. Different immunization strategies have been suggested and/or already adopted such as immunization of newborns, pre-school and school children, adolescents, adults, healthcare workers, childcare workers, pregnant women, cocoon strategy. Prevention of pertussis requires an integrated approach and the adoption of different immunization strategies, with the objective of achieving and maintaining high coverage rates.
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Affiliation(s)
- Giovanni Gabutti
- Department of Medical Sciences; University of Ferrara; Ferrara, Italy
| | - Chiara Azzari
- Department of Health Sciences; University of Florence and Anna Meyer Children’s University Hospital; Florence, Italy
| | - Paolo Bonanni
- Department of Health Sciences; University of Florence; Florence, Italy
| | - Rosa Prato
- Department of Medical and Surgical Sciences; University of Foggia; Foggia, Italy
| | - Alberto E Tozzi
- Bambino Gesù Children's Hospital and Research Institute; Rome, Italy
| | - Alessandro Zanetti
- Department of Biomedical Sciences for Health; University of Milan; Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics; University of Milan and Luigi Sacco Hospital; Milan, Italy
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Tozzi AE, Azzari C, Bartolozzi G, Esposito S, Fara GM, Giudice ML. Can Hexavalent Vaccines Be Simultaneously Administered with Pneumococcal or Meningococcal Conjugate Vaccines? Human Vaccines 2014; 3:252-9. [PMID: 17881905 DOI: 10.4161/hv.4626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Local immunization programs may include hexavalent and conjugate pneumococcal or meningococcal vaccines administered in the same vaccination visit. Information based on evidence is necessary for correctly planning schedules and for parents who often fear the administration of too many vaccines. We reviewed the available literature to assess the effects on immunogenicity and safety of simultaneous administration of hexavalent and conjugate pneumococcal and meningococcal C vaccines in healthy children. METHODS We searched for papers including a comparison of coadministration and single administration of hexavalent with conjugate pneumococcal or meningococcal C vaccines. Data sources included Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Immunogenicity and safety results were extracted and compared. We calculated the absolute risk increase of being a non responder to any antigen and of experiencing common adverse events. RESULTS Four relevant articles were included in the review. Immunogenicity of components included in the hexavalent vaccines was maintained with coadministration of conjugate pneumococcal and meningococcal C vaccines. However individuals who received hexavalent vaccine with conjugate pneumococcal vaccines were 18% more likely to have anti-PRP < 1 microg/mL after the third dose although this difference disappeared after the fourth dose, and titres against meningococcal C antigens were higher when vaccines were administered separately. Children who received simultaneous administration of hexavalent vaccines with conjugate pneumococcal vaccines had a 13-17% additional risk of experiencing fever compared with single administration. CONCLUSION Few studies deal with coadministration of vaccines. Hexavalent and conjugate pneumococcal or meningococcal vaccines may however be administered simultaneously without noteworthy negative effects on immunogenicity or safety profile. Parents of vaccinees should be appropriately informed on the effects of coadministration to improve their compliance. Studies on vaccine coadministration should be promoted and unpublished studies realized for vaccine registration should be made available.
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Shashaj B, Bedogni G, Graziani MP, Tozzi AE, DiCorpo ML, Morano D, Tacconi L, Veronelli P, Contoli B, Manco M. Origin of cardiovascular risk in overweight preschool children: a cohort study of cardiometabolic risk factors at the onset of obesity. JAMA Pediatr 2014; 168:917-24. [PMID: 25111132 DOI: 10.1001/jamapediatrics.2014.900] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE To date, the relationship among adiposity, insulin resistance, and cardiovascular risk factors at the onset of overweight or obesity has been unexplored. OBJECTIVES To assess whether insulin resistance and metabolic abnormalities are detectable at the onset of obesity and to unravel the interplay among adiposity, insulin resistance, and other such abnormalities. DESIGN, SETTING, AND PARTICIPANTS The Origin of Cardiovascular Risk in Overweight Preschool Children cohort study aimed to evaluate at the onset of obesity in preschool children the prevalence of metabolic abnormalities, including hypertension, dyslipidemia, impaired carbohydrate metabolism, and nonalcoholic fatty liver disease. Between July 1, 2011, and July 30, 2012, in the Rome municipality, 13 family pediatricians enrolled healthy children (age range, 2.0-5.8 years) in the study during their routine practice of growth monitoring. Clinical medical records of 5729 children were reviewed; 597 children manifested new-onset overweight or obesity as their body mass index changed from normal weight to overweight or obesity in the previous 12 months according to the International Obesity Task Force classification. Of them, 219 were studied. MAIN OUTCOMES AND MEASURES Patients with new-onset overweight or obesity underwent clinical laboratory testing, including oral glucose tolerance test, and ultrasonographic investigations of fatty liver and intimal medial thickness of the common carotid arteries, subcutaneous adipose tissue, and visceral adipose tissue. The homeostatic assessment model algorithm-insulin resistance was calculated. RESULTS Among the entire population (n = 5729), overweight increased from 7.0% at 2.0 years to 16.9% at 5.8 years, with corresponding figures of 1.1% to 2.9% for obesity. In total, 597 overweight or obese children (10.4%) were identified, and 219 of them (36.7%) were studied. Among the latter, 86 patients (39.3%) had at least 1 metabolic abnormality. Hypertension was diagnosed in 29 patients (13.2%), dyslipidemia in 55 patients (25.1%), impaired fasting glucose level in 7 patients (3.2%), and glucose intolerance in 6 patients (2.7%). Nonalcoholic fatty liver disease was diagnosed in 68 patients (31.1%). CONCLUSIONS AND RELEVANCE Cardiometabolic risk factors, including fatty liver, are detectable in preschoolers at the onset of overweight or obesity, despite short-term exposure to excess weight and reduced insulin sensitivity. Our findings suggest the need to screen for cardiometabolic abnormalities at an earlier age than is now recommended.
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Affiliation(s)
- Blegina Shashaj
- Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Area Science Park, Trieste, Italy
| | | | - Alberto E Tozzi
- Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | | | | | | | | | - Benedetta Contoli
- Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Melania Manco
- Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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Barrat A, Cattuto C, Tozzi AE, Vanhems P, Voirin N. Measuring contact patterns with wearable sensors: methods, data characteristics and applications to data-driven simulations of infectious diseases. Clin Microbiol Infect 2014; 20:10-6. [PMID: 24267942 DOI: 10.1111/1469-0691.12472] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Thanks to recent technological advances, measuring real-world interactions by the use of mobile devices and wearable sensors has become possible, allowing researchers to gather data on human social interactions in a variety of contexts with high spatial and temporal resolution. Empirical data describing contact networks have thus acquired a high level of detail that may yield new insights into the dynamics of infection transmission between individuals. At the same time, such data bring forth new challenges related to their statistical description and analysis, and to their use in mathematical models. In particular, the integration of highly detailed empirical data in computational frameworks designed to model the spread of infectious diseases raises the issue of assessing which representations of the raw data work best to inform the models. There is an emerging need to strike a balance between simplicity and detail in order to ensure both generalizability and accuracy of predictions. Here, we review recent work on the collection and analysis of highly detailed data on temporal networks of face-to-face human proximity, carried out in the context of the SocioPatterns collaboration. We discuss the various levels of coarse-graining that can be used to represent the data in order to inform models of infectious disease transmission. We also discuss several limitations of the data and future avenues for data collection and modelling efforts in the field of infectious diseases.
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Affiliation(s)
- A Barrat
- Aix Marseille Université, CNRS, CPT, UMR 7332, Marseille; Université de Toulon, CNRS, CPT, UMR 7332, La Garde, France; Data Science Laboratory, ISI Foundation, Torino
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Pandolfi E, Agricola E, Gonfiantini MV, Gesualdo F, Romano M, Carloni E, Mastroiacovo P, Tozzi AE. Women participating in a web-based preconception study have a high prevalence of risk factors for adverse pregnancy outcomes. BMC Pregnancy Childbirth 2014; 14:169. [PMID: 24885235 PMCID: PMC4038071 DOI: 10.1186/1471-2393-14-169] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 04/28/2014] [Indexed: 12/16/2022] Open
Abstract
Background Adverse pregnancy outcomes (APOs) can be increased by preconception risk factors and lifestyles. We measured the prevalence of preconception risk factors for APOs in a population of Italian women of childbearing age enrolled in a web-based study. Methods Participants were enrolled through a web platform (http://www.mammainforma.it). After enrollment, participants filled in a questionnaire regarding socio-demographic characteristics, clinical data and preconception risk factors for adverse pregnancy outcomes. Through logistic regression, we explored how the prevalence of risk factors was affected by age, education level, employment, parity, physician’s recommendation and knowledge of the specific risk factor. Results We enrolled a total of 728 women. Sixty-two percent had a University degree, 84% were employed and 77% were planning their first pregnancy. Nearly 70% drank alcohol in any quantity; 16% were smokers; 6% was underweight; 21.4% was overweight; 51.6% did not assume folic acid; 22% was susceptible to rubella, 44.5% to hepatitis b and 13.2% to varicella. According to the multivariate analysis, compared to women who already had at least one pregnancy, nulliparous women had a higher BMI [OR 1.60 (CI 1.02;2.48)] and were less likely to be susceptible to rubella [OR 0.33 (CI 0.20;0.58)] and to be consuming alcohol [OR 0.47 (CI 0.31;0.70)] or cigarettes [OR 0.48 (CI 0.26;0.90)]. Appropriate knowledge was associated with a correct behavior regarding smoking, drinking alcohol and folic acid supplementation. Conclusions This study shows that the prevalence of risk factors for APOs in our population is high. Interventions aimed at reducing risk factors for APOs are needed and, to this purpose, a web intervention may represent a feasible tool to integrate tailored information and to inform preconception counseling targeting a specific group of women planning a pregnancy who are engaged on the web.
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Affiliation(s)
- Elisabetta Pandolfi
- Bambino Gesù Children's Hospital IRCCS, Epidemiology Unit, Piazza S, Onofrio 4, 00165 Rome, Italy.
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Agricola E, Pandolfi E, Gonfiantini MV, Gesualdo F, Romano M, Carloni E, Mastroiacovo P, Tozzi AE. A cohort study of a tailored web intervention for preconception care. BMC Med Inform Decis Mak 2014; 14:33. [PMID: 24731520 PMCID: PMC4021543 DOI: 10.1186/1472-6947-14-33] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 04/07/2014] [Indexed: 11/24/2022] Open
Abstract
Background Preconception care may be an efficacious tool to reduce risk factors for adverse pregnancy outcomes that are associated with lifestyles and health status before pregnancy. We conducted a web-based cohort study in Italian women planning a pregnancy to assess whether a tailored web intervention may change knowledge and behaviours associated with risks for adverse pregnancy outcomes. Methods The study was entirely conducted on the web on a cohort of Italian women of childbearing age. Data collected at baseline on health status, lifestyles and knowledge of risk factors for adverse pregnancy outcomes were used for generating a tailored document including recommendations for folic acid supplementation, obesity and underweight, smoking, alcohol consumption, vaccinations, chronic and genetic diseases, exposure to medications. Prevalence of risk factors and knowledge was assessed 6 months after the intervention. Logistic regression models were used to explore the factors associated with risk factors after the intervention. Results Of the 508 enrolled women, 282 (55.5%) completed the study after 6 months since the delivery of tailored recommendations. At baseline, 48% of the participants took folic acid supplementation (95% CI 43.2; 51.9) and 69% consumed alcohol (95% CI 64.7; 72.9). At the follow up 71% of the participants had a preconception visit with a physician. Moreover we observed a decrease of alcohol consumption (−46.5% 95% CI −53.28; −38.75) and of the proportion of women not taking folic acid supplementation (−23.4% 95% CI −31.0; 15.36). We observed an improvement in knowledge of the information about the preconception behaviours to prevent adverse pregnancy outcomes (20.9% 95% CI 14.6%; 27.1%). Having a preconception visit during follow up was significally associated to an increase in folic acid supplementation (OR 2.53 95% CI 1.40; 4.60). Conclusions Our results suggest that a tailored web intervention may improve general preconception health in women planning a pregnancy. A web preconception intervention may be integrated with classic preconception care by health professionals. Clinical trials should be conducted to confirm these findings.
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Affiliation(s)
- Eleonora Agricola
- Bambino Gesù Children's Hospital IRCCS, Epidemiology Unit, Piazza S, Onofrio 4, Rome 00165, Italy.
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Velardi P, Stilo G, Tozzi AE, Gesualdo F. Twitter mining for fine-grained syndromic surveillance. Artif Intell Med 2014; 61:153-63. [PMID: 24613716 DOI: 10.1016/j.artmed.2014.01.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 12/20/2013] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Digital traces left on the Internet by web users, if properly aggregated and analyzed, can represent a huge information dataset able to inform syndromic surveillance systems in real time with data collected directly from individuals. Since people use everyday language rather than medical jargon (e.g. runny nose vs. respiratory distress), knowledge of patients' terminology is essential for the mining of health related conversations on social networks. OBJECTIVES In this paper we present a methodology for early detection and analysis of epidemics based on mining Twitter messages. In order to reliably trace messages of patients that actually complain of a disease, first, we learn a model of naïve medical language, second, we adopt a symptom-driven, rather than disease-driven, keyword analysis. This approach represents a major innovation compared to previous published work in the field. METHOD We first developed an algorithm to automatically learn a variety of expressions that people use to describe their health conditions, thus improving our ability to detect health-related "concepts" expressed in non-medical terms and, in the end, producing a larger body of evidence. We then implemented a Twitter monitoring instrument to finely analyze the presence and combinations of symptoms in tweets. RESULTS We first evaluate the algorithm's performance on an available dataset of diverse medical condition synonyms, then, we assess its utility in a case study of five common syndromes for surveillance purposes. We show that, by exploiting physicians' knowledge on symptoms positively or negatively related to a given disease, as well as the correspondence between patients' "naïve" terminology and medical jargon, not only can we analyze large volumes of Twitter messages related to that disease, but we can also mine micro-blogs with complex queries, performing fine-grained tweets classification (e.g. those reporting influenza-like illness (ILI) symptoms vs. common cold or allergy). CONCLUSIONS Our approach yields a very high level of correlation with flu trends derived from traditional surveillance systems. Compared with Google Flu, another popular tool based on query search volumes, our method is more flexible and less sensitive to changes in web search behaviors.
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Affiliation(s)
- Paola Velardi
- Department of Computer Science, University of Rome "Sapienza", via Salaria 113, 00198 Rome, Italy.
| | - Giovanni Stilo
- Department of Computer Science, University of Rome "Sapienza", via Salaria 113, 00198 Rome, Italy
| | - Alberto E Tozzi
- Bambino Gesù Children Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy
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Gesualdo F, Onori M, Bongiorno D, Campanile F, Carloni E, Mancinelli L, Russo C, Villani A, Valentini D, Raponi M, Tozzi AE, Stefani S. Methicillin-resistant Staphylococcus aureus nasal colonization in a department of pediatrics: a cross-sectional study. Ital J Pediatr 2014; 40:3. [PMID: 24410796 PMCID: PMC3896672 DOI: 10.1186/1824-7288-40-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We describe methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage at admission in patients admitted to a Department of Pediatrics. METHODS All patients received a nasal swab at admission. A questionnaire was administered and molecular genetics analyses were performed on all identified MRSA isolates. RESULTS We enrolled 785 patients, affected with both acute and chronic diseases. MRSA nasal colonization prevalence was 1.15% (CI: 0.5607%-2.093%). Methicillin-sensitive Staphylococcus aureus (MSSA) nasal colonization prevalence at admission was 19.75% (CI 17.07%-22.64%). Only one MRSA isolate carried the SCCmec V variant; all other isolates carried the SCCmecIV variant. Five out of 9 MRSA-colonized patients had an underlying condition. Antibiotic therapy in the previous 6 months was a protective factor for both MRSA (OR 0,66; 95% CI: 0,46-0,96) and MSSA (OR 0,65; 95% CI: 0,45-0,97) colonization. A tendency to statistical significance was seen in the association between hospitalization in the 6 months prior to admission and MRSA colonization at admission (OR 4,92; 95% CI: 0,97-24,83). No patient was diagnosed with an S. aureus infection during hospitalization. CONCLUSIONS The majority of our MRSA colonizing isolates have community origins. Nevertheless, most MRSA-colonized patients had been hospitalized previously, suggesting that strains that circulate in the community also circulate in hospital settings. Further studies should elucidate the role of children with frequent contact with health care institutions in the circulation of antibiotic resistant strains between the hospital and the community.
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Tozzi AE, Piga S, Corchia C, Di Lallo D, Carnielli V, Chiandotto V, Fertz MC, Miniaci S, Rusconi F, Cuttini M. Timeliness of routine immunization in a population-based Italian cohort of very preterm infants: results of the ACTION follow-up project. Vaccine 2014; 32:793-9. [PMID: 24397902 DOI: 10.1016/j.vaccine.2013.12.044] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 10/16/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although very preterm infants are recommended to receive immunizations, according to their chronological age, immunization start in these infants is often delayed. Aim To measure coverage and timeliness of routine immunizations in Italian very preterm infants and to assess determinants of delay. METHODS We followed up infants 22-31 completed weeks of gestational age discharged from intensive care. We measured the proportion of children with one dose of diphtheria-tetanus-pertussis-poliohepatitis, B-Hib vaccine (DTP-Pol-HBV-Hib), measles-mumps-rubella vaccine (MMR), conjugate pneumococcal vaccine (Pnc), conjugate meningococcal C vaccine (MenC), and varicella vaccine (Var) by 24 months. We used the Kaplan Meier method and Cox proportional hazard models to estimate the age, at immunization start and determinants of timeliness for each vaccine. RESULTS Data on 1102 (92.1%) children out of 1196 included in the cohort were analyzed. Immunization start by 24 months of age occurred in 95.9% of children for DTP-Pol-HBV-Hib; 84.0% for MMR; 49.7% for Pnc; 38.5% for MenC; and 4.1% for Var. Eighty-seven percent of participants received the first dose of DTP-Pol-HBV-Hib by 6 months of age, and 66.7% had their first MMR administered by 18 months. Hospitalization was associated with delay for all vaccines with the exception of MenC and Var. Maternal employment was associated with earlier immunization for MMR, Pnc, and MenC. DTP-Pol-HBV-Hib timeliness improved with increasing birthweight and paternal employment and decreased with a larger number of siblings in the household. MMR was delayed in children with cerebral palsy, and in those with a larger number of children in the household. Immunization for Pnc was delayed in children with larger number of siblings. CONCLUSIONS Immunization start for all vaccines was considerably delayed in many very preterm infants. Public health strategies taking into account determinants of delay should be implemented to improve coverage and timeliness of vaccination in this group of infants.
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Affiliation(s)
- Alberto E Tozzi
- Unit of Epidemiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Simone Piga
- Unit of Epidemiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Carlo Corchia
- International Centre on Birth Defects and Prematurity, Rome, Italy
| | | | - Virgilio Carnielli
- Maternal and Child Health Institute, Marche University and Salesi Hospital, Ancona, Italy
| | - Valeria Chiandotto
- Neonatal Intensive Care Unit, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Maria Cristina Fertz
- Neonatal Intensive Care Unit, Burlo Garofolo Maternal and Child Health Institute, IRCCS, Trieste, Italy
| | - Silvana Miniaci
- Neonatal Intensive Care Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Franca Rusconi
- Unit of Epidemiology, Anna Meyer Children's University Hospital and Regional Agency for Health of Tuscany, Florence, Italy
| | - Marina Cuttini
- Unit of Epidemiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Romanò L, Carsetti R, Tozzi AE, Mele A, Zanetti AR. Chronic hepatitis B infection in adolescents vaccinated at birth: an alarm bell in favor of the need for a booster? Hepatology 2014; 59:349. [PMID: 23695813 DOI: 10.1002/hep.26458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 03/13/2013] [Indexed: 01/05/2023]
Affiliation(s)
- Luisa Romanò
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
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Gesualdo F, Stilo G, Agricola E, Gonfiantini MV, Pandolfi E, Velardi P, Tozzi AE. Influenza-like illness surveillance on Twitter through automated learning of naïve language. PLoS One 2013; 8:e82489. [PMID: 24324799 PMCID: PMC3853203 DOI: 10.1371/journal.pone.0082489] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/24/2013] [Indexed: 11/24/2022] Open
Abstract
Twitter has the potential to be a timely and cost-effective source of data for syndromic surveillance. When speaking of an illness, Twitter users often report a combination of symptoms, rather than a suspected or final diagnosis, using naïve, everyday language. We developed a minimally trained algorithm that exploits the abundance of health-related web pages to identify all jargon expressions related to a specific technical term. We then translated an influenza case definition into a Boolean query, each symptom being described by a technical term and all related jargon expressions, as identified by the algorithm. Subsequently, we monitored all tweets that reported a combination of symptoms satisfying the case definition query. In order to geolocalize messages, we defined 3 localization strategies based on codes associated with each tweet. We found a high correlation coefficient between the trend of our influenza-positive tweets and ILI trends identified by US traditional surveillance systems.
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Affiliation(s)
- Francesco Gesualdo
- Multifactorial Diseases and Complex Phenotypes Research Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- * E-mail:
| | - Giovanni Stilo
- Department of Informatics, “Sapienza” University of Rome, Rome, Italy
| | - Eleonora Agricola
- Multifactorial Diseases and Complex Phenotypes Research Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Michaela V. Gonfiantini
- Multifactorial Diseases and Complex Phenotypes Research Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Elisabetta Pandolfi
- Multifactorial Diseases and Complex Phenotypes Research Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Paola Velardi
- Department of Informatics, “Sapienza” University of Rome, Rome, Italy
| | - Alberto E. Tozzi
- Multifactorial Diseases and Complex Phenotypes Research Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
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43
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Nicolai R, Cortis E, Ravà L, Bracaglia C, Pardeo M, Insalaco A, Buonuomo PS, De Benedetti F, Tozzi AE. PReS-FINAL-2096: Herpes virus infections in patients with juvenile idiopathic arthritis (JIA) treated with etanercept. Pediatr Rheumatol Online J 2013. [PMCID: PMC4044023 DOI: 10.1186/1546-0096-11-s2-p108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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44
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Pardeo M, Insalaco A, Bracaglia C, Nicolai R, Tozzi AE, Prencipe G, De Benedetti F. P01-050 – Anakinra in systemic JIA: single center experience. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952957 DOI: 10.1186/1546-0096-11-s1-a53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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45
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Tozzi AE, Asturias EJ, Balakrishnan MR, Halsey NA, Law B, Zuber PLF. Assessment of causality of individual adverse events following immunization (AEFI): a WHO tool for global use. Vaccine 2013; 31:5041-6. [PMID: 24021304 DOI: 10.1016/j.vaccine.2013.08.087] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/23/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
Abstract
Serious illnesses or even deaths may rarely occur after childhood vaccinations. Public health programs are faced with great challenges to establish if the events presenting after the administration of a vaccine are due to other conditions, and hence a coincidental presentation, rather than caused by the administered vaccines. Given its priority, the Global Advisory Committee for Vaccine Safety (GACVS) commissioned a group of experts to review the previously published World Health Organization (WHO) Adverse Event Following Immunization (AEFI) causality assessment methodology and aide-memoire, and to develop a standardized and user friendly tool to assist health care personnel in the processing and interpretation of data on individual events, and to assess the causality after AEFIs. We describe a tool developed for causality assessment of individual AEFIs that includes: (a) an eligibility component for the assessment that reviews the diagnosis associated with the event and identifies the administered vaccines; (b) a checklist that systematically guides users to gather available information to feed a decision algorithm; and (c) a decision support algorithm that assists the assessors to come to a classification of the individual AEFI. Final classification generated by the process includes four categories in which the event is either: (1) consistent; (2) inconsistent; or (3) indeterminate with respect of causal association; or (4) unclassifiable. Subcategories are identified to assist assessors in resulting public health decisions that can be used for action. This proposed tool should support the classification of AEFI cases in a standardized, transparent manner and to collect essential information during AEFI investigation. The algorithm should provide countries and health officials at the global level with an instrument to respond to vaccine safety alerts, and support the education, research and policy decisions on immunization safety.
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Affiliation(s)
- Alberto E Tozzi
- Multifactorial Diseases and Complex Phenotypes, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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46
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Rosado MM, Gesualdo F, Marcellini V, Di Sabatino A, Corazza GR, Smacchia MP, Nobili B, Baronci C, Russo L, Rossi F, Vito RD, Nicolosi L, Inserra A, Locatelli F, Tozzi AE, Carsetti R. Preserved antibody levels and loss of memory B cells against pneumococcus and tetanus after splenectomy: tailoring better vaccination strategies. Eur J Immunol 2013; 43:2659-70. [PMID: 23813052 DOI: 10.1002/eji.201343577] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/17/2013] [Accepted: 06/25/2013] [Indexed: 01/07/2023]
Abstract
Splenectomized patients are exposed to an increased risk of septicemia caused by encapsulated bacteria. Defense against infection is ensured by preformed serum antibodies produced by long-lived plasma cells and by memory B cells that secrete immunoglobulin in response to specific antigenic stimuli. Studying a group of asplenic individuals (57 adults and 21 children) without additional immunologic defects, we found that spleen removal does not alter serum anti-pneumococcal polysaccharide (PnPS) IgG concentration, but reduces the number of PnPS-specific memory B cells, of both IgM and IgG isotypes. The number of specific memory B cells was low in splenectomized adults and children that had received the PnPS vaccine either before or after splenectomy. Seven children were given the 13-valent pneumococcal conjugated vaccine after splenectomy. In this group, the number of PnPS-specific IgG memory B cells was similar to that of eusplenic children, suggesting that pneumococcal conjugated vaccine administered after splenectomy is able to restore the pool of anti-PnPS IgG memory B cells. Our data further elucidate the crucial role of the spleen in the immunological response to infections caused by encapsulated bacteria and suggest that glycoconjugated vaccines may be the most suitable choice to generate IgG-mediated protection in these patients.
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Affiliation(s)
- M Manuela Rosado
- Immunology Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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47
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Tozzi AE, Mingarelli R, Agricola E, Gonfiantini M, Pandolfi E, Carloni E, Gesualdo F, Dallapiccola B. The internet user profile of Italian families of patients with rare diseases: a web survey. Orphanet J Rare Dis 2013; 8:76. [PMID: 23680013 PMCID: PMC3662591 DOI: 10.1186/1750-1172-8-76] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/12/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The use of the Internet for searching and sharing health information and for health care interactions may have a great potential for families of children affected with rare diseases. We conducted an online survey among Italian families of patients with rare diseases with the objective to describe their Internet user profile, and to explore how Internet use affects their health decisions. METHODS All members of UNIAMIO FIMR, a federation of associations of patients with rare diseases, were invited via mail to participate in an online questionnaire including questions on socio-demographic and clinical information, Internet use with a specific focus on health, and impact of web information on health behaviors. Logistic regression models were used to explore the effect of socio-demographic variables and Internet user profile on dependent variables representing the impact of web information on health behaviors. Multiple imputation by chained equations was applied. RESULTS A total of 516 parents of patients with rare diseases completed the online questionnaire. Mean age was 43 years. 87% of respondents accessed the Internet daily, 40% through their smartphones. 99% had an email account, 71% had a Facebook account. 66% participate in an online forum on health. 99% searched for information on disease characteristics, 93% on therapy, 89% on diagnosis, 63% on alternative therapies, 62% on nutrition and 54% on future pregnancies. 82% stated that web information increased comprehension of the disease, 65% that it improved management of the disease. For 52% web information increased his or her anxiety. 62% recognized diagnosis, 69% discussed online information with their physician. People participating in forums more frequently stated that Internet information was useful for recognizing their child's disease (OR 1.68; 95%CI 1.08-2.63) and for improving its management (OR 1.77; 95%CI 1.11-2.81). CONCLUSION Italian parents of patients with rare diseases are active Internet users, engaged in information search and in online communities.
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Machens A, Gesualdo F, Rizzo C, Tozzi AE, Barrat A, Cattuto C. An infectious disease model on empirical networks of human contact: bridging the gap between dynamic network data and contact matrices. BMC Infect Dis 2013; 13:185. [PMID: 23618005 PMCID: PMC3640968 DOI: 10.1186/1471-2334-13-185] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/16/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The integration of empirical data in computational frameworks designed to model the spread of infectious diseases poses a number of challenges that are becoming more pressing with the increasing availability of high-resolution information on human mobility and contacts. This deluge of data has the potential to revolutionize the computational efforts aimed at simulating scenarios, designing containment strategies, and evaluating outcomes. However, the integration of highly detailed data sources yields models that are less transparent and general in their applicability. Hence, given a specific disease model, it is crucial to assess which representations of the raw data work best to inform the model, striking a balance between simplicity and detail. METHODS We consider high-resolution data on the face-to-face interactions of individuals in a pediatric hospital ward, obtained by using wearable proximity sensors. We simulate the spread of a disease in this community by using an SEIR model on top of different mathematical representations of the empirical contact patterns. At the most detailed level, we take into account all contacts between individuals and their exact timing and order. Then, we build a hierarchy of coarse-grained representations of the contact patterns that preserve only partially the temporal and structural information available in the data. We compare the dynamics of the SEIR model across these representations. RESULTS We show that a contact matrix that only contains average contact durations between role classes fails to reproduce the size of the epidemic obtained using the high-resolution contact data and also fails to identify the most at-risk classes. We introduce a contact matrix of probability distributions that takes into account the heterogeneity of contact durations between (and within) classes of individuals, and we show that, in the case study presented, this representation yields a good approximation of the epidemic spreading properties obtained by using the high-resolution data. CONCLUSIONS Our results mark a first step towards the definition of synopses of high-resolution dynamic contact networks, providing a compact representation of contact patterns that can correctly inform computational models designed to discover risk groups and evaluate containment policies. We show in a typical case of a structured population that this novel kind of representation can preserve in simulation quantitative features of the epidemics that are crucial for their study and management.
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Affiliation(s)
- Anna Machens
- CNRS UMR 7332, CPT, Aix Marseille Université, Marseille 13288, France
- CNRS UMR 7332, CPT, Université du Sud Toulon-Var, La Garde 83957, France
- Data Science Laboratory, ISI Foundation, Torino, Italy
| | | | - Caterina Rizzo
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | | | - Alain Barrat
- CNRS UMR 7332, CPT, Aix Marseille Université, Marseille 13288, France
- CNRS UMR 7332, CPT, Université du Sud Toulon-Var, La Garde 83957, France
- Data Science Laboratory, ISI Foundation, Torino, Italy
| | - Ciro Cattuto
- Data Science Laboratory, ISI Foundation, Torino, Italy
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Valentini D, Vittucci AC, Grandin A, Tozzi AE, Russo C, Onori M, Menichella D, Bartuli A, Villani A. Coinfection in acute gastroenteritis predicts a more severe clinical course in children. Eur J Clin Microbiol Infect Dis 2013; 32:909-15. [PMID: 23370970 DOI: 10.1007/s10096-013-1825-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/10/2013] [Indexed: 11/30/2022]
Abstract
The objectives of this study were to determine the incidence of enteric pathogens causing acute gastroenteritis (AGE) among hospitalized children in a large Italian hospital, to measure the incidence of coinfections, and to compare the clinical characteristics of those infected with one versus multiple agents. A prospective study was conducted from March 2010 to April 2011 at the Bambino Gesù Pediatric Hospital in Rome, Italy. All patients between 1 month and 16 years of age admitted to the Pediatric Department with a diagnosis of AGE were eligible for enrollment. Two stool samples for each patient were tested for gastrointestinal pathogens. We summarized the clinical severity of episodes, describing the duration of diarrhea, duration and frequency of vomiting, fever, and severity of dehydration. All the patients underwent medical evaluation with estimation of dehydration. One or more etiological agents were detected in 151 out of 232 patients (65.1%), while we did not detect any etiological agent in 81 (34.9%). Rotavirus was detected in 96 (63.6%), adenovirus in 17 (11.2%), norovirus in 7 (4.6%), toxin-producing Clostridium difficile in 23 (15.2%), Salmonella spp. in 15 (9.9%, B group in 12/15 and D group in 3/15), C. perfringens in 12 (7.9%), Campylobacter spp. in 6 (4%), and verotoxigenic Escherichia coli (VTEC) in 2 (1.3%). In 27 children out of 151 (17.9%), we found evidence of coinfection. Coinfection with rotavirus and toxin-producing C. difficile was the most common (63%). Children with coinfection had a more severe clinical presentation and had a higher probability to be severely dehydrated, independently of age and living community type.
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Affiliation(s)
- D Valentini
- Department of Pediatrics, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy.
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50
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Esposito S, Marchese A, Tozzi AE, Rossi GA, Da Dalt L, Bona G, Pelucchi C, Schito GC, Principi N. DNA bacterial load in children with bacteremic pneumococcal community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 2013; 32:877-81. [PMID: 23354677 DOI: 10.1007/s10096-013-1821-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/07/2013] [Indexed: 11/26/2022]
Abstract
This study was conducted to evaluate the association between pneumococcal DNA load and parapneumonic pleural effusion (PPE) in children with community-acquired pneumonia. Bacterial load was quantified and related to the presence of PPE with or without empyema in 72 otherwise healthy children aged ≤5 years who were hospitalised because of radiographically confirmed CAP and showed a real-time polymerase chain reaction that was positive for Streptococcus pneumoniae. The proportion of children with a high bacterial load (i.e. ≥265 DNA copies/mL) was larger among the subjects with PPE than those without it. Multivariate analysis showed that a high bacterial load was significantly associated with PPE (OR 8.65; 95% CI 1.10-67.8 vs a bacterial load of <125 copies/mL). Children with infection due to pneumococcal serotype 19A were at highest risk of developing PPE (OR 7.44; 95% CI 1.10-50.4 vs all other typeable serotypes). The patients with CAP due to pneumococcal serotypes that are not included in the 13-valent conjugate vaccine (PCV13) were more frequently affected by PPE than those with infections associated with serotypes included in the vaccine, except for serotype 19A. Bacterial loads of ≥265 DNA copies/mL are significantly associated with PPE, and serotype 19A is significantly associated with a high bacterial load and the development of PPE. The mean bacterial load of the patients with empyema was higher than that of patients with simple PPE. Although further studies are required, it seems that serotypes not included in PCV13 can play a major role in causing a higher bacterial load and PPE.
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Affiliation(s)
- S Esposito
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy.
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