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Magurano F, Baggieri M, Bucci P, D'Ugo E, Sabbatucci M, Maraglino F, Iannazzo S, Marchi A, Nicoletti L. MoRoNet a network to strengthen the quality of measles and rubella surveillance in Italy. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Measles is a vaccine-preventable infectious disease and it remains one of the leading causes of infant mortality globally. The World Health Organization (WHO) has adopted the goal of eliminating measles and rubella. Detection and control of communicable diseases would not be possible without accurate laboratory results regarding when and where a particular disease circulates.
Methods
WHO/Europe therefore works with all Member States to steadily improve the quality of the laboratory data in order to determine the Region's progress towards measles and rubella elimination. For this purpose coordinates the European Measles and Rubella Laboratory Network (MR LabNet). National labs in this network undergoes regular external quality assessment through an annual accreditation programme.
Results
In Italy, a Sub-national Reference Laboratories Network for measles and rubella (MoRoNET) has been developed since March 2017 and currently includes 15 laboratories. MoRoNet was developed following the indications of the MR LabNet. It is accreditate, coordinated and supervised by the National Reference Laboratory.
Conclusions
Strengthening the role of national laboratories in overseeing the performance of subnational laboratories has become a critical need in order to properly monitor the Region's measles and rubella elimination efforts. MoRoNet permits to Italy to develop a country-specific work plan for establishing national networks and oversight mechanism, including preliminary monitoring and evaluation indicators compliant with MR LabNet standards. This is very significant not only to optimize the participation in national and regional processes to verify disease elimination, but also to strengthen the quality of vaccine-preventable disease surveillance.
MoRoNet Group: A Amendola; F Baldanti; MR Capobianchi; M Chironna; MG Cusi; P D'Agaro; P Lanzafame; T Lazzarotto; K Marinelli; A Orsi; E Pagani; G Palù; F Pittaluga, A Sacchi; F Tramuto.
Key messages
MoRoNet has permitted to Italy to develop a country-specific work plan for establishing national networks and oversight mechanism, compliant with WHO MR LabNet standards. MoRoNet network has permitted to optimize the participation in processes to verify disease elimination, but also to strengthen the quality of vaccine-preventable disease surveillance.
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Affiliation(s)
- F Magurano
- National Reference Lab for measles and rubella, WHO/LabNet, DMI, National Institute of Health, Rome, Italy
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
- MoRoNet, NRL-WHO/LabNet, DMI, National Institute of Health, Rome, Italy
| | - M Baggieri
- National Reference Lab for measles and rubella, WHO/LabNet, DMI, National Institute of Health, Rome, Italy
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
- MoRoNet, NRL-WHO/LabNet, DMI, National Institute of Health, Rome, Italy
| | - P Bucci
- National Reference Lab for measles and rubella, WHO/LabNet, DMI, National Institute of Health, Rome, Italy
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
- MoRoNet, NRL-WHO/LabNet, DMI, National Institute of Health, Rome, Italy
| | - E D'Ugo
- National Reference Lab for measles and rubella, WHO/LabNet, DMI, National Institute of Health, Rome, Italy
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - M Sabbatucci
- General Directorate Health Prevention, Communicable Diseases, Ministry of Health, Rome, Italy
| | - F Maraglino
- General Directorate Health Prevention, Communicable Diseases, Ministry of Health, Rome, Italy
| | - S Iannazzo
- General Directorate Health Prevention, Communicable Diseases, Ministry of Health, Rome, Italy
| | - A Marchi
- National Reference Lab for measles and rubella, WHO/LabNet, DMI, National Institute of Health, Rome, Italy
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
- MoRoNet, NRL-WHO/LabNet, DMI, National Institute of Health, Rome, Italy
| | - L Nicoletti
- National Reference Lab for measles and rubella, WHO/LabNet, DMI, National Institute of Health, Rome, Italy
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
- MoRoNet, NRL-WHO/LabNet, DMI, National Institute of Health, Rome, Italy
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Filia A, Bella A, Del Manso M, Baggieri M, Magurano F, Iannazzo S, Sabbatucci M, Nicoletti L, Rota MC. Who is at risk for measles in Italy? Continued measles outbreaks in 2019 and barriers to elimination. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Measles is a highly contagious vaccine preventable disease that can lead to serious complications, including death. All five regions of the World Health Organization have set targets to eliminate measles. In Italy, measles vaccination was introduced in 1976, with sustained low uptake in the 1980s and 1990s. Uptake improved in subsequent years but never reached 95% coverage required for elimination. Two doses of measles-mumps-rubella (MMR) vaccine are recommended (at 12-15 months and 5-6 years respectively). Since July 2017, MMR vaccine has become mandatory for all children up to 16 years of age. Large outbreaks continue to occur, with over 8.000 cases reported in 2017-2018.
Methods
We analysed measles cases reported to the national integrated measles and rubella surveillance system during January 1 - December 31, 2019.
Results
From 1 January to 31 December 2019, 1,627 cases (87% laboratory-confirmed), were reported from all 21 administrative regions. National incidence was 27 cases/million. Overall, 86% of cases were unvaccinated. Median age was 30 years but the highest incidence was in infants below one year of age. Ninety-six cases were reported amongst healthcare workers and transmission in the healthcare setting was frequent. Overall, 31% of cases reported complications, including three cases of encephalitis (in two adults and one child) and one death in an adult patient. Complications were more frequent in cases ≥20 years of age compared to younger patients. Forty-six percent of cases were hospitalised.
Conclusions
The median age of cases has increased further in 2019 compared to 2017 (27 years) and 2018 (28 years). The proportions of complicated and hospitalised cases are high, this may be due to the high median age of cases but also to underreporting from general practitioners who are likely to see milder cases. Wide immunity gaps among adults (including healthcare workers) and nosocomial transmission are major challenges to measles elimination in Italy.
Key messages
Measles is still endemic in Italy and large outbreaks continue to occur, with a significant public health impact. Wide immunity gaps among adults (including healthcare workers) and nosocomial transmission are major challenges to measles elimination in Italy.
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Affiliation(s)
- A Filia
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - A Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - M Del Manso
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - M Baggieri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - F Magurano
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - S Iannazzo
- General Directorate of Prevention, Ministry of Health, Rome, Italy
| | - M Sabbatucci
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- General Directorate of Prevention, Ministry of Health, Rome, Italy
| | - L Nicoletti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - M C Rota
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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Ciceri G, Canuti M, Bianchi S, Gori M, Piralla A, Colzani D, Libretti M, Frati ER, Baggieri M, Lai A, Rovida F, Zehender G, Baldanti F, Magurano F, Tanzi E, Amendola A. Genetic variability of the measles virus hemagglutinin gene in B3 genotype strains circulating in Northern Italy. Infect Genet Evol 2019; 75:103943. [PMID: 31255832 DOI: 10.1016/j.meegid.2019.103943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022]
Abstract
Sequencing the whole measles virus hemagglutinin (H) gene, in conjunction with a 450-nucleotide region of the nucleoprotein gene (N-450), is helpful for the identification of new genotypes and as an auxiliary in outbreak characterization. In addition, it is essential to be able to predict the antigenic changes of the H protein to gain a better monitoring of the response to the vaccine. In this study, we obtained the full-length H gene sequences from 19 measles virus (MV) strains belonging to two B3 genotype variants circulating in Lombardy (Northern Italy) between July 2015 and February 2016 and evaluated the variability of the whole MV-H gene. Furthermore, we compared the obtained H amino acid sequences to all MV sequences available in the GenBank database (n = 1152 in total) and analyzed the amino acid substitutions in the H protein within clades where the Italian strains were included. We identified a higher variability in the H gene compared to the N-450 region and our results support previous studies, highlighting that the H gene is more informative for characterizing the MV B3 genotype than the N-450 sequence. Some of the amino acid substitutions were fixed in the viral population and, remarkably, some of the amino acid substitutions were typically present only in the Italian sequences. Accumulating further molecular information about MV-H gene will be necessary to enable in-depth analyses of the variability of this gene in the vaccinated population.
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Affiliation(s)
- G Ciceri
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy.
| | - M Canuti
- Department of Biology, Memorial University of Newfoundland, 232 Elizabeth Ave., St. John's, NL A1B 3X9, Canada
| | - S Bianchi
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy.
| | - M Gori
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy
| | - A Piralla
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, via Taramelli, 5, 27100 Pavia, Italy.
| | - D Colzani
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy.
| | - M Libretti
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy
| | - E R Frati
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy
| | - M Baggieri
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy.
| | - A Lai
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Section of Infectious Diseases, University of Milan, Via Gian Battista Grassi, 74, 20157 Milan, Italy.
| | - F Rovida
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, via Taramelli, 5, 27100 Pavia, Italy.
| | - G Zehender
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Section of Infectious Diseases, University of Milan, Via Gian Battista Grassi, 74, 20157 Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy.
| | - F Baldanti
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, via Taramelli, 5, 27100 Pavia, Italy.
| | - F Magurano
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy.
| | - E Tanzi
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy.
| | - A Amendola
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy.
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Filia A, Bella A, Rota M, Tavilla A, Magurano F, Baggieri M, Nicoletti L, Iannazzo S, Pompa M, Declich S. Analysis of national measles surveillance data in Italy from October 2010 to December 2011 and priorities for reaching the 2015 measles elimination goal. Euro Surveill 2013; 18:20480. [PMID: 23725868] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
From 1 October 2010 to 31 December 2011, Italy experienced high measles burden with 5,568 measles cases (37.4% laboratory-confirmed) reported to the enhanced measles surveillance system (cumulative incidence in the 15-month reference period: 9.2/100,000 population). Adolescents and young adults were especially affected, and the median age of cases was 18 years. Most cases (95.8%) were either unvaccinated or incompletely vaccinated. Complications were reported for 20.3% of cases, including 135 cases of pneumonia, seven of encephalitis and one case of Guillain–Barré syndrome. One death occurred in an immunocompromised adult. Over 1,300 cases were hospitalised. Identified priorities for reaching the measles elimination goal include evidence-based interventions such as reminder/recall for both doses of measles vaccine, supplementary immunisation activities aimed at susceptible age cohorts, and vaccinating healthcare workers.
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Affiliation(s)
- A Filia
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy.
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Filia A, Bella A, Rota MC, Tavilla A, Magurano F, Baggieri M, Nicoletti L, Iannazzo S, Pompa MG, Declich S. Analysis of national measles surveillance data in Italy from October 2010 to December 2011 and priorities for reaching the 2015 measles elimination goal. Euro Surveill 2013. [DOI: 10.2807/ese.18.20.20480-en] [Citation(s) in RCA: 27] [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: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- A Filia
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
| | - A Bella
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
| | - M C Rota
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
| | - A Tavilla
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
| | - F Magurano
- Viral Diseases and Attenuated Vaccines Unit, National Institute of Health, Rome, Italy
| | - M Baggieri
- Viral Diseases and Attenuated Vaccines Unit, National Institute of Health, Rome, Italy
| | - L Nicoletti
- Viral Diseases and Attenuated Vaccines Unit, National Institute of Health, Rome, Italy
| | - S Iannazzo
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy
| | - M G Pompa
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy
| | - S Declich
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
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Magurano F, Remoli ME, Baggieri M, Fortuna C, Marchi A, Fiorentini C, Bucci P, Benedetti E, Ciufolini MG, Rizzo C, Piga S, Salcuni P, Rezza G, Nicoletti L. Circulation of West Nile virus lineage 1 and 2 during an outbreak in Italy. Clin Microbiol Infect 2012; 18:E545-7. [PMID: 23020657 DOI: 10.1111/1469-0691.12018] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In 2011, from 26 September to 16 October, a small outbreak of West Nile virus (WNV) disease occurred on the island of Sardinia (Italy). According to the national case definition, six cases with acute neurological disease were confirmed in hospitalized patients, and four of them died; one of these was only 34 years old. In two case, WNV RNA was detected in urine, suggesting renal involvement. Sequence analysis showed lineage 1 and 2 circulation.
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Affiliation(s)
- F Magurano
- Istituto Superiore di Sanitá, Department of Infectious, Parasitic and Immunomediated Disease, Rome, Italy.
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