[A vaccination campaign for gypsy children in Rome]

Several studies conducted in Rome have shown low levels of vaccination coverage in gypsy communities. Thus a vaccination campaign targeting to 2400 gypsy children aged 0-13 years, present in 32 settlements in Rome, was conducted in 2002. The campaign was related to vaccinations required and recommended in Italy: diphtheria, tetanus, hepatitis B, pertussis (whooping cough), haemophilus influenzae and measles. In the majority of cases it was decided to carry out the vaccinations directly in the gypsy settlements, in accordance with the methods of pulse immunisation. In the case of small settlements a strategy for reorienting the population to vaccination centres was adopted. Around 2000 children were vaccinated, equivalent to 80% of the paediatric population present during the period. The number of children who have never been vaccinated has decreased from 40% prior to the campaign to 9% after the third week. Vaccination coverage in medium- and small-sized settlements (<200 inhabitants) after the campaign shows values of over 70%; in the large settlements, more modest increases have been recorded and coverage has rarely exceeded 50%. This experience has highlighted the importance of networking between public healthcare institutions and non-profit organisations. The mobilisation of a wide range of competences has thus enabled the attainment of a high level of effectiveness.

Do antenatal classes benefit the mother and her baby?

OBJECTIVE

To examine the characteristics of women attending antenatal classes and evaluate the effects of these classes on mothers' and babies' health.

METHODS

A population-based observational study on care during pregnancy, delivery and in the postnatal period was carried out in 1995-96. A total of 9004 women resident in 13 regions of Italy who delivered in a 4-month period were interviewed. The outcomes studied were attendance at antenatal classes, Cesarean section, bottle feeding, satisfaction with the experience of childbirth, knowledge of contraception, breast feeding and baby care.

RESULTS

A total of 2065 (23.0%) women attended antenatal classes. Women without previous children, those with a higher level of education and office workers were more likely to attend classes. Women who attended antenatal classes had a much lower risk of Cesarean section and were about half as likely to bottle feed while in hospital compared with non-attenders. They received better information on contraception, breast feeding and baby care. Women who attended classes and applied the techniques learned were more satisfied with the experience of childbirth.

CONCLUSION

Antenatal classes seem to improve women's knowledge and competence. This may provide a defence against the tendency to overmedicalize pregnancy and childbirth.

A population-based study on the frequency of additional congenital malformations in infants with congenital hypothyroidism: data from the Italian Registry for Congenital Hypothyroidism (1991-1998)

In the last decade a high frequency of other congenital anomalies has been reported in infants with congenital hypothyroidism (CH) detected by neonatal screening. In the present study the occurrence of additional congenital malformations (CM) in the population of CH infants detected in Italy between 1991 and 1998 (n = 1420) was investigated. In Italy all of the centers in charge of screening, treatment, and follow-up of CH adhere to the Italian National Registry of infants with CH. In this study a high prevalence of additional CM (8.4%), more than 4-fold higher than that reported in the Italian population (1-2%), was found in the population of CH infants. Cardiac anomalies represented the most frequent malformations associated with CH, with a prevalence of 5.5%. However, a significant association between CH and anomalies of nervous system, eyes, and multiple CM was also observed. In conclusion, the significantly higher frequency of extrathyroidal congenital malformations reported in the CH infants than in the general population represents a further argument supporting the role of a genetic component in the etiology of CH. Investigations of the molecular mechanisms underlying developmental events of formation of thyroid and other organs represent critical steps in the knowledge of CH etiology.

Drug use in pregnancy among Italian women

OBJECTIVE

To describe the use of drugs among Italian women during pregnancy and to compare it with other reports in Italy from the last 10 years.

METHODS

A random sample of women who delivered in 1995-1996 were interviewed with regard to the care they received during pregnancy, delivery and the post-natal period. Information on antenatal care included maternal reports on the use of drugs during pregnancy.

RESULTS

Of the 9004 women interviewed, 75% took at least one drug during pregnancy. Users took a median number of two drugs. Iron (51%) and vitamins (25%) dominate prescriptions throughout pregnancy. Fifteen percent of women reported treatment for threatened abortion and 27% for risk of pre-term delivery. The data do not differ from the drug exposure profile during pregnancy reported in other Italian studies. Logistic regression analysis of drug use (excluding haematologicals and nutritionals) shows an increased risk of usage for older women, the better educated, for those who reported health problems and those who had compulsory bed rest and/or hospitalisation during pregnancy.

CONCLUSION

Seventy-five percent of the women reported use of at least one drug during pregnancy. Haematological and nutritional drugs are over prescribed. Although hormones have been clearly proven to be ineffective in preventing threatened abortion, the study shows an almost unchanged and out of date prescription pattern of progestational drugs. In order to avoid unnecessary exposure to potential risk, maternity care procedures should be reviewed and strictly related to an "evidence-based" approach.

Sex education in secondary schools: an Italian experience

PURPOSE

To evaluate the impact on Italian teenagers' knowledge and attitudes of an experimental program in sex education.

METHODS

The program consisted of five workshops in five public secondary schools in Rome. The impact of the program was evaluated with three questionnaires designed for this study. A pretest evaluated baseline knowledge, a posttest measured the gain in knowledge, and a third questionnaire estimated retention of information 4-6 months later. Three hundred seventy-six students attending secondary school participated in the program. Thirteen questions were selected for the analysis, and improvement was measured by the difference between pretest and posttest scores.

RESULTS

Ninety-six percent of the sample was in favor of sex education programs in schools. The students had an average 50% gain in the percentage of correct answers following the course. The mean score based on the number of correct answers to questions showed a baseline value of 5.00, a posttest value of 11.80, and a test value 4-6 months later of 10.7. Results showed students' positive attitude toward school sex education courses, low baseline knowledge, and a good ability to learn.

CONCLUSIONS

In Italy there is a need for collaboration between schools and local health services to promote knowledge and prevention in reproductive health among teenagers.

[Family health services and preventive strategies]

Health promotion is effective if it is based on the active offer of preventive measures to the target population. The active offer must be sustained by non standardised communication procedures, with the aim of producing empowerment of involved people. People, who are socially deprived and therefore at high risk, are hard to reach. They need special attention and resources. Prevention services and, in particular, those devoted to women, children and adolescents must be sufficiently diffused among the population. They must change from being dependent on demand to being based on active offer of preventive measures.

[Incidence of measles in Italy in the 1985-1994 period]

Measles notifications in Italy underestimate the actual incidence by a factor of ten, as it is ascertained by seroepidemiological investigation. In the decade 1980-89, 45,000 measles cases were notified, on average, per year. Since 1988 mass vaccination campaigns were implemented in several Italian regions. The strategy aimed to offer the prophylaxis actively to all children aged 13 months to 8-12 year for whom a sure recollection of measles was absent. The study has aimed to evaluate the impact of the strategy that worked in the period 1989-91, on the standardised average annual incidence of measles notification, comparing the periods 1985-89 and 1990-94. A reduction of 45% resulted all over Italy. On the contrary the incidence of chickenpox notifications has increased, indicating that the notification system did not worse.

[Control of congenital toxoplasmosis in Italy: The project of the Istituto Superiore di Sanità]

Toxoplasma gondii infection during pregnancy is a public health concern; many resources are used in diagnostic and therapeutic activities, sometime with a low benefit/cost due to lack of standardization in practices. In the lack of suitable epidemiological knowledge at national level regarding the congenital toxoplasmosis trend in Italy, an evaluation of the public health impact of this pathology is required. The Istituto Superiore di Sanità (ISS) has worked out a project on a prevalence-incidence study at national level, performing standard reference methods for diagnosis and both case definition and case management. Furthermore, the ISS urges all the involved centers on congenital toxoplasmosis to set up a network for an active collaboration to this project.

[Congenital forms of hypothyroidism: study of risk factors and preventive interventions]

Maternal and child health represents one of the most relevant fields of interest in public health and particular attention is given to congenital pathologies. In Italy, the incidence of congenital hypothyroidism (CH) is 1:3200 live birth. CH is diagnosed at birth by neonatal thyroid screening. This allows a precocious onset of substitutive therapy which avoids severe psychomotor deficits in infants with CH. Moreover, the newborn screening program have permitted to identify transient disorders of thyroid function in newborns. These are essentially due to neonatal, maternal and environmental risk factors, especially iodine deficiency. The National Register (NR) of infants with CH was established in 1987. The aim of the NR is to provide disease surveillance and to monitor efficiency and effectiveness of neonatal screening. Furthermore, the NR represents an useful tool for developing epidemiological studies to identify possible environmental and/or familial risk factors of CH.

[Evolution of voluntary interruption of pregnancy in Italy from its legalization until today]

Induced abortion was legalized in Italy in 1978. After an initial increase in the incidence, from 187,631 in 1979 to 234,801 in 1983, induced abortion has steadily decreased to 140,398 in 1996. Analysis of the abortion rates has shown that the main decrease has been among married women aged 25-35, while there has been an increase among unmarried women. Women with lower levels of education tend to have higher rates and housewives have higher rates than women in paid work. Programmes for the prevention of induced abortion should be directed at directed at easily accessible groups: women who have just delivered a baby, couples who marry, teenagers in school and women who have already had an induced abortion. In any case, the need for rationalisation of the procedure to obtain an induced abortion is urgent.

[Pilot study on compulsory vaccination coverage]

The disappearance of diphtheria and poliomyelitis is the best evidence of the efficacy of the vaccination strategies adopted in Italy. The active offer of the prophylaxis, reinforced by law, has characterised the operational aspects of the strategy. The active surveillance system is the main tool to take under control the effectiveness of health services responsible for vaccination. This system could be more easily implemented if the health services will be given a specific software aiming to handle and evaluate vaccination registers. The present pilot study, performed in the regions Marche and Sardegna, is an example of active surveillance and it is based on the ARVA software produced by the Istituto Superiore di Sanità. The results show a good level of coverage (> 95%) within the second year of life. Unsatisfactory results were obtained on the timing of vaccinations, as recommended by the vaccination schedule, mostly for the third doses.

[Care in pregnancy, labor, and during the puerperium in Italy]

In 1995-96 a KAP (knowledge, attitude and practice) survey on care during pregnancy, delivery and in the post-natal period was carried out in Italy by the National Institute of Health (Istituto Superiore di Sanità). A sample of 9004 women was interviewed in 13 regions within two months of the delivery. Care during pregnancy was generally at a good standard, but with an excessive use of some medical procedures. The level of knowledge was often low and some non-invasive but effective methods for preventing negative outcomes were not widely adopted. Many women were ill informed about the procedures to which they were subjected and their degree of satisfaction was often low. In general, a wide geographic variability and a lack of continuity in pre- and post-natal care were observed.

[Evaluation of the impact of birth preparation courses on the health of the mother and the newborn]

In 1995-96 a knowledge, attitude and practise (KAP) survey on care during pregnancy, delivery and in the post-natal period was carried out by the National Institute of Health in Italy. Of the 9004 women interviewed, 23% have attended antenatal classes (36% in hospitals, 51% in maternal and child health, MCH, clinics and 13% privately). Women attending these classes tend to be well-educated, primigravidae and resident in the North. Women who attend antenatal classes, especially at MCH clinics, have a lower risk of caesarean section (OR = 0.60), of bottle feeding while in hospital (OR = 0.45) and of receiving no information on contraception (OR = 0.31). Women who attend classes and are able to apply the technique learnt have a reduced risk of being dissatisfied with the experience of childbirth (OR = 0.72), whereas the others have an increased risk of dissatisfaction (OR = 1.87).

Surveillance of acute flaccid paralysis in Italy: 1996-1997. AFP Study Group. Acute flaccid paralysis

The last case of poliomyelitis due to transmission of indigenous wild poliovirus occurred in Italy in 1982. To achieve the certification of the eradication of poliomyelitis in Italy, an active surveillance of acute flaccid paralysis (AFP) in the population aged less than 15 years was set up following the World Health Organization (WHO) guidelines. The survey started in 1996 with a pilot study involving 4 out of 21 regions, and was gradually extended to a national level in 1997. The two-year survey identified five patients with diagnosis of vaccine associated paralytic poliomyelitis (VAPP). Polioviruses type 2 and 3 Sabin-like were isolated and characterized in three of them. In the remaining two cases, samples were collected late after the onset of symptoms, and poliovirus could not be isolated. No wild polioviruses were detected during the survey. The rate of non-polio AFP found in Italy in 1997 was 0.61 cases per 100,000, which is lower than the level of 1.0 case per 100,000 considered as acceptable by the WHO. This was mainly due to the delay in organizing the hospital network and starting the active search of AFP cases in the largest and most densely populated regions. Therefore, the overall rate of AFP found in Italy underestimates the global effectiveness of the program, which however will be better evaluated in the next few years. This study is the first systematic attempt to determine the rate of AFP in Italy.

[Transient congenital hypothyroidism in iodine deficiency areas. Gruppo di Studio per il Registro Nazionale degli Ipotiroidei Congeniti]

On the basis of data collected in the National Register of infants with congenital hypothyroidism (CH), a mean incidence of 1 case of CH to 3200 live births has been estimated in Italy. Nevertheless a higher incidence (> 1:2000) than national mean value has been observed in several districts of our country. The aim of this study was to verify a possible occurrence of transient hypothyroidism (TH) in these areas. Results of our study showed that the proportion of infants with thyroid in situ was significantly higher in the areas with very high CH incidence than in the remaining parts of the country. Also serum TSH levels at confirmation showed a less severe hypothyroidism in infants of these areas when compared with the other CH infants. Furthermore, preliminary results of diagnosis reevaluation showed 58% of TH in the areas with CH incidence > 1:2000. Lower percentages of TH have been observed in the other areas in relation to the decreasing of CH incidence. Most of the high CH incidence areas are historically affected by iodine deficiency. This observation supports the hypothesis that iodine deficiency can contribute to the occurrence of transient disorders of thyroid function in our population and stresses the need of promoting diffusion of an adequate iodine prophylaxis.

Prevention of allergies of infants: breast-feeding and special formulas. Influence on the response to immunization

Infant formulas containing partially hydrolyzed cow milk-proteins are used for the prevention of allergy when maternal milk is not available, and, in preterm infants, also for improving gastric emptying. The nutritional adequacy of such formulas has not yet been completely defined. As the type of feeding may influence the antibody response to immunization, the aim of the present study was to evaluate the antibody response to oral polio virus immunization in term infants and to acellular pertussis and hepatitis B immunization in preterm infants, exclusively fed a partially hydrolyzed cow-milk formula during the first 5 months of life, in comparison with exclusively breast-fed infants. Active immune response occurred in all the infants after the second dose of immunization and no significant difference in the antibody titres was found according to the type of milk. On the basis of these results, it seems that protein nutrition based exclusively on a partially hydrolyzed formula does not impair the response to immunization in both preterm and term infants.

Seroepidemiological evaluation of 1989-91 mass vaccination campaigns against measles, in Italy

In 1989-91 anti-measles vaccination campaigns were conducted in several Italian regions to vaccinate all children aged between 13 months and 10-12 years without a history of measles or measles vaccination. This study was conducted to evaluate serological status after the mass vaccination campaigns. In 1994, capillary blood samples were collected from randomly selected children, aged 2-14 years, living in 13 local health units. Antibody titres were determined by ELISA. Blood spot samples were analysed for 4114 (75.6%) of 5440 selected children. Among the 835 that reported measles before 1990, 806 (96.5%) were immune and of the 2798 vaccinated, 2665 (95.2%) were immune. The Edmoston-Zagreb (E-Z) strain vaccine was associated with a lower level of immunity than the Schwarz (SW) strain. A history of measles identified almost all immune children. Vaccination with the SW strain conferred persistent immunity (at least 5 years) in 98% of vaccinees. The strategy was able to unite natural and induced immunity.

[Ethical aspects of strategies for prevention]

Prevention must be offered actively to all sections of the target population. The spontaneous process select people at lower risk. The active offer of preventive measures must be modulated on the difficulty to be reached of the different sections of the target population. The main problem of prevention is that the risk factors of non compliance are the same for a higher incidence or prevalence of events or conditions. The efficacy of a preventive strategy is valuable observing a reduction of the incidence or prevalence of preventable events or conditions in a definite period of time and in a defined community. In the case of prevention ethical and professional quality coincide.

Reducing pain of first trimester abortion under local anaesthesia

The study aimed to estimate the pain related to first trimester abortion under local and general anaesthesia. One hundred and eighty-one women undergoing abortion of first trimester under local anaesthesia and 198 under general anaesthesia were interviewed 1 h after the end of the procedure. About 50% of all women described their experience as less painful than expected. Over 50% of the women described the pain during the procedure as mild or moderate according to the verbal rating scale. The step-up logistic regression analyses identified four important variables: time interval less than 2 min from local anaesthesia injection to the beginning of the procedure (RR = 3), lack of choice between local and general anaesthesia (RR = 1.9), history of frequent use of analgesics (RR = 1.9) and nulliparity (RR = 1.7). These data indicate that skillfully performed abortion with local anaesthesia is a procedure tolerated by most women. Moreover, because it carries lower risk of complications and costs less, its use should be encouraged.

Persistence of immunity to poliomyelitis among a southern population that received four doses of OPV 5 to over 15 years before

The immune status against polioviruses was investigated in a population of 545 students aged 11-20 years residing in the Neapolitan area, who had completed the vaccination cycle with four doses of OPV 5 to over 15 years before. Assuming as unprotected those individuals without detectable neutralizing antibodies at the dilution 1:2, nobody resulted without protection against all types of poliovirus; 0.7% lacked antibodies only against type 1, 0.6% only against type 3 and none against type 2. A very slight decreasing trend was observed for GMT values in function of the distance from the last dose of OPV for polio 1 and 2, but not for polio 3. As expected, GMT values for polio 2 resulted higher than those for polio 1 and both were higher than those for polio 3, when calculated by age groups as well as by distance groups. The last four Italian cases of autochthonous paralytic poliomyelitis, occurred in the period 1981/83, regarded unvaccinated children aged 6 months-2 years, residing in the same geographical area to which the study population belong. In the same area a delay of immunization practices was also ascertained in the recent past. Results of this study confirm that a priority for public health services is to devote their human and economic resources to reduce the vaccination delay more than administrate a further fifth dose of OPV at the age of twelve.

The National Register of infants with congenital hypothyroidism detected by neonatal screening in Italy

Neonatal screening for congenital hypothyroidism began in Italy in 1977 and then progressively developed covering 94% of live births in 1991. The National Register of infants with congenital hypothyroidism was established in 1987 as a project of the Health Ministry. The results of the Register provided valuable epidemiological information about congenital hypothyroidism in Italy and evidenced some aspects in the screening organization which had to be improved. Discussion of Register data during annual national meetings has recently allowed an improvement of the screening program with particular regard to the beginning of therapy with L-thyroxine and its dose.

Three years of experience of the congenital hypothyroidism National Register

Mental retardation caused by congenital deficiency of thyroid hormones can be prevented by early diagnosis and therapy which are assured by neonatal thyroid screening. Congenital hypothyroidism screening is performed in Italy by regional centres which in 1989 have screened more than 82% of neonatal population. Since 1987 a National Register of children affected by CH has been instituted. The results of the analysis of data collected in the first three years are reported.

Influence of environmental iodine deficiency on neonatal thyroid screening results

During a multicentric pilot screening program for congenital hypothyroidism a comparison between the results obtained from Urbino, an area characterized by low iodine supply and endemic goiter, and Rome, a non-endemic area, has been made. The evaluation of neonatal urinary iodine excretion in the two areas showed significantly lower iodine urinary excretion levels in Urbino than in Rome. A shift of TSH at screening toward higher values as well as a higher percentage of recall in Urbino area than in Rome was observed. This finding, which well correlates with a low environmental iodine supply, emphasizes the importance of screening for congenital hypothyroidism as a suitable index of the presence and action of goitrogenic factors in the environment.

Paralytic poliomyelitis in Italy (1981-85)

Fifteen cases of presumptive poliomyelitis occurring in Italy between 1981-85 were studied in order to differentiate between paralysis caused by poliovirus and that of different etiology. Out of seven confirmed cases three were "temporally associated with vaccination". Three aspects are discussed: the need for a careful differential diagnosis of paralytic cases; the over concern about the problem of vaccine-associated cases: the risk connected with re-importation of wild poliovirus strains.

Longitudinal assessment of children with congenital hypothyroidism detected by neonatal screening

Clinical and laboratory data from 42 children (31 females and 11 males) with primary congenital hypothyroidism (CH) diagnosed by neonatal screening over a six-year period are reported. The mean age at onset of thyroid hormone therapy was 33 days. The adequacy of replacement therapy was assessed by repeated TT4, FT4, T3 and TSH serum determinations. The high serum TT4 concentrations frequently observed were not accompanied by clinical evidence of hyperthyroidism. rT3 levels determined in 28 CH children with TT4 greater than 15 micrograms/dl were clearly higher than in the controls. The mean weight, length and head circumference remained always between the 50th and 75th centile. The radiological assessment of the knee, mainly the distal femoral surface, has been considered as an important clinical value in the initial diagnosis and in the evaluation of both severity and duration of disease. The psychomotor development was assessed using Brunet-Lezine's test until age 36 months, Stanford-Binet at 4 and 5 and WISC at 6 years of age. The mean global developmental quotients (GDQ) were always between 85 and 97 at 6 to 72 months of age, only eight children were below 85. A significant correlation was found between GDQ at 6 months and the bone age. The neurological examination showed an impairment of posture, coordination and subtle deficits in motor and perceptual abilities in a small percentage of children.

Epidemiology of legal abortion in Italy

The paper reports on the trends of induced abortion in Italy since its legalization in 1978. Data collected through the national surveillance system show that the abortion rates and ratios in Italy, after an initial increase, have been stable in the last four years, and are comparable to those of other European countries. Italian women seeking abortion, however, are generally older and more frequently married and parous than in most other western countries. The data on abortion services and procedures show a slow improvement with increasing use of local rather than general anaesthesia, suction rather than surgical curettage, and outpatient rather than inpatient admissions. Post-abortion complications are infrequent and there have been no cases of death from legal abortion. The paper attempts to analyse the effect of legal abortion on fertility and on other maternal and child health indices, reaching tentative conclusions on the contribution of the legalization of abortion to the improvement of reproductive health. Uneven availability of abortion services, however, is currently a major problem; in many of the less developed areas of the country, it is estimated that as many as 50% of abortions are still performed outside the legal abortion service network.

[Epidemiology of measles and its complications in Italy. Personal experience with a hospital case load]

The authors relate and comment on the results of admission for measles in the Hospitals of Chieti and Pescara, in the period between 1974 and 1983. The authors have studied the number of admissions and their duration; moreover, they have evaluated the relationship with the pediatric population of the considered area. They point out the importance of the complications of measles to determine the admission's length to Hospital.

Legal abortion in Italy: 1980-1981

In 1980 and 1981, there were 446,430 legal abortions performed in Italy. There were about 345 legal abortions per 1,000 live births in 1980 and 363 in 1981. About 1.6 percent of women aged 15-49 obtained abortions in both years. An analysis of the characteristics of Italian women who obtained abortions indicates that most were married (about 70 percent), aged 18-36 (74 percent), had had less than a high school education (74 percent) and had had at least one previous live birth (70-75 percent). In 1981, 88 percent of abortions were obtained in public hospitals; 58 percent were carried out at eight or fewer weeks of gestation; and 78 percent were performed under general anesthesia. Only 20 percent were performed without an overnight stay in the hospital; and over 40 percent of women were hospitalized for two days or longer. Infection after the abortion was reported in only 0.03 percent of cases in 1981, and hemorrhage was reported in only 0.27 percent. In 1981, between 43 percent and 84 percent of gynecologists (depending on the region of the country) declined to perform abortions on grounds of conscience.

Serum antibodies against Coxsackie B1-6 viruses in type 1 diabetics

Twenty-two newly diagnosed insulin-dependent diabetics and 46 control subjects have been examined for Coxsackie B1-6 serum antibodies. Evidence for CoxB4 neutralizing antibodies at titers greater than or equal to 16 and two seroconversions for this single virus type were shown in the diabetic group (31.8% of patients with titers greater than or equal to 16 in comparison with 10% of controls, p = 0.08). Reduced titers against CoxB2 and CoxB5 in diabetics were also observed. In agreement with the majority of publications, these data suggest the hypothesis that CoxB4 infections are frequently associated with type 1 diabetes, and the positive relationship found only for this type of virus may be related to greater tropism for the pancreas. The specificity of this viral infection, as shown by our serologic results, could suggest a possible causative role in the development of type 1 diabetes only in a limited number of cases. The authors propose new studies with monoclonal and IgM specific antibodies, obtained from new isolates, to detect more accurately the qualiquantitative differences between type 1 diabetics and controls.

Measles epidemiology in Italy

In preparation for a mass vaccination programme, the immune status with regard to measles was determined in over 8300 unvaccinated children aged 0-13 years, residing in eight Italian cities with different socioeconomic situations and geographical locations. The age corresponding to the 50% prevalence of immunes appeared to be intermediate (2.9-5.5 years) between that reported for industrialized (6-7 years) and developing countries (1-2 years). The 50% prevalence of natural immunity was reached at an earlier age in southern cities in which poorer socioeconomic and hygienic conditions prevailed; the earlier occurrence of measles in these areas was confirmed by a more detailed serological study of children in the first 24 months of life. For children aged 2-13 years, serological results showed that the history of measles reported by parents on questionnaires gave high positive predictive values (over 85%). Our seroepidemiological study shows that, on the basis of the ages of 25 and 75% prevalence of immunes, the target population for a mass immunization programme in Italy can be assumed to be aged from 12 months to 7 years. However, special attention should be given to the poorest areas, especially in southern Italy, where measles occurs earlier and can be particularly severe.

Serum antibodies to poliomyelitis in Italy

A seroepidemiological survey was conducted to assess the effectiveness of the Italian nationwide immunization programme against poliomyelitis. Over 3800 serum samples were collected from persons, aged between 6 months and 79 years and residing in urban and rural areas with different socioeconomic conditions and geographic locations.A very high level of protection was found in the target population, confirming the almost 100% history of complete immunization. Almost all subjects over 30 years of age were found to have poliovirus antibodies, although they had never been vaccinated. In Naples, a higher proportion of subjects susceptible to all 3 types of virus was found in the age group 6-23 months, suggesting a delay in the administration of vaccine. This was confirmed by the analysis of the immunization history. No difference was observed between urban and rural areas, in either serological results or history of immunization.The results confirmed the higher immunogenicity of poliovirus type 2 with respect to the other two types, the effectiveness of the vaccine, and, finally, the efficiency of the operational procedures adopted for its administration.

Study of a BCG vaccine. Influence of dose and time

When a vaccine in three different concentrations (non-diluted, half-strength and one-third strength) was used on a study population of 159 students, six weeks after the vaccination only the vaccine at one-third strength showed small vaccination lesions in comparison with those of the other two concentrations. There is no evidence of any significant difference between them with respect to the positive reaction to the tuberculin testing. After one year, the number of subjects with a positive vaccination scar is drastically reduced in the case of the vaccine at one-third strength. As regards the tuberculin reaction, even if the difference in the number of positive values is not significant, the reaction size for the one-third and one-half strength dose diminishes significantly with respect to that observed at six weeks.

[Serological studies of influenza viruses in a sample of the population of Rome]

Haemagglutination inhibiting antibodies (H.I.A.) to influenza viruses A/Victoria/3/75, A/Victoria/112/76, B/Hong Kong/8/73 and A/New Jersey/8/76 were titrated in 1110 serum specimens collected in Rome in the period between March-May 1977 and obtained from subjects 0-60 years old. The H.I.A. protective level (greater than or equal to 1 : 40) found in 21.7% of the sera against A/Victoria/3/75 is such that it does not avoid a possible diffusion of this strain in the successive epidemic season. Moreover this finding suggests that there will be probably no antigenic change (4) in the same period. The age group 0-20 showed the higher titer H.I.A. Low protective levels were found against the virus A/Victoria/112/76 and B/Hong Kong/8/73, while the H.I.A. to virus A/New Jersey/8/76 showed a percentage of protective level increasing with the age.