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Vimercati L, Stefanizzi P, De Maria L, Caputi A, Cavone D, Quarato M, Gesualdo L, Lopalco PL, Migliore G, Sponselli S, Graziano G, Larocca AMV, Tafuri S. Large-scale IgM and IgG SARS-CoV-2 serological screening among healthcare workers with a low infection prevalence based on nasopharyngeal swab tests in an Italian university hospital: Perspectives for public health. Environ Res 2021; 195:110793. [PMID: 33508260 PMCID: PMC7839391 DOI: 10.1016/j.envres.2021.110793] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 11/30/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Healthcare workers (HCWs) are highly exposed to SARS-CoV-2 infection given their specific tasks. The IgG-IgM serological assay has demonstrated good accuracy in early detection in symptomatic patients, but its role in the diagnosis of asymptomatic patients is uncertain. The aim of our study was to assess IgM and IgG prevalence in sera in a large cohort of HCWs previously subjected to Nasopharyngeal swab test (NST) after accurate risk assessment due to positive COVID-19 patient exposure during an observation period of 90 days. METHODS 2407 asymptomatic HCWs that had close contact with COVID-19 patients in the period between April 8th and June 7th were screened with NST based on the RT-PCR method. In parallel, they underwent large-scale chemiluminescence immunoassays involving IgM-IgG serological screening to determine actual viral spread in the same cohort. RESULTS During the 90-day observation period, 18 workers (0.75%) resulted positive for SARS-CoV-2 infection at the NST, whereas the positivity rates for IgM and IgG were 11.51% and 2.37%, respectively (277 workers). Despite high specificity, serological tests were inadequate for detecting SARS-CoV-2 infection in patients with previous positive NST results (IgM and IgG sensitivities of 27.78% and 50.00%, respectively). CONCLUSIONS These findings indicate a widespread low viral load of SARS-CoV-2 among hospital workers. However, serological screening showed very low sensitivity with respect to NST in identifying infected workers, and negative IgG and IgM results should not exclude the diagnosis of COVID-19. IgG-IgM chemiluminescence immunoassays could increase the diagnosis of COVID-19 only in association with NST, and this association is considered helpful for decision-making regarding returning to work.
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Affiliation(s)
- Luigi Vimercati
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Occupational Medicine Unit, University Hospital of Bari, Bari, Italy.
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Luigi De Maria
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Occupational Medicine Unit, University Hospital of Bari, Bari, Italy
| | - Antonio Caputi
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Occupational Medicine Unit, University Hospital of Bari, Bari, Italy
| | - Domenica Cavone
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Occupational Medicine Unit, University Hospital of Bari, Bari, Italy
| | - Marco Quarato
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Occupational Medicine Unit, University Hospital of Bari, Bari, Italy
| | - Loreto Gesualdo
- President, School of Medicine, University of Bari, Bari, Italy
| | - Pier Luigi Lopalco
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | | | - Stefania Sponselli
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Occupational Medicine Unit, University Hospital of Bari, Bari, Italy
| | - Giusi Graziano
- Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | | | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
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Vimercati L, De Maria L, Quarato M, Caputi A, Stefanizzi P, Gesualdo L, Migliore G, Fucilli FIM, Cavone D, Delfino MC, Sponselli S, Chironna M, Tafuri S. COVID-19 hospital outbreaks: Protecting healthcare workers to protect frail patients. An Italian observational cohort study. Int J Infect Dis 2020; 102:532-537. [PMID: 33157297 PMCID: PMC7610093 DOI: 10.1016/j.ijid.2020.10.098] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 01/20/2023] Open
Abstract
Objectives To determine the prevalence of SARS-CoV-2 infection among exposed healthcare workers (HCWs) after preventive protocol implementation. Methods A total of 5750 HCWs were included in the study. Those in contact with COVID-19 patients were allocated into a high-risk or a low-risk group based on contact type (PPE- or non-PPE-protected); high-risk workers underwent nasopharyngeal swab tests, while among low-risk workers, swab tests were carried out only for symptomatic workers (active surveillance). The prevalence was determined by real-time reverse transcriptase–polymerase chain reaction on nasopharyngeal samples. Results 3570 HCWs had contact with 1065 COVID-19 patients. Among them, 3494 were subjected to active surveillance (low-risk group); 2886 (82.60%) were subjected to a swab test; and 15 were positive (0.52%). Seventy-six HCWs (2.13% of exposed) were included in the high-risk group, and a swab test was mandatory for each participant. Overall, 66 (86.84% of high-risk) were negative, and 10 were positive (13.16%), resulting in a higher risk of infection than in the low-risk group [OR = 29.00; 95% CI:12.56-66.94; p < 0.0001]. Conclusion To date, the SARS-CoV-2 infection prevalence is 0.70% among exposed HCWs and 0.435% among all HCWs working at the examined university hospital. The correct use of PPE and the early identification of symptomatic workers are essential factors to avoiding nosocomial clusters.
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Affiliation(s)
- Luigi Vimercati
- Interdisciplinary Department of Medicine, University of Bari, Unit of Occupational Medicine, University Hospital of Bari, 11 G. Cesare Square, 70124, Bari, Italy.
| | - Luigi De Maria
- Interdisciplinary Department of Medicine, University of Bari, Unit of Occupational Medicine, University Hospital of Bari, 11 G. Cesare Square, 70124, Bari, Italy
| | - Marco Quarato
- Interdisciplinary Department of Medicine, University of Bari, Unit of Occupational Medicine, University Hospital of Bari, 11 G. Cesare Square, 70124, Bari, Italy
| | - Antonio Caputi
- Interdisciplinary Department of Medicine, University of Bari, Unit of Occupational Medicine, University Hospital of Bari, 11 G. Cesare Square, 70124, Bari, Italy
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | | | | | | | - Domenica Cavone
- Interdisciplinary Department of Medicine, University of Bari, Unit of Occupational Medicine, University Hospital of Bari, 11 G. Cesare Square, 70124, Bari, Italy
| | - Maria Celeste Delfino
- Interdisciplinary Department of Medicine, University of Bari, Unit of Occupational Medicine, University Hospital of Bari, 11 G. Cesare Square, 70124, Bari, Italy
| | - Stefania Sponselli
- Interdisciplinary Department of Medicine, University of Bari, Unit of Occupational Medicine, University Hospital of Bari, 11 G. Cesare Square, 70124, Bari, Italy
| | - Maria Chironna
- Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
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Vimercati L, Dell'Erba A, Migliore G, De Maria L, Caputi A, Quarato M, Stefanizzi P, Cavone D, Ferorelli D, Sponselli S, Mansi F, Tafuri S. Prevention and protection measures of healthcare workers exposed to SARS-CoV-2 in a university hospital in Bari, Apulia, Southern Italy. J Hosp Infect 2020; 105:454-458. [PMID: 32445776 PMCID: PMC7239006 DOI: 10.1016/j.jhin.2020.05.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 04/11/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-related infection has a major impact on public health, and healthcare workers (HCWs) are exposed to high biological risk. This paper describes the prevention procedures introduced at the University Hospital of Bari, Italy to reduce the risk to HCWs, consisting of enhanced preventive measures and activation of a report system to collect HCWs' contacts. Twenty-three confirmed cases of infection (0.4% of all HCWs) were reported in the 30-day observation period following implementation of the protocol. This shows that correct management of HCWs' contacts is essential to avoid nosocomial clusters.
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Affiliation(s)
- L Vimercati
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Unit of Occupational Medicine, University Hospital of Bari, Bari, Italy.
| | - A Dell'Erba
- Department of Interdisciplinary Medicine, Section of Legal and Forensic Medicine, University of Bari, Bari, Italy
| | - G Migliore
- General Direction, University Hospital of Bari, Bari, Italy
| | - L De Maria
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Unit of Occupational Medicine, University Hospital of Bari, Bari, Italy
| | - A Caputi
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Unit of Occupational Medicine, University Hospital of Bari, Bari, Italy
| | - M Quarato
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Unit of Occupational Medicine, University Hospital of Bari, Bari, Italy
| | - P Stefanizzi
- Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - D Cavone
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Unit of Occupational Medicine, University Hospital of Bari, Bari, Italy
| | - D Ferorelli
- Department of Interdisciplinary Medicine, Section of Legal and Forensic Medicine, University of Bari, Bari, Italy
| | - S Sponselli
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Unit of Occupational Medicine, University Hospital of Bari, Bari, Italy
| | - F Mansi
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Unit of Occupational Medicine, University Hospital of Bari, Bari, Italy
| | - S Tafuri
- Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
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Quarato M, De Maria L, Caputi A, Cavone D, Cannone ESS, Mansi F, Gatti MF, Vimercati L. A case report of idiopathic environmental intolerance: A controversial and current issue. Clin Case Rep 2020; 8:79-85. [PMID: 31998492 PMCID: PMC6982481 DOI: 10.1002/ccr3.2535] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/21/2019] [Indexed: 11/13/2022] Open
Abstract
In this case of idiopathic environmental intolerance, a little known disease characterized by many symptoms of irritation due to exposure to several toxic compounds, genetic analysis could be helpful in case of differential diagnosis issue.
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Affiliation(s)
- Marco Quarato
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Luigi De Maria
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Antonio Caputi
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Domenica Cavone
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Enza Sabrina Silvana Cannone
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Francesca Mansi
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Maria Franca Gatti
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Luigi Vimercati
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
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Vimercati L, Cavone D, De Maria L, Caputi A, Quarato M, Serio G. 1579 Environmental asbestos exposure in southern italy: mesothelioma cases due to the same pollution source. Epidemiology 2018. [DOI: 10.1136/oemed-2018-icohabstracts.404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Quarato M, Gatti MF, De Maria L, Caputi A, Fucilli FIM, Vimercati L. Occupational exposure to fluorescent light in a pathologist with myopic complications and asthenopia onset. Med Lav 2017; 108:228-232. [PMID: 28660874 DOI: 10.23749/mdl.v108i3.6233] [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] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pathologic myopia is often associated with many complications, e.g. retinopathy, vitreous detachment and glaucoma. To date, occupational exposure of workers suffering from myopic co-morbidities to fluorescence light is not clearly linked to a worsening of retinal damage and eye symptoms. CASE REPORT A 56-year-old pathologist, suffering from myopic retinopathy and other ocular comorbidities, asked for medical examination due to worsening vision and burning eyes, after occupational exposure to fluorescence microscope. Eye examination performed by an ophthalmologist detected a severe chorio-retinal atrophy in peri-papillar region and scotopic-photopic reduced voltages at electroretinogram. Moreover, a workplace inspection noted high light intensity from power source (9600 lux). Considering severity of the retinopathy, frequency of the ocular symptoms and steady occupational exposure both to low-intensity fluorescent light and high intensity light, we decided to declare the worker only fit for specific tasks which do not include the use of a fluorescence microscope. Almost six months later, the worker was recalled for a new examination and she reported the absence of the ocular discomfort that had led her to request the previous examination. CONCLUSION In this unconventional case, we considered appropriated to use great caution, to avoid ocular fatigue and prevent possible retinal damage in the worker.
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Affiliation(s)
- Marco Quarato
- Interdisciplinary Department of Medicine, Occupational Medicine "B. Ramazzini", University of Bari Medical School, Giulio Cesare Square 11, 70124 Bari, Italy.
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Vimercati L, Gatti MF, Gagliardi T, Cuccaro F, De Maria L, Caputi A, Quarato M, Baldassarre A. Environmental exposure to arsenic and chromium in an industrial area. Environ Sci Pollut Res Int 2017; 24:11528-11535. [PMID: 28321698 PMCID: PMC5393286 DOI: 10.1007/s11356-017-8827-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 11/08/2016] [Accepted: 03/13/2017] [Indexed: 05/06/2023]
Abstract
Arsenic and chromium are widespread environmental contaminants that affect global health due to their toxicity and carcinogenicity. To date, few studies have investigated exposure to arsenic and chromium in a population residing in a high-risk environmental area. The aim of this study is to evaluate the exposure to arsenic and chromium in the general population with no occupational exposure to these metals, resident in the industrial area of Taranto, Southern Italy, through biological monitoring techniques. We measured the levels of chromium, inorganic arsenic, and methylated metabolites, in the urine samples of 279 subjects residing in Taranto and neighboring areas. Qualified health staff administered a standardized structured questionnaire investigating lifestyle habits and controlling for confounding factors. The biological monitoring data showed high urinary concentrations of both the heavy metals investigated, particularly Cr. On this basis, it will be necessary to carry out an organized environmental monitoring program, taking into consideration all exposure routes so as to correlate the environmental concentrations of these metals with the biomonitoring results.
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Affiliation(s)
- Luigi Vimercati
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, Giulio Cesare Square 11, 70124 Bari, Italy
| | - Maria F Gatti
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, Giulio Cesare Square 11, 70124 Bari, Italy
| | - Tommaso Gagliardi
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, Giulio Cesare Square 11, 70124 Bari, Italy
| | | | - Luigi De Maria
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, Giulio Cesare Square 11, 70124 Bari, Italy
| | - Antonio Caputi
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, Giulio Cesare Square 11, 70124 Bari, Italy
| | - Marco Quarato
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, Giulio Cesare Square 11, 70124 Bari, Italy
| | - Antonio Baldassarre
- Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari Medical School, Giulio Cesare Square 11, 70124 Bari, Italy
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