Immunity status against poliomyelitis in childbearing women in a province of northern Italy. A cross-sectional analysis

This cross-sectional seroprevalence study was carried out in 2007 to estimate the immunological status associated with poliomyelitis among fertile women , according to demographic changes. We consecutively enrolled 493 healthy mothers at the time of delivery in order to assess immunity against poliomyelitis by a neutralisation inhibition test. Despite the lack of seronegative subjects, our investigation showed low GMTs, which confirmed a reduction in the "booster effect". The GMTs against poliovirus 1, poliovirus 2 and poliovirus 3 were 25.20, 14.79 and 8.80, respectively. The data that emerged from our survey showed that GMTs have decreased significantly since 1983 and reached low-to-medium values over the past 25 years. The serum prevalence studies, together with the vaccination coverage estimates, are useful and are strongly recommended in order to highlight and identify the possible scenarios in which susceptible subject groups may be present simultaneously as well the possibility of the reintroduction of wild virus in an area that was previously free of polio.

Vaccination status and prevalence of enteric viruses in internationally adopted children. The case of Parma, Italy

On age basis, internationally adopted children may have begun or fully completed all required vaccinations, but official documentation from original Countries is frequently insufficient. Aims of this study were to evaluate the seroprotection rate for tuberculosis, hepatitis B, poliomyelitis and tetanus according to immunization cards in 67 children recently adopted and to test the prevalence of enterovirus on faecal specimens. Seroprotection and vaccination status were frequently inconsistent and these results confirm that immunitary surveillance is a cornerstone for the prevention of diseases for which a vaccination is available. (www.actabiomedica.it).

Detection of enteroviruses from urban sewage in Parma

BACKGROUND AND AIM OF THE WORK

The human enteroviruses (EV) are the most common and widespread human viruses in the world. They have bowel as their natural habitat and they can spread in the environment through the faecal excretion. In the continental climate Regions these viruses may cause epidemic outbreaks in summer and fall, while in the tropical Regions the EV infections present a high incidence during all year. The symptoms can be minor or subclinic, but they can be also associated to rare and serious diseases. The aim of this study was to evaluate the environmental circulation of polioviruses and non-polio enteroviruses (NPEV) using standard methods of urban wastewater surveillance recommended by the WHO.

METHODS

A total of 188 wastewater samples were collected between February 2005 and December 2008 from two sewage treatment plants in Parma. The sampling was carried out twice a month. Environmental variables were collected for each day of sampling.

RESULTS

Out of the 188 examined wastewater samples, 78.7% were positive to the enterovirus research. One out of the 148 positive samples was identified as poliovirus Sabin-like type 3. The remaining 147 positive samples were enteroviruses non polio: Coxsakieviruses and Echoviruses. All Coxsakieviruses isolated were of type B.

CONCLUSIONS

The proposed method has shown high sensibility, also in presence of very low expected prevalence of vaccine poliovirus. It allows to verify the kind and relative frequency of enteric viruses circulating in the country, whose characteristics (virulence and pathogenicity) may vary with reference to a different epidemiologic and demographic structure of the resident population.

[Oral health conditions and systemic diseases prevalence in long term institutionalizated elderly. A cross sectional study in Parma province]

People aging 74 years and more are in Parma province about 11,5% of residents. Disability conditions and familiar ties loss frequently let the elderly to recovery in long term home care where quality of care became synonymous of quality of life. To best evaluate oral health conditions in institutionalized elderly and their needs of care, we conducted, between August 2002 and July 2003 a cross-sectional study with clinical oral examinations in 200 long-term patients. Number of teeth, tooth remnants, mucosal findings, edentulousness, level of dental hygiene, needs for operative treatment and prevalence of systemic disease associated were evaluated. Subjects' mean age was 84,4 years (interval 57 _ 105); 59% were edentulous. As reported by several authors, a correlation between edentulousness and cardiovascular disease was found even after controlling for confounding variables (age, sex, smoking habit and Alzheimer disease).

Release phenomena and toxicity in polymer-based dental restorative materials

In this work, the origin of the release phenomena occuring in resin-based dental restorative materials is demonstrated using confocal fluorescence microscopy and tapping mode atomic force microscopy techniques. The surface structure (microcavities, protruded filler particles, grain boundaries, and cracks) produced by water environment on the surface of composite resins and resin-modified glass-ionomeric cements (RMGICs) are shown. The water absorption and the subsequent weight decrease, induced by leaching process, have been measured by gravimetric analysis. The different toxicity effects induced by the component release are described.

Legionella contamination in the water system of hospital dental settings

BACKGROUND AND AIM OF THE WORK

Among hospital facilities the dental unit is an environment that is at major risk of Legionella due to equipment such as the air/water syringe, the turbine, the micromotor and the scaler which generate potentially harmful aerosols that may to be a source of exposure to Legionella spp. particularly in immunodeficient patients, and those affected by chronic diseases, and also in dental personnel. Therefore, an examination of the extent of Legionella spp. contamination in the dental chairs waterlines and the incoming water supply of some public dental units is the subject of the present study.

METHODS

From February 2002 to March 2004, a total of 208 water samples were collected: 160 samples from the water supply of 4 dental chair and 48 samples from the cold incoming tap water of 2 units.

RESULTS

Legionella spp. was detected in 46 samples (22.1% ): 19 of them (41.3% of Legionella spp.; 9.1% of the total) were Legionella pneumophila; Pseudomonas aeruginosa was detected in 86 samples (41.4%) and both microorganisms were detected in 2 samples (0.96%).

CONCLUSIONS

Our results show a microbiological condition in dental settings, that is not at all satisfactory due to the presence of Legionella in concentrations that are considered to be a health hazard (> or = 10(3)) in certain cases. Given the extent of the health risk in these surroundings, the difficulty in its assessment, and also considering the wide diffusion of general dental care, our investigation has confirmed the need to regularly monitor the microbiological condition of water in dental units.

Mother to child transmission of hepatitis C virus in a province of northern Italy

INTRODUCTION

Study reports of mother to child transmission of hepatitis C virus (HCV) have shown transmission rates ranging from 3 to 37%, according to maternal viremia and HIV-1 coinfection. The present study evaluated the prevalence of the HCV infection in the general population and the incidence of vertical transmission, from women who delivered in the Obstetric Clinic of the Hospital of Parma from January 1st 1996 to 31st 2001 December.

METHODS

Mothers and children were tested for the presence of HCV-RNA within one week after delivery. Children were considered to be infected when they were found positive at least twice for viral RNA or antibodies were still detectable at the end of the follow-up period (18 months) in blood.

RESULTS

Out of 13,025 women, 110 (0.8%) were found positive for anti-HCV antibodies; 72 of them (65.4%) were HCV-RNA positive. All 110 children were positive for anti-HCV antibodies in the first blood sample (time 0); 8 of them were HCV-RNA positive. Three children were still viremic at the end of the follow-up whereas 5 showed a clearance. No significant differences were found between viremic and nonviremic children with respect to gestational week, maternal alanine aminotransferase (ALT) levels and newborns weight at birth.

CONCLUSION

This investigation shows that vertical transmission may occur in a general obstetric population despite a low prevalence of HCV-positive subjects.

[Pilot study on the presence of Legionella spp in 6 Italian cities' dental units]

Among the microorganism involved in environmental contamination, Legionella spp is actually considered an important infectious hazard. The aim of this study is to evaluate the incidence of Legionella spp in water samples collected from 138 dental unit selected from public outpatient clinics of 6 Italian cities. The samples were taken from oral rinsing cup, air-water syringe, ultrasonic scaler and the turbine to investigate Legionella spp, Pseudomonas aeruginosa and the total heterotrophic count at 36 degrees and 22 degrees. Legionella spp was present in 33,3% dental unit water; but a significant difference was shown among the enrolled cities. In 43,5% of water sample Legionella concentration was 1.000-10.000 CFU/L and in 30,4% was >10.000 CFU/L. L. pneumophila 1 was found in 23,9% of water samples. The results demonstrate that the concentration of Legionella spp in dental unit water lines could be high and this suggests that the exposure to these micoorganism during the dental practise could be a potential health risk both for dental personnel and for the patients too, especially when immunocompromised.

Multicity Italian study of congenital cytomegalovirus infection

BACKGROUND

Cytomegalovirus (CMV) infection is the most frequent congenital infection in humans. Its prevalence and the frequency of disabling sequelae must be assessed in different populations to permit the formulation or assessment of preventive measures.

OBJECTIVES

To check the prevalence of congenital infection and seroprevalence in Italy; to verify the rate of sensorineural hearing loss (SNHL) in infected infants; and to assess the proportion of children with SNHL attributable to congenital CMV infection.

METHODS

Diagnosis of congenital CMV infection was sought in 9032 children born between March 2002 and February 2003 by testing for viral DNA [CMV dried blood spot (DBS) test] in each newborn's Guthrie card and confirmation by isolation of CMV from urine collected in the first 3 weeks of life; CMV IgG testing in 1200 women of childbearing age; clinical and audiologic tests in the first 24 months for infected children; CMV DBS tests on the Guthrie cards collected from screening centers for 77 children (3 months-5 years) presenting SNHL of 40 dB or more.

RESULTS

CMV infection was diagnosed in 14 asymptomatic and 2 symptomatic newborns (0.18%). CMV seroprevalence was 80%. In 2 infected infants, transient, unilateral SNHL was found. Nineteen of the 71 children with SNHL >70 dB were congenitally infected.

CONCLUSIONS

The prevalence of congenital CMV infection is low in Italy. Population characteristics limiting the circulation of CMV strains in adult women might explain this. The fact that CMV contributes to significant SNHL highlights the need for preventive measures.

Status of immunity against poliomyelitis: a study among European and extra-European young immigrants living in Parma

From January 2001 to December 2003 blood specimens obtained from 323 European and extra-European young immigrants were collected for the determination of anti-polio antibody levels. They were sent to the Section of Hygiene, Department of Public Health, by the Local Health Authorities. A neutralization assay was performed to detect the anti-polio antibodies against serotypes 1, 2 and 3, using rhesus monkey kidney cells. The results showed 98,1% prevalence of anti-polio 1 antibodies (titre > or =1:2), 99,1% of anti-polio 2, and 98,8% prevalence of anti-polio 3 antibodies. The seronegativity against only one or two serotypes (antibody titre <1:2) was found in 9 subjects (2,8%) while no subject was found totally seronegative against all 3 serotypes. According to the total amount of the analyzed samples, the estimated Geometric Mean Titre (GMT) resulted from moderate to low (GMT=29 of serotype 3; GMT=48,4 of serotype 2; GMT=56,5 of serotype 1) and it appeared to be similar to the results obtained in the previous years for all 3 serotypes; the GMT of serotype 3 was still the lowest. No difference was observed in the specimens with respect to the country of origin of the examined subjects and the data collected showed a good level of immunity.

[Sensorineural hearing loss in childhood: evaluation of economic impact in view of vaccine prevention of cases due to congenital cytomegalovirus infection]

Sensorineural hearing loss (SNHL) is a serious public health problem which affects 1-3% per hundred live born babies in developed countries. The congenital cytomegalovirus (CMV) infection is its most important non-genetic cause. The evaluation of the effectiveness of future programs of anti-CMV vaccination requires an assessment of the present costs of SNHL. Direct costs for the Italian public system were calculated per prosthesis child until his full age and turned out to add up to 260,000 euro. Private costs are difficult to be assessed and anyhow are highly dependent from the socio-economic level. This preliminary assessment suggests that the vaccination would be cost-saving if SNHL cases due to congenital CMV were more than 21 per year, corresponding to a congenital infection prevalence higher than 0.21%o.

Health hazard evaluation in private dental practices: a survey in a province of northen Italy

The purpose of this questionnaire survey was to evaluate the knowledge and attitudes of private dental health care workers about cross-infection hazards through examination of practising behaviour in respect of infection control. A questionnaire was sent by mail to the private dentists operating in Parma province. The survey concerned 7 groups of questions about demographic data, personal protective equipment, immunization, sterilization and disinfection, waste disposal and occupationally acquired injuries, behaviour. Four hundred questionnaires were sent to the members of the Medical and Dentist College of Parma: 122 were returned and analysed (30.5%). Among the infectious diseases 45% of the interviewed think that the most dangerous diseases are Hepatitis B and C, followed by HIV infection (21.5%). The most used personal protective equipments are gloves (98%), masks (95%) and protective eyewear (94%). Sixty eighth per cent of the dentists treat HBV, HCV, HIV, TB, HSV suffering patients at the end of the working day. Twenty nine point 7% of them claim to have written protocols to follow in case of accident. Altogether the results show a good knowledge of the most important risks related to dentistry activity and of the main procedures for the infection control and management.

[Air pollution and mortality and hospital admission for respiratory disease in Parma on 1992-2001 period]

A study into the effects of atmospheric pollution on the health of people living in the city of Parma (population 170,000) shows motor vehicle traffic of average density and light industrial activities that have little impact on air pollution. General mortality and hospitalisation for all causes and for DRG specific were considered as sanitary events. The day values of the total PT, PM10, SO2 and NO2, CO and benzene were analysed. In addition, atmospheric conditions and outbreaks of flu were considered. The study results for the period 1992-2001 show quite moderate pollution levels with the sole exception of PM10 that shows average values often higher than 40 microg/l. An analysis of the associations between mortality and climatic parameters shows the role of temperature with RR equal to 1.0064 (CI95% 1.0046-1.0082) and epidemics of influenza with RR 1.042 (CI95% 1.0219-1.0671). As regards the pollution parameters, the total PT and SO2 turned out to be related to increases in mortality of respectively 0.6% for 100 microg/m3 of PT and 1.72% for 50 microg/m3 of SO2 while the NO2 turned out to be related to an increase in hospitalisations of 1.9% for 10 microg/m3 of NO2.

[Multicentric survey on hygienic aspects in private dental practice]

The aim of this research was to evaluate the knowledge of cross-infection hazards in private dental practices, and their control procedures. The survey, carried out by questionnaire in 11 Italian cities, showed that dental personnel do not completely follow the main procedures for infection control. The interviewed subjects usually wear gloves (95.5%), masks (90.1%) and glasses (91.2%), less frequently caps (23.9%) and coats (54.9%). They use steam sterilizers (92.9%) and periodically check the effectiveness (80.6%). Regarding individuals protection, 20.5% is not vaccinated against HBV and only 55.2% of those previously vaccinated has checked their immunity. Moreover, the majority of subjects underestimate the infection hazards especially for air-transmitted diseases.

[Evaluation of the immune status against poliomyelitis in a group of young immigrants]

The immunity state towards poliomyelitis has been evaluated in 506 young immigrants coming from European and extraeuropean countries without immunization history. Polioviruses 1, 2 and 3 antibodies were detected in 97% of the serum samples. 15 subjects did not have detectable antibodies at 1:2 dilution for one or two polioviruses. Out of these subjects, 6 (coming mostly from East European Region) were negative in the undiluted serum too. On the whole, GMTs for type 1 (43,29) and 2 (41,9) appeared higher than those for type 3 (33,6). Moreover there are differences among the origin countries; in fact, GMTs more elevated for type 1 and 3 (74,6 and 49,6 respectively) have been observed in the subjects coming from the African region, as well in those coming from the American region.

[Vertical transmission of the hepatitis C virus]

The incidence of hepatitis C in childhood is approximately 0.4%. The mode of transmission can be parenteral, sexual, occupational and also vertical. The latter has an incidence that varies widely and it increases in the case of human immuno-deficiency virus (HIV) coinfection and high titers of HCV in the mother. The vertical transmission is not influenced by breast feeding, however, data are discrepant with regard to child delivery (cesarean section vs vaginal delivery). Ninety-seven babies born from mothers with hepatitis C from 1996 to 1999, were evaluated prospectively in the Day Hospital of the Pediatric Department of Parma. The protocol of observation established a blood sampling for titers of antibodies anti-HCV and HCV-RNA at the 3rd trimester of pregnancy and subsequent clinical and biochemical controls at 3-6-9-12-15 and 18 months. Thirty (31.2%) out of the 96 mothers evaluated were positive for antibodies anti-HCV and 66 (68.8%) were positive for antibodies anti-HCV and HCV-RNA. Five (5.15%) out of the 97 babies evaluated were infected by HCV. Of these 4 were delivered vaginally and 1 by cesarean section. Of the 3 babies born to mothers with HIV coinfection, none was infected by HIV, but 1 was infected by HCV. Vertical transmission is increased by HCV viral load or HIV coinfection in the mother. The vaginal delivery and breastfeeding do not represent an additional risk factor.

[Measurement of anti-HBs antibodies in a population of 18-year-olds 6 years after the primary vaccination series]

We have analized the persistence of vaccine-induced antibodies to hepatitis B surface antigen, in a cohort of 445 eighteen-year-old males, who had been immunized against hepatitis B six years earlier (when they were 12 years old, according to the Italian law). These young men were about to begin their military service and were going through the routine check-up. They came from two different towns Reggio Emilia and Mantova, in the north of Italy, and were divided into two groups (group A no 258 men, group B no 187 men) depending on where they had been vaccinated. The serologic results showed that 97% of subjects had anti-HBs and 94% anti-HBs protective levels (> or = 10 mIU/ml). Moreover 81% of responder subjects showed titles > or = 100 mIU/ml, and 25% showed titles even > or = 1000 mIU/ml. Anti-HBs GMT of the total responders was 367.1. Differences have been found in the anti-HBs levels of men vaccinated in the two different towns.

Antipoliomyelitis neutralizing antibodies in maternal and neonatal serum

During 1993 blood samples were taken from 1251 women consecutively admitted to the Maternity Ward of the University of Parma. Samples were also taken from all the newborn babies. Absence of antipolio neutralizing antibodies in serum diluted 1/2 was shown in 6 mothers; 4 mothers for polio 1, 1 mother for polio 2 and 1 simultaneously for the poliovirus 1 and 3. If one considers only the cases of absence in undiluted serum, there were 2 negative subjects (0.16%). One of these was for antibodies against polio 1 and the other for antibodies against polio 2. In the cord blood samples the frequency of negative results in serum diluted 1/2 is higher: 42 in all with 13 babies negative for polio 1. 17 babies for polio 2, 8 for polio 3 and 2 babies simultaneously for polio 1 and polio 3. If one considers just the babies without antibodies even in undiluted serum, the fraction of seronegatives is 9 (0.7%) with 1 for polio 1, 6 for polio 2 and 1 for types 1 and 3. The Geometric Mean Titres of the antibodies are significantly higher in mothers born before 1964 (year of introduction of mass vaccination with OPV) compared with those born after that year. Likewise, the same phenomenon was observed in the respective children.

Antipoliomyelitis immunity status among a population that was regularly vaccinated 11-12 years before

A study of poliomyelitis neutralizing antibodies was carried out on 165 samples of blood serum drawn from subjects aged 14-15 years who had completed vaccination with OPV 11 or 12 years ago. Two different methods of incubation of the serum-virus mixtures (1 hour at 37 degrees C; 6 hours at 37 degrees C and then 18 hours at 4 degrees C, respectively) and two different cell lines (RC-37 and Hep-2) for the inoculation of these mixtures were employed. The results were also evaluated in relation to different initial dilutions of the sera (from 1:4 to 1:1). With the 1:4 initial serum dilution the highest frequencies of sero-negativity were observed utilizing the short incubation time and inoculation in Hep-2 (42% for polio 1, 10% for polio 2, 32% for polio 3). These frequencies diminish significantly utilizing the RC-37 cell line and the long incubation respectively. Under all the experimental conditions the results were better when the 1:2 initial serum dilutions were employed and even better when undiluted sera were used. Neutralizing antibodies against the 3 types of poliovirus were detected in the undiluted sera of all the subjects utilizing the long incubation and inoculation in either the RC-37 or the Hep-2 cell lines. In three subjects lacking detectable antibodies at the 1:4 dilution of the sera, the administration of a dose of IPV produced after 5-7 days a high response which remained almost unchanged 30 days later.

Poliomyelitis immunity status at different intervals from vaccination

Research on neutralizing antibodies against the 3 serotypes of poliovirus was carried out on 441 blood specimens drawn from children and young people living in Parma, a town of about 200,000 inhabitants, where the vaccination services were well organized. From June 1983 to June 1984 blood samples were taken from different groups of subjects at different stages of vaccination (before vaccination, and after 1, 2, 3, and 4 doses of trivalent balanced OPV). In addition, groups of children and young people vaccinated from 2 to more than 14 years earlier were bled. Ten per cent of unvaccinated babies (aged 1-3 months) were lacking in neutralizing antibodies for types 1 and 3 and five per cent for type 2; among children aged 4-5 months vaccinated by one dose of OPV a residual 5% of subjects without antibodies for type 1 was also found. All subjects who received two, three, or four doses, had antibodies against all serotypes of poliovirus. As for the number of administered doses, significant differences among GMTs of antibodies were recorded only for type 1, when the group given 3 doses, was compared with the group which received two and one dose, respectively. At different intervals from completion of vaccination (2-14 years), all groups we examined still had antibodies against all three serotypes. For poliovirus type 1 antibody, GMTs were not significantly different in the examined groups. For types 2 and 3 significant decreases were observed in the groups vaccinated from 2 to 5 years. The high levels of immunity observed earlier in Parma were not found throughout the entire territory.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute respiratory syndromes caused by viruses in a pediatric department. Clinical and epidemiological studies of a series of cases admitted in the period from February to May, 1979]

In the period between February and May 1979, in concomitance with a sharp increase in admittance to the pediatric Division of the Parma General Hospital for acute respiratory infections, we carried out a virologic and serologic investigation on hospitalized children aged 21 days-12 years. The investigation was carried out on 137 patients with respiratory diseases: 33 with bronchiolitis, which occurred mainly (32/33) between February and March in children that were prevalently (30/33) in the first year of life; 27 with upper respiratory tract infections; 54 with mid respiratory tract infections; 23 with pneumonia. Forty-eight controls (without respiratory infections) were also investigated. In the months of February and March there was a high circulation of respiratory syncytial virus (RSV): throughout the entire period there was a lower incidence of Adenovirus infections and more uniformly distributed.

[Virological research in acute respiratory diseases in 1976--1977 (author's transl)]

From October 1976 to June 1977 virological researches have been carried out on 5 subjects with influenza, on 302 children hospitalized in pediatric departments for respiratory illness and 94 children hospitalized in the same departments for other (non respiratory) diseases. The incidence of influenza was moderate and restricted to small epidemic episodes in school and preschool children. The isolated viruses resulted of A type, substantially similar to the prototype strains appeared from 1972 to 1975. Among children hospitalized for respiratory diseases Adenoviruses (6.8%) and, with decreasing frequency, Enteroviruses, paraifluenza viruses and RS have been also isolated. The incidence of isolation of RS virus is significantly related to bronchopneumonia cases in infants under on year of age. The incidence of significant increases of FC antibodies against influenza (A and B) viruses, RS and Myc. pneumoniae in children with bronchitis and broncho-pneumonia is also considerable. The drawing of pharyngeal swabs at different intervals from the entry to the hospital has shown that the shedding of respiratory viruses is generally very short and that hospital cross-infections may occur.

[Detection of Salmonella in surface waters]

After a detailed description of some of the methods used for the research of Salmonella in superficial waters, the AA. examine some problems relative to the collection of the samples and to the culture of these bacteria. Results obtained in the Po river and its affluents are also briefly presented; the high incidence of samples positive for Salmonella is stressed and some aspects of an epidemiological nature are considered.

[Epidemic due to group B Coxsackie viruses in a newborn infants' department (author's transl)]

Virological and clinical researches have been done on hospitalized newborn infants' with various infectious diseases (respiratory infections, aseptic meningitis, serious generalized disease). Initially from some newborn children Coxsackie B5 virus has been isolated and later from other patients Coxsackie B3 virus. The pathological findings, in those newborn who died as a result of serious generalized disease were dominated by hemorragic lesions in different organs.