1
|
Piscitelli A, Agodi A, Agozzino E, Arrigoni C, Barchitta M, Brusaferro S, Castaldi S, Castiglia P, Cozzi L, D'Errico MM, De Caro F, De Giglio O, Iannazzo S, Laganà P, Laurenti P, Mascipinto S, Montagna MT, Mura I, Pasquarella C, Veronesi L, Rossi F, Ripabelli G, Rossini A, Scippa F, Sodano L, Squeri R, Staniscia T, Torregrossa V, Auxilia F. The Clean Care Contest: promoting hand hygiene among healthcare and medical students. Ann Ig 2021; 32:462-471. [PMID: 32744581 DOI: 10.7416/ai.2020.2370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Despite continuing efforts, compliance rates and knowledge of best practices in hand hygiene remain disappointing. Recognizing that conventional educational tools seem out of touch with young people and that the med and messages contents need refreshing, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health devised a novel approach to promote the creation of innovative educational tools for improving knowledge of, and compliance with, hand hygiene rules among healthcare and medical students. METHODS A contest in creating educational material on hand hygiene practices involved university students of nursing and medicine, and of other healthcare degrees. Students from the universities of the GISIO network were invited to create educational material (e.g., videos, posters, presentations, leaflets, and screensavers) to be presented by May 5th 2019 during the World Hand Hygiene Day / Save Lives: Clean Your Hands Global Annual Initiative of the World Health Organization). A local and a national winners were awarded. RESULTS Three different local and national contests were performed during 2016, 2017 and 2018. During the three-year period, more than 270 educational tools have been developed: 130 (48%) were judged useful for hand hygiene promotion campaigns. The most frequent projects participating in the contests were videos (39%), posters (29%), leaflets (14%), and others (18%) submitted by more than 1,500 students of nursing (40%), medicine (31%), dentistry (7%), and of other healthcare courses in 14 universities. Products were evaluated by a local committee and, subsequently, local winners represented their University in a national contest. CONCLUSIONS The contest provided a framework for the creation of innovative and potentially effective educational tools via an engaging approach that leveraged student creativity. Given the need to improve compliance rates, this study suggests that new ways can be advantageously explored to teach hand hygiene procedures and increase awareness of the importance of their consistent use among healthcare and medical students.
Collapse
Affiliation(s)
- A Piscitelli
- Hospital Health Management, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | - A Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Italy
| | - E Agozzino
- Department of Experimental Medicine, University of Campania Vanvitelli, Napoli, Italy
| | - C Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Unit of Hygiene, University of Pavia, Italy
| | - M Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Italy
| | - S Brusaferro
- Department of Medicine, University of Udine, Italy
| | - S Castaldi
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Ca' Granda, Milan, Italy
| | - P Castiglia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - L Cozzi
- School of Specialization in Pediatrics, University of Milan, Italy
| | - M M D'Errico
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Torrette di Ancona, Italy
| | - F De Caro
- Department of Medicine, Surgery, Odontoiatrics University of Salerno, Fisciano (SA), Italy
| | - O De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - S Iannazzo
- Department of Prevention, ASL Roma 3, Rome, Italy
| | - P Laganà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - P Laurenti
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - S Mascipinto
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - M T Montagna
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - I Mura
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - C Pasquarella
- Department of Medicine and Surgery University of Parma, Italy
| | - L Veronesi
- Department of Medicine and Surgery University of Parma, Italy
| | - F Rossi
- European Institute of Design, Milan, Italy
| | - G Ripabelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Italy
| | - A Rossini
- IRCCS Santa Lucia Foundation Rome, Italy
| | | | - L Sodano
- Our Lady of Good Counsel, Catholic University, Elbasan, Albania
| | - R Squeri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - T Staniscia
- Department of Medicine and Aging Sciences, University of Chieti-Pescara "G. D'Annunzio", Chieti, Italy
| | - V Torregrossa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties University of Palermo, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, ASST Fatebenefratelli - Sacco, Milan, Italy
| |
Collapse
|
2
|
von Mehren M, Heinrich M, Shi H, Iannazzo S, Mankoski R, Dimitrijević S, Hoehn G, Chiroli S, George S. 1630P Clinical efficacy comparison of avapritinib versus other tyrosine kinase inhibitors (TKIs) in gastrointestinal stromal tumours (GIST) with PDGFRA D842V mutation: A retrospective analysis of clinical trial and real-world data. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
3
|
Vaccaro C, Fortunato F, Iannazzo S, Furiozzi F, Martinelli D, Prato R. Knowledge, attitude and practice on antibiotic use and resistance among the Italian population, 2019. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.318] [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
Public knowledge, awareness and behaviors related to antibiotic use and antimicrobial-resistance (AMR) are vital to ensure the prudent use of these drugs. In this work, we present the top-line results of the first national survey of AMR among the Italian general population aged ≥18 years.
Methods
From August to September 2019, we conducted a population-based cross-sectional random survey through mixed CATI/CAMI/CAWI methodologies among representative samples of the general population, parents of children aged 0-11 years, adults ≥65 years and pet's owners. Results were summarized using relative frequencies.
Results
Of 1,400 persons interviewed, 47% and 68% respectively correctly said that it is false that antibiotics kill viruses and are effective at treating colds and flu. More than 80% of respondents considered themselves to be well-informed about antibiotics but only one in two people knew what is meant by AMR. While the vast majority (96%) of respondents said that they obtained the last course of antibiotics that they used from a medical prescription, 11% incorrectly said that they stopped taking antibiotics when they felt better or that they used those left over from a previous course. In addition, 55% of pet's owners said they obtained antibiotics without a prescription from a pharmacy or elsewhere. Almost all respondents (97%) believed that it's everyone's responsibility to use antibiotics wisely, with the 80% who expressed concerns about the potential of AMR to affect themselves and their families; however, 40% did not think that action at an individual level is the most effective way of tackling resistance to antibiotics.
Conclusions
Our findings show some improvement in Italians' knowledge, awareness and behaviors related to antibiotic use and AMR but there are needs to be a greater sense of responsibility to take charge of the AMR problem. These results may be drivers of structured national awareness campaigns.
Key messages
In 2019, we conducted the first national survey of AMR among the Italian population: >80% of respondents felt themselves well-informed about antibiotics but only 1/2 people knew what is meant by AMR. Almost all Italian sample believed that it's everyone's responsibility to use antibiotics wisely, but 40% did not think that action at an individual level is effective to tackle AMR.
Collapse
Affiliation(s)
| | - F Fortunato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | - D Martinelli
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - R Prato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
D'Ancona F, Gianfredi V, Riccardo F, Iannazzo S. Immunisation Registries at regional level in Italy and the roadmap for a future Italian National Registry. Ann Ig 2019; 30:77-85. [PMID: 29465145 DOI: 10.7416/ai.2018.2199] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Immunization Information Systems, or Immunisation registries (IRs), are essential to monitor and evaluate the accessibility, quality and outcomes of immunisation programmes both at local and national level. STUDY DESIGN We conducted a cross-sectional survey in order to investigate and map the level of IRs implementation obtained by the 21 Italian Regional Health Authorities. On this basis we defined a roadmap towards implementing an Italian National IR. METHODS We designed an online questionnaire. Data were collected from July to September 2016 from all the 21 Regional Health Authorities in charge of infectious diseases control and immunization management. RESULTS 18/21 Italian Regions have fully implemented an IR, out of them, 11 use the same software for all Local Health Units. Two Regions have partially implemented their IRs and one Region is not yet computerised. CONCLUSION The decentralization of the Italian Health System is reflected also on the IRs characteristics and functionalities in terms of fragmented implementation of IRs and diversity in the software systems and data flows in place. Future efforts should not only aim not only to clarify the functionalities of Regional IRs, but should also aim to define how aggregation of data at national level can be optimised.
Collapse
Affiliation(s)
- F D'Ancona
- National Institute of Health, Rome, Italy - Ministry of Health, Rome, Italy
| | - V Gianfredi
- Department of Experimental Medicine, School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Italy
| | - F Riccardo
- National Institute of Health, Rome, Italy
| | | |
Collapse
|
7
|
Signorelli C, Odone A, Cella P, Iannazzo S. Childhood vaccine coverage in Italy after the new law on mandatory immunization. Ann Ig 2019; 30:1-10. [PMID: 30062373 DOI: 10.7416/ai.2018.2227] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Italian National Immunization Prevention Plan (PNPV) identifies vaccines actively offered free of charge to target populations within the National Health Service. Despite this, childhood immunization coverage has been declining in Italy in recent years. As a response, the Italian Parliament in July 2017 approved law n. 119 extending mandatory childhood vaccines from four to ten, this stimulating a lively debate at both the scientific and policy level. METHODS We analysed and critically interpreted 2000-2017 Italian national childhood immunization coverage trends, by different vaccine, target population, birth cohort and by Region. In particular, in order to preliminarily assess the impact of the new law, we computed percentage changes in 2016-2017 vaccine coverage for both mandatory and recommended vaccine programs. Data were provided by the Directorate General of Health Prevention of the Italian Ministry of Health. RESULTS In 2017 national-level vaccine coverage at 24 months of age was 94.5% for Polio and 91.7% for Measles, this representing, respectively 1.2% and 4.4% increase, as compared to 2016. Conjugate Pneumococcal and Meningococcal C vaccines coverage increased, respectively, by +2.5% and +2.4% between 2016 and 2017. National-level polio vaccine coverage remained above the 95% PNPV coverage target between 2000 and 2013 and has remained below since then. In particular, it has had been steadily declining between 2011 and 2016 (-2.8%). Measles coverage remained well below the 95% coverage target for the entire study period. In recent times, it declined by 4.8% between 2011 and 2015 with the lowest coverage rate reported for year 2015 (85.3%). There is high heterogeneity in coverage within Regions for both mandatory and recommended vaccines. CONCLUSION Preliminary data show that childhood immunization coverage increased since the approval of the new law on mandatory vaccination. Nonetheless, as additional data are accumulating and will make it possible to further assess the impact of the new law, strengthened efforts are needed in Italy to promote informed and proactive vaccine uptake.
Collapse
Affiliation(s)
- C Signorelli
- Department of Medicine and Surgery, University of Parma, Parma, Italy - School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - A Odone
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - P Cella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - S Iannazzo
- Directorate-General of Health Prevention, Ministry of Health, Rome, Italy
| |
Collapse
|
8
|
Gianfredi V, D'Ancona F, Maraglino F, Cenci C, Iannazzo S. Polio and measles: reasons of missed vaccination in Italy, 2015-2017. Ann Ig 2019; 31:191-201. [PMID: 31069364 DOI: 10.7416/ai.2019.2282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Also in Italy, a flourishing evidence confirms the recent spread of vaccine hesitancy movements resulting in approximately 4-7% of the paediatric population not immunised every year against polio and approximately 9-15% against measles in the last few years. The aim of this paper is to describe the reasons of polio and measles missed vaccination in Italy, in the period 2015-2017, and to analyse any potential effect of the 2017 mandatory vaccination law. METHODS Number of missed vaccinations in children younger than 24 months, stratified by reason, were collected separately for measles and polio with a regional level of detail. Data were collected using an electronic form developed using Microsoft Excel®. RESULTS The most frequent reason for missed polio vaccination was "definitive informed dissent" with a mean value 1.5%, followed by "found/contacted, but did not attend the appointment" with a mean value 1.3%. Inversely, "acquired immunity subsequent to previous disease or vaccination performed elsewhere" and "excused in a permanent way for health conditions" were the less frequent with a mean value 0.03% for both. For measles vaccination the reason "found/contacted, but did not attend the appointment" was the most frequent (mean value 3.2%), followed by "definitive informed dissent" (mean value 2.9%). CONCLUSIONS Percentage of missed vaccination showed a remarkable reduction in 2017. This decrease is likely due to the introduction of mandatory vaccination law. In point of fact, "Dissent" decreased for both polio and measles during the study period. While, "Delay" increased during the 3-years. It seems that hesitant parents prefer to postpone vaccinations instead of refusing them. Counselling, parents' empowerment and vaccine education are central to contrast vaccination postponing. Thus, for parents who refuse vaccines ("Dissent"), monitoring the trend is important as well as trying to understand their reasons.
Collapse
Affiliation(s)
- V Gianfredi
- Postgraduate School of Hygiene and Preventive Medicine, Department of Experimental Medicine. University of Perugia, Italy - National Institutes of Health, Rome, Italy
| | - F D'Ancona
- National Institutes of Health, Rome, Italy
| | | | - C Cenci
- Ministry of Health, Rome, Italy
| | | |
Collapse
|
9
|
Stefanelli P, Fazio C, Vacca P, Palmieri A, Ambrosio L, Neri A, Piana A, Castiglia P, Argiolas F, Santus S, Masala L, Steri G, Riccardo F, Iannazzo S, Maraglino FP, D'Amario C, Rezza G. An outbreak of severe invasive meningococcal disease due to a capsular switched Neisseria meningitidis hypervirulent strain B:cc11. Clin Microbiol Infect 2018; 25:111.e1-111.e4. [PMID: 30036673 DOI: 10.1016/j.cmi.2018.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim was to investigate an outbreak of invasive meningococcal disease (IMD) in Southern Sardinia. METHODS Epidemiological and microbiological investigations were performed. The latter included antimicrobial susceptibility testing and whole-genome sequencing (WGS). RESULTS Seven individuals with severe IMD were found to be infected with serogroup B (MenB) Neisseria meningitidis in the first quarter of 2018. Five of the seven cases (five males; mean age 19 years; range 18-21 years; CFR 40%) were due to a unique strain B:P1.5-1,10-8:F3-6:ST-11(cc11), probably switched from the hypervirulent C-cc11, as confirmed by WGS. All five patients had attended the same nightclub in the 2 weeks prior to symptom onset. Public health measures, including chemoprophylaxis of contacts and active immunization against MenB, were implemented. CONCLUSIONS We observed five IMD cases due to the same switched MenB strain. The hypervirulent B:P1.5-1,10-8:F3-6:ST-11(cc11) strain, probably switched from C-cc11, is of concern due to the observed high virulence and case fatality rates. All the patients shared the same place of probable exposure. The molecular characterization of the invasive strain allowed the outbreak to be confirmed, which was then controlled through timely public health action.
Collapse
Affiliation(s)
- P Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - C Fazio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - P Vacca
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - A Palmieri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - L Ambrosio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - A Neri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - A Piana
- Department of Medical Surgical and Experimental Sciences, University Hospital of Sassari, Italy
| | - P Castiglia
- Department of Medical Surgical and Experimental Sciences, University Hospital of Sassari, Italy
| | - F Argiolas
- Servizio promozione della salute e osservatorio epidemiologico, Assessorato dell'Igiene e Sanità e dell'assistenza sociale-Regione Autonoma della Sardegna, Italy
| | - S Santus
- Public Health Service, Local Health Unit, Cagliari, Italy
| | - L Masala
- Laboratory SS Trinità Hospital, Sardinian Health Service, Italy
| | - G Steri
- Public Health Service, Local Health Unit, Cagliari, Italy
| | - F Riccardo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - S Iannazzo
- Director General for Health Prevention, Ministry of Health, Rome, Italy
| | - F P Maraglino
- Director General for Health Prevention, Ministry of Health, Rome, Italy
| | - C D'Amario
- Director General for Health Prevention, Ministry of Health, Rome, Italy
| | - G Rezza
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
10
|
Adamo G, Sturabotti G, D'Andrea E, Baccolini V, Romano F, Iannazzo S, Marzuillo C, Villari P. The end of measles and congenital rubella: an achievable dream? Ann Ig 2017; 29:1-26. [PMID: 28067934 DOI: 10.7416/ai.2017.2128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Despite substantial progress towards measles and rubella control, outbreaks continue to threaten elimination goals worldwide. STUDY DESIGN This paper aims to document progress towards the global eradication of measles and rubella. In particular, it investigates the major challenges faced by Italy in reaching the elimination goals. METHODS A review of the most important literature was carried out. Furthermore, a systematic review of the scientific literature on measles and rubella in the Italian setting was performed for the period 2000-2016. RESULTS In the National Plan 2010-2015, Italy renewed its commitment to eliminate measles and rubella by 2015. However, Italy recently experienced a high measles burden (2,205 cases in 2013, 1,694 in 2014). Between June 2015 and May 2016, 515 cases were reported, accounting for 28% all cases in Europe. Immunization coverage decreased in recent years, with no Region reaching the 95% target. The systematic review included a total of 175 papers, with an upward trend in the number of published articles, which demonstrates an increasing interest in the field of measles and rubella. The review highlights the need to improve the commitment of the Italian Regions to the elimination goals; to promote Supplementary Immunization Activities (SIAs); to improve the communication skills of health care workers; to improve the health literacy of citizens; and to enhance integrated measles and rubella surveillance. CONCLUSION Elimination of measles and rubella in Italy will require a substantial improvement in both commitment of the 21 Regions and activity of the whole country towards the WHO goals.
Collapse
Affiliation(s)
- G Adamo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - G Sturabotti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - E D'Andrea
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - V Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - F Romano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - S Iannazzo
- Office of Infectious Diseases and Prophylaxis, Ministry of Health, Rome, Italy
| | - C Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - P Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy - Chairperson of the Italian National Verification Committee for measles and rubella elimination
| |
Collapse
|
11
|
Gaultney J, Benucci M, Iannazzo S, Nappi C, Sion K, Sabater FJ. Trial-based cost-effectiveness of abatacept for rheumatoid arthritis patients in Italy. Expert Rev Pharmacoecon Outcomes Res 2015; 16:409-17. [PMID: 26495961 DOI: 10.1586/14737167.2016.1102636] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic, inflammatory disorder leading to disability and reduced quality of life. Effective treatment is a significant economic burden on the Italian healthcare system. Economic models in RA are commonly based on indirect treatment comparisons. METHODS This study assessed the cost-effectiveness of abatacept relative to adalimumab for RA in Italy based on a head-to-head trial by means of a cost-consequence analysis. RESULTS Health benefits based on the most stringent efficacy criteria were in favor of abatacept compared to adalimumab. Rates for more costly adverse events were higher for adalimumab compared to abatacept, which was reflected in the lower costs for abatacept (-€237,246 or -€237per patient). CONCLUSION The health economic value of abatacept compared with adalimumab from the perspective of the Italian NHS depends on the choice of health outcome. Health gains with abatacept were generally based on more stringent criteria and lower total costs.
Collapse
Affiliation(s)
| | - M Benucci
- b Ospedale S.Giovanni di Dio Firenze , Florence , Italy
| | - S Iannazzo
- c SIHS Health Economics Consulting , Turin , Italy
| | - C Nappi
- d Bristol-Myers Squibb , Rome , Italy
| | - K Sion
- a Mapi Group , Houten , Netherlands
| | | |
Collapse
|
12
|
Gaultney J, Budd D, Nappi C, Benucci M, Iannazzo S, Alemao E, Sabater J. FRI0348 Cost Comparison of Abatacept and Adalimumab Based on Ample, A 2-Year Head-to-Head Outcomes Study in Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
13
|
Iannazzo S, Colombatto P, Bonino F, Brunetto MR. Cost-Effectiveness Analysis Of A Personalized Therapy For Genotype 1, Naive, Chronic Hepatitis C Patients In Italy. Value Health 2014; 17:A366. [PMID: 27200766 DOI: 10.1016/j.jval.2014.08.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- S Iannazzo
- SIHS Health Economics Consulting, Torino, Italy
| | - P Colombatto
- University Hospital (AOUP), Cisanello (Pi), Italy
| | - F Bonino
- University Hospital (AOUP), Cisanello (Pi), Italy
| | - M R Brunetto
- University Hospital (AOUP), Cisanello (Pi), Italy
| |
Collapse
|
14
|
Gonfiantini MV, Carloni E, Gesualdo F, Pandolfi E, Agricola E, Rizzuto E, Iannazzo S, Ciofi Degli Atti ML, Villani A, Tozzi AE. Epidemiology of pertussis in Italy: Disease trends over the last century. Euro Surveill 2014; 19:20921. [DOI: 10.2807/1560-7917.es2014.19.40.20921] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [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
Collapse
Affiliation(s)
| | - E Carloni
- Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - F Gesualdo
- Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - E Pandolfi
- Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - E Agricola
- Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | | | | | - A Villani
- Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - A E Tozzi
- Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| |
Collapse
|
15
|
De Medici D, Alfonsi V, Bruni R, Busani L, Ciccaglione AR, Di Pasquale S, Equestre M, Escher M, Ricotta L, Rizzo C, Scavia G, Taffon S, Tosti ME, Pompa MG, Martini V, Iannazzo S, Losio MN, Varisco G, Pavoni E, Massaro M, Cappelletti B, Noè P, Menghi A, Guizzardi S, Lena R, Plutino G, Monteleone D, Borrello S. Hepatitis A outbreak in Italy associated with frozen berries. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
Iannazzo S. [Improving vaccination measures]. Ann Ig 2014; 26:53-55. [PMID: 25486692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite the benefits of routine vaccination of newborns are known and widely documented, in recent years we are observing a gradual increase in the number of parents who express doubts and concerns about the safety of vaccines and the real need to submit their children to vaccinations included in the national recommendations. This attitude is reinforced by the current epidemiological profile, in Western countries, of many vaccine preventable diseases, accompanied by a low risk perception among parents. Institutions and all the actors involved in vaccination programs have a duty to investigate the reasons for the loss of confidence in vaccination among the population in order to identify and implement appropriate and effective interventions. The improvement of vaccination should, theoretically, goes on a double track, placing side by side the provision of effective vaccines, safe and necessary, and interventions designed to increase demand for vaccination among the population, improve access to vaccination services, improve the system as a whole. But to actually improve the vaccinations' offer it is necessary also to provide interventions aimed at regaining the confidence of the population in relation to vaccination and the institutions that promote them. Particular attention should be given to the aspects of communication and risk communication.
Collapse
|
17
|
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.
Collapse
Affiliation(s)
- A Filia
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
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
Collapse
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
| |
Collapse
|
19
|
Abstract
In Italy, the 21 regional health authorities are in charge of organising and implementing their own vaccination strategy, based on the national vaccine plan. Immunisation coverage varies greatly among the regions for certain vaccines. Efforts to increase childhood immunisation coverage have included initiatives to develop and implement computerised immunisation registers in as many regions as possible. We undertook a cross-sectional online survey in July 2011 to provide an updated picture of the use, heterogeneity and main functions of different computerised immunisation registers used in the Italian regions and to understand the flow of information from local health units to the regional authorities and to the Ministry of Health. Comparing current data with those obtained in 2007, a substantial improvement is evident. A total of 15 regions are fully computerised (previously nine), with 83% of local health units equipped with a computerised register (previously 70%). Eight of the 15 fully computerised regions use the same software, simplifying data sharing. Only four regions are able to obtain data in real time from local health units. Despite the progress made, the capacity to monitor vaccination coverage and to exchange data appears still limited.
Collapse
Affiliation(s)
- V Alfonsi
- Istituto Superiore di Sanita, National Centre for Epidemiology Surveillance and Health Promotion, Rome, Italy
| | | | | | | | | | | | | |
Collapse
|
20
|
Zaniolo O, Iannazzo S, Pradelli L, Miravitlles M. Pharmacoeconomic evaluation of tiotropium bromide in the long-term treatment of chronic obstructive pulmonary disease (COPD) in Italy. Eur J Health Econ 2012; 13:71-80. [PMID: 21086017 DOI: 10.1007/s10198-010-0285-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 10/28/2010] [Indexed: 05/30/2023]
Abstract
The randomized, double-blind trial UPLIFT(®) demonstrated in 5,993 patients with moderate to very severe COPD that 4 years of tiotropium bromide therapy were associated with improvements in lung function, exacerbations, quality of life, and mortality compared with placebo. The pharmacoeconomic evaluation was performed through a probabilistic, patient-level simulation Markov model. Routine COPD care (RC) was compared with the inclusion of tiotropium bromide on it. The analysis was conducted over a lifetime horizon, with 1 year cycles and a 3.5% annual discount rate. Patients were characterized by gender, age, height, smoking status, and forced expiratory volume in 1 s (FEV1). FEV1 time trend was modeled according to the annual decline recorded in UPLIFT®. Mortality derived from that of the general Italian population was adjusted by smoking status and FEV1. Health utilities derived from published Italian observational studies and were varied in time according to UPLIFT® data. Exacerbation rates were derived from a published Italian observational prospective study. The cost perspective was that of the Italian National Health Service. Healthcare resource consumption for RC and exacerbations derived from Italian observational studies were valued according to current price and tariffs. Simulated patients in the tiotropium arm gained an average (95% CI) 0.50 (-1.63 to 6.27) Life Years (LYs) and 0.42 (-0.25 to 3.05) Quality-Adjusted Life Years (QALYs). The incremental lifetime cost resulted €3,357 (-€10,669 to €29,820). The incremental cost-effectiveness ratio (ICER) was €6,698/LY and €7,916/QALY. In the cost-effectiveness acceptability curve (CEAC), tiotropium had a 90% probability of being cost-effective for a willingness to pay (WTP) threshold of € 10,000/QALY.
Collapse
Affiliation(s)
- O Zaniolo
- c/o AdRes Health Economics & Outcomes Research, C.so Vigevano, 35, 10152 Turin, Italy
| | | | | | | |
Collapse
|
21
|
Paggiaro PL, Buseghin G, Nicolini G, Patel S, Iannazzo S, Zaniolo O, Papi A. P113 The cost-effectiveness of step down from high dose fluticasone/salmeterol dry powder or suspension formulations in asthma applied to the UK setting. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
22
|
Filia A, Tavilla A, Bella A, Magurano F, Ansaldi F, Chironna M, Nicoletti L, Palù G, Iannazzo S, Declich S, Rota MC. Measles in Italy, July 2009 to September 2010. Euro Surveill 2011. [DOI: 10.2807/ese.16.29.19925-en] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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
Outbreaks of measles continue to occur in Italy, as in other European countries. We present here details of cases reported through the Italian enhanced measles surveillance system from July 2009 to September 2010. In total, 2,151 cases were reported, 42% (n=895) of which were laboratory confirmed. The median age of cases was 18 years and 1,709 of 1,856 cases (92%) were unvaccinated. Many cases with complications were reported (n=305), including three with encephalitis. A total of 652 of 1,822 cases (36%) were hospitalised. Molecular characterisation revealed circulation of a limited number of measles virus genotypes (D4, D8 and B3), which is consistent with the current epidemiology of the disease in Italy. A national measles elimination plan was approved in 2003 with the aim of interrupting endemic measles transmission by 2007. Since elimination was not achieved, the target date was recently moved to 2015. The emphasis of the new elimination plan, approved in March 2011, is on strengthening surveillance, implementing evidence based-interventions to increase measles-mumps-rubella vaccine uptake in children, adolescents and young adults, and implementing communication activities related to the vaccine. The strategies proposed by the plan should be implemented fully and appropriately by all regions in order to meet the elimination goal by 2015.
Collapse
Affiliation(s)
- A Filia
- Infectious Diseases Epidemiology Unit, National Health Institute, Rome, Italy
| | - A Tavilla
- Infectious Diseases Epidemiology Unit, National Health Institute, Rome, Italy
| | - A Bella
- Infectious Diseases Epidemiology Unit, National Health Institute, Rome, Italy
| | - F Magurano
- Viral Diseases and Attenuated Vaccines Unit, National Health Institute, Rome, Italy
| | - F Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M Chironna
- Department of Biomedical Sciences and Human Oncology, Hygiene Section, University of Bari, Bari, Italy
| | - L Nicoletti
- Viral Diseases and Attenuated Vaccines Unit, National Health Institute, Rome, Italy
| | - G Palù
- Regional Reference Centre for Infectious Diseases, Microbiology and Virology Unit, Padua University Hospital, Padua, Italy
| | - S Iannazzo
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy
| | - S Declich
- Infectious Diseases Epidemiology Unit, National Health Institute, Rome, Italy
| | - M C Rota
- Infectious Diseases Epidemiology Unit, National Health Institute, Rome, Italy
| |
Collapse
|
23
|
Filia A, Tavilla A, Bella A, Magurano F, Ansaldi F, Chironna M, Nicoletti L, Palù G, Iannazzo S, Declich S, Rota MC. Measles in Italy, July 2009 to September 2010. Euro Surveill 2011; 16:19925. [PMID: 21801692] [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: 05/31/2023] Open
Abstract
Outbreaks of measles continue to occur in Italy, as in other European countries. We present here details of cases reported through the Italian enhanced measles surveillance system from July 2009 to September 2010. In total, 2,151 cases were reported, 42% (n=895) of which were laboratory confirmed. The median age of cases was 18 years and 1,709 of 1,856 cases (92%) were unvaccinated. Many cases with complications were reported (n=305), including three with encephalitis. A total of 652 of 1,822 cases (36%) were hospitalised. Molecular characterisation revealed circulation of a limited number of measles virus genotypes (D4, D8 and B3), which is consistent with the current epidemiology of the disease in Italy. A national measles elimination plan was approved in 2003 with the aim of interrupting endemic measles transmission by 2007. Since elimination was not achieved, the target date was recently moved to 2015. The emphasis of the new elimination plan, approved in March 2011, is on strengthening surveillance, implementing evidence based-interventions to increase measles-mumps-rubella vaccine uptake in children, adolescents and young adults, and implementing communication activities related to the vaccine. The strategies proposed by the plan should be implemented fully and appropriately by all regions in order to meet the elimination goal by 2015.
Collapse
Affiliation(s)
- A Filia
- Infectious Diseases Epidemiology Unit, National Health Institute, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Dal Negro RW, Pradelli L, Tognella S, Micheletto C, Iannazzo S. Cost-utility of add-on omalizumab in difficult-to-treat allergic asthma in Italy. Eur Ann Allergy Clin Immunol 2011; 43:45-53. [PMID: 21608372] [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: 05/30/2023]
Abstract
OBJECTIVE Omalizumab (OM), an innovative biological treatment for difficult asthma with perennial sensitisations, is an humanized monoclonal anti-IgE antibody that binds free circulating IgE; inhibits mast cell and basophil activation by combining free IgE, leads to IgE receptor down-regulation, thus blocking the inflammatory cascade. AIM OF THE STUDY To assess real-world cost-utility ofadd-on OM in Italy. METHODS changes in clinical and economical outcomes, and in quality of life (QoL) associated with add-on OM in adults (n=23) with severe dfficult asthma were compared with those recorded before OM in the same subjects. Variables were: lung function; IgE levels; health status; ACT score; QoL (SGRQ); n. GP and specialist visits; emergency visits; hospitalizations, and concomitant pharmacological treatments. Further indices were: changes in Health-related QoL; total health-care costs, and incremental cost/utility. Data were statistically compared (Student's T test), and p < 0.01 was accepted for statistical significance. RESULTS asthma clinical outcomes and patients' health-related quality of life improved significantly by adding OM, and both costs for drugs and hospital care dropped significantly (p < 0.01). The net economic effect was a 350 Euro increase in overall monthly costs; when related to health benefits, it corresponded to an incremental cost/utility ratio ofabout 26,000 Euro/QALY, which represents a quite favourable figure in terms of willingness to pay for health benefits in industrialised countries. CONCLUSIONS Omalizumab added to an optimised therapy significantly improves clinical outcomes in difficult-to-treat, persistent allergic asthma. Costs also increased, but proved justified by health benefits achieved.
Collapse
Affiliation(s)
- R W Dal Negro
- Lung Dept., Orlandi Gen. Hospital, Bussolengo, Verona, Italy.
| | | | | | | | | |
Collapse
|
25
|
Iannazzo S. Pharmacoeconomic evaluation of the MF59--adjuvanted influenza vaccine in the elderly population in Italy. J Prev Med Hyg 2011; 52:1-8. [PMID: 21710816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Influenza vaccination has proven effective in the reduction of influenza-like illness (ILI) cases and influenza-related hospitalizations, drug consumption, primary care consultations and deaths in the elderly population. The aim of this study is the assessment of the financial budget impact of a seasonal vaccination program based on the use of the MF59 adjuvanted vaccine as compared with the traditional vaccine or the absence of vaccination in Italian elderly population. METHODS A pharmacoeconomic simulation model was developed to simulate the effect of the three different vaccination programs during a single influenza season. Health economics and demographic data were taken from specific Italian sources, and vaccine effectiveness data derived from published literature. Direct medical costs were considered according to current Italian prices and tariffs. RESULTS About 83% of the 12 million people of at least 65 years of age currently resident in Italy can be considered at high risk for influenza complications due to underlying chronic diseases. Absence of vaccination could lead to more than 2 million ILl cases, and 29,000 related deaths. The vaccination program with a coverage rate of 65.6% would lead to an estimated 1.5 million ILl cases (26.9% reduction) with a standard vaccine and to 1.3 million (35.8% reduction) with the MF59 adjuvanted vaccine with a relative increase of avoided cases of 33,1%. The standard vaccination program produced a moderate direct cost increase of about 50 million Euro (+4.6%), whereas the adjuvanted vaccine provided an estimated saving of about 74 million Euro (-6.8%), both compared to the non vaccination. Cost savings were mainly related to hospital admissions avoided in the elderly population (>or=65 years of age). CONCLUSIONS The vaccination with the MF59 adjuvanted vaccine resulted more effective and cost saving when compared with the standard vaccination and with no vaccination, thus representing the optimal strategy for the elderly population. The standard vaccine, even though a light cost increase, still proved to be effective compared to the null option, with the initial cost for the vaccination program nearly offset by healthcare resources savings obtained during the season.
Collapse
Affiliation(s)
- S Iannazzo
- AdRes Health Economics & Outcomes Research, Torino, Italy.
| |
Collapse
|
26
|
Iannazzo S, Pradelli L, Carsi M, Perachino M. Cost-effectiveness analysis of LHRH agonists in the treatment of metastatic prostate cancer in Italy. Value Health 2011; 14:80-89. [PMID: 21211489 DOI: 10.1016/j.jval.2010.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Luteinizing hormone-releasing hormone (LHRH) agonists represent one of the main cost factors in the management of patients with metastatic prostate cancer. We compared the cost-effectiveness of the five different 3-month formulations of LHRH agonists currently available for advanced prostate cancer in Italy, because these differ both in their capacity to suppress testosterone and in their acquisition costs. METHODS A probabilistic, patient-level simulation model was developed to compare the cost-effectiveness, from the perspective of the Italian National Health Service (INHS), of leuprorelin 11.25 mg and 22.5 mg, triptorelin 11.25 mg, buserelin 9.9 mg, and goserelin 10.8 mg. The model incorporated testosterone-dependent progression-free and cancer-specific survival functions, LHRH agonist effectiveness data, and national costs and tariffs. Cox's proportional hazard models were used to compute total and progression-free survival functions based on clinical data from 129 patients with metastatic prostate cancer treated in an Italian center. Bayesian random effects models were employed to summarize evidence from published literature on testosterone suppression obtained with the available LHRH agonists. RESULTS Estimated total survival was ≈5 years, with a maximum difference between treatment options of ≈2 months. There was a mean difference of almost €2,500 in lifetime total costs between the least costly option (leuprorelin 22.5 mg) and the most expensive (goserelin). In the incremental cost-effectiveness analysis, leuprorelin 22.5 mg dominated all alternatives except buserelin, which had an incremental cost-effectiveness ratio versus leuprorelin 22.5 mg of ≈€12,000 per life-month gained. CONCLUSIONS Based on modelling with meta-analysis of comparative survival data, leuprorelin 22.5 mg was the most cost-effective treatment of the available depot formulation LHRH agonists.
Collapse
Affiliation(s)
- S Iannazzo
- AdRes Health Economics & Outcomes Research, Torino, Italy.
| | | | | | | |
Collapse
|
27
|
Benucci M, Iannazzo S, Zaniolo O, Sabadini L. Rituximab in the treatment of rheumatoid arthritis patients in Italy: a budget impact analysis. Clin Exp Rheumatol 2010; 28:722-727. [PMID: 20883636] [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] [Received: 01/08/2010] [Accepted: 05/06/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The objective of this Budget Impact Analysis is to evaluate the financial implications of a rituximab-based sequencing strategy in the treatment of rheumatoid arthritis in the perspective of the Italian National Health Service. METHODS Yearly patients who were eligible for a second-line biological DMARD in Italy were entered into a 5-year model. A Markov chain reproduced the course of this cohort under a number of alternative strategies, including anti-TNF-α cycling and rituximab or abatacept as second and third line agents. The dynamic of the simulation was given by first biological drug failure data, mortality rates, and survival-on-treatment data from published literature. Drug acquisition, administration and monitoring costs were assessed. RESULTS Italian patients refractory to a first anti-TNF-α therapy resulted to be about 650 per year, giving a cumulative number of treated patients in five years of 3,240. The anti-TNF-α cycling had a total direct cost which rose from €8.2 million in the first year to €33.8 million in the fifth. The cost per patient of rituximab was lower than the average cost of the anti-TNF-α therapies; the annual difference was around € 4,300. The savings gained from lower individual costs with rituximab were partially offset by the increasing number of patients receiving active medication, resulting in a substantial cost equivalence between third line rituximab and anti-TNF-α cycling scenarios; rituximab, as a second line therapy, produced a savings in total costs of -31.8%. Strategies including abatacept shared the same dynamics, but with higher costs. CONCLUSIONS The introduction of rituximab in clinical practice could allow an increase in the number of patients receiving an active rheumatoid arthritis treatment without inflating therapy costs.
Collapse
Affiliation(s)
- M Benucci
- Rheumatology Unit, Department of Internal Medicine, Nuovo Ospedale di S. Giovanni di Dio, Azienda Sanitaria di Firenze, Florence, Italy.
| | | | | | | |
Collapse
|
28
|
Abstract
UNLABELLED The XENDOS study showed that behavioural and pharmacological therapy can decrease the risk of metabolic disorders in obese patients. METHODS A probabilistic Bayesian Markov model simulating the outcomes of orlistat treatment on the obese Italian population has been developed with the WinBUGS software. The model integrates an algorithm to estimate cardiovascular risk based on Framingham Heart Study equations. Analyses adopted the societal cost perspective, including direct medical costs borne by both the National Health Service and the patient, since orlistat is not included in the Italian reimbursement list. RESULTS The simulation on the Italian obese population estimated an average increase in quality-adjusted life expectancy, a reduction of cardiovascular events and new diabetes cases. The average incremental cost-utility ratio is euro75.3 (7.6-180.6) x 1000/QALY. The subgroup analysis showed that the benefits are relatively greater in older patients and in patients with impaired glucose tolerance (IGT). Two hypotheses have been explored to estimate the impact of a potential reimbursement decision by the Italian NHS: (1) orlistat is given to every obese patient; (2) orlistat is given only to obese IGT patients with a previous glucose tolerance general screening program to assess their eligibility. The cost utility of the strategies are euro42.3 (-22.16-108.7) and euro10.16 (-60.4-38.76) x 1000/QALY, respectively. CONCLUSION Orlistat shows a good pharmacoeconomic profile and, in particular, the strategy of a screening programme to identify and treat the IGT subgroup has a cost-utility value of about euro10000/QALY. This value is lower than that of several therapeutic strategies commonly accepted and reimbursed in developed countries.
Collapse
Affiliation(s)
- S Iannazzo
- Sergio Iannazzo, MBA, Engineer, Advanced Research Srl, Turin, Italy.
| | | | | |
Collapse
|
29
|
Negro RD, Eandi M, Pradelli L, Iannazzo S. Cost-effectiveness and healthcare budget impact in Italy of inhaled corticosteroids and bronchodilators for severe and very severe COPD patients. Int J Chron Obstruct Pulmon Dis 2007; 2:169-76. [PMID: 18044689 PMCID: PMC2695615] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Current practice guidelines for the treatment of COPD recommend the use of combined inhaled corticosteroids and long-acting bronchodilators in severe and very severe patients (GOLD stages III and IV). The aim of this study was to evaluate, through a simulation model, the economic consequences of this recommendation in Italy. We developed a cost-effectiveness analysis (CEA) on five alternative therapeutic strategies (salmeterol/fluticasone, SF; formoterol! budesonide, FB; salmeterol alone, S; fluticasone alone, F; control, C). Published data on the Italian COPD population and efficacy data from international reference trials were fitted in a disease progression model based on a Markov chain representing severity stages and death. The yearly total direct costs of treating COPD patients in Italy was estimated at approximately Euro 7 billion, with a mean cost per patient per year of around Euro 2450. Mean survival of the cohort is 11.5 years. The C and F strategies were dominated (ie, are associated with worse outcomes and higher costs) by all alternatives. SF and FB were the most effective strategies, with a slight clinical superiority of SF, but they were also marginally more expensive than S. Incremental cost-effectiveness of SF vs S was Euro 679.5 per avoided exacerbation and Euro 3.3 per symptom-free day. Compared with current practice, the recommended use of combined inhaled corticosteroids and long-acting bronchodilators for severe and very severe COPD patients has the potential for improving clinical outcomes without increasing healthcare costs.
Collapse
Affiliation(s)
- Roberto Dal Negro
- Lung Dept., Orlandi General Hospital, Bussolengo, Verona, Italy;,Correspondence: Roberto Dal Negro, Lung Dept., Orlandi General Hospital, Bussolengo, Verona, Italy, Email
| | - M Eandi
- Clinical Pharmacology, University of Torino, Italy
| | | | | |
Collapse
|
30
|
Filia A, Curtale F, Kreidl P, Morosetti G, Nicoletti L, Perrelli F, Mantovani J, Campus D, Rossi G, Sanna MC, Zanetti A, Magurano F, Fortuna C, Iannazzo S, Pompa MG, Ciofi degli Atti M. Cluster of measles cases in the Roma/Sinti population, Italy, June-September 2006. ACTA ACUST UNITED AC 2006; 11:E061012.2. [PMID: 17213534 DOI: 10.2807/esw.11.41.03062-en] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Three clusters of measles cases occurred between June and September 2006, in the Roma/Sinti populations in three different Italian regions: the Bolzano-South Tyrol in northern Italy; Lazio in central Italy; and the island of Sardinia in the southwest.
Collapse
Affiliation(s)
- A Filia
- Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute, Istituto Superiore di Sanita, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Ciofi degli Atti M, Filia A, Verteramo R, Iannazzo S, Curtale F, Masini L, De Santis M, Pompa MG. First cases of rubella infection during pregnancy detected by new reporting system in Italy. ACTA ACUST UNITED AC 2006; 11:E060323.5. [PMID: 16804234 DOI: 10.2807/esw.11.12.02930-en] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
On 1 January 2005, rubella infection during pregnancy and congenital rubella syndrome/infection were made statutorily notifiable in Italy, as recommended by the national plan for the elimination of measles and congenital rubella
Collapse
Affiliation(s)
- M Ciofi degli Atti
- Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute (CNESPS), Istituto Superiore di Sanità, Rome, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
D'Elia R, Iannazzo S, Rossigni A, Santi AL, Patti AM. [Osteoporosis: problems and considerations of economical nature]. Ann Ig 2004; 16:59-67. [PMID: 15554511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In 1991 WHO classified osteoporosis as a major social disease, on the basis of its high prevalence, expected to rise in the future, its physical and psychological consequences and its economical costs for both the society and the individual. In the past, costs, especially the undirected and intangible ones, have been largely underestimated, due to their complex quantification. A more accurate and a deeper evaluation of the pathology and its economical burden on National Health Services will lead to a better planning of prevention strategies.
Collapse
Affiliation(s)
- R D'Elia
- Dipartimento di Scienze di Sanità Pubblica G. Sanarelli, Università degli Studi di Roma La Sapienza.
| | | | | | | | | |
Collapse
|
33
|
Petti S, Iannazzo S, Tarsitani G. [Comparison between different methods to monitor the microbial level of indoor air contamination in the dental office]. Ann Ig 2003; 15:725-33. [PMID: 14969327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
There is no unanimous consensus on the best methodology to monitor the microbial contamination level of the air in the dental offices. Therefore, we compared a precise but expensive and complex active air sampler (Surface Air System--SAS) with a passive method (Air Microbiological Index--AMI) and a microbial parameter of salivary microrganisms, (oral streptococci--OS), with other, more simply detectable, yet more generic, parameters (staphilococci--ST total viable flora--TVF). We tested the various combinations of systems and parameters in three multi-chair dental departments, for two different weekdays, before (T0) and during (T1) the working period. Using non-parametric statistical tests we analysed, (i) the difference between T0 and T1 contamination levels assessed by various methods, in order to confirm their efficacy; (ii) the association between parameters, in order to assess whether generic parameters were as reliable as the specific parameter; (iii) the association between sampling systems, in order to test whether AMI could efficaciously substitute the active samplers. The microbial levels were significantly higher at T1 than at T0, excluding ST assessed by SAS. The parameters were highly inter-correlated. However, for low SO levels, the level of the association of this parameter with the others decreased. The results provided by SAS and AMI were also significantly correlated. However, for low contamination levels this association was not significant. In conclusion, the complex and expensive method (SO level assessed by SAS) seems more reliable for low aerial contamination levels, whereas for high levels, more simple and cheap methods could also be used.
Collapse
Affiliation(s)
- S Petti
- Dipartimento di Scienze di Sanità Pubblica G. Sanarelli, Università degli Studi di Roma La Sapienza.
| | | | | |
Collapse
|
34
|
Iannazzo S, Petti S, Fabi F, Divizia M, Pasca-Raymondo F, Simonetti D'Arca A. [Health-related behaviour and HCV prevalence among elderly and younger adults in an isolated community close to Rome (Italy)]. Ann Ig 2003; 15:477-85. [PMID: 14969300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
The aim of this study has been to investigate the differences in the health-related behaviour by means of a questionnaire in a sample of elderly (>54 years, 1st generation) and younger adults (<54 years, 2nd generation, all of them sons/daughters of HCV positive subjects), given the high difference in HCV positive prevalence among the two groups (19.4% vs. 2.1%). Most (53.4% vs. 0.0%) of the 1st generation subjects used glass syringes while all the 2nd generation subjects used disposable syringes. Among the elderly, the frequency of hospitalisation (70% vs. 50%), transfusions (11.8% vs. 2.9%) and dental therapy by false dentists (52% vs. 0%) were higher. These results show that the use of non recyclable syringes is the main responsible for the drastic reduction of HCV circulation in the present community, and the consequent decrease in the risk for infection in younger subjects. Moreover, dental therapy was not related to an increased risk for infection, providing that the treatment has been made by a "true" dentist. Finally, the intrafamiliar transmission was not supported by the present data.
Collapse
Affiliation(s)
- S Iannazzo
- Dipartimento di Scienze di Sanità Pubblica G. Sanarelli, Università degli Studi di Roma La Sapienza.
| | | | | | | | | | | |
Collapse
|
35
|
Petti S, Iannazzo S, Gemelli G, Rocchi R, Novello MR, Ortensi V, Nicolussi A, Simonetti D'Arca A, Tarsitani G. [Incidence of caries in a sample of 3-7-year old children in Rome who were not included in population prevention programs]. Ann Ig 2001; 13:329-38. [PMID: 11590868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- S Petti
- Sezione di Igiene Vittorio Puntoni, Dipartimento di Scienze di Sanità Pubblica G. Sanarelli, Università degli Studi di Roma La Sapienza, P. le Aldo Moro 5, 00185 Roma
| | | | | | | | | | | | | | | | | |
Collapse
|