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Donzelli S, Spinella F, di Domenico EG, Pontone M, Cavallo I, Orlandi G, Iannazzo S, Ricciuto GM, Team ISGVC, Pellini R, Muti P, Strano S, Ciliberto G, Ensoli F, Zapperi S, La Porta CA, Blandino G, Morrone A, Pimpinelli F. Evidence of a SARS-CoV-2 double Spike mutation D614G/S939F potentially affecting immune response of infected subjects. Comput Struct Biotechnol J 2022; 20:733-744. [PMID: 35096288 PMCID: PMC8780065 DOI: 10.1016/j.csbj.2022.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/18/2022] [Accepted: 01/18/2022] [Indexed: 12/16/2022] Open
Abstract
Objectives Despite extensive efforts to monitor the diffusion of COVID-19, the actual wave of infection is worldwide characterized by the presence of emerging SARS-CoV-2 variants. The present study aims to describe the presence of yet undiscovered SARS-CoV-2 variants in Italy. Methods Next Generation Sequencing was performed on 16 respiratory samples from occasionally employed within the Bangladeshi community present in Ostia and Fiumicino towns. Computational strategy was used to identify all potential epitopes for reference and mutated Spike proteins. A simulation of proteasome activity and the identification of possible cleavage sites along the protein guided to a combined score involving binding affinity, peptide stability and T-cell propensity. Results Retrospective sequencing analysis revealed a double Spike D614G/S939F mutation in COVID-19 positive subjects present in Ostia while D614G mutation was evidenced in those based in Fiumicino. Unlike D614G, S939F mutation affects immune response by the slight but significant modulation of T-cell propensity and the selective enrichment of potential binding epitopes for some HLA alleles. Conclusion Collectively, our findings mirror further the importance of deep sequencing of SARS-CoV-2 genome as a unique approach to monitor the appearance of specific mutations as for those herein reported for Spike protein. This might have implications on both the type of immune response triggered by the viral infection and the severity of the related illness.
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2
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Barchitta M, Sabbatucci M, Furiozzi F, Iannazzo S, Maugeri A, Maraglino F, Prato R, Agodi A, Pantosti A. Knowledge, attitudes and behaviors on antibiotic use and resistance among healthcare workers in Italy, 2019: investigation by a clustering method. Antimicrob Resist Infect Control 2021; 10:134. [PMID: 34507607 PMCID: PMC8431867 DOI: 10.1186/s13756-021-01002-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 08/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Identifying healthcare workers (HCW) who have less awareness and knowledge on antibiotic use and resistance represents a challenge for public health, since it might help the development of novel educational and training initiatives tailored on specific subgroups of professionals. This work aims to compare knowledge, attitudes and behaviors on antibiotic use and resistance across different groups of Italian HCW. METHODS We used data from the multi-country and multi-professional survey launched by the European Centre for Disease Prevention and Control between 28 January to 4 March 2019 to assess knowledge, attitude and behaviors of HCW on antibiotics, antibiotic use and resistance. We distinguished three clusters of HCW using the Two-Step Cluster analysis, based on their personal and professional characteristics (i.e. profession, role, activity as prescriber, setting, and activity as antibiotic use advisor). RESULTS In general, cluster 1 consisted mostly of allied healthcare workers, while clusters 2 and 3 were made up almost completely of pharmacists and medical doctors, respectively. Interestingly, healthcare workers in cluster 3 had the highest knowledge on antibiotic use and resistance. Workers in cluster 1, instead, were those reporting the highest awareness of the importance and role of hand hygiene as an infection prevention and control measure. However, HCW in cluster 2 were those who recognized more their role of advisors on prudent antibiotic use. CONCLUSIONS Italian HCW exhibited different knowledge, attitudes, and behaviors on antibiotic use and resistance. These findings raised the need for educational and training interventions targeting specific professional groups.
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Affiliation(s)
- Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Michela Sabbatucci
- Department Infectious Diseases, Italian National Institute of Health, Rome, Italy. .,Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, Ministry of Health, Rome, Italy.
| | - Francesca Furiozzi
- Directorate General for European and International Relations, Ministry of Health, Rome, Italy
| | - Stefania Iannazzo
- Hygiene and Public Health Service, Local Health Authority Rome 3, Rome, Italy
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Francesco Maraglino
- Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, Ministry of Health, Rome, Italy
| | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy. .,AOU Policlinico "G. Rodolico - San Marco", Catania, Italy.
| | - Annalisa Pantosti
- Department Infectious Diseases, Italian National Institute of Health, Rome, Italy
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3
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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.
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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
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Tavoschi L, Forni S, Porretta A, Righi L, Pieralli F, Menichetti F, Falcone M, Gemignani G, Sani S, Vivani P, Bellandi T, Tacconi D, Turini L, Toccafondi G, Privitera G, Lopalco P, Baggiani A, Gemmi F, Luchini G, Petrillo M, Roti L, Pezzotti P, Pantosti A, Iannazzo S, Mechi MT, Rossolini GM, On Behalf Of The Tuscan Clinical Microbiology Laboratory Network. Prolonged outbreak of New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE), Tuscany, Italy, 2018 to 2019. ACTA ACUST UNITED AC 2021; 25. [PMID: 32070467 PMCID: PMC7029447 DOI: 10.2807/1560-7917.es.2020.25.6.2000085] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) have increased since November 2018. Between November 2018 and October 2019, 1,645 samples were NDM-CRE-positive: 1,270 (77.2%) cases of intestinal carriage, 129 (7.8%) bloodstream infections and 246 (14.9%) infections/colonisations at other sites. Klebsiella pneumoniae were prevalent (1,495; 90.9%), with ST147/NDM-1 the dominant clone. Delayed outbreak identification and response resulted in sustained NDM-CRE transmission in the North-West area of Tuscany, but successfully contained spread within the region.
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Affiliation(s)
- Lara Tavoschi
- Department of Translational Research and New technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Silvia Forni
- Regional Health Agency of Tuscany, Florence, Italy
| | - Andrea Porretta
- University Hospital of Pisa, Pisa, Italy.,Department of Translational Research and New technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Lorenzo Righi
- Quality of care and Clinical networks, Tuscany Region, Florence, Italy
| | | | | | | | | | - Spartaco Sani
- Livorno Hospital, Toscana North-West Health Authority, Livorno, Italy
| | - Paola Vivani
- Massa Carrara Hospital, Toscana North-West Health Authority, Massa Carrara, Italy
| | | | - Danilo Tacconi
- Arezzo Hospital, Toscana South-East Health Authority, Arezzo, Italy
| | - Lucia Turini
- Toscana North-West Health Authority, Pisa, Italy
| | - Giulio Toccafondi
- Quality of care and Clinical networks, Tuscany Region, Florence, Italy
| | - Gaetano Privitera
- University Hospital of Pisa, Pisa, Italy.,Department of Translational Research and New technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Pierluigi Lopalco
- University Hospital of Pisa, Pisa, Italy.,Department of Translational Research and New technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Angelo Baggiani
- University Hospital of Pisa, Pisa, Italy.,Department of Translational Research and New technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | | | | | - Lorenzo Roti
- Toscana North-West Health Authority, Pisa, Italy
| | | | | | | | | | - Gian Maria Rossolini
- Department of Experimental Medicine, University of Florence, Florence, Italy.,Florence Careggi University Hospital, Florence, Italy
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5
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Abstract
Italy introduced a national law extending the number of compulsory vaccines from four to 10 in July 2017. The implementation placed a further burden on immunisation centres as they were required to cover the increased demand of vaccination by the parents of unvaccinated children. Vaccine coverage (VC) estimated 6 months and 1 year later, at 24 and 30 months (same birth cohort), had increased for all vaccines. At 24 months of age, measles VC increased from 87.3% in 2016 to 91.8% in 2017 and 94.1% at 30 months of age as at June 2018. In six of 21 regions and autonomous provinces, VC for measles was >95%. Despite the implementation of this law, vaccine hesitancy is still a problem in Italy and the political and social debate on mandatory vaccination is ongoing. Regardless of the policy to be adopted in the future, strategies to maintain high vaccination rates and the related herd immunity should be considered, including adequate communication to the population and the implementation of electronic immunisation registries.
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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
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7
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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.
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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
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8
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Magurano F, Baggieri M, Bucci P, D'Ugo E, Sabbatucci M, Maraglino F, Iannazzo S, Marchi A, Nicoletti L. MoRoNet a network to strengthen the quality of measles and rubella surveillance in Italy. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Measles is a vaccine-preventable infectious disease and it remains one of the leading causes of infant mortality globally. The World Health Organization (WHO) has adopted the goal of eliminating measles and rubella. Detection and control of communicable diseases would not be possible without accurate laboratory results regarding when and where a particular disease circulates.
Methods
WHO/Europe therefore works with all Member States to steadily improve the quality of the laboratory data in order to determine the Region's progress towards measles and rubella elimination. For this purpose coordinates the European Measles and Rubella Laboratory Network (MR LabNet). National labs in this network undergoes regular external quality assessment through an annual accreditation programme.
Results
In Italy, a Sub-national Reference Laboratories Network for measles and rubella (MoRoNET) has been developed since March 2017 and currently includes 15 laboratories. MoRoNet was developed following the indications of the MR LabNet. It is accreditate, coordinated and supervised by the National Reference Laboratory.
Conclusions
Strengthening the role of national laboratories in overseeing the performance of subnational laboratories has become a critical need in order to properly monitor the Region's measles and rubella elimination efforts. MoRoNet permits to Italy to develop a country-specific work plan for establishing national networks and oversight mechanism, including preliminary monitoring and evaluation indicators compliant with MR LabNet standards. This is very significant not only to optimize the participation in national and regional processes to verify disease elimination, but also to strengthen the quality of vaccine-preventable disease surveillance.
MoRoNet Group: A Amendola; F Baldanti; MR Capobianchi; M Chironna; MG Cusi; P D'Agaro; P Lanzafame; T Lazzarotto; K Marinelli; A Orsi; E Pagani; G Palù; F Pittaluga, A Sacchi; F Tramuto.
Key messages
MoRoNet has permitted to Italy to develop a country-specific work plan for establishing national networks and oversight mechanism, compliant with WHO MR LabNet standards. MoRoNet network has permitted to optimize the participation in processes to verify disease elimination, but also to strengthen the quality of vaccine-preventable disease surveillance.
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Affiliation(s)
- F Magurano
- National Reference Lab for measles and rubella, WHO/LabNet, DMI, National Institute of Health, Rome, Italy
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
- MoRoNet, NRL-WHO/LabNet, DMI, National Institute of Health, Rome, Italy
| | - M Baggieri
- National Reference Lab for measles and rubella, WHO/LabNet, DMI, National Institute of Health, Rome, Italy
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
- MoRoNet, NRL-WHO/LabNet, DMI, National Institute of Health, Rome, Italy
| | - P Bucci
- National Reference Lab for measles and rubella, WHO/LabNet, DMI, National Institute of Health, Rome, Italy
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
- MoRoNet, NRL-WHO/LabNet, DMI, National Institute of Health, Rome, Italy
| | - E D'Ugo
- National Reference Lab for measles and rubella, WHO/LabNet, DMI, National Institute of Health, Rome, Italy
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - M Sabbatucci
- General Directorate Health Prevention, Communicable Diseases, Ministry of Health, Rome, Italy
| | - F Maraglino
- General Directorate Health Prevention, Communicable Diseases, Ministry of Health, Rome, Italy
| | - S Iannazzo
- General Directorate Health Prevention, Communicable Diseases, Ministry of Health, Rome, Italy
| | - A Marchi
- National Reference Lab for measles and rubella, WHO/LabNet, DMI, National Institute of Health, Rome, Italy
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
- MoRoNet, NRL-WHO/LabNet, DMI, National Institute of Health, Rome, Italy
| | - L Nicoletti
- National Reference Lab for measles and rubella, WHO/LabNet, DMI, National Institute of Health, Rome, Italy
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
- MoRoNet, NRL-WHO/LabNet, DMI, National Institute of Health, Rome, Italy
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9
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Filia A, Bella A, Del Manso M, Baggieri M, Magurano F, Iannazzo S, Sabbatucci M, Nicoletti L, Rota MC. Who is at risk for measles in Italy? Continued measles outbreaks in 2019 and barriers to elimination. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Measles is a highly contagious vaccine preventable disease that can lead to serious complications, including death. All five regions of the World Health Organization have set targets to eliminate measles. In Italy, measles vaccination was introduced in 1976, with sustained low uptake in the 1980s and 1990s. Uptake improved in subsequent years but never reached 95% coverage required for elimination. Two doses of measles-mumps-rubella (MMR) vaccine are recommended (at 12-15 months and 5-6 years respectively). Since July 2017, MMR vaccine has become mandatory for all children up to 16 years of age. Large outbreaks continue to occur, with over 8.000 cases reported in 2017-2018.
Methods
We analysed measles cases reported to the national integrated measles and rubella surveillance system during January 1 - December 31, 2019.
Results
From 1 January to 31 December 2019, 1,627 cases (87% laboratory-confirmed), were reported from all 21 administrative regions. National incidence was 27 cases/million. Overall, 86% of cases were unvaccinated. Median age was 30 years but the highest incidence was in infants below one year of age. Ninety-six cases were reported amongst healthcare workers and transmission in the healthcare setting was frequent. Overall, 31% of cases reported complications, including three cases of encephalitis (in two adults and one child) and one death in an adult patient. Complications were more frequent in cases ≥20 years of age compared to younger patients. Forty-six percent of cases were hospitalised.
Conclusions
The median age of cases has increased further in 2019 compared to 2017 (27 years) and 2018 (28 years). The proportions of complicated and hospitalised cases are high, this may be due to the high median age of cases but also to underreporting from general practitioners who are likely to see milder cases. Wide immunity gaps among adults (including healthcare workers) and nosocomial transmission are major challenges to measles elimination in Italy.
Key messages
Measles is still endemic in Italy and large outbreaks continue to occur, with a significant public health impact. Wide immunity gaps among adults (including healthcare workers) and nosocomial transmission are major challenges to measles elimination in Italy.
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Affiliation(s)
- A Filia
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - A Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - M Del Manso
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - M Baggieri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - F Magurano
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - S Iannazzo
- General Directorate of Prevention, Ministry of Health, Rome, Italy
| | - M Sabbatucci
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- General Directorate of Prevention, Ministry of Health, Rome, Italy
| | - L Nicoletti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - M C Rota
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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10
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Iacchini S, Sabbatucci M, Gagliotti C, Rossolini GM, Moro ML, Iannazzo S, D'Ancona F, Pezzotti P, Pantosti A. Bloodstream infections due to carbapenemase-producing Enterobacteriaceae in Italy: results from nationwide surveillance, 2014 to 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 30722813 PMCID: PMC6386214 DOI: 10.2807/1560-7917.es.2019.24.5.1800159] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Following the rapid increase of infections due to carbapenemase-producing Enterobacteriaceae (CPE) in Italy, the national surveillance of bloodstream infections (BSI) due to CPE (Klebsiella pneumoniae and Escherichia coli) was instituted in 2013. All CPE-BSI cases reported to the surveillance in the years 2014-17 were analysed in order to investigate incidence rate (IR), trend, main individual characteristics and enzymes involved in CPE resistance. Throughout this period, 7,632 CPE-BSI cases (IR: 3.14/100,000 inhabitants) were reported from all 21 regions and autonomous provinces in Italy, with an increasing number of reported cases (2014: 1,403; 2015: 1,838; 2016: 2,183; 2017: 2,208). CPE-BSI cases mainly occurred in subjects aged over 60 years (70.9%) and more frequently in males (62.7%) than in females. Most of the cases originated in hospitals (87.2%), mainly in intensive care units (38.0%), and were associated with central or peripheral venous catheter use (23.9%) or with urinary tract infections (21.1%). Almost all CPE-BSI (98.1%) were due to K. pneumoniae carrying the K. pneumoniae carbapenemase (KPC) enzyme (95.2%). These data show that carbapenemase-producing K. pneumoniae are endemic in our country, causing a high number of BSI and representing a threat to patient safety.
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Affiliation(s)
- Simone Iacchini
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Michela Sabbatucci
- European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Carlo Gagliotti
- Agenzia Sanitaria e Sociale Regionale - Regione Emilia-Romagna, Bologna, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Careggi University Hospital, Florence, Italy
| | - Maria Luisa Moro
- Agenzia Sanitaria e Sociale Regionale - Regione Emilia-Romagna, Bologna, Italy
| | - Stefania Iannazzo
- Ufficio V - Prevention of Communicable Diseases and International Prophylaxis, Ministry of Health, Rome, Italy
| | - Fortunato D'Ancona
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Annalisa Pantosti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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11
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Sartelli M, Pagani L, Iannazzo S, Moro ML, Viale P, Pan A, Ansaloni L, Coccolini F, D'Errico MM, Agreiter I, Amadio Nespola G, Barchiesi F, Benigni V, Binazzi R, Cappanera S, Chiodera A, Cola V, Corsi D, Cortese F, Crapis M, Cristini F, D'Arpino A, De Simone B, Di Bella S, Di Marzo F, Donati A, Elisei D, Fantoni M, Ferrari A, Foghetti D, Francisci D, Gattuso G, Giacometti A, Gesuelli GC, Marmorale C, Martini E, Meledandri M, Murri R, Padrini D, Palmieri D, Pauri P, Rebagliati C, Ricchizzi E, Sambri V, Schimizzi AM, Siquini W, Scoccia L, Scoppettuolo G, Sganga G, Storti N, Tavio M, Toccafondi G, Tumietto F, Viaggi B, Vivarelli M, Tranà C, Raso M, Labricciosa FM, Dhingra S, Catena F. A proposal for a comprehensive approach to infections across the surgical pathway. World J Emerg Surg 2020; 15:13. [PMID: 32070390 PMCID: PMC7029591 DOI: 10.1186/s13017-020-00295-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/10/2020] [Indexed: 02/08/2023] Open
Abstract
Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should always focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy.
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | | | - Maria Luisa Moro
- Regional Agency for Health and Social Care, Emilia-Romagna Region-ASSR, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum"-University of Bologna, Bologna, Italy
| | - Angelo Pan
- Infectious Diseases, ASST di Cremona, Cremona, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Federico Coccolini
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Marcello Mario D'Errico
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Iris Agreiter
- Bone Marrow Transplant Unit, Denis Burkitt, St. James's Hospital, Dublin, Ireland
| | | | - Francesco Barchiesi
- Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Valeria Benigni
- Clinical Administration, Senigallia Hospital, ASUR Marche, Senigallia, AN, Italy
| | | | - Stefano Cappanera
- Infectious Diseases Clinic, Department of Medicine, "S. Maria" Hospital, Terni, University of Perugia, Perugia, Italy
| | | | - Valentina Cola
- Department of Hospital Pharmacy, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Daniela Corsi
- Department of Anesthesiology and Intensive Care Unit, Civitanova Marche Hospital, ASUR Marche, Civitanova Marche, MC, Italy
| | - Francesco Cortese
- Emergency Surgery and Trauma Care Unit, San Filippo Neri Hospital, Rome, Italy
| | - Massimo Crapis
- Infectious Diseases Unit, Pordenone Hospital, Pordenone, Friuli-Venezia Giulia, Italy
| | | | - Alessandro D'Arpino
- Hospital Pharmacy Unit, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Belinda De Simone
- Operative Unit of General Surgery, Azienda USL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Di Bella
- Infectious Diseases Department, Trieste University Hospital, Trieste, Italy
| | | | - Abele Donati
- Department of Anesthesiology and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Elisei
- Department of Anesthesiology and Intensive Care Unit, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Massimo Fantoni
- Department of Infectious Diseases, Fondazione Policlinico A. Gemelli IRCCS, Istituto di Clinica delle Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy
| | - Anna Ferrari
- Department of Critical Care Medicine Unit, San Filippo Neri Hospital, Rome, Italy
| | - Domitilla Foghetti
- Department of Surgery, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | | | - Gianni Gattuso
- Infectious Diseases Unit, Carlo Poma Hospital, Mantua, Italy
| | - Andrea Giacometti
- Infectious Diseases Clinic, Department of Biological Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | | | - Cristina Marmorale
- Department of Surgery, Marche Polytechnic University of Marche Region, Ancona, Italy
| | - Enrica Martini
- Hospital Hygiene Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Rita Murri
- Department of Infectious Diseases, Fondazione Policlinico A. Gemelli IRCCS, Istituto di Clinica delle Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy
| | - Daniela Padrini
- Clinical Administration Santa Maria Annunziata Hospital, USL Toscana Centro, Florence, Italy
| | | | - Paola Pauri
- Unit of Microbiology and Virology, Senigallia Hospital, Senigallia, AN, Italy
| | | | - Enrico Ricchizzi
- Regional Agency for Health and Social Care, Emilia-Romagna Region-ASSR, Bologna, Italy
| | - Vittorio Sambri
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.,Unit of Microbiology, The Great Romagna Area Hub Laboratory, Pievesestina, Cesena, Italy
| | | | - Walter Siquini
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Loredana Scoccia
- Unit of Hospital Pharmacy, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Giancarlo Scoppettuolo
- Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriele Sganga
- Division of Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Marcello Tavio
- Infectious Diseases Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Giulio Toccafondi
- Clinical Risk Management and Patient Safety Center, Tuscany Region, Florence, Italy
| | - Fabio Tumietto
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum"-University of Bologna, Bologna, Italy
| | - Bruno Viaggi
- Department of Anesthesiology, Neuro Intensive Care Unit, Florence Careggi University Hospital, Florence, Italy
| | - Marco Vivarelli
- Unit of Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Cristian Tranà
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | | | | | - Sameer Dhingra
- Faculty of Medical Sciences, School of Pharmacy, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
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12
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Moro ML, Ciofi Degli Atti M, D'Amore C, Diegoli G, Forni S, Gagliotti C, Gemmi F, Iannazzo S, Miraglia V, Pan A, Pantosti A, Pittalis S, Puro V, Ricchizzi E, Sarnelli B, Torti C, Zotti C. [Good practices for the surveillance and control of antimicrobial resistance]. Epidemiol Prev 2020; 43:185-193. [PMID: 31293138 DOI: 10.19191/ep19.2-3.p185.058] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Italy is one of the European Countries with the highest level of antimicrobial consumption, both in the community and in hospital settings, and with the highest prevalence of antimicrobial resistant microorganisms. In 2015, the Project "Good practices for the surveillance and control of antimicrobial resistance" was funded by the Italian National Centre for Disease Prevention and Control (CCM): the aim was to promote integrated actions at national level to control antimicrobial resistance, favouring the transfer of existing good practices. The principal objectives of the project were: to describe the Italian scenario of good practices based on literature review; to improve the capacity of surveillance, through achieving consensus on a core set of indicators, including paediatrics, and through the strengthening of the national surveillance system of antimicrobial resistance coordinated by the Italian National Institute of Health; to define tools useful for priority setting; to evaluate the efficacy of intervention programme aimed at promoting the appropriate use of antibiotics among children for upper respiratory tract infections in the community; to set up training programmes on the prudent use of antibiotics in veterinary medicine. Seven regions were enrolled in the project (Emilia-Romagna with the role of programme coordinator, Campania, Calabria, Lazio, Lombardy, Piedmont, Tuscany) and the Italian National Health Institute. The project allowed to document: the scarce spread of control practices at national level (out of 277 studies reviewed, only 6.1% of the cases were targeted to evaluating the effectiveness of intervention programmes); a significant variability among regions both in relation to antimicrobial consumption and antimicrobial resistance prevalence, with a worrying spread in some regions of several antimicrobial resistant organisms responsible for "critical" infections with great potential health impact; the effectiveness of an intervention aimed at promoting appropriate use of antibiotics in frequent infections for children in the community, such as pharingotonsillitis and acute otitis media (35% reduction of antimicrobial consumption between 2010 and 2017 in Emilia-Romagna; an inversion of the ratio amoxicillin/amoxicillin-clavulanate); the need for new indicators to monitor antimicrobial consumption in hospital paediatric wards and of a new national system for timely identification of new antimicrobial resistance profiles; a positive evaluation of the training programme for veterinary physicians. In conclusion, the project has contributed to identify the most critical areas for antimicrobial resistance control and to select appropriate solutions, potentially transferable to the national level.
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Affiliation(s)
| | | | | | - Giuseppe Diegoli
- Direzione generale cura della persona, salute e welfare della Regione Emilia-Romagna, Bologna
| | - Silvia Forni
- Agenzia regionale di sanità della Toscana, Firenze
| | | | | | - Stefania Iannazzo
- Ufficio V, Direzione generale della prevenzione, Ministero della salute, Roma
| | - Viviana Miraglia
- Direzione generale cura della persona, salute e welfare della Regione Emilia-Romagna, Bologna
| | - Angelo Pan
- Azienda ospedaliera "Istituti ospitalieri", Cremona
| | | | - Silvia Pittalis
- Istituto nazionale malattie infettive "Lazzaro Spallanzani", Roma
| | - Vincenzo Puro
- Istituto nazionale malattie infettive "Lazzaro Spallanzani", Roma
| | | | - Bruno Sarnelli
- Direzione generale tutela della salute e coordinamento del Sistema sanitario regionale della Regione Campania, Napoli
| | - Carlo Torti
- Azienda ospedaliero universitaria "Mater Domini", Catanzaro
| | - Carla Zotti
- Dipartimento di scienze della sanità pubblica e pediatriche, Università di Torino
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13
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Bechini A, Bonanni P, Moscadelli A, Lauri S, Tiscione E, Levi M, Prato R, Fortunato F, Martinelli D, Gasparini R, Panatto D, Amicizia D, Coppola RC, Pellizzari B, Tabacchi G, Costantino C, Casuccio A, Vitale F, Iannazzo S, Boccalini S. [ESCULAPIO: A project to elaborate strategies and actions of multi-purpose health communication on vaccine preventable infectious diseases in order to increase vaccination coverage in the population]. Epidemiol Prev 2020; 43:71-75. [PMID: 31111716 DOI: 10.19191/ep19.1.p71.023] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
ESCULAPIO Project, funded by the Centre for Disease Prevention and Control (CCM) of the Italian Ministry of Health, for the program 2013, aims at increasing awareness on vaccine preventable infectious diseases (VPID) and vaccination in different targets of population and at spreading the culture of prevention by the development of information/training interventions on VPID. In Tuscany Region (Central Italy), educational courses on VPID in high schools were organized and students were stimulated to prepare informative materials on VPID for lower grade school pupils. Educational games for school pupils were realized in Liguria Region (Northern Italy) with the aim to increase awareness and knowledge of vaccination among primary school children, their families, and teachers. The Sicilian Operative Unit (OU) developed and validated a questionnaire to collect data on the main factors influencing vaccine uptake in a population from Southern Italy and spreading information on vaccines to the general population. Aim of the activities performed in Apulia Region (Southern Italy) was to collect, directly from the public, a set of issues to which people were more "sensitive," in order to perceive the dimension of informative needs and the misinformation in the field of vaccinations. A toll-free telephone line to answer questions on VPID was also the aim of the Apulian activities. The objective of the OU of Sardinia (Southern Italy) was to increase knowledge on VPID and adherence to immunization campaigns in health care workers (HCW) by realizing traditional and e-learning training courses and initiatives of health promotion in healthcare and hospital setting. Interventions to promote vaccinations in maternal and child health services and outreach interventions in case of parental non-compliance with vaccination schedules were performed in the Veneto Region (Northern Italy), with the aim to reach a particular subgroup of the general population: new or future parents. The activities of Veneto Region aimed also at realizing individual interviews with parents and/or home visit, if considered useful, for families not respondents to the active ordinary call.
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Affiliation(s)
- Angela Bechini
- Dipartimento di scienze della salute, Università degli Studi di Firenze;
| | - Paolo Bonanni
- Dipartimento di scienze della salute, Università degli Studi di Firenze
| | - Andrea Moscadelli
- Dipartimento di scienze della salute, Università degli Studi di Firenze
| | - Sara Lauri
- Dipartimento di scienze della salute, Università degli Studi di Firenze
| | - Emilia Tiscione
- Dipartimento di scienze della salute, Università degli Studi di Firenze
| | - Miriam Levi
- Dipartimento di scienze della salute, Università degli Studi di Firenze
| | - Rosa Prato
- Dipartimento di scienze mediche e chirurgiche, Università di Foggia
| | | | | | - Roberto Gasparini
- Dipartimento di scienze della salute, Università degli Studi di Genova
| | - Donatella Panatto
- Dipartimento di scienze della salute, Università degli Studi di Genova
| | - Daniela Amicizia
- Dipartimento di scienze della salute, Università degli Studi di Genova
| | | | - Barbara Pellizzari
- Dipartimento di prevenzione, Azienda per l'assistenza sanitaria n. 5 "Friuli Occidentale", Pordenone
| | - Garden Tabacchi
- Dipartimento di promozione della salute, materno-infantile e medicina interna specialistica di eccellenza "G. D'Alessando", Università degli Studi di Palermo
| | - Claudio Costantino
- Dipartimento di promozione della salute, materno-infantile e medicina interna specialistica di eccellenza "G. D'Alessando", Università degli Studi di Palermo
| | - Alessandra Casuccio
- Dipartimento di promozione della salute, materno-infantile e medicina interna specialistica di eccellenza "G. D'Alessando", Università degli Studi di Palermo
| | - Francesco Vitale
- Dipartimento di promozione della salute, materno-infantile e medicina interna specialistica di eccellenza "G. D'Alessando", Università degli Studi di Palermo
| | | | - Sara Boccalini
- Dipartimento di scienze della salute, Università degli Studi di Firenze
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14
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Adamo G, Baccolini V, Massimi A, Barbato D, Cocchiara R, Di Paolo C, Mele A, Cianfanelli S, Angelozzi A, Castellani F, Salerno C, Isonne C, Bella A, Filia A, del Manso M, Baggieri M, Nicoletti L, Magurano F, Iannazzo S, Marzuillo C, Villari P. Towards elimination of measles and rubella in Italy: Progress and challenges. PLoS One 2019; 14:e0226513. [PMID: 31841530 PMCID: PMC6913993 DOI: 10.1371/journal.pone.0226513] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In the WHO European Region, endemic transmission of measles and rubella had been interrupted by 37 and 42 of the 53 member states (MSs), respectively, by 2018. Sixteen MSs are still endemic for measles, 11 for rubella and nine for both diseases, the latter including Italy. Elimination is documented by each country's National Verification Committee (NVC) through an annual status update (ASU). OBJECTIVE By analysing data used to produce the ASUs, we aimed to describe the advances made by Italy towards elimination of measles and rubella. Moreover, we propose a set of major interventions that could facilitate the elimination process. METHODS A total of 28 indicators were identified within the six core sections of the ASU form and these were evaluated for the period 2013-2018. These indicators relate to the incidence of measles/rubella; epidemiological investigation of cases; investigation of outbreaks; performance of the surveillance system; population immunity levels; and implementation of supplemental immunization activities (SIAs). RESULTS From 2013 to 2018, epidemiological and laboratory analyses of measles cases in Italy improved substantially, allowing timely investigation in 2017 and 2018 of most outbreak and sporadic cases and identification of the majority of genotypic variants. Moreover, since 2017, vaccination coverage has increased significantly. Despite these improvements, several areas of concern emerged, prompting the following recommendations: i) improve outbreak monitoring; ii) strengthen the MoRoNet network; iii) increase the number of SIAs; iv) reinforce vaccination services; v) maintain regional monitoring; vi) design effective communication strategies; vii) foster the role of general practitioners and family paediatricians. CONCLUSIONS The review of national ASUs is a crucial step to provide the NVC with useful insights into the elimination process and to guide the development of targeted interventions. Against this background, the seven recommendations proposed by the NVC have been shared with the Italian Ministry of Health and the Technical Advisory Group on measles and rubella elimination and have been incorporated into the new Italian Elimination Plan 2019-2023 as a technical aid to facilitate the achievement of disease elimination goals.
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Affiliation(s)
- Giovanna Adamo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
- * E-mail:
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Domenico Barbato
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Rosario Cocchiara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Di Paolo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Annamaria Mele
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Sara Cianfanelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Aurora Angelozzi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Fulvio Castellani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carla Salerno
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Claudia Isonne
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Antonietta Filia
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Martina del Manso
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Melissa Baggieri
- National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Loredana Nicoletti
- National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Fabio Magurano
- National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Stefania Iannazzo
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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15
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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.
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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
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16
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Iannazzo S, De Salazar V, Loffredo M, Leone F, Amato S. [Protocol proposal for the management of tuberculosis cases for healthcare Local Authority]. Ig Sanita Pubbl 2019; 75:419-427. [PMID: 32242167] [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: 06/11/2023]
Abstract
TB is still a major public health problem and a threat to global health security. In Italy, TB control is consistent with the WHO global strategy, in which the role of prevention and, within it, contacts tracing and their management are emphasized. In this work, a protocol for the correct and homogeneous management of TB cases, at local level, is described in all its phases, from reporting to contacts management. The containment of the diffusion of the infection and the prevention of new outbreaks depend on the immediate identification of the index case and the proper performance of the epidemiological investigation. For this reason, the translation of scientific evidence into Recommendations and Guidelines is essential, and of these into operational protocols for the local level, with a clear indication of actions and responsibilities.
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17
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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.
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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
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18
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Miglietta A, Fazio C, Neri A, Pezzotti P, Innocenti F, Azzari C, Rossolini GM, Moriondo M, Nieddu F, Iannazzo S, D'Ancona F, Maraglino FP, Guerra R, Rezza G, Voller F, Stefanelli P. Interconnected clusters of invasive meningococcal disease due to Neisseria meningitidis serogroup C ST-11 (cc11), involving bisexuals and men who have sex with men, with discos and gay-venues hotspots of transmission, Tuscany, Italy, 2015 to 2016. ACTA ACUST UNITED AC 2019; 23. [PMID: 30153883 PMCID: PMC6113744 DOI: 10.2807/1560-7917.es.2018.23.34.1700636] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In 2015 an increased incidence of invasive meningococcal disease due to serogroup-C (MenC) occurred in Tuscany, Italy. This led the Regional Health Authority of Tuscany to implement a reactive immunisation campaign and to launch an epidemiological field investigation aiming to address targeted immunisation interventions. In 2011–14, 10 MenC cases had been reported compared with 62 cases in 2015–16. The case fatality rate was 21% (n = 13) and 51 cases (82.3%) were confirmed as C:P1.5–1,10–8:F3–6:ST-11(cc11). Overall, 17 clusters were recognised. Six discos and four gay-venues were found to have a role as transmission-hotspots, having been attended by 20 and 14 cases in the 10 days before symptoms onset. Ten and three cases occurred, respectively, among men who have sex with men (MSM) and bisexual individuals, who were involved in 11 clusters. In addition, heterosexual cases (n = 5) attending gay-venues were also found. Secondary cases were not identified. Molecular typing indicated close relationship with MenC clusters recently described among gay, bisexual and other MSM in Europe and the United States, suggesting a possible international spread of the serogroup-C-variant P1.5–1,10–8:F3–6:ST-11(cc11) in this population-group; however, epidemiological links were not identified. In December 2016, a targeted vaccination campaign involving discos and lesbian, gay, bisexual, and transgender (LGBT) associations was implemented. During 2017, 10 cases of MenC occurred, compared with 32 and 30 cases reported in 2015 and 2016 respectively, suggesting the effectiveness of the reactive and targeted immunisation programmes.
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Affiliation(s)
- Alessandro Miglietta
- Units of Epidemiology and Preventive Medicine, Central Tuscany Health Authority, Florence, Italy.,Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.,Regional Health Agency of Tuscany, Epidemiologic Observatory, Florence, Italy
| | - Cecilia Fazio
- These authors contributed equally to this work.,Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Arianna Neri
- These authors contributed equally to this work.,Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Francesco Innocenti
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Florence, Italy
| | - Chiara Azzari
- Laboratory of Immunology and Infectious Diseases, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, and Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Maria Moriondo
- Laboratory of Immunology and Infectious Diseases, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Francesco Nieddu
- Laboratory of Immunology and Infectious Diseases, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Stefania Iannazzo
- Ministry of Health, Directorate-General of health prevention, Rome, Italy
| | - Fortunato D'Ancona
- Ministry of Health, Directorate-General of health prevention, Rome, Italy.,Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Raniero Guerra
- Ministry of Health, Directorate-General of health prevention, Rome, Italy
| | - Giovanni Rezza
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Fabio Voller
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Florence, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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19
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D'Ancona F, D'Amario C, Maraglino F, Rezza G, Ricciardi W, Iannazzo S. Introduction of new and reinforcement of existing compulsory vaccinations in Italy: first evaluation of the impact on vaccination coverage in 2017. ACTA ACUST UNITED AC 2019; 23. [PMID: 29871721 DOI: 10.2807/1560-7917.es.2018.23.22.1800238] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 11/20/2022]
Abstract
In June 2017, a decree-law to increase the number of mandatory vaccinations from 4 to 10 for minors up to 16-years-old was issued in Italy. The vaccination coverage for 2017 showed a positive impact for all the vaccines, particularly for the measles, mumps and rubella vaccine at 91.6% for the year 2017, showing a 4.4% increase compared with 2016 (87.2%). Continued monitoring is needed to evaluate the medium to long-term effects of the law.
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20
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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.
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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
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21
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Adamo G, Sturabotti G, Baccolini V, de Soccio P, Prencipe GP, Bella A, Magurano F, Iannazzo S, Villari P, Marzuillo C. Regional reports for the subnational monitoring of measles elimination in Italy and the identification of local barriers to the attainment of the elimination goal. PLoS One 2018; 13:e0205147. [PMID: 30356247 PMCID: PMC6200208 DOI: 10.1371/journal.pone.0205147] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/20/2018] [Indexed: 01/07/2023] Open
Abstract
Although most countries in the WHO European Region were verified in 2017 as having interrupted endemic measles transmission, nine countries were still endemic. Among these, Italy accounted for the second highest number of measles cases reported in Europe in 2017. The elimination of measles is verified at national level by each country's National Verification Committee (NVC) through the production of an Annual Status Update (ASU). Since in Italy decentralization has led to an inhomogeneous implementation of immunization strategies among the 21 administrative Regions, the Italian NVC proposed that measles elimination should also be documented at the subnational level through regional ASUs and Synthetic Regional Reports (SRRs). The regional ASUs and the SRRs for 2014, 2015 and 2016 were produced and appraised by the NVC to evaluate the Regions' performances in each individual year as well as over the whole period. A specific analysis of vaccination coverage, including official immunization data for 2017, was performed. Moreover, the measles epidemic of 2017 was examined. Firstly, in the period 2014-2016, low immunization rates were registered in most Regions. Sixty-three per cent of southern Regions reported rates below the national mean and an overall low-quality performance. The approval of Italy's mandatory vaccination law in 2017 resulted in a marked increase in vaccination coverage; however, this increase was not homogeneous among Regions. Secondly, more than 50% of Regions did not report any supplemental immunization activity (SIA) for the period 2014-2016. Thirdly, from 2014 to 2016, fewer than one-third of Regions improved their reporting of outbreaks. Finally, over the study period, only two Regions reached the target required by the WHO for measles laboratory investigations. In countries with decentralized health policies, subnational monitoring can help identify local barriers to measles elimination. In Italy it has highlighted the need for further SIAs and a stronger surveillance system.
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Affiliation(s)
- Giovanna Adamo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giulia Sturabotti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Pasquale de Soccio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Grazia Pia Prencipe
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Fabio Magurano
- National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Stefania Iannazzo
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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22
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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.
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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
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23
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Signorelli C, Odone A, Cella P, Iannazzo S, D'Ancona F, Guerra R. Infant immunization coverage in Italy (2000-2016). Ann Ist Super Sanita 2018; 53:231-237. [PMID: 28956803 DOI: 10.4415/ann_17_03_09] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In Italy, national-level immunization polices are included in the National Immunization Prevention Plan (PNPV), whose latest edition - 2017-2019 PNPV - was finally approved in February 2017. Coverage rates are a key measure of immunization system performance; it can inform and support national and regional polices' implementation monitoring, as well as measure the impact of interventions aimed at increasing vaccine uptake. METHODS We collected, analysed and critically interpreted 2000-2016 Italian national infant immunization coverage trends, by different vaccine, target population, and by Region. Data were provided by the Directorate General for Prevention of the Italian Ministry of Health. RESULTS In 2016, none of the mandatory or recommended vaccines reached the 95% national coverage target set in the PNPV. Weighted average national coverage for currently mandatory vaccines (against Polio, Tetanus, Diphtheria, Hepatitis B) and other antigens included in the hexavalent vaccine (Pertussis, and Haemophilus influenzae type b) ranged between 93.0% for Hepatitis B and 93.7% for Tetanus; it was lower for Measles, Mumps and Rubella vaccines (87.2%), pneumococcal (88.4%) and meningococcal C conjugate vaccines (80.7%), with a high degree of heterogeneity by Region. Both hexavalent and MMR vaccines coverage rates have been decreasing in the last years, respectively from 2012 (-2.8%) and from 2010 (-3.6%). DISCUSSION Further efforts are needed to increase vaccine uptake in Italy, to improve data collection and reporting, as well as to fight the growing phenomenon of the vaccine hesitancy so that PNPV's objectives and targets can be met in the near future.
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Affiliation(s)
- Carlo Signorelli
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Parma, Italy - Università Vita-Salute San Raffaele, Milan, Italy
| | - Anna Odone
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Parma, Italy
| | - Paola Cella
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Parma, Italy
| | - Stefania Iannazzo
- Direzione Generale della Prevenzione Sanitaria, Ministero della Salute, Rome, Italy
| | - Fortunato D'Ancona
- Direzione Generale della Prevenzione Sanitaria, Ministero della Salute, Rome, Italy
| | - Raniero Guerra
- Direzione Generale della Prevenzione Sanitaria, Ministero della Salute, Rome, Italy
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24
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Menichetti F, Falcone M, Lopalco P, Tascini C, Pan A, Busani L, Viaggi B, Rossolini GM, Arena F, Novelli A, De Rosa F, Iannazzo S, Cohen J. The GISA call to action for the appropriate use of antimicrobials and the control of antimicrobial resistance in Italy. Int J Antimicrob Agents 2018; 52:127-134. [PMID: 29802887 DOI: 10.1016/j.ijantimicag.2018.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/17/2018] [Accepted: 05/12/2018] [Indexed: 12/21/2022]
Abstract
The spread of antibiotic resistance is one of the leading public health problems in Italy. A European Centre for Disease Prevention and Control country visit recently confirmed the major challenges and made important suggestions. In response, the Ministry of Health published the National Plan for Antimicrobial Resistance Containment, and a group of experts belonging to the Italian Group of Antimicrobial Stewardship (GISA) convened to develop a summary of practical recommendations. The GISA document is intended for use by practising physicians; it aims to increase the rational use of antimicrobials in the treatment of infections, and to change the culture of infection control of antibiotic-resistant bacteria, through the translation of theoretical knowledge into priority actions. This document has been endorsed by several national scientific societies, and reflects the particular challenges that are faced in Italy. Nevertheless, it is considered that the general principles and approaches discussed are relevant, particularly to other developed economies.
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Affiliation(s)
- Francesco Menichetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Marco Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Pierluigi Lopalco
- Hygiene and Epidemiology Section, Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Carlo Tascini
- Department of Infectious Diseases, Cotugno Hospital, Naples, Italy
| | - Angelo Pan
- Infectious Diseases, Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Luca Busani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Bruno Viaggi
- NeuroAnesthesia and Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Fabio Arena
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Andrea Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | | | - Stefania Iannazzo
- Department of Prevention and Innovation, General Direction, Italian Ministry of Health, Rome, Italy
| | - Jonathan Cohen
- Department of Medicine, Brighton & Sussex Medical School, Brighton, UK
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25
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Martinelli D, Fortunato F, Iannazzo S, Cappelli MG, Prato R. Using Routine Data Sources to Feed an Immunization Information System for High-Risk Patients-A Pilot Study. Front Public Health 2018; 6:37. [PMID: 29503815 PMCID: PMC5820309 DOI: 10.3389/fpubh.2018.00037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/31/2018] [Indexed: 02/03/2023] Open
Abstract
Background Vaccine-preventable diseases among high-risk patients are a public health priority in high-income countries. Most national immunization programs have included vaccination recommendations for these population groups but they remain hard-to-reach and coverage data are poorly available. In a pilot study, we developed and tested an automated approach for identifying individuals with underlying medical conditions to feed an immunization information system (IIS). Methods We reviewed published recommendations on medical conditions that indicate vaccination against influenza, pneumococcal disease, meningococcal disease, hepatitis A, and hepatitis B. For each medical condition, we identified the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes, the user fee exempt codes and the Anatomical Therapeutic Chemical Classification System codes and we reported these data in correspondence tables. Using these tables, we extracted three lists of patients recorded in three current data sources between 2001 and 2010 in the Apulia region of Italy: the hospital discharge registry, the user fee exempt registry, and the drug prescription registry. Using a unique personal identification number, we linked these three lists of patients with the regional IIS (2012 database), obtaining a list of patients with chronic diseases eligible for vaccination. We tested completeness, sensitivity, and positive predictive value (PPV) of this approach by asking a sample of 28 general practitioners (GPs) to evaluate the matching between a sublist of patients with clinical recommendations for influenza vaccination and the GPs individual subjects medical records. Results We included a total of 1,204,496 subjects with underlying medical conditions eligible to receive any of the aforementioned vaccinations. Of these, 9% were identified in all three data sources, 18% in two sources, and 73% in one source. The completeness of this automated process in identifying GPs high-risk patients eligible for influenza vaccination was 88.9% [95% confidence intervals (95% CI): 88.1–89.8%], with a sensitivity of 69.2% (95% CI: 67.7–70.6%) and a PPV of 85.7% (95% CI: 84.4–86.8%). Conclusion The high completeness of the methodology used for identifying high-risk patients in current data sources encouraged us to apply this approach for feeding the regional IIS.
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Affiliation(s)
- Domenico Martinelli
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesca Fortunato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Stefania Iannazzo
- Directorate-General of Health Prevention, Ministry of Health, Rome, Italy
| | | | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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26
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Signorelli C, Iannazzo S, Odone A. The imperative of vaccination put into practice. The Lancet Infectious Diseases 2018; 18:26-27. [DOI: 10.1016/s1473-3099(17)30696-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 11/02/2017] [Indexed: 11/27/2022]
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27
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Bechini A, Bonanni P, Lauri S, Tiscione E, Levi M, Prato R, Fortunato F, Martinelli D, Gasparini R, Panatto D, Amicizia D, Coppola RC, Pellizzari B, Tabacchi G, Costantino C, Vitale F, Iannazzo S, Boccalini S. Strategies and actions of multi-purpose health communication on vaccine preventable infectious diseases in order to increase vaccination coverage in the population: The ESCULAPIO project. Hum Vaccin Immunother 2017; 13:369-375. [PMID: 28215120 DOI: 10.1080/21645515.2017.1268008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/20/2022] Open
Abstract
The ESCULAPIO Project aims at increasing awareness on vaccine preventable infectious diseases (VPID) and vaccinations in different target populations and to spread the culture of prevention. Information/training interventions on VPID have been developed and health promotion activities for the general population, students and their parents, teachers and health care workers (HCWs) were set up. In Tuscany, educational courses on VPID in high schools were organized and students were stimulated to prepare informative materials on VPID for lower grade school pupils. In Liguria, an educational card game (named 'Vaccine at the Fair') was presented to children of primary schools. Stands in shopping centers were used in Palermo to distribute the regional vaccination schedule and gadgets, also providing indications on reliable websites where to find correct information on vaccinations. A music video played by health care workers (HCWs) was created and used in the University Hospital of Cagliari to promote the anti-flu vaccination campaign in HCWs. In Apulia, meetings with the general population were organized to collect controversial issues about vaccinations and a national call center was launched to create a direct line from the general population to experts in vaccines and vaccination strategies. In Veneto, meetings in the birth centers and home visits for subjects refusing vaccination have been organized. All activities are useful and effective tools to increase knowledge about VPID and confidence in vaccination, which are crucial aspects in order to increase vaccine uptake. The project was funded by the Italian Ministry of Health, Center for Disease Prevention and Control (CCM) in 2013.
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Affiliation(s)
- Angela Bechini
- a Department of Health Sciences , University of Florence , Florence , Italy
| | - Paolo Bonanni
- a Department of Health Sciences , University of Florence , Florence , Italy
| | - Sara Lauri
- a Department of Health Sciences , University of Florence , Florence , Italy
| | - Emilia Tiscione
- a Department of Health Sciences , University of Florence , Florence , Italy
| | - Miriam Levi
- a Department of Health Sciences , University of Florence , Florence , Italy
| | - Rosa Prato
- b Department of Medical and Surgical Sciences , University of Foggia , Foggia , Italy
| | - Francesca Fortunato
- b Department of Medical and Surgical Sciences , University of Foggia , Foggia , Italy
| | - Domenico Martinelli
- b Department of Medical and Surgical Sciences , University of Foggia , Foggia , Italy
| | - Roberto Gasparini
- c Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Donatella Panatto
- c Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Daniela Amicizia
- c Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Rosa Cristina Coppola
- d Department of Public Health , Clinical and Molecular Medicine, University of Cagliari , Cagliari , Italy
| | - Barbara Pellizzari
- e Regional Center for Disease Prevention and Control, Veneto Region , Venezia , Italy
| | - Garden Tabacchi
- f Department of Science for Health Promotion and Mother to Child Care G. d'Alessandro , University of Palermo , Palermo , Italy
| | - Claudio Costantino
- f Department of Science for Health Promotion and Mother to Child Care G. d'Alessandro , University of Palermo , Palermo , Italy
| | - Francesco Vitale
- f Department of Science for Health Promotion and Mother to Child Care G. d'Alessandro , University of Palermo , Palermo , Italy
| | | | - Sara Boccalini
- a Department of Health Sciences , University of Florence , Florence , Italy
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Adamo G, Sturabotti G, De Soccio P, Prencipe GP, Sciarra I, Baccolini V, Massimi A, Marzuillo C, Iannazzo S, Villari P. [The elimination of measles and rubella in Italy]. Ig Sanita Pubbl 2017; 73:429-442. [PMID: 29433130] [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: 06/08/2023]
Abstract
Despite the WHO target for measles and rubella elimination in 2015, outbreaks still occur in all WHO Regions. After a description of the epidemiological situation of measles and rubella worldwide and especially in Europe, this paper aims to provide a detailed analysis of the current epidemiological context of Italy. The surge in the number of measles cases since the beginning of 2017, together with vaccination coverage still far from the 95% target, requires priority actions to be taken to achieve the elimination goals. Alongside the recently approved decree reintroducing compulsory vaccinations for school admissions, further measures are needed and should include the increase in the commitment of the 21 Regions; the implementation of supplemental immunization activities; improving the communication skills of health care workers; ensuring an effective communication with citizens; the enhancement of the surveillance network.
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Affiliation(s)
- Giovanna Adamo
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Italia
| | - Giulia Sturabotti
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Italia
| | - Pasquale De Soccio
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Italia
| | - Grazia Pia Prencipe
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Italia
| | - Iliana Sciarra
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Italia
| | - Valentina Baccolini
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Italia
| | - Azzurra Massimi
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Italia
| | - Carolina Marzuillo
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Italia
| | - Stefania Iannazzo
- Ufficio Prevenzione Malattie Trasmissibili e Profilassi Internazionale, Ministero della Salute, Roma, Italia
| | - Paolo Villari
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Italia
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Magurano F, Baggieri M, Filia A, Del Manso M, Lazzarotto T, Amendola A, D'Agaro P, Chironna M, Ansaldi F, Iannazzo S, Bucci P, Marchi A, Nicoletti L. Towards measles elimination in Italy: Virological surveillance and genotypes trend (2013-2015). Virus Res 2017; 236:24-29. [PMID: 28522332 DOI: 10.1016/j.virusres.2017.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 11/25/2022]
Abstract
In accordance with the goal of the World Health Organization Regional Office for Europe, the Italian National Measles and Rubella Elimination Plan aimed to interrupt indigenous measles transmission in Italy by the end of 2015. However, from 2013 to 2015, Italy experienced high measles burden with 4902 measles cases (49.3% laboratory-confirmed) reported to the enhanced measles surveillance system (cumulative incidence in the triennium reference period: 2.4/100,000 population). The measles elimination goal was not reached. Laboratory surveillance of measles circulating genotypes is performed by the Measles and Rubella National Reference Laboratory (NRL) at the Italian National Institute of Health (Istituto Superiore di Sanità - ISS), in Rome. Samples received from 1 January 2013-31 December 2015 were analysed. Those positive for measles genome by molecular tests were sequenced and phylogenetically analysed. Phylogenetic analysis performed by NRL identified that genotypes D4 and D8 were endemic and co-circulated in 2011-2013: study results show that genotype D4 disappeared during 2013. Sporadic cases were associated to genotype B3 during 2011-2013, which became endemic in Italy during 2014 and co-circulated with D8 until 2015. Sporadic cases were found belonging to genotypes D9 and H1 all over the period in exam. Similar trend has been observed in European WHO Region.
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Affiliation(s)
- Fabio Magurano
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Melissa Baggieri
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Antonietta Filia
- Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Martina Del Manso
- Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Tiziana Lazzarotto
- DIMES, Operative Unit of Clinical Microbiology, Laboratory of Virology St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy.
| | - Antonella Amendola
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Pierlanfranco D'Agaro
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy; Institute for Maternal and Child Health-IRCCS "Burlo". Garofolo", Trieste, Italy.
| | - Maria Chironna
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy.
| | | | - Stefania Iannazzo
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy.
| | - Paola Bucci
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Antonella Marchi
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Loredana Nicoletti
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
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30
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Scavia G, Alfonsi V, Taffon S, Escher M, Bruni R, Medici DD, Pasquale SD, Guizzardi S, Cappelletti B, Iannazzo S, Losio NM, Pavoni E, Decastelli L, Ciccaglione AR, Equestre M, Tosti ME, Rizzo C, National Italian Task Force On Hepatitis A. A large prolonged outbreak of hepatitis A associated with consumption of frozen berries, Italy, 2013-14. J Med Microbiol 2017; 66:342-349. [PMID: 28086079 DOI: 10.1099/jmm.0.000433] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE In 2013/2014, Italy experienced one of the largest community-wide prolonged outbreaks of hepatitis A virus (HAV) throughout the country. The article provides a comprehensive description of the outbreak and the investigation carried out by a multidisciplinary National Task Force, in collaboration with regional and local public health authorities. Control strategies of food-borne HAV infection in both the human and food sectors are also described. METHODOLOGY Enhanced human epidemiological and microbiological surveillance together with microbiological monitoring of HAV in food and trace-back investigation were conducted. RESULTS A total of 1803 HAV cases were identified from 1 January 2013 to 31 August 2014, in Italy. Sequencing was possible for 368 cases (20.4 %), mostly collected between 1 January 2013 and 28 February 2014, and 246 cases (66.8 %) harboured an HAV outbreak strain. Imported frozen berries contaminated with HAV were identified as the vehicle of the outbreak which also involved many other European countries in 2013 and 2014. Epidemiological evidence obtained through a case-control study was supported by the finding of a 100 % nucleotide similarity of the VP1/2A sequences of HAVs detected in human and food samples. Trace-back investigation revealed an extremely complex supplying network with no possibility for a point source potentially explaining the vast contamination of berries found in Italy. CONCLUSION The investigation benefited from an excellent collaboration among different sectors who shared proactively the available information. Our findings highlight the importance of considering frozen berries among the highest risk factors for HAV.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Nadia Marina Losio
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna, Brescia, Italy
| | - Enrico Pavoni
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna, Brescia, Italy
| | - Lucia Decastelli
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Turin, Italy
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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.
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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
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Boccalini S, Alicino C, Martinelli D, Bechini A, Tiscione E, Pellizzari B, Prato R, Icardi G, Iannazzo S, Bonanni P. Clinical and economic impact of herpes zoster vaccination in elderly in Italy. Hum Vaccin Immunother 2016; 13:405-411. [PMID: 27925856 DOI: 10.1080/21645515.2017.1264832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/20/2022] Open
Abstract
Herpes zoster (HZ) is a very relevant pathology among elderly people (≥ 60 years of age), with a considerable disease burden and loss of quality of life. In the last years a new vaccine against HZ became available in Italy. Therefore, the Italian decision makers are now confronted with the decision whether that vaccination should be implemented. Pharmaco-economic analyses represent useful tools to value the feasibility of new immunization programs and their sustainability. To this aim, an ad hoc population model was developed in order to value the clinical and economic impact of HZ vaccination program for the elderly in Italy. Particularly, different immunization scenarios were modeled: vaccination of 60 years-old subjects (single cohort strategy), simultaneous vaccination of people aged 60 and 65 years (double cohort strategy) and, lastly, immunization of people aged 60, 65 and 70 years (triple cohort strategy), thus leading to the vaccination of 5, 10 and 15 cohorts during the first 5 years of the program. The mathematical model valued the clinical impact of vaccination on the number of HZ, post-herpetic neuralgia (PHN) and ophthalmic HZ. The results of the analysis show that, in Italy, a cohort-based HZ vaccination program in elderly could have a relevant impact on the reduction of clinical cases and a favorable economic profile for the National Health Service (NHS), as already foreseen in other countries. In addition, further benefits could be obtained when extending the study period beyond the 5-year horizon of our analysis.
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Affiliation(s)
- Sara Boccalini
- a Department of Health Sciences , University of Florence , Florence , Italy
| | - Cristiano Alicino
- b Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Domenico Martinelli
- c Department of Medical and Surgical Sciences , University of Foggia , Foggia , Italy
| | - Angela Bechini
- a Department of Health Sciences , University of Florence , Florence , Italy
| | - Emilia Tiscione
- a Department of Health Sciences , University of Florence , Florence , Italy
| | - Barbara Pellizzari
- d Regional Center for Disease Prevention and Control , Veneto Region , Italy
| | - Rosa Prato
- c Department of Medical and Surgical Sciences , University of Foggia , Foggia , Italy
| | - Giancarlo Icardi
- b Department of Health Sciences , University of Genoa , Genoa , Italy
| | | | - Paolo Bonanni
- a Department of Health Sciences , University of Florence , Florence , Italy
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Alicino C, Trucchi C, Paganino C, Barberis I, Boccalini S, Martinelli D, Pellizzari B, Bechini A, Orsi A, Bonanni P, Prato R, Iannazzo S, Icardi G. Incidence of herpes zoster and post-herpetic neuralgia in Italy: Results from a 3-years population-based study. Hum Vaccin Immunother 2016; 13:399-404. [PMID: 27925843 PMCID: PMC5328218 DOI: 10.1080/21645515.2017.1264834] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Herpes Zoster (HZ) and its main complication, post-herpetic neuralgia (PHN), represent important public health issues because of their relevant burden among older adults. However, data on the epidemiology of HZ and PHN in Italy are very limited. A population-based study was performed by seeking for cases of HZ and PHN, occurred in the period 2013-2015, in the clinical charts of 56 General Practitioners working in 4 Italian Regions (Liguria, Puglia, Toscana and Veneto). The main objective of the study was to estimate the incidence of HZ and the proportion of PHN (at 1 and 3 mo from the onset of HZ; PHN1 and PHN3) among people aged ≥ 50 y. Overall, 598 cases of HZ were identified over 93,146 person-years of observation, thus corresponding to an overall incidence of 6.42 (IC95%: 5.93 – 6.95) HZ cases per 1,000 person-years. The incidence of HZ increased with age and was higher in female than in male. In total, 22.7%, 12.7%, and 2.4% of HZ cases suffered PHN at 1 and 3 mo and 1 y from the onset of acute episode. The proportions of these complications significantly increased with age, with the peak occurring in people aged ≥ 85 y. Four per cent of patients suffered ophthalmic zoster. The study provided an update of the epidemiological burden of HZ and PHN in Italy, confirming the relevant burden of the disease in the elderly population. The study was funded by the Italian Ministry of Health, Center for Disease Prevention and Control (CCM) in 2013.
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Affiliation(s)
- Cristiano Alicino
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Cecilia Trucchi
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Chiara Paganino
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Ilaria Barberis
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Sara Boccalini
- b Department of Health Sciences , University of Florence , Florence , Italy
| | - Domenico Martinelli
- c Department of Medical and Surgical Sciences , University of Foggia , Foggia , Italy
| | - Barbara Pellizzari
- d Regional Center for Disease Prevention and Control , Veneto Region , Italy
| | - Angela Bechini
- b Department of Health Sciences , University of Florence , Florence , Italy
| | - Andrea Orsi
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Paolo Bonanni
- b Department of Health Sciences , University of Florence , Florence , Italy
| | - Rosa Prato
- c Department of Medical and Surgical Sciences , University of Foggia , Foggia , Italy
| | | | - Giancarlo Icardi
- a Department of Health Sciences , University of Genoa , Genoa , Italy
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Stefanelli P, Miglietta A, Pezzotti P, Fazio C, Neri A, Vacca P, Voller F, D'Ancona FP, Guerra R, Iannazzo S, Pompa MG, Rezza G. Increased incidence of invasive meningococcal disease of serogroup C / clonal complex 11, Tuscany, Italy, 2015 to 2016. ACTA ACUST UNITED AC 2016; 21:30176. [PMID: 27035155 DOI: 10.2807/1560-7917.es.2016.21.12.30176] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/24/2016] [Indexed: 11/20/2022]
Abstract
We report an increase of serogroup C Neisseria meningitidis invasive meningococcal disease in Tuscany. From January 2015 to end February 2016, 43 cases were reported, among which 10 were fatal, compared to two cases caused by serogroup C recorded in 2014 and three in 2013. No secondary cases occurred. Thirty-five strains belonged to C:P1.5-1,10-8:F3-6:ST-11(cc11). Control measures have been adopted and immunisation campaigns implemented. Studies on risk factors and carriage are ongoing.
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Affiliation(s)
- Paola Stefanelli
- Department of Infectious, Parasitic & Immuno-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
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Magurano F, Baggieri M, Bordi L, Lalle E, Chironna M, Lazzarotto T, Amendola A, Baldanti F, Ansaldi F, Filia A, Declich S, Iannazzo S, Pompa MG, Bucci P, Marchi A, Nicoletti L. Measles in Italy: Co-circulation of B3 variants during 2014. J Med Virol 2015; 88:1081-5. [PMID: 26496509 DOI: 10.1002/jmv.24416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 11/09/2022]
Abstract
In 2013, the majority of the WHO/EUR countries reported an annual incidence of >1 case per one million population indicating that the elimination target is far from being met. Thus, there is the urgent need to uncover and analyze chains of measles virus (MV) transmission with the objective to identify vulnerable groups and avoid possible routes of introduction of MV variants in the European population. The analysis of molecular epidemiology of MV B3 strains identified in 2014 has shown that four different variants co-circulated in Italy, including the strain that caused a cruise-line ship outbreak at the beginning of the year.
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Affiliation(s)
- Fabio Magurano
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Melissa Baggieri
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Licia Bordi
- Laboratory of Virology, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Eleonora Lalle
- Laboratory of Virology, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Maria Chironna
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Tiziana Lazzarotto
- DIMES, Operative Unit of Clinical Microbiology, Laboratory of Virology St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy
| | - Antonella Amendola
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Fausto Baldanti
- Department of Microbiology and Virology, Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Antonietta Filia
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
| | - Silvia Declich
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
| | - Stefania Iannazzo
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy
| | - Maria Grazia Pompa
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy
| | - Paola Bucci
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Antonella Marchi
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Loredana Nicoletti
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
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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.
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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
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Bonanni P, Ferro A, Guerra R, Iannazzo S, Odone A, Pompa MG, Rizzuto E, Signorelli C. Vaccine coverage in Italy and assessment of the 2012-2014 National Immunization Prevention Plan. Epidemiol Prev 2015; 39:146-158. [PMID: 26499433] [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: 06/05/2023]
Abstract
BACKGROUND In 2012, the ItalianMinistry of Health issued the National Immunization Prevention Plan (Piano Nazionale Prevenzione Vaccinale, or PNPV 2012-2014), with the aim of harmonizing immunization strategies across the country and ensuring equitable access to infectious disease prevention to all citizens. The Plan defines the immunization standards all regions should comply with. OBJECTIVE AND METHODS As new evidence has accumulated in the field of immunization, and the new National Immunization Prevention Plan is about to be launched, the aim of the current study is to: i. present immunization coverage data (2000-2014) for 14 vaccines included in the PNPV to be offered to the general population, ii. assess to what extent the PNPV coverage targets and objectives have been met, and iii. report on how the PNPV was transposed into regional immunization programs. Data are also available for the eight regions that piloted varicella immunization. RESULTS The 2012-2014 PNPV first introduced a "lifecourse" approach to vaccination at the institutional level, and has been a milestone for prevention in the Italian health policy agenda. However, infant vaccine coverage rates have been decreasing over the last years, as has influenza immunization in the elderly. HPV vaccine coverage has been increasing for all birth cohorts, but is still far below the targets set in the Plan. Promising preliminary data show that pneumococcal and meningococcal C conjugate vaccines were well introduced in regional immunization schedules. CONCLUSION The 2012-2014 PNPV objectives have only been partially met, due to several factors, in particular increase in vaccine hesitancy. Strengthened efforts are needed to promote immunization. The new National Immunization Prevention Plan should introduce new vaccines and extend immunization programs to other target populations on the basis of the most recent scientific evidence available. It is of crucial importance that interventions of proven efficacy be planned and implemented to contrast the growing phenomenon of vaccine hesitancy and ultimately increase immunization uptake.
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Affiliation(s)
- Paolo Bonanni
- Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica (SItI)
| | - Antonio Ferro
- Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica (SItI)
| | - Raniero Guerra
- Direzione generale della prevenzione sanitaria, Ministero della salute, Roma, Italy
| | - Stefania Iannazzo
- Direzione generale della prevenzione sanitaria, Ministero della salute, Roma, Italy
| | - Anna Odone
- Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica (SItI).
| | - Maria Grazia Pompa
- Direzione generale della prevenzione sanitaria, Ministero della salute, Roma, Italy
| | - Elvira Rizzuto
- Direzione generale della prevenzione sanitaria, Ministero della salute, Roma, Italy
| | - Carlo Signorelli
- Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica (SItI)
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D'Ancona F, Caporali MG, Del Manso M, Giambi C, Camilli R, D'Ambrosio F, Del Grosso M, Iannazzo S, Rizzuto E, Pantosti A. Invasive pneumococcal disease in children and adults in seven Italian regions after the introduction of the conjugate vaccine, 2008-2014. Epidemiol Prev 2015; 39:134-138. [PMID: 26499431] [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: 06/05/2023]
Abstract
OBJECTIVE To describe the trend of invasive pneumococcal disease in the years 2008-2014; to verify the impact of the conjugate vaccine and monitor the occurrence of serotype replacement. DESIGN Prospective observational study based on data from the national surveillance for invasive bacterial diseases coordinated by the Istituto superiore di sanità. SETTING AND PARTICIPANTS Seven Italian regions (A.P. Bolzano, A.P. Trento, Emilia-Romagna, Friuli-Venezia Giulia, Lombardia, Piemonte, Veneto), accounting for 43% of the national population. MAIN OUTCOME MEASURES Number of cases and incidence of invasive pneumococcal diseases: global, stratified by age groups and by serotypes included or not in the PCV13. RESULTS In 2008-2014, in the 0-4 age group IPD incidence for all serotypes decreased from 7.1 to 2.9/100,000; incidence for vaccine serotypes (VT) decreased from 5.5 to 1.1/100,000, while incidence for non-vaccine serotypes (NVT) increased from 1.6 to 2.0/100,000 (2.5 in 2013). In the >64 age group, IPD incidence increased from 5.3 to 7.5/100,000; VT incidence decreased from 3.9 to 3.2 (4.9 in 2010 and 4.3 in 2013), whereas NVT incidence increased from 1.4 to 4.4/100,000. CONCLUSION Use of the conjugate vaccine has reduced the number of cases of IPD by VT in children; the increase in IPD by NVT, above all in older age groups, suggests a serotype replacement.
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Affiliation(s)
| | | | | | | | - Romina Camilli
- Dip. Malattie infettive, parassitarie e immunomediate, Istituto superiore di sanità, Roma, Italy
| | - Fabio D'Ambrosio
- Dip. Malattie infettive, parassitarie e immunomediate, Istituto superiore di sanità, Roma, Italy
| | - Maria Del Grosso
- Dip. Malattie infettive, parassitarie e immunomediate, Istituto superiore di sanità, Roma, Italy
| | - Stefania Iannazzo
- Direzione generale della prevenzione, Ministero della salute, Roma, Italy
| | - Elvira Rizzuto
- Direzione generale della prevenzione, Ministero della salute, Roma, Italy
| | - Annalisa Pantosti
- Dip. Malattie infettive, parassitarie e immunomediate, Istituto superiore di sanità, Roma, Italy
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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]
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40
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Fortuna C, Baggieri M, Marchi A, Benedetti E, Bucci P, Del Manso M, Declich S, Iannazzo S, Pompa MG, Nicoletti L, Magurano F. Measles in Italy, laboratory surveillance activity during 2010. Ann Ist Super Sanita 2014; 50:341-4. [PMID: 25522074 DOI: 10.4415/ann_14_04_08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The European Regional Office of the World Health Organization (WHO/Europe) developed a strategic approach to stop the indigenous transmission of measles in its 53 Member States by 2015. This study describes the measles laboratory surveillance activity performed by the National Reference Laboratory for Measles and Rubella at the Italian National Institute of Health (Istituto Superiore di Sanità) during 2010. METHODS Urine, oral fluid and capillary blood samples from 211 suspected measles cases arrived to the NRL from different regions of Italy for confirmation of the clinical diagnosis. Serological and/or molecular assays were performed; after molecular detection, positive samples were sequenced and genotyped. RESULTS AND DISCUSSION 85% (180/211) of the specimens were confirmed as measles cases and 139 of these were analyzed phylogenetically. The phylogenetic analysis revealed a co-circulation of D4 and D8 genotypes for the reviewed period.
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Affiliation(s)
- Claudia Fortuna
- Dipartimento di Malattie Infettive, Parassitarie ed Immunomediate, Istituto Superiore di Sanità, Rome, Italy
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41
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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
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42
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Iannazzo S, Rizzuto E, Pompa MG. [Polio vaccination failure in Italy, years 2006-2010]. Epidemiol Prev 2014; 38:98-102. [PMID: 25759353] [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: 06/04/2023]
Abstract
OBJECTIVE The purpose of this paper is to describe the lack of antipolio vaccination and its reasons, in the period 2006-2010. STUDY DESIGN, SETTING AND PARTICIPANTS. Until 2014 the data on vaccination activities, aggregated at the regional level, were sent to the Ministry of Health using a paper form used to collect the data and then to calculate vaccine coverage (CV) at 24 months. This form contains a section for identifying the reasons for polio vaccination failure. RESULTS During the reporting period the national CV was always above 95%. The highest rates of non-vaccination were always observed in the same Region. Polio vaccination failure is well explained in 82%of cases, but only three Regions have always provided an explanation, while two have extremely low percentages of explanation, less than 50%. The dominant mode is «noncompliant » (45.5%), followed by «undetectable» (26.5%). CONCLUSIONS The percentage of explanation of non-vaccination was lower than expected. At the moment we cannot clarify why, but only speculate that the lack of a computerized immunization registry has been a key element. Probably, the form used was not sufficiently detailed to monitor the phenomenon of non-vaccination and program interventions. Updating the form, in 2013, we took into account these and other critical issues.
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Affiliation(s)
- Stefania Iannazzo
- Ufficio V, Malattie infettive e profilassi internazionale, Direzione generale della prevenzione sanitaria, Ministero della salute.
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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
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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
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44
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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
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45
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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.
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46
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Filia A, Bella A, Rota M, Tavilla A, Magurano F, Baggieri M, Nicoletti L, Iannazzo S, Pompa M, Declich S. Analysis of national measles surveillance data in Italy from October 2010 to December 2011 and priorities for reaching the 2015 measles elimination goal. Euro Surveill 2013; 18:20480. [PMID: 23725868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
From 1 October 2010 to 31 December 2011, Italy experienced high measles burden with 5,568 measles cases (37.4% laboratory-confirmed) reported to the enhanced measles surveillance system (cumulative incidence in the 15-month reference period: 9.2/100,000 population). Adolescents and young adults were especially affected, and the median age of cases was 18 years. Most cases (95.8%) were either unvaccinated or incompletely vaccinated. Complications were reported for 20.3% of cases, including 135 cases of pneumonia, seven of encephalitis and one case of Guillain–Barré syndrome. One death occurred in an immunocompromised adult. Over 1,300 cases were hospitalised. Identified priorities for reaching the measles elimination goal include evidence-based interventions such as reminder/recall for both doses of measles vaccine, supplementary immunisation activities aimed at susceptible age cohorts, and vaccinating healthcare workers.
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Affiliation(s)
- A Filia
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy.
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47
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Filia A, Bella A, Rota MC, Tavilla A, Magurano F, Baggieri M, Nicoletti L, Iannazzo S, Pompa MG, Declich S. Analysis of national measles surveillance data in Italy from October 2010 to December 2011 and priorities for reaching the 2015 measles elimination goal. Euro Surveill 2013. [DOI: 10.2807/ese.18.20.20480-en] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- A Filia
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
| | - A Bella
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
| | - M C Rota
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
| | - A Tavilla
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
| | - F Magurano
- Viral Diseases and Attenuated Vaccines Unit, National Institute of Health, Rome, Italy
| | - M Baggieri
- Viral Diseases and Attenuated Vaccines Unit, National Institute of Health, Rome, Italy
| | - L Nicoletti
- Viral Diseases and Attenuated Vaccines Unit, National Institute of Health, Rome, Italy
| | - S Iannazzo
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy
| | - M G Pompa
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy
| | - S Declich
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
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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.
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Affiliation(s)
- V Alfonsi
- Istituto Superiore di Sanita, National Centre for Epidemiology Surveillance and Health Promotion, Rome, Italy
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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.
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Affiliation(s)
- O Zaniolo
- c/o AdRes Health Economics & Outcomes Research, C.so Vigevano, 35, 10152 Turin, Italy
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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]
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