A nosocomial outbreak of 2009 pandemic influenza A(H1N1), with eight confirmed cases, occurred in a paediatric oncology ward in Italy, in October/November 2009. The fact that one case was infected despite being isolated and without contact to a symptomatic patient, hints towards potential transmission through a health care worker (HCW) and underlines the importance of vaccination of HCW who are involved in the care of critically ill patients.

This article described an outbreak of bacterial pneumonia/bronchopneumonia in a group of visitors to a mineral water spa contaminated with Pseudomonas aeruginosa in summer 2009. The epidemiologic investigation was activated after the hospitalization for pneumonia of three people who had undergone therapy at the spa. Discharge with a diagnosis of pneumonia/bronchopneumonia in weeks 27 to 39 of 2009 of four hospitals near the spa were data-linked with the list of spa’s visitors. Environmental samples of thermal water were performed and analysed. Investigations discovered a total of 39 cases of pneumonia among the spa visitors. Checks carried out in the hospitals near the spa revealed more hospitalizations for pneumonia in summer 2009 than the average for the previous five summers. There was a significant association between pneumonia and inhalation therapy (RR=7.33; p<0.0001) and aerosol therapy (RR=8.25; p<0.0001). P. aeruginosa was discovered in the water of the inhalation equipment. The spa micro-environment offers a risk of infection from pathogenic and/or opportunistic micro-organisms and therefore in-house testing, surveillance and prevention systems should be put in place for the well-being of clients.

We report a fatal case of overwhelming pneumococcal infection in an asplenic young adult not vaccinated against Streptococcus pneumoniae (S. pneumoniae).

OBJECTIVE: To assess knowledge and attitudes towards cervical cancer prevention in a sample of 2400 Italian women. STUDY DESIGN: Cross-sectional study. METHODS: The study was conducted through a standardized questionnaire administered in the workplace. RESULTS: Regular Pap testing was reported by 65.6% of the sample, and 86.9% were aware of the human papillomavirus (HPV) vaccine. Just over half of the women (51.8%) stated that they would pay for the vaccine for themselves or family members. Significant differences in responses were associated with monthly income and educational level. CONCLUSION: Introduction of payment for the HPV vaccine may increase health inequalities significantly. For overall improvement in the quality of life, effective prevention and treatment services should be made available to all.

Macrolide-resistant Mycoplasma pneumoniae (MR-MP) is an increasing problem worldwide. This study describes the clonal spread of a unique strain of MR-MP within a single family. On January 23, 2015, nasopharyngeal swabs and sputum samples were collected from the index case (a 9-year-old girl) in southern Italy. The patient had pneumonia and was initially treated with clarithromycin. MR-MP infection was suspected due to prolonged symptoms despite appropriate antibiotic therapy. Two further cases of pneumonia occurred in relatives (a 7-year-old cousin and the 36-year-old mother of the index case); therefore, respiratory samples were also collected from other family members. Sequence analysis identified mutations associated with resistance to macrolides. Both P1 major adhesion protein typing and multiple loci variable-number tandem repeat analysis (MLVA) typing were performed to assess the relatedness of the strains. The index case, the cousin, the mother, and another 4 family members (twin siblings of the index case, a 3-year-old cousin, and the grandmother) were positive for MR-MP. All strains harbored the mutation A2063G, had the same P1 subtype (1), and were MLVA (7/4/5/7/2) type Z. In addition, the index case's aunt (31 years of age and the probable source of infection) harbored an M pneumoniae strain with the same molecular profile; however, this strain was susceptible to macrolides. This cluster of MR-MP infection/carriage caused by a clonal strain suggests a high transmission rate within this family and highlights the need for increased awareness among clinicians regarding the circulation of MR-MP. Novel strategies for the treatment and prevention of M pneumoniae infections are required.

This study aims to investigate the knowledge, the attitudes and practices on HPV vaccination of health professionals of Mother and Child Service of Puglia Region (Italy). The study was conducted through a standardized questionnaire. Of 455 respondents, 74.2% judged HPV vaccine very important for immunization calendar. 88.9% did not believe that the administration of HPV vaccine implies consent to the initiation of sexual activity but 34.2% sustained that vaccine can give a false sense of protection against sexually transmitted diseases. 62.2% believed that boys should also be vaccinated. Skills necessary in the implementation of strategies in the promotion of health are partially inadequate and appropriate ongoing education should be carried out for health care workers.

BACKGROUND: This study aims to evaluate the effectiveness of pre-travel counselling carried out in Travel Clinics. METHODS: This is a retrospective cohort. Three hundred international travellers were enrolled; 150 people were from users of Bari Travel Clinic, 150 were users of a travel agency. Enrolled subjects were interviewed using a questionnaire. RESULTS: The average age of the enrolled subjects was 37.5 ± 13.9, without statistically significant differences between the two groups. 86% of cases and 19.3% of the controls reported the use of anti-malaria prophylaxis (p < 0.0001). Vaccination against cholera was given to 62% of cases and 7.3% of the controls (p < 0.001). Travel Clinic users, 6% reported diarrhoea and these figures were 27% in the control group (p < 0.0001). The proportion of those interviewed who reported fever (3.7) or insomnia (1.3) did not differ between the two groups. Mosquito bites were reported by 8% of cases and 20% of the controls (p = 0.003). Three cases of malaria were reported among the controls but no cases were detected among the cases (chi-square = 3.03; p = 0.08). CONCLUSIONS: Our study demonstrated the effectiveness of pre-travel counselling; in the future, new studies must investigate the cost-effectiveness of pre-travel prevention measures.

OBJECTIVES: Mycoplasma pneumoniae is a frequent cause of human lower respiratory tract infections (LRTIs) for which macrolides are the treatment of choice. The aim of this study was to determine the rate of macrolide resistance and to subtype M. pneumoniae strains in Italy. PATIENTS AND METHODS: During an outbreak of M. pneumoniae infections in southern Italy in 2010, 48 clinical specimens from 43 paediatric patients hospitalized for LRTIs were analysed for macrolide resistance. The mutations associated with resistance (A2063G and A2064G) and M. pneumoniae subtypes were detected by sequencing the targeted domain V region of the 23S rRNA gene and a region in the MPN528a gene, respectively. RESULTS: Macrolide resistance genotypes were detected in 11 (26%) of the 43 M. pneumoniae-positive children. The A2063G mutation was identified in seven patients and the A2064G mutation was identified in the remaining four. Upon admission, the isolates from three patients showed a susceptible genotype but subsequently acquired the A2063G mutation. Genotyping revealed M. pneumoniae subtype 1 in 33 of 40 sequenced strains and subtype 2 in the remaining 7. There was no association between macrolide resistance or susceptibility and the M. pneumoniae subtypes. CONCLUSIONS: This is the first report of macrolide resistance among M. pneumoniae strains in Italy. Our findings indicate an unexpected high prevalence of macrolide resistance genotypes in children, and so macrolide resistance should be carefully considered in patients who do not respond appropriately to antibiotic treatment. The epidemiological monitoring of macrolide resistance has become necessary in Italy and in the rest of Europe.

INTRODUCTION: In the Puglia region (South Italy) about 200 new hospitalizations for cervical cancer are registered every year. The study investigated the frequency of Human Papillomavirus (HPV) infection and the genotype distribution of HPV in a sample of women with known cytology attending the outpatient clinics of four Gynecological Departments of the University of Bari over a four-year period (2005-2008). METHODS: Cervical samples from 1,168 women were analyzed for the presence of HPV-DNA through Polymerase Chain Reaction (PCR) in L1 region and reverse hybridization. The cytological results were associated with HPV positivity and type-specific prevalence. RESULTS: Overall, HPV infection was found in 355 (30.4%) women. HPV-DNA was found in 34.4% of women with a cytological diagnosis of ASCUS, in 46.8% of women with Low-grade Squamous Intraepithelial Lesion (LSIL) and in 87.0% of women with High-grade Squamous Intraepithelial Lesion (HSIL)/carcinoma. Also 16.0% of women with normal Pap smear were found to be HPV-DNA positive. The most common HPVgenotype was type 16 found in 27.3% of positives, followed by type 53 (11.5%), type 66 (9.2%) and type 31 (9.0%). HPV genotype 18 was found in 6.4% of positives. Types 16 or 18 were detected in about 34% (120/355) of all infected women, in about 33% of LSIL and in 60% of HSIL/ carcinoma HPV-positive women. Among low risk (LR) genotypes, type 61 was found in 10.7% of HPV positive women, type 62 in 8.4%, type 42 in 8.1% and type CP6108 in 7.8%. DISCUSSION AND CONCLUSIONS: The findings of the study give evidence that HPV infection is frequent in the studied cohort of women. The most widespread genotypes found were 16 and 53. These data may represent a benchmark for future evaluation after the recent introduction of vaccination against HPV in 12-year-old girls.

BACKGROUND: Raw seafood consumption was identified as the major risk factor for hepatitis A during the large epidemic of 1996 and 1997 in Puglia (South Italy). In Puglia, vaccination for toddlers and preadolescents has been recommended since 1998.The aim of the study was to evaluate the incidence, seroprevalence, molecular epidemiology, and environmental circulation of hepatitis A virus (HAV) in Puglia more than ten years after the introduction of anti-HAV vaccination in the regional immunization program. METHODS: Data on the incidence of acute hepatitis A in Puglia were analyzed. Characteristics and risk factors of 97 acute hepatitis A cases occurring in 2008-2009 were analyzed. Serum samples from 868 individuals aged 0 to 40 years were tested for anti-HAV antibodies. Fecal samples from 49 hepatitis A cases were analyzed by sequence analysis in the VP1/P2A region. In 2008, 203 mussel samples and 202 water samples from artesian wells were tested for HAV-RNA. RESULTS: Between 1998 and 2009, the incidence of acute hepatitis A declined from 14.8 to 0.8 per 100,000. The most frequent risk factors reported by cases in 2008-2009 were shellfish consumption (85%) and travel outside of Puglia or Italy (26%). Seroepidemiologic survey revealed high susceptibility to HAV in children and adults up to age 30 (65%-70%). None of the mussel or water samples were HAV-positive. Phylogenetic analysis revealed co-circulation of subtypes IA (74%) and IB (26%) and clustering of strains with strains from Germany and France, and those previously circulating in Puglia. CONCLUSION: Vaccination and improved sanitation reduced the incidence of hepatitis A. Strict monitoring and improved vaccination coverage are needed to prevent disease resurgence

We aimed to investigate the Web site contents of Italian National Health System structures regarding health care-associated infection (HAI). For each Web site a form inquiring about the availability of information about HAI issues and their prevention was filled in. An HAI section was available in the Web site of 19.3% of facilities. In 1.6% of Web sites this information was available on the homepage. The most frequently reported information was related to infection control practitioners, HAI surveillance systems, and handwashing hygiene. In conclusion, the communication of risks related to clinical practice should be part of risk management systems and should assume a significant position in content strategy activities. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

OBIETTIVI: Il presente studio si propone di valutare la presenza dei fenomeni di bullismo e di cyber bullismo nei preadolescenti (10 – 13 anni), le modalità e la frequenza con cui questi episodi si verificano e la relazione con l’ambiente familiare e scolastico in cui i preadolescenti vivono. La scelta del target più giovane, rispetto alle analisi finora condotte, risiede soprattutto nella mancanza di evidenze in merito ai fenomeni di cyber bullismo in questa fascia d’età. Lo studio si propone, inoltre, di descrivere la diffusione e l’uso, tra i preadolescenti, delle tecnologie e degli strumenti informatici di ultima generazione e valutarne la correlazione con l’aumento degli episodi di cyberbullismo. METODI E AZIONI: È stato effettuata una ricerca nel territorio di Ruffano (Le) presso l’Istituto Comprensivo Statale di Ruffano presso cui è stata svolta un’indagine conoscitiva attraverso l’utilizzo di un questionario modificato, costruito ad hoc utilizzando parte degli items contenuti nel “Questionario sulle prepotenze tra i ragazzi a scuola” [versione originale a cura di Dan Olweus (1991) e di I. Whitney& P.K. Smith (1993)], tradotto e adattato da A. Fonzi, M.L. Genta e E. Menesini (1993) del Dipartimento di Psicologia Generale dei Processi di Sviluppo e Socializzazione dell’Università degli Studi di Firenze e un questionario sviluppato dalla sezione di Psichiatria della Facoltà di Medicina dell’Università di Foggia come strumento per valutare il fenomeno del cyberbullismo. RISULTATI : Il campione oggetto di indagine era costituito da 200 bambini e ragazzi appartenenti a quattro classi di quinta elementare e cinque classi di prima media. Hanno aderito allo studio 85 bambini e ragazzi, di cui il 54,1% (n=46) erano di erano di sesso femminile. Il tasso di adesione allo studio risulta pari al 42,5%. È stato possibile osservare un altissimo tasso di diffusione degli strumenti elettronici tra i preadolescenti attraverso cui, la metà degli intervistati ha dichiarato di aver subito atti assimilabili ad episodi di cyberbullismo. CONCLUSIONI: Un dato preoccupate è rappresentato dal fatto che il 70% dei ragazzi intervistati ha affermato di utilizzare il pc per navigare su Internet in totale autonomia, senza il controllo di un adulto, 268 e quasi due terzi ha la consuetudine di giocare on-line. I ragazzi hanno mostrato di avere buona conoscenza ed esperienza dello strumento Internet: conoscono i social network e sono iscritti ad almeno uno di questi, Facebook in particolare nonostante l’iscrizione sia consentita solo ai maggiori di 18 anni e li utilizzano abitualmente per chattare con amici e parenti. A fronte di questa esperienza, l’indagine ha mostrato come in realtà i bambini non abbiano consapevolezza della possibilità di incorrere in episodi di cyberbullismo: 44 ragazzi hanno dichiarato di essere stati oggetto di episodi assimilabili a comportamenti di cyberbullismo, ma solo 5 di loro hanno affermato di esserne stati vittima. La valutazione della reazione dei genitori nei confronti degli atti di prepotenza attuati dai propri figli ha messo in luce come in molti casi i genitori siano impreparati di fronte a tali eventi: infatti solo una proporzione ridotta di genitori cercano di indagare le motivazioni che spingono i loro figli a compiere atti di prepotenza nei confronti di altri bambini. PAROLE CHIAVE: Cyberbullismo, internet, preadolescenti.

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011-2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the 2 previous seasons (P<0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011-2012 season (P<0.001). "To avoid spreading influenza among patients" was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future.

BACKGROUND: Healthcare professionals have an important role to play both as advisers-influencing smoking cessation-and as role models. However, many of them continue to smoke. The aims of this study were to examine smoking prevalence, knowledge, attitudes, and behaviours among four cohorts physicians specializing in public health, according to the Global Health Profession Students Survey (GHPSS) approach. MATERIALS AND METHODS: A multicentre cross-sectional study was carried out in 24 Italian schools of public health. The survey was conducted between January and April 2012 and it was carried out a census of students in the selected schools for each years of course (from first to fourth year of attendance), therefore among four cohorts of physicians specializing in Public Health (for a total of n. 459 medical doctors). The GHPSS questionnaires were self-administered via a special website which is created ad hoc for the survey. Logistic regression model was used to identify possible associations with tobacco smoking status. Hosmer-Lemeshow test was performed. The level of significance was P ≤ 0.05. RESULTS: A total of 388 answered the questionnaire on the website (85%), of which 81 (20.9%) declared to be smokers, 309 (79.6%) considered health professionals as behavioural models for patients, and 375 (96.6%) affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 388 (89.7%) heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization. CONCLUSIONS: The present study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in public health, their key role both as advisers and behavioural models, and the limited tobacco training offered in public health schools.

Influenza vaccination is strongly recommended for Italian healthcare professionals, but vaccine coverage is low. Since 2012, vaccination is also offered to medical students as part of the National Immunization Plan; however, few Medical Schools has implemented the plan so far. To study determinants of vaccination compliance, we conducted a survey among medical students at the University of Bari, where influenza vaccination has been actively offered since 2013. Information was obtained by means of an online anonymous questionnaire administered in April 2014. We enrolled 669 students, 383 (57%) vaccinated; 54% were female and the average age was 23.9 ± 4.9 y. Determinants of getting vaccinated were analyzed in a multivariate logistic model. Receiving invitation from the University (aOR = 3.8; 95%CI = 1.2-12.3; p = 0.026), the opinion that vaccine is safe (aOR = 2.8; 95%CI = 1.5-5.0; p = 0.001) and useful (aOR = 3.4; 95%CI = 1.7-6.7; p<0.0001), a specific training about influenza vaccination during the course (aOR = 1.5; 95%CI = 1.1-2.1; p = 0.043), and considering himself as at a major risk of influenza complication (aOR = 1.8; 95% CI = 1.1-2.9; p = 0.001) were significantly associated with vaccine acceptance. Active invitation and training are confirmed as key actions (as in children vaccination strategies) and, according to our results, they could be routinely used to promote vaccination in hard-to-reach groups such as healthcare workers.

BACKGROUND: The aim of this study was to assess the prevalence of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) serological markers and the prevalence of VDRL positive subjects in a population of refugees of various nationalities, living in the Asylum Seeker Centre in Bari Palese, Southern Italy. METHODS: The study was carried out in the period May-July 2008 and recruited only voluntarily enrolled healthy refugees. HBsAg, anti-HBc, anti-HCV and anti-HIV virus antibodies were detected. VDRL syphilis screening was also carried out on the serum samples. RESULTS: A total of 529 refugees, 442 males and 87 females, aged between 7 and 52 years, were studied. Of these, 510 were from Africa and 19 from Asia.Forty-four individuals (8.3%) were HBsAg positive and 241 (45.6%) were anti-HBc positive. A total of 24 (4.5%) individuals were anti-HCV positive. Eight asylum seekers (1.5%) were HIV positive. VDRL tests were performed on 269 subjects and 4 (1.5%) were positive. 12.3% of the study population had serological markers of chronic and transmissible infections with potential blood-borne or sexual transmission. CONCLUSIONS: In Italy, a suitable protocol is necessary for the early diagnosis of infectious diseases on entering Asylum Centres, so allowing the adoption of prevention measures to safeguard the health of the individuals, the residents and workers in the Centres and the general population.

INTRODUCTION: This study aims to determine risk factors for the acquisition of HIV, HBV and HCV infections among Injection Drug Users (IDUs) who attended the out-patient clinic of the Department of Pathological Dependence at Bari Hospital in Bari Province (Italy). METHODS: The study was conducted in the year 2008 using the information available in the out-patient files of 291 drug addicts who were undergoing treatment. RESULTS: Their average age was 29.3 and 133 (45.7%) of them were affected by HIV/HBV/WHCV. The use of injected heroin, being separated or divorced, and having committed a crime were found to be risk factors for infection by HIV/ HBV/ HCV, while having a school diploma or a university degree and the use of cannabinoids were negatively associated with the infective diseases. DISCUSSION AND CONCLUSIONS: While the data from the Italian Departments of Pathological Dependence concerning HIV diffusion in treated patients have been showing a reduction in the number of cases of seropositivity, drug addiction in industrialized countries is still the second most important risk factor, after promiscuous sexual behaviour, for infection by parenteral transmission. Correct risk assessment is essential for the planning of effective strategies for primary and secondary prevention.

In recent decades in South-Italy, drastic epidemiological changes in the pattern of the enterically transmitted diseases were recorded. This work aims to support the hypothesis that universal routine vaccination against hepatitis A started in Puglia in 1998 could be also effective in reducing contamination in seafood. Three studies on different samples of Mitylus edulis lamellibranch were conducted over 20 years. Microbiological analysis measured both the standard bacteriological indexes (faecal coliforms, Escherichia coli, Salmonella spp.) and the presence of hepatitis A, enterovirus, norovirus and rotavirus. Between 1989 and 2009, the highest number of hepatitis A cases was reported in 1996 and in 1997 (mean incidence rate of 130 per 100,000). Since 1999, the number of cases progressively decreased, reaching 29 cases in 2006 (incidence rate of 0.7 per 100,000). A progressive improvement in vaccination coverage of newborns was recorded ranging from 1997 (38.3%) to 2005 birth-cohorts (63.4%). Vaccination coverage of 12-year-old adolescents was 67.6% (95% CI: 58.4-76.8%). Hepatitis A was detected in 3.7% of samples in the 1987 study, in 18.3% of samples in the 1999-2000 study and it was absent in the 2007 study. The decreasing of HAV circulation in humans and in shellfish provides support for the link between vaccination efforts and the safety of molluscs

The amount of boys and girls who manipulate their body in a permanent way with tattoo and body piercing is an ever-increasing number. The body becomes the instrument through which young people show their feeling of uneasiness, which is consequence of adolescence. These kinds of manipulation of the body may be related to self injury phenomenon, or common adolescential behavior, such as use of tobacco, drugs or alcohol abuse, or to family conflicts and abnormal temperament traits. Considering adolescence as a critical period, this paper indicates the needfulness to monitor adolescents who manifest these behavioral tendencies not only to identify possible related medical complications, but also in order to recognize useful and early indicators of their feeling of uneasiness. This also in the view to carry out specific preventive strategies against the unset of risky behavior, such as smoking, alcohol and drugs abuse, and any other dangerous attitude.

BACKGROUND: The aim of the study is to describe temporal trend, distribution and characteristics of new HIV infections detected in Puglia Region in years 2007-2011. METHODS: Case surveillance data for all individuals newly diagnosed with HIV infection in these years were analysed. Risk factors associated with late presentation at diagnosis were analysed by multivariate logistic analysis. RESULTS: In the years 2007-2011 a total of 632 new diagnoses of HIV infection were notified. 573 (90,7%) of all cases were residents (83,8% Italians, 16,2% migrants). Among residents, 76,8% were males (median age 36 years), 23,2% females (median age 30 years). On the whole, 58,3% were late presenters (LP) and 40,8% were subjects with advanced HIV disease (AHD). At multivariate analysis, older age and being a migrant were risk factors significantly associated with late presentation at diagnosis. CONCLUSIONS: Clinical-epidemiological analysis of new HIV diagnosis/infections in Puglia shows a high proportion of LP and AHD. The results of the study strongly suggest the need to promote access to counselling and screening services of subjects at high risk of late presentation for a better targeting of information campaigns.

BACKGROUND: Tuberculosis (TB) is a social disease that is common in immigrants who are forced to live in difficult circumstances. In Italy, the guidelines for preventing TB include X-ray screening and application of the Mantoux test for migrants from high-TB-endemic countries as soon as possible after admission to Italy. This article describes a field survey conducted in the reception center for asylum seekers in Bari Palese in southern Italy following the death of a center resident from pulmonary TB. METHODS: A Mantoux screening test, followed by chest X-ray, was carried out in March 2009 on 982 immigrants, representing 97.5% of the residents of the center. RESULTS: A positive Mantoux test result was seen in 60.7% of the residents screened. The chest X-rays were performed on 92.9% of cuti-positive patients and on cuti-negative patients who were recent contacts of the deceased TB case and/or with symptoms suspicious for TB. Eight residents were diagnosed with active TB (0.8% of residents), and 117 residents (11.9%) had TB sequelae. In our survey, the Mantoux test demonstrated 88% sensitivity, 17% specificity, and a positive predictive value of 1% for active TB. CONCLUSION: The survey results suggest that residents in asylum centers are a special type of immigrant. Specific risk factors, such as overcrowding, may expose these residents to a greater risk for infectious diseases.