The 1853 Vaccination Act, adopted in England during XIX century, was the first law about compulsory vaccination in Europe. The Act caused a violent movement of opposition with the birth of Victorian anti-vaccination. The modern anti-vaccination movement was born in 1998 following a paper of Andrew Wakefield published in the Lancet. In this paper Wakefield illustrated a study of twenty patients and concluded that the administration of the MMR vaccine caused autism and some forms of colitis. The publication was later disowned by almost all authors. However the study of Wakefield caused a reduction of compliance to the anti-MMR vaccination in the United Kingdom, resulting in lower coverage and new outbreaks. The theorethical principles of anti-vaccinationists of 19th and 20th century were: the hypothesis that vaccines cause illnesses; the presence of toxic substances in the vaccine; the violation of freedom Personal and People's; the ineffectiveness of vaccinations. Moreover, anti-vaccinationists always refused the scientific methods and the peer-review of their scientific studies.

Over the last two decades, growing numbers of parents in the industrialized world are choosing not to have their children vaccinated. The re-emergence of the anti-vaccination movements has been theorized as an important determinant of this phenomenon. The crisis of the «vaccination system» and the resurgence of the anti-vaccination movements is related both, to the increased accessibility to the information from the general population and to the decreased credibility and authority of health professionals. Another critical element in the fight against anti-vaccination movements, in Italy, is the system of assessing the damage from the vaccine, both in pharmacovigilance activities and in the procedures for the compensation of biological damage provided by law. The contrast in these bugs, along with the strengthening of communication skills of the health care workers and to an investment on communication in the mass media, is not to postpone for fighting the anti-vaccination movements.

In Italy there have been several court appeals registered, which have been driven by individual convictions or group actions or movements and were aimed at obtaining exemption from the obligation to comply with compulsory vaccinations required by law. The aim of the present paper is to provide a quick review of the sentences resulting from activating these disputes, in order to contribute to the debate on overturning compulsory vaccination. The Jurisprudence of the Italian Constitutional Court has repeatedly confirmed the judgment on the constitutionality of rules on obligation, clarifying that only where specific reasons exist that make vaccinating the individual dangerous may non-compliance with the rules on compulsory vaccination be justified. This is in contrast with the case law on enforcement of compulsory vaccination, through the temporary suspension of parental authority. Taking responsibility for promoting immunisation decisions away from Public Health Services and handing it to the courtroom is not advisable, given the very small benefit. The problem must be placed under the careful attention of the Health Service due to communicative implications, which can be serious during the transition from a compulsory system of immunisation to a voluntary one.

The aim of this study is to describe the immunization strategies for 23-valent pneumococcal vaccine in the Italian regions. Sixteen regions offer pneumococcal vaccine to elderly people and 18 regions to risk groups. Nine among them offer the vaccine free of charge and perform the call for immunization. Five regions created a database of the risk groups. Data about vaccination coverage are available for seven regions; in the other only the number of administered doses is collected yearly. Different immunization strategies may represent a determinant of health inequalities.

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.

The objective of this study is to describe the knowledge and skills of managers working in health organizations in the Region of Puglia (South of Italy) on the principles and tools of clinical governance.

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.

Computerised reminders can be a support for clinical improvement. We verified their effect on heart-failure (HF) re-hospitalisation rate. Methods and Results: A software (Millewin®) widely used in Italian general practice enbedded an automatic reminder to help general practitioners (GPs) to identify HF patients and to prescribe them with recommended drugs. This reminder system was already activated in the first 2004 release, but required voluntary activation in the successive releases. We had no possibility to know who decided to keep using the reminders. We examined the 2004-2009 HF hospitalisations in Puglia, a Southern Italian Region with a population of over 4000000, and with high HF hospitalisation rate compared with the Italian mean7. We compared the hospitalisations for patients cared for by GPs who used Millewin® in 2004 to those of the patients cared for by GPs who never used Millewin®. Data were provided by the local Health Authority, and were extracted from the administrative database. Users of Millewin® cared for 4969 patients (mean age 76 y, sd 12; 48,6% men), the non-users cared for 48781 patients (mean age 76 y, sd 11; 50% men ): no significant difference as far as age and gender are concerned. We examined 17810 patients with > 2 hospitalisation. No difference in re-hospitalisations was observed. Conclusions: Availability of computerised automatic reminders aimed to improve detection of HF patients and prescription of recommended drugs doesn’t decrease repeated hospitalisation; these tools should be probably part of a more complex strategy, such as a long-term audit. KEYWORDS: Computerised reminder; heart failure; hospitalisation

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

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.

OBJECTIVE: To identify factors that can hinder condom use in a sample of young adults. METHODS: The survey was carried out using a self-administered standardised anonymous questionnaire modified from the self-efficacy scale Condom Use Skill Measure. The questionnaire was administered to 1091 school-leavers who were attending a pre-university study course in August 2008 at Bari University, Italy. RESULTS: Of those interviewed, 88% had had sexual intercourse and the average age at the first experience was 16.8 years. The frequency of condom use at the most recent sexual intercourse was 52.6%. Non-condom use was associated with not having a condom immediately available, with problems in the partner accepting this particular barrier method, with the belief that proposing its use could lead to problems between the couple, with the assumption of not risking anything, with the fear that it causes irritation and with the belief that it does not feel natural. CONCLUSION: Our survey shows that there are opinions and attitudes held by young adults which hinder condom use. They should be a targeted by health education.

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.

BACKGROUND: Streptococcus pneumoniae, lancet-shaped, gram-positive, facultative anaerobic organisms, are common inhabitants of the respiratory tract and may be isolated from the nasopharynx of 5% to 70% of healthy adults. OBJECTIVE: The aims of the study were to estimate the vaccination coverage for pneumococcal 23-valent polysaccharide vaccine and to assess the impact its introduction in the Italian region of Puglia, where a program to provide this vaccination has been operative since 2000. METHODS: Estimation of the coverage for pneumococcal 23-valent polysaccharide vaccine was implemented by a 2-step study consisting of data collection from local health unit vaccination registers between 2000 and 2008 in Puglia and of a cluster sampling study among general practitioners to validate routine data collected during the first step. Moreover, hospitalization for invasive pneumococcal diseases was studied. RESULTS: From 2000 to 2004, among individuals > or =65 years, the overall coverage rate estimated by routine data amounted to 26.3%; between 2005 and 2007, annual coverage rates did not exceed 8%/year. Between 2002 and 2007, the overall coverage rate estimated by interviewing general practitioners was 46.6% (95% confidence interval: 39.9-53.4). The coverage rate in chronic patients by routine data was approximately 23%, whereas the rate provided by general practitioners was 17.6% (95% confidence interval: 12.5-22.8). From 2001 to 2007, hospitalization data did not show a reduction in invasive pneumococcal disease trends among the elderly population in Puglia. CONCLUSION: The results of this study demonstrate the need for improving vaccine coverage and implementing new immunization strategies and practices.

BACKGROUND AND AIMS: Pulmonary embolism (PE) is a relatively common cardiovascular emergency: present evidence suggests that PE is the third most acute cardiovascular disease after cardiac ischemic syndromes and stroke. The aim of this study is to evaluate hospital admissions for PE in the Apulia Region of Italy in the period 2001-2007 through an analysis of the Apulia Region hospital patient discharge database. METHODS: Patients were selected on the basis of admissions between 01/01/2001 and 31/12/2007 with ICD-9-CM code of 415.11 (Iatrogenic pulmonary embolism and infarction) or 415.19 (Other pulmonary embolism and infarction) as principal or secondary diagnosis. RESULTS: The number of patients selected from the database was 4,303. The raw annual admission data shows an increasing trend from 13.9x100,000 residents in 2001 to 18.9 x 100,000 residents in 2007. The average patient age was 68.7 years and 59% were females and 41%. There were 470 deaths in hospital (10.9% of patients). CONCLUSIONS: PE is associated with much health care and a substantial economic burden, yet many PE and general venous thromboembolism (VTE) events are preventable. It remains the responsibility of individual hospitals to identify specific areas in which they can improve their VTE prophylaxis rates to obtain positive results from the reporting initiatives and incentive programs.

Serological studies have many important epidemiologic applications. They can be used to investigate acquisition of various infections in different populations, measure the induction of an immune response in the host, evaluate the persistence of antibody, identify appropriate target groups and the age for vaccination. Serological studies can also be used to determine the vaccine efficacy. Since 1995 a varicella vaccine is available and it has been recommended in several countries (e.g. USA, Australia, Canada, Costa Rica, Ecuador, etc.). Nevertheless few varicella seroprevalence studies in countries that adopted an URV are available. It is related to the relatively recent introduction of the vaccination and to the lack of structured and collaborative surveillance systems based on serosurvey at national or regional level. Varicella seroprevalence data collected before the introduction of vaccination strategies allowed to establish the age of vaccination (e.g., indicated the opportunity to offer the vaccine to Italian susceptible adolescents). In the post-vaccination era, seroprevalence data demonstrated vaccine as immunogenic and excluded an increase of the age of infection linked to the vaccination strategy. New seroprevalence studies should be performed to answer to open questions, such as the long-term immunity and the change of the herpes zoster epidemiological pattern related to the vaccine.

Italian national guidelines recommend regional implementation of organized screening programmes for cervical cancer. As we have been doing since 1998, we collected aggregated tables of data from Italian organized cervical screening programmes in order to centrally compute process indicators. Data on women invited during 2011 and 2012 and screened up to April of the subsequent year were considered. In 2012, the target population of Italian organized screening programmes included 14,497,207 women, corresponding to 87.3% of Italian women aged 25-64 years. Compliance to invitation was 41.2%in 2011 and 40.8%in 2012, with a strong decreasing North-South trend. However, it should be considered that many women are screened outside any organized programmes. In 2012, of the women screened, 3.5% were referred for repeat cytology and 71.1% of them complied; 2.4% of screened women were referred to colposcopy. Compliance with colposcopy referral was 85.3%among women referred because of ASC-US or more severe cytology and 90.4% among those referred because of HSIL or more severe cytology. The positive predictive value (PPV) of referral because of ASC-US or more severe cytology for CIN2 or more severe histology was 16.9%. The unadjusted detection rate of CIN2 or more severe histology was 3.4 per 1,000 screened women (3.6 standardized on the Italian population, truncated 25-64). CIN2 or more severe histology was detected in 64.6% of colposcopies classified as grade 2 or higher. Of all colposcopies during which a CIN2 or more severe histology was obtained, 33.6% were classified as grade 2 or higher. Follow-up only was recommended to 81.7% of women with CIN1. Excision by radio-frequency device was the most common treatment for women with CIN2 (52.8%) and CIN3 (57.0%). However 0.4% of all CIN2 and 2.3% of all CIN3 had hysterectomy.

A survey was proposed to Italian Prevention Department Directors to investigate the opinions on the value of the cocoon strategy and its introduction. Cocoon was considered the most efficacious strategy to protect newborns against pertussis by 76% of the interviewees. Prevention Departments should promote and coordinate locally the strategy in 75% of the respondents. Cocoon should be recommended by Regional Authority in 82% of the interviewees.

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

The aim of this study was to evaluate the level of poliomyelitis immunization in refugees residing in the Asylum Seeker Center in Bari. The study was carried out during 2008 and involved 573 refugees. An antibody titer >or=1:8 was found in 99.6% for poliovirus 1, in 99.8% for poliovirus 2, and in 99.5% for poliovirus 3.

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.

Bacillus cereus, a ubiquitous bacterium, can be isolated in various starchy food items, causing both emetic and diarrhoeal disease. The real burden of B. cereus outbreaks is actually poorly known in Italy. We report a B. cereus foodborne outbreak that occurred in a pub in Bari (Italy) on January 22nd 2012 during a birthday party, promptly reported by the pub owner.

In a multicentre European hospital study we measured influenza vaccine effectiveness (IVE) against A(H3N2) in 2016/17. Adjusted IVE was 17% (95% confidence interval (CI): 1 to 31) overall; 25% (95% CI: 2 to 43) among 65-79-year-olds and 13% (95% CI: -15 to 30) among those ≥ 80 years. As the A(H3N2) vaccine component has not changed for 2017/18, physicians and public health experts should be aware that IVE could be low where A(H3N2) viruses predominate.

This report is an update of a number of papers that have been published by the ONS (Osservatorio nazionale screening, National centre for screening monitoring) since 2002. Data for the survey come from several programmes that may have changed over time, and may have different settings of organization and management. During 2011-2012, a slight increase in actual extension was recorded compared to the previous years. Currently, all Italian regions have implemented screening programmes. In 2011-2012, almost 5,300,000 women aged 50-69 years were invited to have a screening mammogram, and almost 3,000,000 were screened.While potential extension was 94.4%, actual extension was 73.3%. An imbalance in extension is still present when comparing northern and central Italy, that have an actual screening extension of 94% and 86% respectively, to southern Italy, that has less than 40%. During the last few years, participation rates have been substantially stable, at around 56%for crude rate, and 60% for adjusted rate, respectively. Women actually screened during 2011-2012 were 38.9%of the national target population. Referral rates of 9.2%at first screening and 4.7%at repeat screening were recorded, showing an increasing trend in recent years. Detection rate was 4.8x1,000 at first screening and 4.4x1,000 at repeat screening, while benign to malignant surgical biopsy ratio for first and repeat screening was 0.2 and 0.1, respectively. Detection rate of small (≤10 mm) invasive cancers was 1.3x1,000 at first screening and 1.4x1,000 at repeat screening; the proportion of in situ carcinomas was 13.3%and 12.0%for first and repeat screening, respectively. Indicators by 5-year age group confirm greater diagnostic problems at younger ages (50-54 years), with higher referral rates and a substantially lower detection rate as compared to older age groups.

The surveillance network RotaNet-Italia was established in 2007 in order to investigate the diversity of co-circulating rotavirus strains in Italy, and to provide a baseline for future assessment of possible effects of vaccine implementation in selecting novel versus common rotavirus strains. A total of 2,645 rotavirus strains from pediatric patients with acute diarrhea were collected over three consecutive seasons from September 2006 through August 2009, and partially characterized by standardized multiplex RT-PCR. Most of strains (89.1%) belonged to genotypes G1-G4, and G9, associated with either P[8] or P[4], commonly found in humans worldwide. However, in at least 2.0% of cases, viruses exhibited either a G or P type typical of animal viral strains, suggesting gene reassortment events between rotaviruses of different origin. Mixed infections with two or more rotavirus strains were observed frequently (7.6% of patients), and depended on the frequencies of co-circulating rotaviruses of one particular genotype. The numbers and genotypes of likely natural reassortants of common genotype rotaviruses were found to be correlated with the observed numbers and genotypes of mixed infections. Large variation in the relative frequency of different rotavirus genotypes was observed between different seasons and/or areas of Italy, suggesting independent evolution or differential introduction of viral strains with respect to both time and space.

In the region of Puglia, Italy, the mortality rates from primary liver cancer (PLC) show a considerable geographical variability. In an area including the city of Bari and the northern province [high-risk (HR) area] the mortality rates are significantly higher than elsewhere in the region [low-risk (LR) area]. The aim of this study is to analyze mortality because of PLC from 1980 to 2002 in the HR and LR areas using an age-period-cohort model to identify their respective trend characteristics and the differences that emerge from their comparison. Attention was focused on the identifiable effects, which are on the drift and on the deviations from this regular trend (curvature), specifically attributable to the cohort and the period effects by applying the method recently proposed by Carstensen. The HR area is characterized by a more marked increase in the mortality trend compared with that observed in the LR area, as indicated in the model by a greater drift effect. In both areas the cohort (curvature) effect shows a decreasing trend starting from the early 1930s whereas the period effect shows a peak in the first half of the 1990s. Despite the correspondence of the trends, the rate ratio of death from PLC between the two areas is not constant and tends to rise uniformly by age, birth cohort, and period of time: in 2002, the rate ratio of death was 1.40 [confidence interval (CI): 1.15-1.70] at 40 years old, 1.73 (CI: 1.55-1.93) at 60 years old, and 2.14 (CI: 1.92-2.38) at 80 years old.

HPV type-specific distribution was evaluated in genital samples collected from 151 women from West Africa and Horn of Africa, living in the Asylum Seeker Center in Bari Palese (Italy), undergoing voluntary screening correlated with cytological abnormalities. HPV-DNA was assayed by Linear Array HPV genotyping test. HPV DNA was detected in 39.1 % of the women, 42.5 % of which had multiple infection and 69.5 % had high-risk HPV infection. Age-prevalence rates evidenced a peak of HPV infection in women ≤20 years of age (53.1 %). HPV 53 and 16 were the most common viral types (13.5 and 12.0 % respectively). Abnormal Pap test results were found in 4.4 % of women with known cytological result. Although a prevalence of HPV positive women higher in African than in European women was expected, the differing rate between residents and migrants African women must be investigated in future studies.

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.

In Europe, annual influenza vaccination is recommended to elderly. From 2011 to 2014 and in 2015-16, we conducted a multicentre test negative case control study in hospitals of 11 European countries to measure influenza vaccine effectiveness (IVE) against laboratory confirmed hospitalised influenza among people aged ≥65years. We pooled four seasons data to measure IVE by past exposures to influenza vaccination. We swabbed patients admitted for clinical conditions related to influenza with onset of severe acute respiratory infection ≤7days before admission. Cases were patients RT-PCR positive for influenza virus and controls those negative for any influenza virus. We documented seasonal vaccination status for the current season and the two previous seasons. We recruited 5295 patients over the four seasons, including 465A(H1N1)pdm09, 642A(H3N2), 278 B case-patients and 3910 controls. Among patients unvaccinated in both previous two seasons, current seasonal IVE (pooled across seasons) was 30% (95%CI: -35 to 64), 8% (95%CI: -94 to 56) and 33% (95%CI: -43 to 68) against influenza A(H1N1)pdm09, A(H3N2) and B respectively. Among patients vaccinated in both previous seasons, current seasonal IVE (pooled across seasons) was -1% (95%CI: -80 to 43), 37% (95%CI: 7-57) and 43% (95%CI: 1-68) against influenza A(H1N1)pdm09, A(H3N2) and B respectively. Our results suggest that, regardless of patients' recent vaccination history, current seasonal vaccine conferred some protection to vaccinated patients against hospitalisation with influenza A(H3N2) and B. Vaccination of patients already vaccinated in both the past two seasons did not seem to be effective against A(H1N1)pdm09. To better understand the effect of repeated vaccination, engaging in large cohort studies documenting exposures to vaccine and natural infection is needed.

We describe an outbreak of varicella at a preschool center in Southern Italy, in the period January-May 2009, among children with a vaccination coverage of 53.9% for one dose. The outbreak occurred in a small community in Puglia and enrolled 41 children. The attack rates for unvaccinated and vaccinated children were 72.3% and 12.7%, respectively. The vaccine effectiveness against disease was 82.4%. Our findings add a further piece of evidence in supporting the routine use of a second dose of vaccine for all children without a history of disease, as recently recommended by the ACIP of the CDC.

BACKGROUND: The introduction of universal pertussis immunization and the high coverage achieved in most developed countries have largely changed the epidemiology of the disease. Although vaccination rates are high in the first year of life, the rates of booster doses are unsatisfactory and lead to the onset of outbreaks. This report describes an outbreak of pertussis affecting school students already immunized in a town of Puglia (Italy), detected at the end of April 2009. METHODS: Vaccine effectiveness is measured by calculating the incidence rates (attack rates- AR) of disease among vaccinated (ARV) and unvaccinated (ARU) people and determining the percentage reduction in the incidence rate of disease among vaccinated people compared to unvaccinated people. RESULTS: The index case was a healthy child, female, 9-years-old who attended a local elementary school and developed pertussis on 27 April 2009. The secondary cases were the aunt and the cousin of the index case who developed a cough on 10 May 2009. In the elementary class of the index case, a cluster occurred. The overall AR was 15.8%, in particular 20% in children who did not receive the booster doses at 5-6 years old (ARU) and 14.3% in children receiving the booster (ARV). The VE of booster dose in this setting was 28.5%. Moreover, only the index case developed a persistent cough; the VE against moderate to severe pertussis was 100%. A cluster was detected in the middle school class that the cousin of the index case attended; AR was 44.4% (12/27); ARU was 50% (10/20) and ARV 28.6% (2/7). VE in this setting was 42.8%. CONCLUSIONS: Our results confirm the need to administer booster doses; failure the booster is the principal determinant for the outbreak onset.

BACKGROUND: The aim of this study is to explore the association between celiac disease and menstrual cycle, gestation and puerperal disorders. METHODS: The association between celiac disease and menstrual cycle, gestation and puerperal disorders in a sample of 62 childbearing age women (15-49 age) was assessed within an age and town of residence matched case-control study conducted in 2008. Main outcome measures were the presence of one or more disorders in menstrual cycle and the presence of one or more complication during pregnancy. RESULTS: 62 celiac women (median age: 31.5, range: 17-49) and 186 healthy control (median age: 32.5, range: 15-49) were interviewed. A higher percentage of menstrual cycle disorders has been observed in celiac women. 19.4% frequency of amenorrhea was reported among celiac women versus 2.2% among healthy controls (OR = 33, 95% CI = 7.17-151.8;, p = 0.000). An association has been observed between celiac disease and oligomenorrhea, hypomenorrhea, dysmenorrhea and metrorrhagia (p < 0.05). The likelihood of having at least one complication during pregnancy has been estimated to be at least four times higher in celiac women than in healthy women (OR = 4.1, 95% CI = 2-8.6, p = 0.000). A significant correlation has emerged for celiac disease and threatened abortion, gestational hypertension, placenta abruption, severe anaemia, uterine hyperkinesia, intrauterine growth restriction (p < 0.001). A shorter gestation has on average been observed in celiac women together with a lower birth weight of celiac women babies (p < 0.001). CONCLUSIONS: The occurrence of a significant correlation between celiac disease and reproductive disorders could suggest to consider celiac disease diagnostic procedures (serological screening) in women affected by these disorders.

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

We utilised the IMPATTO study's archives to describe the 2000-2008 colorectal cancer (CRC) incidence rate trends in Italy, once screening programmes based on the faecal immunochemical test were implemented in different areas. Data on CRCs diagnosed in Italy from 2000 to 2008 in subjects aged 40-79 years were collected by 23 cancer registries. Incidence rate trends were evaluated as a whole and by macro-area (North-Centre and South-Islands), presence of a screening programme, sex, ten-year age class, anatomic site, stage at diagnosis, and pattern of diagnosis (screen-detected, non-screen-detected). The annual percent change (APC) of incidence rate trends, with 95% confidence intervals (95%CI), were computed. The study included 46,857 CRCs diagnosed in subjects aged 40-79 years, of which 2,806 were screen-detected. The incidence rates in the North-Centre were higher than in the South and on the Islands. During the study period, screening programmes had been implemented only in the North-Centre and had a significant effect on incidence rates, with an initial sharp increase in incidence, followed by a decrease that started in the 3rd-4th years of screening. These incidence rate trends were exclusively due to modifications in the rates of stage I cases. After screening programmes started, incidence increased in all anatomic sites, particularly in the distal colon. The differential figures introduced by the implementation of screening programmes warrant a continuous surveillance of CRC incidence and mortality trends to monitor the impact of screening at a national level.

I Servizi per le Dipendenze Patologiche (SerD) assolvono annualmente al debito informativo con il Ministero della Salute relativo alle attività svolte e agli utenti in carico attraverso il flusso informativo SIND. Questo rapporto raccoglie i dati relativi alle principali forme di dipendenza patologica per le quali gli utenti si sono rivolti ai SerD della regione Puglia nel corso dell’anno 2015. Il rapporto si suddivide in tre sezioni principali: Dipendenze negli utenti in carico; Altri utenti; Monitoraggio biologico degli utenti.

BACKGROUND: Sarcosine is reported to be a differential metabolite that is greatly increased during prostate cancer (PCa) progression. In this study, we assessed the role of serum sarcosine as a biomarker for PCa, as well as any association between sarcosine levels and clinical-pathological parameters. METHODS: Sarcosine was measured by fluorometric assay in serum samples from 290 PCa patients and 312 patients with no evidence of malignancy (NEM), confirmed by 8-12 core prostate biopsies. Nonparametric statistical tests and receiver operating characteristics (ROC) analyses were performed to assess the diagnostic performance of sarcosine in different (prostate-specific antigen) PSA ranges. RESULTS: ROC analyses in subjects with PSA < 4 ng/ml showed a higher predictive value of sarcosine (AUC = 0.668) versus total PSA (AUC = 0.535) (P = 0.03), whereas for the other two PSA ranges (4-10 ng/ml and >10 ng/ml), percent ratio of free to total PSA (%fPSA) showed a predictive superiority over sarcosine. Moreover, in patients with a PSA < 4 ng/ml, the percentage of low/intermediate-grade cancers was positively associated with sarcosine levels (P = 0.005). The specificities for serum sarcosine, %fPSA, PSA, and the logistic regression model at 95% sensitivity were 24.4, 3.41, 2.22, and 28.4%, respectively. CONCLUSIONS: We provide evidence that serum sarcosine has a higher predictive value than tPSA and %fPSA in patients with PSA < 4 ng/ml. Moreover, sarcosine levels were significantly different in low grade versus high grade cancers in this subset of patients, suggesting that this marker may be a further tool not only for diagnosing PCa in normal PSA and abnormal DRE/TRUS patients but also for selecting candidates for non-aggressive therapies and active surveillance.

Sewage surveillance in seven Italian cities between 2005-2008, after IPV introduction in 2002, showed rare polioviruses, none wild-type or cVDPV, and many other enteroviruses among 1,392 samples analyzed. Two of five polioviruses (PV) detected were Sabin-like PV2 and three PV3, based on ELISA and PCR. Neurovirulence-related mutations were found in the 5'NCR of all strains, and for a PV2 also in the VP1 region 143 (Ile>Thr). Intertypic recombination in the 3D region was detected in a second PV2 (Sabin2/Sabin1) and a PV3 (Sabin3/Sabin2). The low mutation rate in VP1 for all PVs suggests limited inter-human virus passages, consistent with efficient polio immunization in Italy. Nonetheless, these findings highlight the risk of wild or Sabin polio reintroduction from abroad. Non-polio-enteroviruses (NPEVs) were detected, of which 448 were Coxsackievirus B (CVB) and 294 Echoviruses (Echo). Fifty-six NPEVs failing serological typing were characterized by sequencing the VP1 region (nt 2628-2976). Four-hundred forty-eight CVB and two-hundred ninety-four Echo strains were identified, among which CVB2, CVB5 and Echo11 predominated. Environmental CVB5 and CVB2 strains from this study showed high sequence identity with GenBank global strains. The high similarity between environmental NPEVs and clinical strains from the same areas of Italy and periods indicates that environmental strains reflect the viruses circulating in the population and highlights the potential risk of inefficient wastewater treatments. This study confirms that sewage surveillance can be more sensitive than AFP surveillance in monitoring silent poliovirus circulation in the population, and the suitability of molecular approaches to enterovirus typing.

The signal of an association between vaccination in the second year of life with a hexavalent vaccine and sudden unexpected deaths (SUD) in the two days following vaccination was reported in Germany in 2003. A study to establish whether the immunisation with hexavalent vaccines increased the short term risk of SUD in infants was conducted in Italy. METHODOLOGY/PRINCIPAL FINDINGS: The reference population comprises around 3 million infants vaccinated in Italy in the study period 1999-2004 (1.5 million received hexavalent vaccines). Events of SUD in infants aged 1-23 months were identified through the death certificates. Vaccination history was retrieved from immunisation registries. Association between immunisation and death was assessed adopting a case series design focusing on the risk periods 0-1, 0-7, and 0-14 days after immunisation. Among the 604 infants who died of SUD, 244 (40%) had received at least one vaccination. Four deaths occurred within two days from vaccination with the hexavalent vaccines (RR = 1.5; 95% CI 0.6 to 4.2). The RRs for the risk periods 0-7 and 0-14 were 2.0 (95% CI 1.2 to 3.5) and 1.5 (95% CI 0.9 to 2.4). The increased risk was limited to the first dose (RR = 2.2; 95% CI 1.1 to 4.4), whereas no increase was observed for the second and third doses combined. CONCLUSIONS: The RRs of SUD for any vaccines and any risk periods, even when greater than 1, were almost an order of magnitude lower than the estimates in Germany. The limited increase in RRs found in Italy appears confined to the first dose and may be partly explained by a residual uncontrolled confounding effect of age.

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.

The aim of this study was to evaluate the presence of wild poliovirus or sabin-like poliovirus in 152 stool samples from migrants in the Accommodation Center in Italy and liquid waste from the sewage systems. Two surveys were performed in 2008 and 2011. All stool samples were negative for enterovirus and poliovirus. One of the liquid samples analyzed was positive for Coxsackievirus type B5.

Pneumococcal disease epidemiology has changed after introduction of pneumococcal conjugate vaccines. Seven-valent vaccine (PCV7) has been effective in reducing invasive pneumococcal disease (IPD). In europe, PCV13 effective-ness was estimated at 78% (95% CI:-18–96%) for 2-priming doses. In Italy, PcV7 was introduced in 2006 in the childhood immunization schedule and replaced with PcV13 in 2010. In apulia, vaccination coverage has reached 95.1% (birth-cohort 2010). We estimated PCV program effectiveness and its impact on S.pneumoniae diseases. PCV Effectiveness: We used the screening method. We calculated the Proportion of Population Vaccinated from immunization registries and detected cases through a laboratory-confirmed surveillance among hospitalized children ≤60 months. a confirmed IPD case was a child with PCR positive for S.pneumoniae. Differences among children were assessed with the chi-square or the Fisher exact test (P value < 0.05). PCV Impact: We constructed time series using outcome-specific Poisson regression models: hospitalization rate in pre-PcV era and hospitalization Risk Ratios (RRs) with 95% cIs for both PcV7 and PcV7/PcV13 shifting era. We calculated hospitalization RR with 95% Cls comparing pre-PcV years with vaccination period. The PCV effectiveness was 84.3% (95% CI: 84.0–84.6%). In May 2010-January 2013, we enrolled 159 suspected IPD of whom 4 were confirmed. Two (fully vaccinated) were caused by serotype 9V,1(not vaccinated) by serotype 3, 1 (vaccinated with 2 PcV13 doses) by 15B/c. The most important reduction was for pneumococcal pneumonia (RR: 0.43, 95% CI: 0.21–0.90). The PcV program show promising results in terms of both PCV13 effectiveness and its impact in reducing IPD in children < 5 years.

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.

This study describes an outbreak of varicella, in a small town in the region of Puglia, Southern Italy, in the period between February-March 2011. This outbreak presented the opportunity to assess varicella vaccine effectiveness and its determinants. The outbreak occurred in a small community in Puglia; parents of the children attending the schools of the community were contacted by telephone and information was gathered on current disease and varicella history. Varicella vaccination history was verified through the immunization registry of the Local Health Unit. Before the outbreak, immunization coverage was 86.6% of children attending preschool and 51.9% of children attending elementary school. In day care center where the outbreak was happened, the attack rate in vaccinated individuals was 32.1% and 80% in susceptible unvaccinated individuals. VE is therefore estimated as 59.9% (95% CI = 48.3-69.8). In the elementary school the VE can be calculated as 69.2% (95% CI = 50.5-88.1), since the attack rate in unvaccinated children was of 23.1% and in vaccinated of 7.1. The time between vaccination and the onset of the epidemic appears higher in children with a vaccine failure. The results of this study highlight the need for a reflection on the desirability of adopting a shorter schedule in Italy, with a minimum 1 mo interval between MMRV doses

Studies of meningococcal carriage are essential in improving knowledge of the epidemiology of meningococcal disease. The aim of this study is to ascertain the carrier rate and the serogroups of Neisseria Meningitidis circulating in a sample of students from the University of Bari. The population consisted of university students from the University of Bari - School of Medicine, who were invited to take a nasopharyngeal swab. The swabs were plated on selective plate medium; cultural and MLST tests were performed. Of 583 university students 12 carriers were identified (2%). 9 isolates proved auto-agglutinable. The other strains belonged to serogroups B, W135 and Y. Auto-agglutinable strains belonged to different clonal complexes, of which ST-53 was the most common. Only one strain, that belonged to ST-23/cluster A3 clonal complex, could cause meningococcal disease. No type C serogroup strain was detected and this could be directly related to immunization policies that provided meningococcal serogroup C conjugate vaccines for newborns and adolescents. The changing pattern of circulating serogroups of Neisseria meningitidis in healthy carriers could support a new immunization strategy which could provide quadrivalent meningococcal conjugate vaccines to pre-adolescents and adults.