A Cross-Sectional Study of Untoward Reactions Following Homologous and Heterologous COVID-19 Booster Immunizations in Recipients Seventeen Years of Age and Older.

A booster dose after primary COVID-19 vaccination series was considered crucial after the emergence of the B.1.617.2 (Delta) and B.1.1.529 (Omicron) variants. Active surveillance was used to investigate reporting of adverse events post-booster dose of either of the licensed mRNA Comirnaty (Pfizer/BioNTech) or Spikevax (Moderna) vaccines in adult (17 years and older) recipients in central Italy. Eligible participants were enrolled and interviewed via phone using a structured questionnaire. Primary outcomes related to the occurrence of adverse events post-booster were stratified by vaccine, and frequency of local/systemic, mild/moderate/severe events. Of a total of 622 participants interviewed, 554 (89.1%) reported at least one adverse event (88.2% and 92.9% after the Comirnaty or Spikevax vaccine, respectively): 63.4% were female, and 78.5% aged 17 to 64 years, regardless of vaccine. 87.7% and 68.2% of all recipients described at least one local or systemic reaction, respectively: 97.3, 38.6 and 4.7% reported mild, moderate, or severe events, respectively. The most frequent adverse reactions were pain, redness, or swelling at the injection site and fatigue, while malaise and fever significantly occurred after the Comirnaty, and vomiting after the Spikevax booster. Compared to the primary vaccination, lymphadenopathy was more common after the booster (p < 0.001), especially after Comirnaty vaccine. The study findings revealed no serious or unexpected adverse events, and are in agreement with data available on booster dose for both mRNA vaccines. The transient, mild to moderate, and common to very common side reactions reported should be used to reassure potential recipients of the lack of safety concerns.

Active Surveillance of Adverse Events in Healthcare Workers Recipients After Vaccination with COVID-19 BNT162b2 Vaccine (Pfizer-BioNTech, Comirnaty): A Cross-Sectional Study.

In this cross-sectional study, adverse events after the first and second dose of BNT162b2 mRNA (Pfizer-BioNTech, Comirnaty) vaccine against coronavirus disease 2019 were investigated among employees of clinics in central Italy. A 42-items questionnaire was administrated to vaccine recipients. Adverse events were classified based on severity and occurrence as reported in the literature. A descriptive/univariate analysis using Chi-square or Fisher's Exact tests was performed. Odds ratio (OR) and 95% confidence intervals were calculated to assess risk factors. 340 individuals (61.5% females; median age 49 years) participated. Adverse events were reported by 279 (82%) and 281 (82.6%) individuals as induced by the first and second dose, respectively. Mild reactions were mainly reported (80.9% and 80.3%), followed by moderate (11.8% and 37.1%) and severe (3.8% and 4.7%). Adverse events were identical to those already described as very common (81.8% and 80.6%), although vaccine-coincidental events not cited in the literature were reported by 6% and 15.6% following each dose. Age ≤ 55 years was a risk factor for any adverse event after each injection (ORs: 2.942 and 2.818), as well as female sex for those mild (ORs: 1.856 and 2.818) and common (ORs: 3.452 and 2.145). Findings were consistent with national reports as most of the adverse events were mild and associated with female sex and young age, while investigations are needed for reactions not described elsewhere. Data are useful to support the vaccine safety profile, also because largely targeted healthcare personnel more skilled than general population in self-diagnosis of health-related issues.

A SARS-CoV-2 Outbreak Among Nursing Home Residents Vaccinated with a Booster Dose of mRNA COVID-19 Vaccine.

This study describes a SARS-CoV-2 outbreak caused by the Delta (B.1.617.2) variant in a nursing home in Central Italy during October-November 2021. Trained interviewers collected data from residents, staff, and administration officers with an agreed informed consent procedure. Thirty-two (44.5%) out of 72 residents (median age 89 years) and six (26.1%) of 23 healthcare workers were found to be infected with SARS-CoV-2. Infections occurred more often among residents with a higher index of independence in daily living activities, suggesting an increased risk for those with more interactions. Twenty-five infected residents (78.1%) received the booster dose of mRNA anti-COVID-19 vaccine > 7 days before SARS-CoV-2 onset. Half of the infected residents had mild symptoms, and only three required hospitalisation, one of whom died from COVID-19 complications. The study underlines the effectiveness of a booster dose in providing a high protection against severe disease and hospitalisation even among vulnerable individuals infected with the Delta variant of concern.

Public health, personalized medicine, and COVID-19 in the pre-vaccination phase: a narrative review of the literature on unfavorable prognostic factors in Italian patients.

OBJECTIVES: to provide an outline of the factors mainly influencing severe disease and fatal outcome among Italian COVID-19 patients in the pre-vaccination phase, also describing the impact of the scenarios driven by variants, vaccines, and available therapies. DESIGN: a literature search was carried out for peer-reviewed articles searching for COVID-19 and prognosis, including severe disease and death. SETTING AND PARTICIPANTS: Italian patients with COVID-19. MAIN OUTCOME MEASURES: the association between risk factors and severe disease and death as the main outcomes was assessed through epidemiological measures, including relative risk, odds ratio, and hazard ratio. RESULTS: advanced age, obesity, overweight, non-0 blood group, and male gender were the factors more associated with severe disease. Fatal outcome mostly correlated with old age, non-0 blood group, and obesity, together with cardiovascular diseases, diabetes, hypertension, cancer, chronic kidney disease, and acute kidney injury. CONCLUSIONS: clinical and epidemiological characteristics of the Italian population, integrated with omics data, could be highly valuable to stratify risk of worse prognosis among patients, and to address targeted prevention and treatment interventions.

Prevalence of anal, oral, penile and urethral Human Papillomavirus in HIV infected and HIV uninfected men who have sex with men.

Aims of the study were to evaluate Human Papillomavirus (HPV) and type-specific prevalence in four anatomical sites in HIV infected men who have sex with men (MSM) compared with HIV uninfected MSM. Participants were recruited among the attendees of Infectious Diseases Clinics in Central Italy. A trained medical practitioner collected by interview sociodemographic data and information on medical history, sexual behavior, and drug use. Swabs from anal canal, oral cavity, urethral mucosa, and coronal sulcus were tested for HPV DNA and genotyping. Ninety MSM were enrolled, 45 subjects within each group. Overall, 48.9% MSM were HPV positive and prevalence was higher in HIV infected men (60.0% vs 37.8%, P = 0.035). HPV at multiple anatomic sites occurred in 59.1% MSM, with 34.1% and 22.7% at two and three sites, respectively. Prevalence of anal, coronal sulcus, oral, and urethral HPV was 96.3%, 37%, 21.6%, and 18.5% in HIV infected MSM, and 70.6%, 70.6%, 29.4%, and 23.5% among HIV uninfected. A similar proportion of HIV infected and uninfected MSM (59.2% and 58.8%) carried at least one high-risk genotype. Prevalence of types covered by nonavalent vaccine was 77.8% in HIV infected compared with 82.3% in HIV uninfected MSM. HPV 58 and 16 were mostly detected in HIV positive (43.7% and 31.2%) and negative MSM (50.0% and 40.0%). HPV detection rate underlined the high vulnerability of MSM to acquire multisite infections, characterized by various genotype combinations. Since nonavalent vaccine could have prevented 80% of HPV infections, study findings support the implementation of vaccination programs among MSM.

Control and prevention measures for legionellosis in hospitals: A cross-sectional survey in Italy.

Risk assessment, environmental monitoring, and the disinfection of water systems are the key elements in preventing legionellosis risk. The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine, and Public Health and the Italian Multidisciplinary Society for the Prevention of Health Care-Associated Infections carried out a national cross-sectional survey to investigate the measures taken to prevent and control legionellosis in Italian hospitals. A multiple-choice questionnaire was developed, comprising 71 questions regarding hospital location, general characteristics, clinical and environmental surveillance, and control and preventive measures for legionellosis in 2015. Overall, 739 hospitals were enrolled from February to June 2017, and 178 anonymous questionnaires were correctly completed and evaluated (response rate: 24.1%). The survey was conducted using the SurveyMonkey® platform, and the data were analyzed using Stata 12 software. Of the participating hospitals, 63.2% reported at least one case of legionellosis, of which 28.2% were of proven nosocomial origin. The highest case numbers were reported in the Northern Italy, in hospitals with a pavilion structure or cooling towers, and in hospitals with higher numbers of beds, wards and operating theaters. Laboratory diagnosis was performed using urinary antigen testing alone (31.9%), both urinary antigen testing and single antibody titer (17.8%), or with seroconversion also added (21.5%). Culture-based or molecular investigations were performed in 28.8% and 22.1% of the clinical specimens, respectively. The water systems were routinely tested for Legionella in 97.4% of the hospitals, 62% of which detected a positive result (> 1000 cfu/L). Legionella pneumophila serogroup 2-15 was the most frequently isolated species (58.4%). The most common control measures were the disinfection of the water system (73.7%), mostly through thermal shock (37.4%) and chlorine dioxide (34.4%), and the replacement (69.7%) or cleaning (70.4%) of faucets and showerheads. A dedicated multidisciplinary team was present in 52.8% of the hospitals, and 73% of the hospitals performed risk assessment. Targeted training courses were organized in 36.5% of the hospitals, involving nurses (30.7%), physicians (28.8%), biologists (21.5%), technicians (26.4%), and cleaners (11%). Control and prevention measures for legionellosis are present in Italian hospitals, but some critical aspects should be improved. More appropriate risk assessment is necessary, especially in large facilities with a high number of hospitalizations. Moreover, more sensitive diagnostic tests should be used, and dedicated training courses should be implemented.

Tracking Multidrug-Resistant Klebsiella pneumoniae from an Italian Hospital: Molecular Epidemiology and Surveillance by PFGE, RAPD and PCR-Based Resistance Genes Prevalence.

Antimicrobial-resistant Klebsiella pneumoniae represent a global public health concern. K. pneumoniae strains isolated during 2010 and 2014-2016 within a single hospital of Molise Region, Central Italy, were analyzed testing antimicrobial susceptibility, clonality by pulsed-field gel electrophoresis (PFGE) and random amplified polymorphic DNA (RAPD)-PCR, and prevalence of carbapenem resistance genes by PCR. Forty isolates (23 wild-type in 2010 and 17 non-wild-type in 2014-2016) were collected from hospitalized patients (65.2 ± 18.1 years old, 75% male, 80% from intensive care unit-ICU). K. pneumoniae showed multidrug-resistant profiles and 15 resistotypes were identified (discriminatory power D = 0.88). The 69.6 and 17.4% of isolates in 2010 resulted intermediate and resistant to imipenem, respectively, and 91.3% was sensitive to meropenem, while 88.2% of isolates of 2014-2016 were resistant to both antibiotics. PFGE identified 16 clusters versus 23 by RAPD, 26 pulsotypes versus 33 RAPD patterns (D ≥ 0.97). PFGE separated strains according to isolation period and identified an outbreak occurred in the ICU during December 2014 and January 2015. No strains harbored blaGES, blaIMP, blaNDM-1, and blaOXA-48 genes, as well as AmpC plasmid-mediated beta-lactamases genes. Only K. pneumoniae isolated during 2014-2016 were blaKPC positive. Prevalence of blaVIM was 87 and 76.5% during 2010 and 2014-2016, respectively. No strains colistin-resistant harbored mcr-1 plasmid-mediated resistance gene. The study findings underline an increased circulation of multidrug-resistant K. pneumoniae within the hospital, and the acquisition of carbapenem resistance mechanism. The implementation of surveillance and molecular characterization of isolates are needed to identify outbreaks, reduce the spread of resistance, and guide empirical therapy.

[Biological risk in agriculture and construction workplaces: a survey on perception, knowledge and prevention measures.] / Il rischio biologico nei lavoratori dei settori agricoltura ed edilizia: percezione, conoscenze e misure di prevenzione.

OBJECTIVES: Despite the potential presence in many workplaces, biological risk is little known and largely underestimated, except in healthcare environments. Objectives: To evaluate perception, knowledge and behaviors adopted for protection and prevention of biological risk, related also to the occupational activity, among construction and agricultural workers. METHODS: Workers were recruited at farms and construction companies of Molise Region, Central Italy, which were visited within the surveillance activities planned by local institutions. A questionnaire was administered to workers to collect sociodemographic and occupational data, and concerning risk perception and knowledge, and awareness of available prevention measures, also related to the work activity. RESULTS: total of 143 workers (73.4% males, 42.9±10.7 years old) were interviewed, and 56.6% were construction workers. Only 24% of workers believed that infectious diseases could be frequent and health threatening in carrying out the work activities; half of them declared to be exposed to biological hazards, but 70% were unworried. An underestimation of the severity of some pathologies, such as listeriosis, leptospirosis and viral hepatitis emerged, and only 70% of workers believed that tetanus is highly or very highly dangerous for health. Furthermore, 33% of workers said to have scarce or insufficient knowledge of biological risk, and 97.2%, 80.4% and 45.5% were aware that a vaccine is available for tetanus, hepatitis B and A, respectively. All workers undergone the tetanus vaccination and 39.2% the anti-hepatitis B. CONCLUSIONS: Despite the high probability of exposure to biological agents, the results of the survey revealed a lack of perception and knowledge of the risk, as well as a poor awareness of available preventive measures among construction and agricultural workers. These data point out the need to activate information and training programs on exposure to biological agents and on both emerging and re-emerging infectious diseases potentially related to work activities, and to provide prevention procedures specific for these workplaces.

Biological risk among agriculture and construction workers in Molise Region, Central Italy. / Studio pilota sul rischio biologico nei settori agricoltura ed edilizia in Molise.

BACKGROUND: Biological risk is a significant issue in workplaces due to continuous modification of work organization and condition. OBJECTIVES: In this pilot study, perception and knowledge of biological risk, as well as adoption of prevention measures were evaluated among construction and agriculture workers. METHODS: A structured questionnaire was administered to workers to collect socio-demographic and employment information, in addition to data on risk perception and knowledge, and adoption of preventive measures, including those related to work activities. RESULTS: Fifty-three workers aged 45.3±9.8 years participated in the study, 81% were male, and 70% were construction workers. Approximately 80% of participants declared that infectious diseases are neither frequent nor health-threatening in their occupational activity. The majority of workers considered some diseases, such as hepatitis A and B, leptospirosis and listeriosis, as posing a low risk to their health. Forty-seven % claimed to be unexposed to biohazards at their workplace, and 72% were not worried about them. Ninety-six % of the workers knew about vaccination for tetanus, but only 74% and 36% knew about the availability of vaccination for Hepatitis A and B, respectively. During lifetime, 94% of the workers received at least one vaccination. All workers had undergone tetanus vaccination, but only few received vaccine for influenza, hepatitis B and tuberculosis. CONCLUSIONS: This pilot study in occupational settings revealed a poor perception of biological risk and a limited awareness of the severity of infectious diseases. Major knowledge gaps existed about the available preventive measures. It is essential to promote safety culture at the workplace also with regard to biological hazards. This requires improving information and education, conducting appropriate studies, and prompting health and safety professional actors to focus on occupational infectious disease problems.

High prevalence of human papillomavirus type 58 in HIV infected men who have sex with men: A preliminary report in Central Italy.

Human papillomavirus (HPV) infection and type-specific prevalence at anal, oral, coronal sulcus, and urethral mucosa in fifty HIV positive men having sex with men (MSM) were evaluated; patients were enrolled in a non-metropolitan area of Central Italy. Clinical and socio-demographic information, drug, and sexual behaviors were obtained for each participant. HPV was detected by PCR from an overall of 200 specimens, and genotyping was performed by both Restriction Fragment Length Polymorphism analysis and sequencing. HPV DNA was found in 60.0% (n = 30) of HIV positive MSM, and prevalence was higher at anal canal (n = 28, 56.0%) compared to all the other anatomical sites (χ(2) test P < 0.01) of coronal sulcus (n = 11, 22.0%), oral (n = 8, 16.0%), and urethral mucosa (n = 5, 10.0%). We found 63.3% (n = 19) of MSM with at least one high-risk genotype, and HPV-58 was more frequently detected (n = 9, 47.4%) respect to HPV-16 (n = 6, 31.6%). This is the first report on HPV detected at four anatomical sites involved in sexual practices in HIV positive MSM. We found an unusual distribution of oncogenic genotypes with an exceeding prevalence of HPV-58 respect to HPV-16. Hence, the recently licensed nonavalent vaccine should be suitable to prevent a larger number of infections caused by potentially emerging high-risk genotypes.

MicroRNAs expression patterns in the response of poplar woody root to bending stress.

MAIN CONCLUSION: The paper reports for the first time, in poplar woody root, the expression of five mechanically-responsive miRNAs. The observed highly complex expression pattern of these miRNAs in the bent root suggest that their expression is not only regulated by tension and compression forces highlighting their role in several important processes, i.e., lateral root formation, lignin deposition, and response to bending stress. Mechanical stress is one of the major abiotic stresses significantly affecting plant stability, growth, survival, and reproduction. Plants have developed complex machineries to detect mechanical perturbations and to improve their anchorage. MicroRNAs (miRNAs), small non-coding RNAs (18-24 nucleotides long), have been shown to regulate various stress-responsive genes, proteins and transcription factors, and play a crucial role in counteracting adverse conditions. Several mechanical stress-responsive miRNAs have been identified in the stem of Populus trichocarpa plants subjected to bending stress. However, despite the pivotal role of woody roots in plant anchorage, molecular mechanisms regulating poplar woody root responses to mechanical stress have still been little investigated. In the present paper, we investigate the spatial and temporal expression pattern of five mechanically-responsive miRNAs in three regions of bent poplar woody taproot and unstressed controls by quantitative RT-PCR analysis. Alignment of the cloned and sequenced amplified fragments confirmed that their nucleotide sequences are homologous to the mechanically-responsive miRNAs identified in bent poplar stem. Computational analysis identified putative target genes for each miRNA in the poplar genome. Additional miRNA target sites were found in several mechanical stress-related factors previously identified in poplar root and a subset of these was further analyzed for expression at the mRNA or protein level. Integrating the results of miRNAs expression patterns and target gene functions with our previous morphological and proteomic data, we concluded that the five miRNAs play crucial regulatory roles in reaction woody formation and lateral root development in mechanically-stressed poplar taproot.

Real-time PCRs assay for serogrouping Listeria monocytogenes and differentiation from other Listeria spp.

A 5'-exonuclease real-time triplex-PCR assay was developed for serogrouping Listeria monocytogenes, and differentiation from other Listeria spp. The assay was evaluated on 109 Listeria cultures, and results were compared with a previously validated gel-based multiplex-PCR procedure. All L. monocytogenes were correctly classified into four serogroups, including atypical serotype 4b strains, and differentiated from other Listeria species. The assay is a rapid method for categorisation of suspect L. monocytogenes.

Asthma prevalence and risk factors among children and adolescents living around an industrial area: a cross-sectional study.

BACKGROUND: The exposure to air pollution has negative effects on human health, increasing the risk of respiratory diseases, such as asthma. Few data are yet available on the epidemiology of childhood asthma in some areas of Italy. The aim of the study was to estimate asthma prevalence and related risk factors in children and adolescents residents around the industrial area of Termoli, Molise region, Central-South Italy. METHODS: Prevalence was assessed through the administration of modified ISAAC questionnaires filled out by parents of 89 children and adolescents for the identification of confirmed and probable cases, and by analyzing pediatricians' databases on drug prescriptions for symptoms control and treatment of assisted population in the study area (n = 1,004), compared to a control area (n = 920) with lower industrialization. The association of asthma with risk factors was evaluated by univariate (Chi-square or Fisher's Exact test) and regression logistic analysis. RESULTS: A total of 22 (24.7%) asthmatics were identified, including both confirmed (n = 7; 7.9%) and probable cases (n = 15; 16.8%), most of them (n = 17; 77.3%) resident of Termoli town. All asthma cases were georeferenced based on the residence, however clusters were not found. Using drug prescriptions analysis, a higher prevalence (n = 138; 13.7%) of diagnosed cases was found. Lifetime history of both atopic dermatitis and bronchitis were significantly relateds to asthma cases, as well as an elevated body mass index, whose association is consistent with prevalence data of overweight/obese children living in the study area. Moreover, being resident of the town of Termoli was associated to the occurrence of cases. CONCLUSIONS: Although our data indicated a prevalence concordance with previous national studies in pediatric population, a definitive correlation with environmental industrial factors present in the study area was not established. However, asthma outcome was significantly associated to individuals living in the town of Termoli that, despite the industrial/manufacturing activities, is also subjected to a higher environmental pressure due to the presence of toll road, state highway, railroad, and seaport which may cause air pollution from motor vehicle traffic and increase asthma induction. This study provides hitherto unavailable data on asthma in childhood population living in an industrialized area which was never investigated before, could be part of a systematic review or meta-analysis procedure, might suggest significant findings for larger observational studies, and contribute to complete the frame of disease epidemiology in Italy.

Safety of mRNA BNT162b2 COVID-19 (Pfizer-BioNtech) vaccine in children aged 5-11 years: Author's reply to correspondence.

Dear Editor, We would like to reply to "Safety of mRNA BNT162b2 COVID-19 (Pfizer-BioNtech) vaccine in children aged 5-11years: Correspondence" regarding our article entitled "Safety of mRNA BNT162b2 COVID-19 (Pfizer-BioNTech) vaccine in children aged 5-11years: Results from an active pharmacovigilance study in central Italy."

Healthcare infections and antimicrobial consumption in pre-COVID-19 era: a point prevalence survey in three hospitals in a region of Central Italy.

Introduction: Healthcare-associated infections (HAIs) are a major global public health concern, increasing the transmission of drug-resistant infections. This point prevalence survey investigated HAIs occurrence and antimicrobial consumption (AMC) in pre-COVID-19 era in the public hospitals of a region of Central Italy. Methods: Data were collected using the protocol standardised by the European Centre for Disease Prevention and Control. Results: Three-hundred and sixty-four patients were included (59.3% male) in the study. Overall, HAIs prevalence was 6.6% (95%CI 4.4-9.5), ranging from 5.2% to 7.1% within the surveyed hospitals, with at least one infection in 24 patients (ten each in medical and surgical specialties wards, and four in intensive care). Risk factors for HAIs were advanced age, having undergone surgery and wearing invasive devices. At time of the survey, 44.7% (95%CI 39.7-49.9) of patients was under treatment with at least one antibiotic, and AMC varied between 43% and 48% within hospitals. In all hospitals, a prevalence higher than 10% was found for the prescription reasons other than prophylaxis or therapy. Conclusions: The results revealed a HAIs prevalence lower than that estimated compared to the most recent national data, in contrast to higher antimicrobial usage. These findings highlight the need to reinforce hygiene practices and develop bundles for HAIs, as a broad implementation of infection prevention and control practices extensively applied to both hub and spoke hospitals could significantly reduce their occurrence, as well as to implement antimicrobial stewardship for prescriptive appropriateness.

Infections and Colon Surgery: Preliminary Results from a Surveillance Program in an Italian Hospital.

Surgical site infections (SSIs) represent a valid indicator of the healthcare quality. This study described the preliminary results of one-year active surveillance program on colon surgeries in a hospital in Molise region, central Italy. Patients who had undergone colon surgery according to National Healthcare Safety Network were included. Data on intervention, perioperative antibiotic prophylaxis, and SSIs occurrence were collected. Chi-square and Fisher's Exact test were used to evaluate any association between risk factors and SSIs. Sixty-eight patients (mean age 70.6 years) were included, and 44 (64.7%) were males. The most frequent interventions were right (n = 17, 25.0%) and left (n = 15, 22.0%) hemicolectomy. Surgical interventions were largely elective (n = 43, 63.2%) and with laparotomy (n = 56, 82.4%). During hospital stay, 10 (14.7%) SSIs were detected, including five superficial, three deep and two organ/space infections. Three (4.4%) additional SSIs were detected at post-discharge follow-up, for 13 (19.1%; CI95%: 9.7%-28.5%) total cases detected. Metronidazole plus Ceftriaxone (third generation cephalosporin) was the antibiotics combination mostly used (n = 36, 52.9%) for the perioperative antibiotic prophylaxis within 60 minutes of incision. The study underlines the need of improvements of the practices currently adopted, since SSIs could be significantly reduced through a multimodal strategy generating bundles. As third generation cephalosporins may facilitate resistant strains emergence, for perioperative prophylaxis in clean-contaminated interventions with entry into gastrointestinal tract, Cefazolin plus Metronidazole or only second generation cephalosporin are recommended. Due to the large variability of post-intervention antibiotic therapy, antimicrobial stewardship approach is strictly necessary.

Implementation of a centralized, web-based surveillance for healthcare associated infections among residents of long-term care facilities in Italy.

Objective: The Italian National Action Plan to contrast AMR identified among its objectives the development and implementation of a national Healthcare-Associated Infection (HAI) surveillance system based on European Centre for Disease Prevention and Control (ECDC) indications, through point prevalence surveys (PPS) of HAIs and antibiotic use in acute-care hospitals and long-term care facilities (LTCFs). We aimed to assess feasibility and appropriateness of proposed tools for a national surveillance system of HAIs and antibiotic use in LTCFs. Study design: Point prevalence survey. Methods: A pilot PPS was conducted between May-June 2022, among 15 LTCFs of 7 Italian regions. Data were collected in a single day in each LTCF, at the LTCF, ward, and resident levels, using a web-based data collection tool developed ad hoc. Data collector teams of each facility were invited to complete a questionnaire investigating opinions on the proposed tools. Results: Among 1025 included residents, the prevalence of residents with at least one HAI was 2.5% (95% CI 1.7%-3.7%) considering all HAIs and 2.2% (95% CI 1.3%-3%) without considering SARS-CoV-2 infections. The prevalence of antimicrobial use was 3% (95% CI 0.2%-4.3%). Overall, most respondents were satisfied with the web-based software, training and protocol, even though some difficulties were reported. Conclusions: A national surveillance network was established, which will facilitate future surveillance efforts. Further studies are necessary to evaluate the impact of the pandemic on HAI transmission and antibiotic use in LTCFs.

Safety of mRNA BNT162b2 COVID-19 (Pfizer-BioNtech) vaccine in children aged 5-11 years: Results from an active pharmacovigilance study in central Italy.

This survey investigated on adverse events after vaccination with mRNA BNT162b2 (Comirnaty, Pfizer-BioNTech) vaccine in children aged 5-11 years in central Italy through active surveillance reporting. During December 2021-January 2022, parents of children who undergone vaccination were interviewed using a structured questionnaire. 197 out of 208 contacted parents participated (94.7% response rate), of whom 166 (84.3%) had one child. Of the 229 children, the mean age was 8.9 years, 50.7% were female. 193 (84.3%) had at least one adverse event after the first dose (mean age 9.1 years; 54.4% female), and 146 (73.4%) of 199 after the second (mean age 8.9 years; 54.8% female), which was not administered to 30 children due to previous COVID-19 history. Local symptoms after the first and second dose occurred in 183 (94.8%) and 141 (96.6%) recipients (p = .435), respectively, while systemic reactions in 62 (32.1%) and 34 (23.3%) (p = .074). Mild events were reported by 81.7% and 69.8% children after the first and second dose, followed by moderate (3.9% and 10.6%) and severe (1.3% and 0.5%). After each dose, injection site reactions (79.5% and 68.8%) were the most frequent, followed by headache (13.1%) and lymphadenopathy (8.5%) after the first and second dose, respectively. The adverse events were reported to pediatricians only for 5.7% and 3.9% of children and treated for 17.6% and 15.8%. This is the first report about safety profile through active surveillance of mRNA BNT162b2 among children in Italy, revealing temporary and mild-to-moderate symptoms with no serious events after each vaccine dose.

Awareness, knowledge and training gaps regarding asbestos among General Practitioners: a pilot study.

General Practitioners (GPs) have good knowledge of health status and sociocultural backgrounds of their patients, thus could be decisive in early detection of cases of asbestos-related diseases (ARDs). In this cross-sectional pilot study, we investigated perception and knowledge on asbestos risk amongst a sample of GPs practicing in Molise region, central Italy, who have anonymously completed a 29-items questionnaire specifically developed for this research. Based on GPs' answers, we obtained scores and classified awareness and knowledge into four percentage quartile classes including inadequate (0-24%), poor (25-49%), moderate (50-74%) and high (75-100%), and scarce (0-24%), sufficient (25-49%), good (50-74%) and optimal (75-100%), respectively. Twenty-eight GPs (median age 63 years; 82% male) participated. Perception and knowledge among participants varied from 62 to 84% and from 18 to 42%, respectively, with 65 and 42% showing an adequate level, respectively. Our survey revealed a satisfactory perception and knowledge of general features about this topic, while a poor awareness of detailed aspects, underlining the need of continuing medical education in the field of occupational medicine. The study remarks that criteria for ARDs diagnosis should be better specified, introducing a detailed list to harmonize medical protocols for symptoms identification and patients' examination. Hence, increasing awareness of asbestos risk and ARDs among GPs represents a crucial opportunity, because of their prominent position to promptly take care of patients and provide targeted information.

Healthcare-Associated Infections and Antibiotics Consumption: A Comparison of Point Prevalence Studies and Intervention Strategies.

This study compares healthcare-associated infections (HAIs) prevalence and antimicrobial consumption (AMC) from surveys conducted in 2016 and 2019 in an Italian hospital for acute care. HAIs prevalence was 7.1% in both surveys, while patients were under antibiotic treatment slightly increased from 2016 to 2019, from 42.6% to 43.7%, respectively. In the survey of 2016, HAIs risk factors were fatal McCabe score and hospitalization longer than two weeks, while CVC and urinary catheter in that conducted in 2019. In both surveys, CVC and peripheral venous catheter resulted associated to AMC. HAIs and AMC remained stable although the hospital undergone a complexity reduction in the second survey, remarking that critical actions are strictly required implementing infection control practices and antimicrobial stewardship.