Human tularemia in Italy. Is it a re-emerging disease?

Tularemia is a contagious infectious disease due to Francisiella tularensis that can cause serious clinical manifestations and significant mortality if untreated. Although the frequency and significance of the disease has diminished over the last decades in Central Europe, over the past few years, there is new evidence suggesting that tularemia has re-emerged worldwide. To know the real epidemiology of the disease is at the root of correct control measures. In order to evaluate whether tularemia is re-emerging in Italy, data on mortality and morbidity (obtained by the National Institute of Statistics; ISTAT), Italian cases described in the scientific literature and data concerning hospitalizations for tularemia (obtained by the National Hospital Discharge Database) were analysed. From 1979 to 2010, ISTAT reported 474 cases and no deaths. The overall number of cases obtained from the literature review was at least 31% higher than that reported by ISTAT. Moreover, the number of cases reported by ISTAT was 3·5 times smaller than hospitalized cases. In Italy tularemia is sporadic, rarely endemic and self-limiting; but, although the trend of reported tularemia does not support the hypothesis of a re-emerging disease, the study demonstrates a wide underreporting of the disease. The real frequency of the disease should be carefully investigated and taken into account in order to implement specific prevention measures.

National surveillance capacity of water-related diseases in the WHO European region.

Water-related diseases continue to cause a high burden of mortality and morbidity in the countries of the European Region. Parties to the Protocol on Water and Health are committed to the sustainable use of water resources, the provision of safe drinking water and adequate sanitation to all people of the European Region, and to the reduction of the burden of water-related diseases. A specialized Task Force is implementing a work plan aimed at strengthening the capacity for water-related disease surveillance, outbreak detection and contingency planning. Parties to the Protocol are obliged to set targets, and report on progress on water-related disease surveillance. The present paper aims to provide a baseline assessment of national capacities for water-related disease surveillance on the basis of the replies to a questionnaire. This was prepared in English and Russian and administered to 53 countries, 15 of which replied. The results confirm the heterogeneity in surveillance systems, the weakness of many countries to adequately survey emerging water-related diseases, and the need for specific remedial action. The findings of the exercise will form the basis for future action under the Protocol on Water and Health.

[Gray water reuse in domestic environment: implications for public health]. / Riuso delle acque grigie in ambiente domestico: implicazioni per la sanità pubblica.

The Authors describe the main microbiological characteristics of gray and rain waters, the evidence of infections related to the reuse of such waters and the main Italian and international standards and guidelines in this regard. In light of the review, the authors conclude that the limits defined by the Italian regulations are very precautionary and should ensure a very low risk of bacterial and/or viral infection (< 10.5 and 10.9 cases/year). It remains an open problem the risk of parasitic infections, for which the evidences to draw final conclusions are not sufficient yet.

Nonylphenol and octylphenol in human breast milk.

Human milk is the most important form of nourishment for newborn children. Its consumption is strongly recommended by health authorities also for other important advantages. Unfortunately, in the last three decades a great number of investigations have shown the occurrence of several environmental contaminants in human milk, especially those with lipophilic properties. This study investigates the presence of nonylphenol, octylphenol (OP), nonylphenol monoethoxylate (NP1EO) and two octylphenol ethoxylates (OPEOs) (namely OP1EO and OP2EO), in human breast milk of Italian women. NP was the contaminant found at the highest levels with mean concentrations of 32 ng/mL, about two orders of magnitude higher than OP (0.08 ng/mL), OP1EO (0.07 ng/mL) and OP2EO (0.16 ng/mL). In the group of study a positive correlation among fish consumption and levels of NP in the milk was observed, in accordance with the evidence that seafood represents one of the most important sources of exposure to this group of contaminants in Italy. On the basis of the concentrations found in the breast milk samples, a maximum NP daily intake of 3.94 microg/kg/day can be calculated, which is close to the Tolerable Daily Intake (TDI) of 5 microg/kg body weight (bw) proposed by the Danish Institute of Safety and Toxicology. In the cases of OP no TDI is available, but its intake is at least six orders of magnitude lower than the NOAEL of 10 mg/kg/day derived from a two generation study on rats.

[Indicators of water microbial pollution: problems and perspectives]. / Indicatori di qualità microbiologica delle acque: problemi e prospettive.

Conventional indicators of fecal contamination provide a precious contribution in evaluating water microbiological quality. In recent years some important issues have sprung up which have risen doubts about their reliability and have suggested a revision of their function. In developed countries, where the law regarding water quality is very strict, there have been several outbreaks, even though conventional indicators of fecal pollution pointed an appropriate microbiological quality. These outbreaks have been imputed to new pathogenic microorganisms which are often characterized by a great resistance to disinfection treatments than conventional indicators. In order to obtain an appropriate microbiological quality of waters, various approaches have been started such as the Water Safety Plans by World Health Organization the revision of the functions of suitable indicators (of the water quality), the setting up of specific methods either for pathogen microorganisms and for a quick surveying of an inadequate microbiological water quality.

Degradation and leaching of the herbicides metolachlor and diuron: a case study in an area of Northern Italy.

In this work the degradation of the herbicides metolachlor, diuron, monuron and of the metabolites 2-ethyl-6-methylaniline (EMA), and 3,4-dichloroaniline (DCA) was assessed in laboratory experiments on microbiologically active and sterilized soils. Their leaching potentials were calculated, using Gustafson's equation, by determining their mobility (as Koc) and persistence (expressed as DT50). Lysimeter experiments were also conducted to assess the actual leaching of the studied herbicides in a cereal crop tillage area vulnerable to groundwater contamination. The data obtained from the field were compared to the laboratory results. Moreover, some compounds of particular concern were searched for in the groundwater located near the experimental area in order to evaluate actual contamination and to test the reliability of the leaching potential. The GUS index, computed on data from microbiologically active soil, shows monuron as a leacher compound, EMA and DCA as non-leachers, metolachlor and diuron as transient ones. The presence of metolachlor in the groundwater monitored, even at concentrations up to 0.1 mug/l, confirms the possibility that transient compounds can be leached if microbial activity has not completely occurred in active surface soil.

Determination of cadmium, chromium, lead and vanadium in six fish species from the Adriatic Sea.

Concentrations of cadmium, chromium, lead and vanadium were determined in samples of six fish species collected along the coast of the Adriatic Sea. The concentrations of the elements studied were generally low, often below the detection limits of the analytical methods. The highest values (microg x kg(-1) fresh weight) were observed, mainly in the central area of the Adriatic Sea, for anchovy (Cd 20.2, Cr 82.9, Pb 45.9, V 89.9), red mullet (Cd 3.1, Cr 31.0, Pb 36.0, V 79.1) and mackerel (Cd 7.7, Cr 28.0, Pb 11.4, V 43.5). The concentrations of cadmium and lead in all the species examined were below the maximum levels indicated by the European Community for these two elements in seafood, and also would lead to exposure levels lower than the provisional tolerable daily intakes suggested by the FAO/WHO for Cd (420 microg x week(-1) for a 60-kg person) and Pb (1500 microg x week(-1) for a 60-kg person). The concentration of chromium was lower than the recommended daily amount (50-200 microg x day(-1) for a 60-kg person) indicated by the US National Research Council. An 11-34% contribution to the daily vanadium ingestion with fish was calculated for the population of the Adriatic coast.

Organochlorine pesticides and polychlorinated biphenyls in 12 edible marine organisms from the Adriatic Sea, Italy, Spring 1997.

Edible portions of 12 marine organisms from several areas of the Adriatic Sea, Italy, were collected during Spring 1997 and analysed for 32 organochlorine pesticides residues and 27 polychlorobiphenyl congeners. Only eight organochlorine pesticides - hexachlorobenzene (HCB), hexachlorocyclohexane (HCH) isomers, diphenyl-dichloro-trichloroethane (DDT) group, dieldrin - were determined at levels in the range <0.01-19.88 ng g(-1) wet weight, with 1,1'-dichloro-2,2'-bis(4-chlorophenyl)ethylene (DDE) being the more relevant single organochlorine. The contamination by organochlorine pesticides was comparable in organisms from the North, Centre and South Adriatic. Polychlorinated biphenyls (PCBs) were determined at levels in the range <0.05-14.46 ng g(-1), with CB 101, 118, 138, 153, 180 and 187 being more relevant (penta-, hexa- and hepta-chlorinated congeners). The sum of PCBs congeners determined were in the range 1.18-69.05 ng g(-1). The contamination by PCBs is more relevant in organisms from the North Adriatic Sea owing to the antropic discharge from major rivers such as Po and Adige that flow through highly industrialized and densely populated areas.

Alkylphenolic compounds in edible molluscs of the Adriatic Sea (Italy).

This paper reports the first group of results on alkylphenol (APE) contamination of seafood in the Adriatic Sea, in the framework of a national project on the quality of this Sea (PRISMA 2). Nonylphenol (NP), octylphenol (OP), and their ethoxylates (NPE and OPE) were detected in edible molluscs, either filter feeders or predators (clams, mussels, cuttlefishes, and squids), caught from 15 harbors along the Italian coast in the Adriatic Sea in 1997. NP was the compound found always at levels much higher than the other APEs in all the examined species. It reached the maximum concentration of 696 ng/g fresh weight in the squids from the central Adriatic Sea. OP generally occurred at levels 30 times lower than NP. OP was found up to a level of 18.6 ng/g in squids from central Adriatic Sea. OPE was the compound always spotted at the lowest concentrations, up to 0.43 ng/g. NPE was always below the detection limit. The pattern of contamination in the three areas examined was different between bivalve and cephalopod species. No exhaustive risk assessment for marine organisms and human health can be conducted on the basis of these results because data are insufficient. Yet, the occurrence of NP suggests a negligible risk for mussels, which represent the only molluscs for which data are adequate. As to the possible human health implications, the consumption of molluscs of the Adriatic Sea implies APE intakes that are some orders of magnitude lower than those responsible for toxic effects in laboratory animals. Despite these apparently low risks for mussels and human health, the reasons for concern still remain because the levels of alkylphenols found in this study indicate a general contamination of the Adriatic Sea even far from the cost. Furthermore, these levels might represent an unacceptable hazard for other marine organisms. Finally, they contribute to the general environmental estrogen pool.

Assessment of leaching potential of aldicarb and its metabolites using laboratory studies.

The metabolites of pesticides can contaminate groundwater and pose a risk to human health when this water is used for drinking. This paper reports the results of a laboratory study on aldicarb and its main metabolites, aldicarb sulfone and aldicarb sulfoxide. Aldicarb and its metabolites showed Koc values (6-31) which were lower than that of atrazine (55), indicating that they are very mobile in soil. They are less persistent than atrazine (DT50 = 25 days), with DT50 values from less than 1 day and up to 12 days. Aldicarb behaved as a non-leacher, whereas its metabolites clearly showed the characteristics of leachers. Aged residue leaching experiments showed that aldicarb can occur at high concentrations in the leachate, together with its two metabolites. The leachate composition depends on the incubation time of the parent compound. Aldicarb and its metabolites can form various mixtures in groundwater on the basis of the time elapsing between the application of the insecticide and the first significant rainfall. This study confirms the characteristics of contaminants of aldicarb and especially its metabolites, as reported in the literature.

[Alkylphenols: assessment of risks for aquatic ecosystems and for human health with particular reference to endocrine effects]. / Alchilfenoli: valutazione dei rischi per gli ecosistemi acquatici e per la salute umana con particolare riferimento agli effetti endocrini.

(Alkylphenols: evaluation of the risk to aquatic ecosystems and human health with reference to endocrine effects).--Endocrine disrupting chemicals (EDC) are a heterogeneous group of substances that can interfere with many endocrine functions. Their effects have been demonstrated in different taxa and they are suspected to affect human health. Alkylphenols are an important group of EDC. They are formed from the degradation of alkylphenol polyethoxylates in the environment or in the sewage treatment plants. They are generally characterized by a high bioconcentration factor (BCF) and accumulate both in sediments and aquatic species. Alkylphenols (APE) show estrogenic activity: studies on fish and rodents put into evidence on both reproductive and developmental effects. In a recent study, the levels of APE detected in seafood from the Adriatic Sea showed a no negligible human health risk for strong fish consumers.

Leaching properties of some degradation products of alachlor and metolachlor.

Once in soil, pesticides undergo degradation processes that give rise to a complex pattern of metabolites. Those presenting a significant percentage of formation, genotoxic and leaching properties may pose a threat to human health associated with the consumption of drinking water. The aim of this study is to assess the hazard potential of some metabolites that may occur in ground water. 2,6-diethylaniline, 2-chloro-2',6'-diethylacetanilide, 2-hydroxy-2',6'-diethylacetanilide, metabolites of alachlor and 2-ethyl-6-methylaniline, metabolite of metolachlor, were chosen for their genotoxic properties. Under laboratory conditions, these metabolites showed DT50 = 1-5 days and Koc = 45-357. Their leaching potential, calculated according to Gustafson, is very low and, therefore, they should not be regarded as contaminants of ground waters. Aged residue leaching studies as well as preliminary studies on well waters seem to confirm these findings.

Significance of bacteria in the mucilage phenomenon in the northern Adriatic Sea.

Episodes of massive mucilage formation in the northern Adriatic Sea have been recorded for over a century but their cause is still a matter of conjecture and debate. It is generally thought that mucilage forms due to copious polysaccharide exudation by phosphorus limited algae. In this paper we develop the thesis that bacteria play major roles in mucilage formation. We argue that mucilage is largely produced as a consequence of bacteria-organic matter interactions and bacterial capsular polysaccharide synthesis. Ectohydrolytic enzymes of bacteria are critical in producing long-lived polysaccharides. Further, bacteria cause efficient P regeneration, particularly intensely in microscale features e.g. phycospheres, detritus and aggregates. Bacteria thus help sustain high rates of primary production despite vanishingly low levels of phosphorus in the bulk phase seawater. We integrate these roles of bacteria into a conceptual model which emphasizes microscale interactions of microbes within a seawater gel matrix as the basis for a mechanistic understanding of the accumulation of long-lived polysaccharide to form mucilage.

Human health implications associated with mucilage in the northern Adriatic Sea.

Mucilage in the northern Adriatic Sea is well known for its negative impact not only on the ecology of the affected area and on fishing activities but on tourism as well. The microhabitat mucilage creates in the sea can provide favourable conditions for the growth and/or survival of some environmental microorganisms that include human opportunistic pathogens. It also seems to favour the selective development of some marine toxic algae. Finally, mucilage can concentrate chemical contaminants from surrounding waters, hence increasing their bioaccumulation in seafoods. This paper examines the possible direct and indirect effects on human health of mucilage and other forms of marine aggregates.

Review of leaching characteristics of triazines and their degradation products.

Only few data have been published on the environmental impact of pesticide degradation products on soil and groundwater. It is known that some of the degradation products of triazines, particularly those formed from N-dealkylation reactions, can be phytotoxic and more mobile than their parent compounds. In some cases it has been shown that they are present at even higher concentrations than the latter. Yet, their impact on groundwater quality is unknown since information on both environmental levels and chemiodynamic parameters are generally lacking. The conclusions of this work are that many triazine degradation products may pose a significant hazard to the quality of groundwater and that there is a need to promote and extend the production of experimental data on this topic.

Criteria for evaluating the impact of pesticides on groundwater quality.

A lot of data and information are available regarding the presence of pesticides in ground-waters or their tendency to contaminate them. Despite this, for a very large number of pesticides these data and information are almost completely lacking. Many theoretical methods have been proposed to predict the leaching potential of pesticides. Persistence (expressed by DT50) and mobility (expressed by Koc) are key parameters that seem to be particularly representative of the overall leaching potential of nonionic compounds and they are widely used in these methods. Nevertheless, these parameters may vary greatly causing sharp differences in ranking the leaching potential of pesticides. Indeed, when the GUS Index is calculated using the available published values of Koc and DT50 in combinations representing the minimum, medium and maximum leaching potential of herbicides, very different results can be obtained. Many of these compounds can be classified as contaminants or non contaminants, depending on the type of combination used.

Quality problems in waters used for drinking purposes in Italy.

With a grant from the Italian Ministry of the Environment, the National Institute of Health (Istituto Superiore di Sanità) promoted and coordinated some activities aimed at determining the extent and the intensity of contamination of waters used for human consumption by some chemical agents, and describing causes and modalities of contamination and human health implications. The chemical agents examined were herbicides, nitrates, trihalomethanes, asbestos, manganese and fluoride. In this paper a first nationwide picture of these problems is reported.

[Herbicides in drinking water]. / Erbicidi nelle acque potabili.

Toxicological implications due to the use of herbicide-contaminated drinking water, as well as other organic chemicals, are related to their nature and levels. These implications can be defined for each substance on the basis of an adequate evaluation of epidemiological information and experimental data on animals. In this paper, World Health Organization's procedures for establishing guidelines for 11 herbicides widely used in Italy are described. Furthermore, data and information about the use of these herbicides and their levels in Italian drinking-water supplies are also reported and discussed. Finally, factors and conditions responsible for the groundwater contamination by some herbicides in determined areas are presented and discussed.