Assuntos
Antivirais , COVID-19 , Humanos , Antivirais/farmacologia , Antivirais/uso terapêutico , SARS-CoV-2Assuntos
Betapapillomavirus/isolamento & purificação , Gammapapillomavirus/isolamento & purificação , Ceratose Actínica/virologia , Pele/virologia , Idoso , Betapapillomavirus/genética , DNA Viral/isolamento & purificação , Feminino , Testa , Gammapapillomavirus/genética , Voluntários Saudáveis , Humanos , Ceratose Actínica/patologia , Masculino , Reação em Cadeia da Polimerase Multiplex , Pele/patologia , Carga ViralRESUMO
OBJECTIVES: The aim was to investigate an outbreak of invasive meningococcal disease (IMD) in Southern Sardinia. METHODS: Epidemiological and microbiological investigations were performed. The latter included antimicrobial susceptibility testing and whole-genome sequencing (WGS). RESULTS: Seven individuals with severe IMD were found to be infected with serogroup B (MenB) Neisseria meningitidis in the first quarter of 2018. Five of the seven cases (five males; mean age 19 years; range 18-21 years; CFR 40%) were due to a unique strain B:P1.5-1,10-8:F3-6:ST-11(cc11), probably switched from the hypervirulent C-cc11, as confirmed by WGS. All five patients had attended the same nightclub in the 2 weeks prior to symptom onset. Public health measures, including chemoprophylaxis of contacts and active immunization against MenB, were implemented. CONCLUSIONS: We observed five IMD cases due to the same switched MenB strain. The hypervirulent B:P1.5-1,10-8:F3-6:ST-11(cc11) strain, probably switched from C-cc11, is of concern due to the observed high virulence and case fatality rates. All the patients shared the same place of probable exposure. The molecular characterization of the invasive strain allowed the outbreak to be confirmed, which was then controlled through timely public health action.
Assuntos
Cápsulas Bacterianas/imunologia , Surtos de Doenças , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/patogenicidade , Adolescente , Antibacterianos/uso terapêutico , Antígenos de Bactérias/imunologia , Cápsulas Bacterianas/genética , Feminino , Humanos , Itália/epidemiologia , Masculino , Infecções Meningocócicas/transmissão , Pessoa de Meia-Idade , Neisseria meningitidis/genética , Sorogrupo , Virulência , Sequenciamento Completo do Genoma , Adulto JovemRESUMO
In 2014, the Food and Drug Administration approved a new human papillomavirus 9-valent vaccine (9vHPV), targeting nine HPV types: HPV types 6, 11, 16, and 18, which are also targeted by the quadrivalent HPV vaccine (qHPV), plus five additional high cancer risk HPV types (HPV types 31, 33, 45, 52, and 58). The aim of the current study was to systematically retrieve, qualitatively and quantitatively pool, as well as critically appraise all available evidence on 9vHPV from randomized controlled trials (RCTs). We conducted a systematic review of the literature on 9vHPV efficacy, immunogenicity and safety, as well as a systematic search of registered, completed, and ongoing RCTs. We retrieved and screened 227 records for eligibility. A total of 10 publications reported on RCTs' results on 9vHPV and were included in the review. Sixteen RCTs on 9vHPV have been registered on RCT registries. There is evidence that 9vHPV generated a response to HPV types 6, 11, 16 and 18 that was non-inferior to qHPV. Vaccine efficacy against five additional HPV type-related diseases was directly assessed on females aged 16-26 years (risk reduction against high-grade cervical, vulvar or vaginal disease = 96·7%, 95% CI 80·9%-99·8%). Bridging efficacy was demonstrated for males and females aged 9-15 years and males aged 16-26 years (the lower bound of the 95% CIs of both the geometric mean titer ratio and difference in seroconversion rates meeting the criteria for non-inferiority for all HPV types). Overall, 9vHPV has been proved to be safe and well tolerated. Other RCTs addressed: 9vHPV co-administration with other vaccines, 9vHPV administration in subjects that previously received qHPV and 9vHPV efficacy in regimens containing fewer than three doses. The inclusion of additional HPV types in 9vHPV offers great potential to expand protection against HPV infection. However, the impact of 9vHPV on reducing the global burden of HPV-related disease will greatly depend on vaccine uptake, coverage, availability, and affordability.
Assuntos
Neoplasias/prevenção & controle , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/farmacologia , Humanos , Vacinas contra Papillomavirus/efeitos adversosRESUMO
OBJECTIVE: Rickettsia conorii is responsible for the Mediterranean Spotted Fever. Recently, new rickettsial species have been recognized in Europe and implicated in human diseases. Clinical features often differ greatly from each other, but non-severe liver involvement is frequently observed during any rickettsial infection. CASE REPORT: We describe the unique case of a patient presented with significant high aminotransferase levels due to the first human R. aeschlimannii infection ever detected in Italy. The hypothesis of rickettsiosis was made on the basis of a comprehensive medical history and was confirmed by serological tests. Molecular analyses made on a sample of hepatic tissue revealed the presence of a rickettsial species never found before in human liver. CONCLUSIONS: A brief review of the literature is reported to highlight how relevant this case is and to remind that rickettsioses should be in the differential diagnoses of acute hepatitis, considering mostly the recent spread of new rickettsial species.
Assuntos
Hepatite/microbiologia , Infecções por Rickettsia , Rickettsia , Adulto , Diagnóstico Diferencial , Hepatite/diagnóstico , Humanos , Masculino , Infecções por Rickettsia/diagnóstico , Infecções por Rickettsia/microbiologiaRESUMO
OBJECTIVES: To describe a spatio-temporal cluster of invasive meningococcal disease (IMD) due to serogroup C meningococci, occurred in a restricted area of Tuscany between January and October 2015, and the results of whole genome sequencing (WGS). METHODS: Surveillance activities and public health measures were implemented in the Region. Bacterial isolates from IMD cases were characterized by the National Reference Laboratory of the Istituto Superiore di Sanità (ISS), and WGS was performed on available strains. The kSNP software was used to identify core genome SNPs. RESULTS: Overall, 28 IMD cases due to meningococcus C were identified up to 31st October, 2015. Of them, 26 were due to meningococcus C:P1.5-1,10-8: F3-6:ST-11 (cc11) and 2 to C:P1.5-1,10-8: F3-6:ST-2780 (cc11). WGS of 13 meningococci isolated during the outbreak occurred in Tuscany in 2015 showed higher similarity when compared with those of 47 C: P1.5-1,10-8: F3-6:ST-11 (cc11) invasive strains from sporadic cases previously detected in Italy. CONCLUSIONS: A highly aggressive meningococcal C strain was involved in the cluster of severe IMD occurred in Tuscany, a Region with high vaccine coverage among children. Whether this was due to low herd immunity related to the short duration of vaccine protection needs further investigation.
Assuntos
Genoma Bacteriano , Infecções Meningocócicas/epidemiologia , Neisseria meningitidis Sorogrupo C/genética , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos de Bactérias/imunologia , Criança , Surtos de Doenças , Monitoramento Epidemiológico , Feminino , Humanos , Imunidade Coletiva , Incidência , Itália/epidemiologia , Masculino , Infecções Meningocócicas/imunologia , Infecções Meningocócicas/microbiologia , Vacinas Meningocócicas/imunologia , Pessoa de Meia-Idade , Neisseria meningitidis Sorogrupo C/classificação , Neisseria meningitidis Sorogrupo C/patogenicidade , Análise de Sequência de DNA , Sorotipagem , Conglomerados Espaço-Temporais , Adulto JovemRESUMO
We investigated the effect of climatic, demographic factors and intra-country geographical variations on the incidence of invasive meningococcal disease (IMD) in Italy. For this purpose, incidence rates of IMD cases reported in Italy between 1994 and 2012 were calculated, and a cluster analysis was performed. A geographical gradient was determined, with lower incidence rates in central and southern Italy, compared to the northern parts, where most clusters were observed. IMD rates were higher in medium-sized towns than in villages. Adults were at lower risk of IMD than children aged ⩽4 years. IMD incidence tended to decrease with increasing monthly mean temperatures (incidence rate ratio 0·94, 95% confidence interval 0·90-0·99). In conclusion, geographical variations in IMD incidence were found, where age and temperature were associated with disease occurrence. Whether geographical variations should be considered in national intervention plans is still a matter for discussion.
Assuntos
Altitude , Clima , Meningite Meningocócica/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Análise por Conglomerados , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Infecções Meningocócicas/epidemiologia , Pessoa de Meia-Idade , Análise Espaço-Temporal , Urbanização , Adulto JovemRESUMO
To assess trends in HIV-1 incidence and risk factors for seroconversion among men who have sex with men (MSM) resident in Rome, Italy, a retrospective longitudinal cohort study was conducted over 25 years. Incidence rates and trends were modelled using Poisson regression and risk factors were assessed by multivariate Cox models. Of 1,862 HIV-1-negative individuals, 347 seroconverted during follow-up. HIV-1 incidence rates increased from 5.2/100 persons/year (p/y) in 1986 (95% confidence interval (CI): 2.311.5) to 9.2/00 p/y in 1992 (95% CI: 6.413.0), decreased to 1.3/100 p/y in 2001 and increased until 2009 (11.7/100 p/y; 95% CI: 7.418.6). The risk of HIV-1 seroconversion increased during the study period in younger MSM (incidence rate ratio (IRR) = 17.18; 95% CI: 9.7430.32 in 1632 year-olds and IRR = 5.09; 95% CI: 2.928.87 in 3341 year-olds) and in those who acquired syphilis (IRR = 7.71; 95% CI: 5.0011.88). In contrast, the risk of seroconversion decreased among highly educated MSM (IRR = 0.54; 95% CI: 0.350.82) and those without Italian citizenship (IRR = 0.45; 95% CI: 0.280.71). The HIV epidemic in MSM living in Rome continues to expand. Targeted prevention programmes against sexually transmitted infections to enhance knowledge transfer and behavioural skills are urgently required.
Assuntos
Infecções por HIV/epidemiologia , Soroprevalência de HIV/tendências , HIV-1 , Homossexualidade Masculina/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Distribuição de Poisson , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Assunção de Riscos , Cidade de Roma/epidemiologia , Doenças Virais Sexualmente Transmissíveis/prevenção & controle , Fatores Socioeconômicos , Adulto JovemRESUMO
On 31 May 2013, the first case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in Italy was laboratory confirmed in a previously healthy adult man, who developed pneumonia with moderate respiratory distress after returning from a holiday in Jordan. Two secondary cases were identified through contact tracing, among family members and colleagues who had not previously travelled abroad. Both secondary cases developed mild illness. All three patients recovered fully.
Assuntos
Busca de Comunicante , Infecções por Coronavirus/diagnóstico , Coronavirus/isolamento & purificação , Pneumonia Viral/virologia , Adulto , Coronavirus/genética , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , DNA Viral/análise , Humanos , Lactente , Itália , Jordânia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/transmissão , Reação em Cadeia da Polimerase em Tempo Real , Síndrome , ViagemRESUMO
There are compelling data suggesting that antiretroviral (ARV) drugs can prevent the transmission of HIV: 1) ARV therapy reduces the intrinsic risk of transmission by cutting down the viral load in infected people; 2) ARVs may be used to prevent transmission in uninfected subjects who experienced high risk exposures. Despite these encouraging preliminary results, there are several questions that need to be answered before recommending the use of ARV among uninfected subjects: 1) the efficacy of these strategies amongst women is not yet established; 2) the cost-effectiveness of pre-exposure prophylaxis (PrEP) in the long term is undefined since PrEP efficacy may depend on adherence; 3) treating uninfected individuals may be counter-effective, as it may increase risky behavior due to the belief that ARV drugs have unlimited protective power. In conclusion, the public-health use of ARV drugs represents a new paradigm in the field of HIV prevention. However, ARV treatment cannot be considered as a substitute for other measures for preventing transmission but a complement to individual protection. In particular, post-exposure prophylaxis may be used in selected cases, whereas PrEP appears to be a highly costly method with limited public-health potential and possible safety concerns.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/prevenção & controle , Imunidade Coletiva , Fármacos Anti-HIV/economia , Fármacos Anti-HIV/farmacologia , Ensaios Clínicos como Assunto/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Infecções por HIV/transmissão , Soronegatividade para HIV , Política de Saúde , Humanos , Incidência , Itália , Masculino , Adesão à Medicação , Estudos Multicêntricos como Assunto/estatística & dados numéricos , Profilaxia Pós-Exposição , Saúde Pública , Assunção de Riscos , Sexo sem Proteção , Carga Viral/efeitos dos fármacosRESUMO
We describe two cases of probable autochthonous introduced Plasmodium vivax malaria that occurred in 2009 and 2011 in two sites of South-Central Italy. Although the sources of the infections were not detected, local transmission could not be disproved and therefore the cases were classified as autochthonous. Sporadic P. vivax cases transmitted by indigenous vectors may be considered possible in some areas of the country where vector abundance and environmental conditions are favourable to malaria transmission.
Assuntos
Animais Domésticos , Anopheles/parasitologia , Insetos Vetores , Malária/transmissão , Medição de Risco , Adulto , Animais , Animais Domésticos/parasitologia , Anopheles/crescimento & desenvolvimento , Surtos de Doenças/estatística & dados numéricos , Ecossistema , Feminino , Humanos , Insetos Vetores/microbiologia , Insetos Vetores/parasitologia , Itália/epidemiologia , Larva/metabolismo , Larva/fisiologia , Malária/diagnóstico , Malária/etiologia , Malária/microbiologia , Malária Vivax/parasitologia , Masculino , Reação em Cadeia da Polimerase/veterinária , Fatores de Tempo , Viagem , Microbiologia da ÁguaRESUMO
In 2011, from 26 September to 16 October, a small outbreak of West Nile virus (WNV) disease occurred on the island of Sardinia (Italy). According to the national case definition, six cases with acute neurological disease were confirmed in hospitalized patients, and four of them died; one of these was only 34 years old. In two case, WNV RNA was detected in urine, suggesting renal involvement. Sequence analysis showed lineage 1 and 2 circulation.
Assuntos
Surtos de Doenças , Febre do Nilo Ocidental/epidemiologia , Febre do Nilo Ocidental/virologia , Vírus do Nilo Ocidental/classificação , Vírus do Nilo Ocidental/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Genótipo , Humanos , Itália/epidemiologia , Masculino , Epidemiologia Molecular , Dados de Sequência Molecular , Filogenia , RNA Viral/genética , Análise de Sequência de DNA , Urina/virologia , Febre do Nilo Ocidental/mortalidade , Vírus do Nilo Ocidental/isolamento & purificaçãoAssuntos
Doenças das Aves/virologia , Aves/virologia , Vírus da Encefalite Japonesa (Espécie)/isolamento & purificação , Encefalite Japonesa/veterinária , RNA Viral/genética , Animais , Vírus da Encefalite Japonesa (Espécie)/genética , Encefalite Japonesa/virologia , Europa (Continente) , Humanos , Itália , Saúde Pública , Reação em Cadeia da Polimerase em Tempo Real , Análise de Sequência de RNARESUMO
We describe the geographical and temporal distribution of West Nile neuroinvasive diseases (WNND) cases in Italy from 2008 to 2011. The increasing number of confirmed human cases from eight in 2008 to 18 in 2009 and the occurrence of the virus in a larger geographical area in 2009 (moving from east to west) prompted the Ministry of Health to publish, in spring 2010, a national programme for WNND human surveillance, comprising veterinary and vector surveillance. Subsequently, in 2011, a new national plan on integrated human surveillance of imported and autochthonous vector-borne diseases (chikungunya, dengue and West Nile disease) was issued. Between 2008 and 2011, 43 cases of WNND were reported from five regions in Italy with a case fatality rate of 16%. The incidence of WNND during the entire study period was 0.55 per 100,000 population (range: 0.060.23 per 100,000). During 2011, two new regions (Friuli-Venezia Giulia and Sardinia) reported confirmed cases in humans. Integrated human, entomological and animal surveillance for West Nile virus is a public health priority in Italy and will be maintained during 2012.
Assuntos
Vigilância da População , Febre do Nilo Ocidental/epidemiologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Itália/epidemiologia , Meningoencefalite/virologia , Vigilância de Evento Sentinela , Vírus do Nilo Ocidental/imunologiaRESUMO
In order to investigate the current and past activity of phlebovirus and flavivirus in Kosovo, a seroprevalence study among 200 blood donors was performed. Positive results were obtained for the phleboviruses TOSV and SFNV, and for a flavivirus of the Japanese Encephalitis group. No positive results for TBEV were observed.
Assuntos
Anticorpos Antivirais/sangue , Doadores de Sangue , Flavivirus/imunologia , Phlebovirus/imunologia , Vírus da Febre do Flebótomo Napolitano/imunologia , Adolescente , Adulto , Ensaio de Imunoadsorção Enzimática , Feminino , Infecções por Flavivirus/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Febre por Flebótomos/epidemiologia , Estudos Soroepidemiológicos , Adulto Jovem , Iugoslávia/epidemiologiaRESUMO
The clinical severity of human infection with the novel influenza virus A/H1N1v has not been completely defined, especially in HIV/hepatitis C virus (HCV) infected patients. Although most patients develop mild to moderate symptoms, severe disease may occur in a limited proportion of cases. We report the case of a 44-year-old man infected with HIV and HCV with a high CD4 cell count who developed acute respiratory distress syndrome associated with influenza virus A/H1N1v infection. The patient recovered completely after oseltamivir therapy and mechanical ventilation.
Assuntos
Infecções por HIV/complicações , Hepatite C/complicações , Vírus da Influenza A Subtipo H1N1/patogenicidade , Síndrome do Desconforto Respiratório/complicações , Síndrome do Desconforto Respiratório/virologia , Adulto , Antivirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , Hepacivirus/efeitos dos fármacos , Hepatite C/tratamento farmacológico , Hepatite C/virologia , Humanos , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Pulmão/patologia , Masculino , Oseltamivir/uso terapêutico , Síndrome do Desconforto Respiratório/tratamento farmacológico , Síndrome do Desconforto Respiratório/patologia , Resultado do TratamentoRESUMO
Following reports of West Nile neuroinvasive disease in the north-eastern area of Italy in 2009, all blood donations dating from the period between 1 August and 31 October 2009 in the Rovigo province of the Veneto region were routinely checked to exclude those with a positive nucleic acid test for West Nile virus (WNV). Only one of 5,726 blood donations was positive (17.5 per 100,000 donations; 95% confidence interval (CI): 0.497.3). In addition, a selection of 2,507 blood donations collected during the period from 20 July to 15 November 2009 were screened by ELISA for IgG and IgM antibodies against WNV. A positive result was received for 94 of them. The positive sera were further evaluated using immunofluorescence and plaque reduction neutralisation test (PRNT), in which only 17 sera were confirmed positive. This corresponds to a prevalence of 6.8 per 1,000 sera (95% CI: 4.010.9). In a case-control study that matched each of the 17 PRNT-positive sera with four negative sera with the same date of donation and same donation centre, we did not find a significant association with age and sex of the donor; donors who worked mainly outdoors were significantly more at risk to have a positive PRNT for WNV.
Assuntos
Anticorpos Antivirais/sangue , Doadores de Sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Febre do Nilo Ocidental/epidemiologia , Vírus do Nilo Ocidental/isolamento & purificação , Adulto , Idoso , Anticorpos Antivirais/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Imunofluorescência , Técnica de Placa Hemolítica , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Testes de Neutralização , Prevalência , Estudos Retrospectivos , Sensibilidade e Especificidade , Estudos Soroepidemiológicos , Febre do Nilo Ocidental/diagnóstico , Febre do Nilo Ocidental/virologia , Vírus do Nilo Ocidental/imunologiaRESUMO
OBJECTIVES: Literature reports highlighted the presence of discriminatory episodes towards individuals infected with human immunodeficiency virus (HIV) on behalf of dental care workers. The purpose of this study was to assess hygienists' attitude when treating HIV-infected individuals in the era of highly active antiretroviral therapy (HAART). METHODS: A national observational study was carried out on all the members of an Italian hygienist association. An anonymous questionnaire was mailed to 1247 hygienists: the questionnaire investigated demographic data, the relationship between the hygienists and HIV-infected persons, to identify the presence of discriminatory behaviour, the hygienists' scientific knowledge of HIV-related problems and the precautions normally used in the office to prevent cross-infections. RESULTS: Of the 1247 questionnaires that were delivered to hygienists, 287 (23%) were completed and returned within a 6-month period. A total of 287 hygienists answered the question 'Did you ever deny treatment to an HIV-infected persons?' and 17 hygienists (5.9%) replied 'Yes'. Protective eyewear [odds ratio (OR), 0.036; 95% confidence interval (CI), 0.002-0.818; P = 0.037] and public practice [OR, 2.93; 95% CI, 0.97-8.87; P = 0.057] were associated with refusing to treat HIV-infected persons. CONCLUSION: Our findings highlight the existence of episodes of discrimination by some hygienists towards HIV-infected individuals. From clinical point of view, this discriminatory behaviour may expose the dental health care workers and their patients to a greater risk of cross-infection.
Assuntos
Terapia Antirretroviral de Alta Atividade , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Higienistas Dentários/psicologia , Soropositividade para HIV/psicologia , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Higienistas Dentários/educação , Raspagem Dentária , Dispositivos de Proteção dos Olhos , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Soropositividade para HIV/tratamento farmacológico , Educação em Saúde Bucal , Humanos , Controle de Infecções Dentárias/métodos , Itália , Masculino , Educação de Pacientes como Assunto , Projetos Piloto , Preconceito , Prática de Saúde Pública , Recusa em Tratar , Aplainamento Radicular , Inquéritos e Questionários , Precauções UniversaisRESUMO
Eighty-one patients affected by the novel influenza A (H1N1), hospitalized in North-western Italy, were studied. The median age was 32 years (range 1-81 years). Fifty-six (69%) had an underlying medical condition, including lung disorders (asthma or chronic obstructive pulmonary disease) in 34% and obesity in 25%. Fifty percent of them had pneumonia, 12% were admitted to the intensive care unit and 3% died. Antiviral treatment was initiated in 75% of patients started within 48 h. Older age and lung and neurocognitive disorders were associated with severe disease and death.