Regional reports for the subnational monitoring of measles elimination in Italy and the identification of local barriers to the attainment of the elimination goal.

Although most countries in the WHO European Region were verified in 2017 as having interrupted endemic measles transmission, nine countries were still endemic. Among these, Italy accounted for the second highest number of measles cases reported in Europe in 2017. The elimination of measles is verified at national level by each country's National Verification Committee (NVC) through the production of an Annual Status Update (ASU). Since in Italy decentralization has led to an inhomogeneous implementation of immunization strategies among the 21 administrative Regions, the Italian NVC proposed that measles elimination should also be documented at the subnational level through regional ASUs and Synthetic Regional Reports (SRRs). The regional ASUs and the SRRs for 2014, 2015 and 2016 were produced and appraised by the NVC to evaluate the Regions' performances in each individual year as well as over the whole period. A specific analysis of vaccination coverage, including official immunization data for 2017, was performed. Moreover, the measles epidemic of 2017 was examined. Firstly, in the period 2014-2016, low immunization rates were registered in most Regions. Sixty-three per cent of southern Regions reported rates below the national mean and an overall low-quality performance. The approval of Italy's mandatory vaccination law in 2017 resulted in a marked increase in vaccination coverage; however, this increase was not homogeneous among Regions. Secondly, more than 50% of Regions did not report any supplemental immunization activity (SIA) for the period 2014-2016. Thirdly, from 2014 to 2016, fewer than one-third of Regions improved their reporting of outbreaks. Finally, over the study period, only two Regions reached the target required by the WHO for measles laboratory investigations. In countries with decentralized health policies, subnational monitoring can help identify local barriers to measles elimination. In Italy it has highlighted the need for further SIAs and a stronger surveillance system.

[The elimination of measles and rubella in Italy]. / L'eliminazione del morbillo e della rosolia in Italia.

Despite the WHO target for measles and rubella elimination in 2015, outbreaks still occur in all WHO Regions. After a description of the epidemiological situation of measles and rubella worldwide and especially in Europe, this paper aims to provide a detailed analysis of the current epidemiological context of Italy. The surge in the number of measles cases since the beginning of 2017, together with vaccination coverage still far from the 95% target, requires priority actions to be taken to achieve the elimination goals. Alongside the recently approved decree reintroducing compulsory vaccinations for school admissions, further measures are needed and should include the increase in the commitment of the 21 Regions; the implementation of supplemental immunization activities; improving the communication skills of health care workers; ensuring an effective communication with citizens; the enhancement of the surveillance network.

HLA-G 14-bp polymorphism: a possible marker of systemic treatment response in psoriasis vulgaris? Preliminary results of a retrospective study.

Human leukocyte antigen-G (HLA-G) is a nonclassical HLA class I molecule that exerts an immunosuppressive function. A 14-base pair (bp) sequence insertion/deletion (INS/DEL) polymorphism in the exon 8 at the 3' untranslated region (UTR) modifies mRNA stability and protein production and has been shown to concur with efficacy of pharmacological treatments in immune-mediated conditions. The aim of this study was to assess for the first time the correlation between HLA-G 14-bp INS/DEL polymorphism with the response to systemic therapy in psoriatic patients. We retrospectively analyzed the HLA-G 14-bp INS/DEL polymorphism of HLA-G gene in patients with moderate to severe plaque psoriasis: 21 treated with acitretin, 16 with cyclosporine, 11 with anti-TNF-α. Patients who reached PASI 75 at weeks 10-16 were considered responders. Among patients treated with acitretin, we observed a significantly increased frequency of the HLA-G DEL allele and of the DEL/DEL genotype in responder patients when compared with nonresponders. An association between HLA-G genotype and response to cyclosporine and biologics was not found. The significant association between HLA-G 14-bp DEL allele and 14-bp DEL/DEL genotype and acitretin clinical outcome may suggest an advantage of this allele and propose this HLA-G polymorphism as a potential marker of response to acitretin in psoriatic patients.