Using electronic mail to improve MMR uptake amongst third level students.

This study assessed the usefulness of email in informing third level students about special MMR clinics being provided on campus during a mumps outbreak in the North West of Ireland. Email messages were sent directly to students, informing them of the clinics, inviting them to make a clinic appointment by email and providing details of walk-in clinics. At the clinics, all 177 attendees were asked to fill out a questionnaire and the response rate was 89% (n=158). Regarding the main sources of information about the vaccination clinics, email was selected by 117 (74%) students, word-of-mouth by 27 (17%), posters/leaflets by 8 (5%), and other sources by 6 (4%). Use of email as a source of information was rated as very good/excellent by 115 (73%), as good by 35 (22%) and poor/fair by 8 (5%). This study demonstrates that email is a useful and acceptable way of informing third level students about immunisation clinics in an outbreak situation.

The first prevalence survey of nosocomial infections in the University Hospital Centre 'Mother Teresa' of Tirana, Albania.

A survey was conducted in the largest hospital in Albania to estimate the prevalence and risk factors for nosocomial infections (NIs). A one-day prevalence survey was carried out between October and November 2003 in medical, surgical and intensive care wards. Centers for Disease Control and Prevention definitions were used. Study variables included patient and hospital characteristics, surgical procedures, invasive devices, antibiotic treatment, microbiological and radiological examinations, infection signs and symptoms. Risk factors were determined using logistic regression. In all, 185 NIs were found in 163 of 968 enrolled patients. Urinary tract infections (33.0%), surgical site infections (24.3%), pneumonia (13.0%) and venous infections (9.2%) were the most frequent NIs. The prevalence of NIs was higher in intensive care units (31.6%) than in surgical (22.0%) and medical wards (10.3%). Overall, 132 NIs (71.4%) were confirmed by microbiological examination; the single most frequently isolated micro-organism was Staphylococcus aureus (18.2%). By means of logistic regression, the following independent risk factors were identified: age >40 years, length of hospital stay, 'trauma' diagnosis at admission, and invasive devices. Even though comparisons must be made with great caution, the prevalence of NIs was higher than in western European countries and in some developing countries.

The first point prevalence survey of nosocomial infections in Albania: pilot study.

In May 2003, investigators were trained and prevalence pilot study was conducted at the University Hospital of Tirana, Albania. Investigators were trained to assess the organizational problems of the first prevalence survey of nosocomial infections (NIs) in Albania. Twelve investigators were trained in 2 days. After the training, the pilot study was conducted in 3 wards. The investigators collected data using a standard form and the definitions of the Centers for Disease Control, USA. The training improved the investigators' knowledge of NI epidemiology and surveillance. The pilot study underlined the lack of information in the clinical documentation and lack of collaboration between clinicians and the laboratory: microbiological examinations were performed only in 13 (16.5%) patients and none of the 11 NIs reported was confirmed in the laboratory. This led to a review of the survey protocol, above all in order to increase the use of microbiological laboratory.

Testing practices and spread of HIV among sexual partners of HIV-positive haemophiliacs in Italy. Gruppo Italiano Coagulopatie Congenite.

OBJECTIVES: To evaluate rates and predictors of testing and HIV positivity among the sexual partners of Italian HIV-positive haemophiliacs. METHODS: Our index cases were 602 sexually active HIV-positive haemophiliacs (aged 18 years or more) enrolled in the Italian Registry of Haemophilia. Data on the demographic and clinical status of the haemophiliacs, whether their partners had undergone HIV testing, and the results of these tests were collected. RESULTS: To date, 205 (34.1%) partners of HIV-positive haemophiliacs have been tested for HIV, of whom 27 (13.2%) were seropositive. On univariate analysis, haemophiliacs who were unmarried, younger, and asymptomatic were less likely to have partners who had been tested for HIV (P << 0.001). On multivariate analysis, unmarried status [odds ratio (OR), 8.4; 95% confidence interval (CI), 5.4-13.1; P << 0.001] and younger age (OR, 1.9; 95% CI, 1.1-3.2) again predicted a higher rate of non-tested partners. There was no association between the demographic and medical characteristics of HIV-seropositive haemophiliacs and the risk of HIV positivity among their sexual partners. CONCLUSION: This study demonstrates that a high proportion of sexual partners of HIV-positive haemophiliacs have not yet been tested for HIV. The single most important predictor of not being tested was the marital status of the index case. These results emphasize the need to strengthen prevention programmes aimed at minimizing the risk of heterosexual HIV transmission, particularly among younger unmarried haemophiliacs.

Progression to AIDS among Italian HIV-seropositive haemophiliacs. Italian Group.

To investigate the interval between HIV-1 infection and the development of clinical AIDS among Italian patients with congenital coagulation disorders, a national cohort study was undertaken in 1988. Information was collected both retrospectively and prospectively on 499 HIV-1-positive patients enrolled in an ongoing national registry of patients with congenital coagulation disorders. Two methods were used to estimate each patient's seroconversion date: the mid-point between the last negative (either known or estimated) and the first positive test, and the median under a Weibull distribution, which was assumed to fit seroconversion data. The two methods of estimating the seroconversion time yielded similar results. The actuarial incidence of AIDS was estimated using the Kaplan-Meier survival analysis at 12.8% (95% confidence interval = 9.7-15.9) over 7 years for Italian haemophiliacs. Progression appears to be slow in the first 5 years after the infection, and to rise steadily thereafter. A strong association between faster progression and older age at seroconversion was found. Zidovudine-treated individuals seem to have a slower progression than untreated individuals, after controlling for CD4, but there was no association between progression and type and severity of the congenital disorder.

Clinical factors associated with progression to AIDS in the Italian cohort of HIV-positive hemophiliacs. G.I.C.C. Gruppo Italiano Coagulopatie Congenite.

This study updates estimates of the cumulative incidence of AIDS among Italian patients with congenital coagulation disorders (mostly hemophiliacs), and elucidates the role of age at seroconversion, type and amount of replacement therapy, and HBV co-infection in progression. Information was collected both retrospectively and prospectively on 767 HIV-1 positive patients enrolled in the on-going national registry of patients with congenital coagulation disorders. The seroconversion date was estimated as the median point of each patient's seroconversion interval, under a Weibull distribution applied to the overall interval. The independence of factors associated to faster progression was assessed by multivariate analysis. The cumulative incidence of AIDS was estimated using the Kaplan-Meier survival analysis at 17.0% (95% CI = 14.1-19.9%) over an 8-year period for Italian hemophiliacs. Patients with age greater than or equal to 35 years exhibited the highest cumulative incidence of AIDS over the same time period, 32.5% (95% CI = 22.2-42.8%). Factor IX recipients (i.e. severe B hemophiliacs) had higher cumulative incidence of AIDS (23.3% vs 14.2%, p = 0.01) than factor VIII recipients (i.e. severe A hemophiliacs), as did severe A hemophiliacs on less-than-20,000 IU/yearly of plasma-derived clotting factor concentrates, as opposed to A hemophiliacs using an average of more than 20,000 IU (18.8% vs 10.9%, p = 0.02). No statistically significant difference in progression was observed between HBsAg-positive vs HBsAg-negative hemophiliacs (10.5% vs 16.4%, p = 0.10). Virological, immunological or both reasons can account for such findings, and should be investigated from the laboratory standpoint.

Epidemiology of hemophilia and of HIV infection in Italy. GICC. Gruppo Italiano Coagulopatie Congenite.

To evaluate the incidence and prevalence of hemophilia in Italy and the impact of HIV infection on the Italian hemophiliac population, data from a computerized national registry of patients from 95% of the hemophilia care centers in Italy were analyzed. A total of 4643 patients were included in the registry. The prevalence of hemophilia A was 8.2 per 100,000 males, with no significant regional differences; for hemophilia B the corresponding figure was 1.5 per 100,000. Temporal trends in hemophilia incidence suggest that the diagnosis of mild and moderate hemophilia has improved. The overall HIV prevalence was 26% and was significantly (p < 0.001) higher in patients with hemophilia B (47.1%) compared to those with hemophilia A (26.8%) or other diseases (16.5%). The highest rate of HIV seropositivity was among patients 20-29 years of age. The annual amount of clotting factor concentrates received was significantly (p < 0.001) higher in HIV seropositive patients than in those who were seronegative. Antibody testing was never performed on 10.1% of severely affected patients. The number of patients in the Italian registry was similar to the number that would have been expected based on prevalence estimates from other countries. In comparison with other countries, the prevalence of HIV infection recorded in Italy was lower in persons with hemophilia A, but higher in those with hemophilia B. Our study demonstrates the usefulness of a registry in delineating the epidemiology of hemophilia and in studying risk factors for HIV infection. It also underlines the need for continuing surveillance of this population.

Immigration and health: the Italian National Focal Point experience.

This report is a description of the situation of migrant populations in Italy. It was written by a committed team of experts from public institutions, non-governmental organisations (NGO) and volunteer associations that for three years have been part of the Italian National Focal Point (NFP) within the European Project "AIDS & Mobility", which is being co-ordinated by the Netherlands Institute for Health Promotion and Disease Prevention (the Netherlands) and financed by the European Commission DG/V. This year the Italian National Focal Point, co-ordinated by the Telefono Verde AIDS of the Istituto Superiore di Sanità, has produced a second report (the first one was published in 1998) on health issues related to migrant populations. Besides providing an updated picture on the presence of foreigners in Italy, such report illustrates the present legislative situation within the sanitary area and some interventions regarding prevention, treatment and rehabilitation provided by each structure in the Italian NFP to foreign citizens. The initiatives carried out during the year 1999 by public institutions, NGO and volunteer associations are also reported in order to detect the psycho-social-sanitary needs of immigrants and target prevention programmes to their particular and specific needs.

[Population study of knowledge and practice in the Albanian population regarding water usage and diarrhea prevention]. / Studio di popolazione sulle conoscenze e i comportamenti della popolazione albanese rispetto all'uso dell'acqua e la prevenzione delle malattie diarroiche.

The worsening of the social-environmental conditions during the period of transition of Albania and an epidemic of cholera (1994) were the cue for the execution of the study. The main objective is the description of knowledge and attitudes of the Albanian mothers about the risk factors for the gastroenteritis. This is a descriptive study of a representative sample (2100 families) of the population who reside in the central area of Albania, in 1996. The sample has been selected by cluster-sampling method. Interviewers trained previously, collected the data with a questionnaire ad hoc. Data elaboration has been carried out with the software Epilnfo 5. 99.7% (2094) of the enlisted mothers, mean age 28.7 years, were interviewed. 2/3 of them reside in rural areas. We considered social-demographic variables and their relation with the generic hygienic norms and those relative to water, foods, animals. The basic knowledge was very insufficient, particularly in rural areas, and in relation with lower social-economic index and instruction. The study reflects the state of transition train of the political and social-sanitary situation of Albania in the last decade. Still the knowledge and the attitudes about the alimentary hygiene are inadequate. It seems opportune to face this emergency with campaigns aimed at health education and public health interventions.

[Guidelines for a prevalence survey of nosocomial infections in the University Hospital "Madre Teresa" in Tirana, Albania]. / Indagine di prevalenza delle infezioni ospedaliere presso il Centro Ospedaliero Universitario "Madre Teresa" di Tirana, Albania: proposta di un protocollo operativo.

The authors present guidelines for the first prevalence survey of nosocomial infections in the University Hospital "Madre Teresa" in Tirana (almost 1,600 beds), the only tertiary health-care centre in Albania. The survey is a joint project involving Italy and Albania, to be coordinated by the Italian National Health Institute. The paper describes goals, methodology and organization of the prevalence survey. The improvement of local expertise in epidemiology and microbiology is one of the most important goals. Therefore, Albanian personnel training and improvement of the infection microbiological diagnosis are fundamental aspects of the project.

Helicobacter pylori seroprevalence in selected groups of Albanian volunteers.

BACKGROUND: Albania is a Mediterranean, South-East European developing country where epidemiological data on infectious diseases are scarce. In this study, the seroprevalence of Helicobacter pylori infection in 1,088 Albanian healthy volunteers (472 females followed-up to a prenatal clinic, 173 recruits, 443 health care workers) was evaluated. MATERIALS AND METHODS: Sera were tested for immunoglobulin-G (IgG) antibodies against H. pylori using a quantitative enzyme immunosorbent assay. RESULTS: The overall H. pylori seroprevalence was 70.7%. The H. pylori seroprevalence increased by age, from 60.4% in individuals younger than 20 years to 81% among those > or = 50 years of age with a significant trend of increase by age. The overall seroprevalence was 73.9% for females and 59.5% for males. In addition the seroprevalence was 55.3% for people living in rural areas and 72.3% for people living in urban areas. No significant differences were found according to level of education except for individuals with elementary level of education. Nurses and hospital auxiliaries have significantly higher H. pylori seroprevalence when compared to other health care workers (physicians and office workers). When each variable (age, gender, area of residence, occupation, and education level) was adjusted for the confounding effect of the other variables by stepwise logistic analysis, we observed that age greater than 40 years and female gender remain the only variables independently associated with the presence of H. pylori IgG antibodies. CONCLUSIONS: H. pylori is highly prevalent among the Albanian population. Improving living conditions, education in hygiene, and the supply of running water are measures to prevent the transmission of H. pylori infection and other infections spread by the fecal-oral route in Albania.

Acute intestinal infections in Europe. A review of reported cases.

Acute intestinal infections still constitute one of the leading causes of death in the world and a major cause of morbidity in Europe. Unfortunately, most European countries do not have an information system oriented towards acute intestinal infection surveillance. The present work is an analysis of cases of typhoid fever, Salmonellosis, Shigellosis, foodborne infections, and acute gastroenteritis reported from January 1980 to December 1985. Data from 24 of the 33 countries belonging to WHO Regional Office for Europe (EURO-WHO) were considered. Data for 1980 and 1981 were taken from World Health Organization statistics, while data for 1982-85 were taken from bulletins sent to EURO-WHO and WHOCCHDS by individual countries. Data was entered in an IBM 4341 computer system and a data base was organized using a general purpose inquiry language (IBM's APLDI). Rates per 100,000 were calculated using as a denominator 1983 WHO official population figures. The quality of the data is a great problem, as the only available sources of information are official national reports which underestimate the actual incidence of diseases. For typhoid fever, Mediterranean countries show much higher incidences than the rest of Europe, although a decreasing trend can be seen for all European countries. We estimate that the data for typhoid fever, Salmonellosis and Shigellosis are reliable, while reports of foodborne infections and acute gastroenteritis represent only a very small percentage of the actual number of cases.

Time from diagnosis of acquired immune deficiency syndrome (AIDS) to death among persons with blood-borne AIDS in Italy.

The objective of the study reported here was to analyze survival time and factors associated with more rapid death among persons with acquired immune deficiency syndrome (AIDS) in Italy who acquired human immunodeficiency virus (HIV) infection through the transfusion of blood (n = 115) or blood components (n = 111). Subjects included all persons with AIDS all reported to the Italian AIDS Registry. The Kaplan-Meier method was used to estimate both the median survival time from the date of AIDS diagnosis to the date of death and the median survival time stratified by age at diagnosis, time of diagnosis, and AIDS-indicator disease. The Cox proportional-hazard model was used to assess factors independently associated with death. The prognosis for persons with blood-borne AIDS in Italy remains poor: overall median survival time was estimated to be 9.2 months, with no significant differences between hemophiliacs and transfusion recipients (p = 0.91). The median survival time for subject > 60 years old was 6.0 months, which is a significantly shorter time than that for younger subjects (p < 0.001). Subjects diagnosed prior to 1988 had a median survival time of 8.2 months, which is a significantly shorter time than that for subjects diagnosed after 1987 (p < 0.03). Subjects neurologically affected by AIDS had a median survival time of 4.1 months, which is a significantly shorter time than that for subjects diagnosed with any other disease (p = 0.03). Such factors were independently associated with more rapid death.

Median time from seroconversion to AIDS in Italian HIV-positive haemophiliacs: different parametric estimates.

The purpose of this study was to estimate the median incubation time between human immunodeficiency virus (HIV) infection and onset of acquired immunodeficiency syndrome (AIDS), using three parametric models and six estimates of seroconversion time. Study subjects were 732 HIV-positive haemophiliacs enrolled in the Italian Registry of patients with congenital coagulation disorders. Seroconversion time was estimated for each subject according to six different criteria, based on three distributions of seroconversion (uniform, uniform on three sub-intervals and truncated Weibull) and two indices synthesizing each distribution (median and median of three random values). The estimated seroconversion times were subsequently used as starting points in the analysis of incubation. This was performed applying Kaplan-Meier non-parametric survival analysis, and fitting to incubation data three probability density functions, representing three different situations with respect to the hazard of developing AIDS following seroconversion (namely Weibull (WE), generalized exponential (GE) and log-logistic (LL)). The cumulative incidence over an 8-year period ranged from 14.9 to 17.8 per cent when applying the Kaplan-Meier method, from 14.1 to 17.2 per cent when using the WE function, from 14.5 to 17.3 per cent when using the GE function and from 14.4 to 17.3 per cent when using the LL function, depending on the estimate of seroconversion time used. Similarly, the median incubation times ranged from 12.6 to 15.0 years with the WE function, from 14.0 to 16.5 years with the GE function, and from 13.4 to 16.1 years with the LL function. The presence of a bound on the increase of the hazard function seems to affect the incubation more strongly than the eventual decrease following the attainment of the maximum risk. This may be due to the decrease in the hazard beginning when most of the seropositive subjects have already developed AIDS.

Effects of different parametric estimates of seroconversion time on analysis of progression to AIDS among Italian HIV-positive haemophiliacs.

The purpose of this study was to estimate seroconversion time using different parametric methods and to assess their influence on the estimation of the incubation time between HIV infection and onset of AIDS. Study subjects were 712 HIV-positive haemophiliacs enrolled in the Italian National Registry of patients with congenital coagulation disorders. Seroconversion time was estimated using the mid-point of each seroconversion interval (MID), the median of each interval under an estimated uniform distribution with cutpoints at December 1981 and December 1985 (MUU), the median of each interval under an estimated Weibull distribution (MUW), and the median of three random values drawn from each interval under the Weibull distribution (RUW). Kaplan-Meier survival analysis showed that the cumulative incidence of AIDS over a 7-year period was 11.6 per cent (SE 1.3 per cent) when using the MID estimate of seroconversion time, 10.8 per cent (1.2 per cent) with the MUU estimate, and 13.4 per cent (1.3 per cent) and 12.3 per cent (1.3 per cent) when using MUW and RUW estimates, respectively. This study demonstrates that the estimate of seroconversion time does not seem to be a major factor affecting estimates of AIDS incidence since the different techniques for estimating HIV seroconversion time yielded very similar results.

Use of ceftazidime in the treatment of otorhinolaryngoiatric bacterial infections.

Within the framework of an investigation into otorhinolaryngoiatric bacterial infections in Italy conducted in 1159 patients (607 with otitis media, 354 with pharyngo-tonsillitis and 198 with sinusitis), 124 ceftazidime-treated subjects (92 with otitis media, 22 with pharyngo-tonsillitis and 10 with sinusitis) were observed. The authors report the examination of a number of microbial isolates obtained in the various forms of otorhinolaryngoiatric bacterial infection. Gram-negative organisms were found as causative agents in such diseases, particularly in otitis media. Bacterial resistance to ceftazidime was assessed in all 1159 cases and proved relatively infrequent (3.6%) and markedly less than the detected resistance to other antibiotics (10.7% resistance to cefotaxime, 35% resistance to ampicillin, 43% resistance to penicillin). Ceftazidime, used mainly in otitis media, showed very substantial clinical efficacy with positive results in as many as 97% of cases treated, which is particularly significant, if one considers that roughly 64% of the infections were caused by "difficult" gram-negative bacteria (49% by Pseudomonas).

Viral gastro-enteritis in children in Malawi.

In a 2-month survey of 186 children with gastro-enteritis attending an out-patient clinic in Malawi, 42% were infected with rotavirus (HRV), 9% Cryptosporidium, 4.2% adenovirus, 1.2% Astrovirus and 0.6% Norwalk agent and small round featureless viruses. We believe this to be the first report of HRV in Malawi and the first of Astrovirus in Africa. Almost all the HRV infections were in children under 12 months old, 40% were in children under 6 months and 64% of children were being breastfed at presentation. Signs of respiratory tract infection were not unique to HRV gastro-enteritis. Polyacrylamide gel electrophoresis of HRV dsRNA from 25 of the faecal samples revealed that each had the same long electropherotype.

Survival of patients with blood-borne AIDS in Italy.

BACKGROUND: AIDS represents an important public health problem in Italy. Long-term health care policy planning requires knowledge about the variability of the risk of mortality. The AIDS Surveillance Registry (RAIDS), maintained by the AIDS Operational Centre (COA) of the National Health Institute of Italy, provides valuable information to study the determinants of survival after diagnosis with AIDS. This study aimed to estimate the trends among people infected by the human immunodeficiency virus (HIV) through blood-related products. METHODS: Study subjects were 595 persons with AIDS whose sole ascertained risk factors were either blood transfusions or plasma-concentrate infusions, diagnosed from the beginning of the epidemic in 1985 through June 1995 and reported to RAIDS by the end of June 1996. The Kaplan-Meier technique was used to estimate the survival distribution; log-rank and Wilcoxon tests were both performed to assess the effects of demographic and clinical factors. Cox proportional hazards models were used to identify those factors independently and significantly associated with death: model building and fitting were performed in a stepwise fashion, by using the score and martingale residuals, based on a new class of graphical and numerical methods developed recently for checking the assumptions underlying the model. RESULTS AND CONCLUSIONS: In Italy the median survival time for AIDS patients infected by contaminated blood, was estimated to be 12.7 months. In univariate analyses it was found that women, younger patients (age < 35) and those diagnosed more recently with a higher value of CD4 cell counts (>37 cells m(-3)) have better survival. Patients diagnosed with AIDS-associated neurological disease (neuro-AIDS), or lymphoma, had a median survival significantly shorter. Patients diagnosed in the south of Italy tend to have a survival time shorter than patients diagnosed in the north. In a multivariate time-dependent regression analysis, only type of AIDS indicator disease, age and calendar time of diagnosis proved to be significant prognostic factors. It was not possible to estimate the effect of risk category (haemophiliacs versus transfused) due to the lack of proportionality in the estimated hazard. In conclusion, survival time is found to improve over time, indicating a likely positive effect of better care in treating HIV and AIDS patients.