Syndromic Surveillance in Public Health Emergencies: A Systematic Analysis of Cases Related to Exposure to 2023 Floodwaters in Romagna, Italy.

BACKGROUND: In May 2023, Romagna, Italy, faced a devastating flood resulting in 16 fatalities, forced displacement of 26,000 citizens, and significant economic losses. Due to potential water contamination, implementing public health strategies became imperative for the Local Health Authority to mitigate the health consequences, analyze the flood's impact on the local population's health, and detect early anomalies requiring timely public health interventions. METHODS: Between June and July 2023, general practitioners who were part of the RespiVirNet surveillance network completed weekly structured forms. These forms collected data on individuals exposed or not to floodwaters and clinical syndromes. Rates per 1000 resident population aged > 14 were stratified by district, week of observation, and symptomatology. Missing data were addressed by imputation using second-order autoregressive modeling. RESULTS: An incidence of 3.52 syndromes potentially related to flood water exposure per 1000 individuals (95% CI 2.82-4.35) was estimated. Ravenna, the city most affected by the flood, recorded the highest rate (6.05 per 1000, 95% CI 4.59-7.82). Incidence decreased in the weeks post-event. Anxiety, or trauma and stress symptoms, exhibited higher rates among the exposed, diminishing over weeks. The incidence for the non-exposed (12.76 per 1000, 95% CI 10.55-15.29) showed no significant territorial differences compared to the exposed ones. CONCLUSIONS: Syndromic surveillance provided timely information on the flood's health impact, revealing a higher incidence of individual syndromes among the non-exposed. This study contributes to guiding the implementation of future public health preparedness and response strategies for populations facing similar natural disasters.

Herpes Zoster Vaccine Uptake and Active Campaign Impact, a Multicenter Retrospective Study in Italy.

The Herpes Zoster (HZ) vaccination has proven both safe and effective in alleviating conditions related to HZ, leading to significant cost savings in national healthcare and social systems. In Italy, it is recommended and provided free of charge to individuals aged 65 and older. To achieve broad vaccination coverage, alongside ordinary immunization campaigns, active and catch-up campaigns were implemented. This retrospective observational study aimed to observe the vaccination coverage achieved in the Romagna Local Health Authority (LHA) during the 2023 active campaign, with a secondary goal of assessing the impact of the 2022 catch-up campaign and the 2023 active campaign compared to ordinary campaigns. As of 3 July 2023, an overall vaccine uptake of 13.5% was achieved among individuals born in 1958, with variations among the four LHA centers ranging from 10.2% to 17.7%. Catch-up and active campaigns together contributed to nearly half of the achieved coverage in Center No. 1 and a quarter in Center No. 2. Notably, individuals born in 1957, not included in the Center No. 2 catch-up campaign, reached significantly lower vaccination coverage compared to other cohorts and centers. Analyzing the use of text messages for active campaigns, it was observed that cohort groups did not show substantial differences in text-message utilization for warnings. However, having relatives who had experienced HZ-related symptoms significantly reduced the reliance on text messages as warnings. These results highlighted how catch-up and active campaigns effectively increased vaccine coverage. Nevertheless, differences in uptake among different centers within the same LHA and the limited contribution of other information sources compared to text messages suggest the necessity of designing campaigns involving all available channels and stakeholders to maximize vaccine uptake.

[Prevalence of and risk factors for functional dependence in the non-institutionalised elderly population of 11 Italian Regions: results of the Argento Study, 2002.]. / La prevalenza e i fattori di rischio per la non autosufficienza nella popolazione anziana non istituzionalizzata in 11 Regioni italiane: risultati dello Studio Argento, 2002.

INTRODUCTION: Elderly people who are not capable of performing the basic activities of daily living (ADL) represent a fragile population at greater risk for morbidity and mortality. In order to better describe the size and characteristics of the non self-sufficient population in Italy, we evaluated data from the Argento Study, a survey conducted in 2002 in 11 Italian regions. MATERIALS AND METHODS: A sample of 210 non-institutionalised elderly individuals aged >65 years was selected in each region (310 in the Campania region) by the cluster sampling technique. Home interviews were performed using a standardised questionnaire which included 6 questions on ADL. Participants were considered to have a severe level of dependence if unable to perform any of the 6 activities of daily living independently, partially dependent if able to perform only 1-5 activities independently, and self-sufficient if able to perform all of the activities. A multivariate analysis was performed to evaluate risk factors associated with functional dependence. RESULTS: Complete information regarding ADLs was available for 2,355 (99%) of the interviewed subjects. Of these, 78% (95% CI 76-80%) were found to be self-sufficient, 19% (95% CI 18-22%) partially dependent and 3% (95% CI 1.9-3.2%) severely dependent. Twenty percent of self sufficient subjects and 18% of partially dependent subjects lived alone. Multivariate analysis showed a statistically significant association between being either partially or severely dependent and the following factors: age >75 years (OR 2.8), female sex (OR 1.5), having >2 chronic disorders, (OR 2.8), history of ictus (OR 2.8), having a cognitive disorder (OR 2.6), vision problems (OR 2.3) and hearing problems (OR 1.9). DISCUSSION: These results highlight the presence of a substantial number of partially dependent elderly people that live in the community and that have numerous medical problems and a high frequency of cognitive disorders. It is essential that these fragile elderly subjects be identified, through the active involvement of general practitioners, so that the necessary measures may be undertaken to improve quality of life and of emergency interventions (for example, during heat waves).

[Design and implementation of evidence-based measures for the prevention and treatment of tobacco use disorder: the experience of the Public Health Department of the Cesena Local Health Authority]. / Progettazione e realizzazione di interventi basati su prove di efficacia nella prevenzione e cura del tabagismo: l'esperienza del Dipartimento di Sanità Pubblica dell'Azienda Sanitaria di Cesena.

Tobacco smoke is the main cause of preventable death in Italy. It is important therefore to develop evidence-based measures aimed at preventing and treating tobacco addiction. This article describes the "Smoke-free" community project, implemented in the territory of the Cesena Local Health Authority. The success of the project shows that it is possible to carry out inter-sectorial and evidence-based prevention. It also leads to considerations about the role of Prevention Services in the fight against tobacco smoke.