[Satisfaction of parents or accompanying persons with vaccination services for children and youngsters being vaccinated]. / Studio sulla "soddisfazione" verso i servizi vaccinali dei genitori o degli accompagnatori dei bambini e dei ragazzi che effettuano le vaccinazioni.

A patient satisfaction survey aimed to assess the quality of immunization services was carried out as part of the new regional vaccination plan launched in Piemonte in 1999 to comply with the targets of the national immunization program. In January and February 2001, persons accompanying children for vaccination at the outpatient clinics were requested to fill a self-administered questionnaire with questions on the organization of the immunization services, the health care facilities, the attitude of the health care workers and the quality of the information provided. The response rate was 93%. Overall, satisfaction with the immunization services scored generally high, except for the quality of the information provided to the public. Many interviewees complained that the written/verbal information about the vaccination schedules was either lacking or insufficient. The survey results indicate a need for better training and updating of health care workers so that they can give immunization service users correct information as requested.

Hospital-acquired infections in Italy: a region wide prevalence study.

Between October and December 2000, a region-wide prevalence study of hospital-acquired infections (HAI) was conducted in all public hospitals (59 facilities with ca. 16000 beds; 560000 admission yearly) in Piemonte Region, Italy, and in the one hospital of the neighbouring autonomous region of Valle d'Aosta. The study population comprised a total of 9467 patients hospitalized for at least 24 h. The prevalence of HAI was 7.84%, with marked differences in prevalence among the participating hospitals (range: 0-47.8%). The higher relative frequency of urinary tract infections (UTI; 52.7%) was due to the inclusion of urine cultures obtained on the day of the study from asymptomatic UTI in catheterized patients. A significant correlation was found with major risk factors related to medical procedures (urinary catheter, mechanical ventilation, surgical drainage, intravascular catheters). Patients with HAI were found to be older and to have a greater mean length of stay in hospital. Multiple logistic regression analyses showed that lack of independence, indwelling urinary catheter and mechanical ventilation were the risk factors more significantly associated with HAI. The use of antibiotics, in particular prophylactic agents used in surgery (cephalosporins, glycopeptides), provided an incentive for corrective intervention in antibiotic administration and in training of healthcare workers.

Use of IgG Avidity test in case definitions of toxoplasmosis in pregnancy.

A survey network for congenital toxoplasmosis (TOXO-NET) was set up in December 1996 in Piedmont (Italy). Participants were asked to classify the infections in pregnant mothers and newborns by the criteria of the European Network on Congenital Toxoplasmosis published by Lebech in 1996. Because the IgG Avidity test is largely employed as a 2nd level test in toxoplasmosis diagnosis and it could be helpful to date infection, the co-ordinators of TOXO-NET suggested including it in the "case definition" of "probable" infection and "unlikely" infection. 117 cases of toxoplasmosis in pregnancy divided into the risk categories under Lebech's criteria were re-examined using the "new" case definitions. 77 out of 117 (65.8%) Toxoplasma gondii infections during pregnancy could be defined with only one serum sample using the IgG Avidity test. The IgG Avidity test proved a useful method to classify the Toxoplasma gondii infections in pregnancy, especially when we had only one serum sample.

[Cost analysis of toxoplasma infection control in pregnancy]. / Analisi dei costi relativi al controllo dell'infezione toxoplasmica in corso di gravidanza.

In Italy, the management of Toxoplasma infection screening in pregnant women is often unproductive and inefficient and generates a wide variability of costs. This study evaluated performance parameters in the screening management of a population of pregnant women, estimated its costs and compared them with the costs of a full application of Ministerial Documents of 1995 and 1998. We controlled until delivery 830 pregnant women who had done the first blood test between September 1st and December 31st 1997. The costs of direct and indirect testing were analysed using the Excel database and statistical software package. Of the 573 pregnant women defined 'susceptible' at the first test, only 240 (42%) did further blood tests during the II and III trimesters, 30% did no more tests and the remaining women adopted a heterogeneous behaviour. The mean cost of each screening was found to be euro 54.47/pregnancy and euro 60.05/pregnancy with a full application of the Ministerial Document of 1995. A full application of Ministerial Document of 1998, instead, would have involved a cost of euro 94.28/pregnancy for 5 tests, euro 111.40/pregnancy for 6 tests and euro 128.51 for 7 tests. The study shows that the management of toxoplasmosis screening during pregnancy needs greater attention to the prescription of tests, so that useless testing can be reduced and the efficacy of the screening improved, two important goals the Ministerial Documents were designed to achieve.

[Prenatal diagnosis and treatment of congenital toxoplasmosis: a program of regional surveillance]. / Diagnosi prenatale e trattamento della toxoplasmosi congenita: un programma di sorveglianza regionale.

Toxo-net is a regional program of survey on congenital toxoplasmosis which has two aims: 1) to estimate the incidence of gestational and congenital toxoplasmosis in our Region (Piemonte); 2) to assess the compliance to our diagnostic, therapeutic and follow-up protocols which are thoroughly described. Thirty-two obstetrical, neonatal and laboratory units of Piemonte Region have been involved. During 18 months (January 1997-June 1998) 365 pregnant women were studied because of suspected seroconversion: in 129 patients infection was confirmed. Amniocentesis for prenatal diagnosis was carried on 11 patients; two fetuses were affected. 35% of the mothers were untreated or inadequately treated. Hydrocephaly was observed in two fetuses. Neonatal follow-up at 12 months is available for 68 of the 129 infected mothers. Four babies (5.8%) were infected, three of them being symptomatic; their mothers had not been treated. It is concluded that the implementation of a screening program for toxoplasmosis during pregnancy seems to be beneficial. However an effort to improve the surveillance system and the education of the gynecologists, general practitioners and of the patients is needed, and economic evaluations are warranted.

Prevalence of diphtheria toxin antibodies in human sera from a cross-section of the Italian population.

A polycentric study was carried out between 1993 and 1995 in order to evaluate diphtheria immunity on a representative sample of population from different areas of Italy. To determine diphtheria antitoxin, sera from 5187 apparently healthy subjects, divided according to sex and age groups, were titrated using an ELISA indirect method. A basic protective titre of diphtheria antitoxin (> 0.01 IU ml-1) was found in 4080 (78.6%) subjects. No statistically significant differences between males and females were observed. Our findings show that the proportion of susceptibles increases with age and a high proportion of adults no longer has diphtheria antitoxin at protective levels since toxigenic C. diphtheriae circulation is presently lacking in Italy.

Characterisation and reactivity of a glycidic antigenic component in Toxoplasma gondii.

Toxoplasma gondii is composed of a complex antigenic mosaic and some antigenic fractions are of major diagnostic interest. We studied an antigenic fraction with molecular weight < 17 kda, identified by SDS-PAGE 15% and immunoblotting. This fraction could be easily extracted from the whole antigen with phenol/CH-Cl3 and its analysis showed a mainly carbohydrate composition. With immunoblotting this fraction showed strong reactivity with specific IgM and IgG in early-acute infection; IgM reactivity disappears or is much less marked in chronic acquired infection. Extraction with phenol/CHCl3 allows this fraction to be used as an antigen in other diagnostic methods.

Congenital toxoplasmosis: 10-year follow up.

A long-term follow up was begun in 1982 on offspring of mothers who acquired toxoplasmosis during gestation. The 114 newborns were subdivided into 3 groups: (1) 26 born to mothers with certain infection; (2) 51 born to mothers with probable infection, and (3) 37 born to mothers with doubtful infection. There were five infections in the first group (19.2%), three in the second (5.8%) and none in the third. For purposes of data elaboration we considered only the 77 offspring of mothers with certain or probable infection. Of these, 2 infected cases out of 52 (3.8%) were born to mothers with infection in the first trimester of pregnancy, 4 out of 21 (19%) in the second trimester, and two out of four in the third. There were a total of 8 congenital infections (10.4%). Specific IgM antibodies were revealed in five out of eight infected children (62.5%). Infection was symptomatic in two children (2.6% of newborns at risk, 25% of infected cases), both born to mothers with infection in the second trimester. In the other six cases diagnosis was reached by evaluating trends in antibody levels: the percentage of infected newborns was higher in the group of maternal infections untreated (50%) or improperly treated (15.4%), compared to those receiving adequate treatment (6.9%). We suggest considering as infected children presenting specific IgM antibodies and/or antibody titres which do not become negative, even when symptoms are absent. Therapy with spiramycin should be started in all newborns at risk, while the use of sulphamides and pyrimethamine is justified only after the presence of infection is confirmed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Poliomyelitis surveillance: seroepidemiologic study on a Piedmont population sample]. / Sorveglianza della poliomielite: indagine sieroepidemiologica su un campione di popolazione piemontese.

In order to assess the immunity/receptivity towards the three poliovirus strains, a sample representative of the sex and age composition of the resident population in Piedmont at census 1981, was examined. For each subject data were collected in order to identify the population from social-ambient point of view. For the evaluation of antibodie's title to poliovirus 1, 2, 3, the serums were analyzed with the neutralization method using the microtitolation plates and epithelial larynx cancer cells (HEp-2), like revealing system. The samples with > or = 2 title were considered positives for specific antibodies. To determine the relation between presence/absence of specific poliovirus antibodies and the other variables, a multiple logistic regression was fitted and the odds ratio was calculated. The results of our study show an immunity in all age groups, underlying a herd immunity condition. Furthermore the incomplete antibodies response to the three poliovirus strains seems to be influenced by age only.

[Immunogenicity of a recombinant vaccine against viral hepatitis B]. / Analisi dell'immunogenicità di un vaccino recombinante anti-epatite virale di tipo B.

The introduction in Italy of recombinant DNA hepatitis B vaccines has allowed to plan out a very important programme of vaccination; in Italy the compulsory vaccination against hepatitis B virus begun from 1991. Because of the reduction of vaccine cost, the screening for serum markers of HBV infection is needless. On the contrary, the test of antiHBs titres after the vaccination is important in order to take into account a booster vaccine dose and to carry out revaccination strategies. In this study, we analyzed 419 subjects vaccinated with Engerix-B; the immune response was correlated with private and behaviour data.

Legionella pneumophila in a hospital in Torino, Italy. A retrospective one-year study.

Legionella pneumophila serogroup 1 was isolated from post mortem specimens from 13 out of 58 patients with pneumonia diagnosed at autopsy. The results of a study undertaken in the hospital environment showed that the water plumbing system was colonized with L. pneumophila serogroup 1 which could also be isolated from respiratory devices filled with tap water. Control measures instituted are described.

[Reactivity of antigenic fractions obtained from Toxoplasma gondii evaluated with Western blotting]. / Reattivitá di frazioni antigeniche ottenute da Toxoplasma gondii valutate mediante Western blot.

A toxoplasma gondii antigen, has been obtained by sonication, separated by SDS gel electrophoresis system in 10% acrylamide and blotted onto nitrocellulose paper (Western Blot). The antigen has been tested against: serum samples from subjects T. gondii negative; serum samples from patients with acute Toxoplasma infection; serum samples from subjects who had serologic evidence of infection with T. gondii, but IgM negatives. IgG and IgM immune response has been evaluated. Gel stained with Coomassie Blue revealed 48 protein fractions; only twenty fractions reacted as antigen. In particular, we have observed that only one protein fraction has been recognized by IgM antibodies present in the serum of patient with acute Toxoplasma infection (with lymphoadenopathy); some protein fractions have been recognized only by IgG antibodies; some protein fractions have been recognized in the same time by IgG and IgM antibodies in the same serum sample.

Immune response to anti-HBV vaccination: study of conditioning factors.

The Authors studied the immune responses of 691 health care workers who were given HEVAC B vaccine (455 subjects) and HB Vax vaccine (216 subjects). The immune responses were correlated with data obtained by questionnaires: age, sex, B.M.I., drinking habits, smoking. The results showed correlation between these variables and immune response to vaccine.

[Epidemiology of whooping cough: study at the Maternal School of the city of Turin]. / Epidemiologia della pertosse: indagine nelle scuole Materne Della città di Torino.

Data about whooping cough and whooping cough vaccine in a population of 1892 children kindergarten attended in Turin (Italy) by means of interview to their parents, are referred. It has been observed that: 28.6% of the children aged from 3 to 5 already had natural infection; only 15.1% had been vaccinated. Data about clinical recovery, sequelae, adverse reaction to vaccine and parents' absences from work are referred and correlated to general population born in those years (1981-1983). Relation exists between pediatric's opinion, family's cultural background and practice of vaccination.

[Epidemiology of bronchopulmonary hospital infections]. / Epidemiologia delle infezioni broncopolmonari ospedaliere.

Hospital acquired infections (HAI) represent one of the major problems, due to their elevated frequency and high number of fatal cases, in the control of infectious diseases. With the perspective to evaluate the incidence of bronchopulmonary infections and to determine their role as cause of death of hospitalized patients, as well as to identify the etiology and the associated risk factors, we have studied 105 autopsy cases of patients decreased in hospital. 37 patients had pneumonias, of which 48.6% were of hospital origin. Hospital pneumonia was responsible for death in 12.3% of the cases. The risk factors significantly associated with HAI were recognized to be the following: hospital recovery for a period longer than 10 days, and surgery. Among the etiologic agents isolated in HAI, there was a distinct prevalence in Gram-negative bacteria (55.5% of the samples), such as Pseudomonas aeruginosa, Klebsiella pneumoniae, Legionella pneumophila.

Immunoprophylaxis for influenza: comparison of a subunit and a whole virion vaccine.

In order to evaluate and compare immunogenicity, reactogenicity and protection of a subunit vaccine and a whole virus vaccine 102 elderly subjects were vaccined against influenza in November 1986: 53 received the subunit vaccine and 49 were immunized with the whole virus preparation. Local and systemic reactions following immunization, as well as the presence of influenza clinical symptoms were recorded throughout the study period (November 1986 - June 1987). Antibodies against influenza were detected using the Single Radial Haemolysis (S.R.H.) technique on two serum samples obtained from volunteers prior to immunization and 1 month later. The subunit vaccine showed equal immunogenicity, equal protection and lower reactogenicity as compared with the whole virus preparation.