Carriage rates and risk factors during an outbreak of invasive meningococcal disease due to Neisseria meningitidis serogroup C ST-11 (cc11) in Tuscany, Italy: a cross-sectional study.

BACKGROUND: During 2015-2016 an outbreak of invasive meningococcal disease due to N. meningitidis serogroup C ST-11 (cc11) occurred in Tuscany, Italy. The outbreak affected mainly the age group 20-30 years, men who have sex with men, and the area located between the cities of Firenze, Prato and Empoli, with discos and gay-venues associated-clusters. A cross-sectional-survey was conducted to assess the prevalence and risk factors for meningococcal-carriage, in order to address public health interventions. METHODS: A convenience sample of people aged 11-45 years provided oropharyngeal swab specimens and completed questionnaires on risk factors for meningococcal carriage during a 3 months study-period, conducted either in the outbreak-area and in a control-area not affected by the outbreak (cities of Grosseto and Siena). Isolates were tested by culture plus polymerase chain reaction. Serogroup C meningococcal isolates were further characterized using multilocus sequence typing. Univariate and multivariate analyses were performed to estimate adjusted odds ratios (AORs) for meningococcal carriage. RESULTS: A total of 2285 oropharyngeal samples were collected. Overall, meningococcal carriage prevalence was 4.8% (n = 110), with nonencapsulated meningococci most prevalent (2.3%; n = 52). Among encapsulated meningococci, serogroup B was the most prevalent (1.8%; n = 41), followed by serogroup Y (0.5%; n = 11) and serogroup C (0.2%; n = 4); one carrier of serogroup E and one of serogroup Z, were also found (0.04%). Three individuals from the city of Empoli were found to carry the outbreak strain, C:ST-11 (cc11); this city also had the highest serogroup C carriage prevalence (0.5%). At the multivariate analyses, risk factors for meningococcal carriage were: illicit-drugs consumption (AOR 6.30; p < 0.01), active smoking (AOR 2.78; p = 0.01), disco/clubs/parties attendance (AOR 2.06; p = 0.04), being aged 20-30 years (AOR 3.08; p < 0.01), and have had same-sex intercourses (AOR 6.69; p < 0.01). CONCLUSIONS: A low prevalence of meningococcal serogroup C carriage in an area affected by an outbreak due to the hypervirulent N. meningitidis serogroup C ST-11 (cc11) strain was found. The city of Empoli had the highest attack-rate during the outbreak and also the highest meningococcal serogroup C carriage-prevalence due to the outbreak-strain. Multivariate analyses underlined a convergence of risk factors, which partially confirmed those observed among meningococcal outbreak-cases, and that should be considered in targeted immunization campaigns.

Analysis of the original notifications in the Tuscany region "Rapid Alert System for Food and Feed" in the seven-year period 2015-2021.

The original notifications (n=1355) managed by the Rapid Alert System for Food and Feed of the Tuscany region in the seven-year period 2015-2021 were analyzed. 68.9% of them were classified as alert notifications, and they mostly originated (56.3%) from official controls on the market, followed by the company's own checks (29.1%). Italy was the most represented notifying country (73.3%) and the most represented country of origin of the notified products (64.5%). Out of the 28 considered food categories, "fish and products thereof" (F), "cereals and bakery products" (C), "bivalve mollusks and products thereof" (B), and "meat and meat products (other than poultry)" (M) were the most notified. F were especially notified for the presence of heavy metals (45.7%), C for undeclared allergens (32.1%), B for microbial contaminants (Escherichia coli, 49.6%), and M for pathogenic microorganisms (55.9%), mostly Salmonella spp. and Listeria monocytogenes. This study provides an updated framework for the main food safety issues at the regional level. The Rapid Alert System for Food and Feed should be periodically analyzed to evaluate historical trends and emerging or poorly known hazards. This is especially important for the planning of official control activities and the prevention of risks through the food supply chain.

Acute hepatitis B 14 years after the implementation of universal vaccination in Italy: areas of improvement and emerging challenges.

BACKGROUND: Italy had intermediate-level endemicity for hepatitis B virus (HBV) infection in the 1970s and 1980s. In 1991, vaccination of infants and adolescents became mandatory. We report the impact of universal vaccination 14 years after its beginning. METHODS: We performed a case-control study within a population-based surveillance for acute viral hepatitis. The incidence of acute hepatitis B (AHB) was estimated for the time since 1991, and the association between AHB and the considered risk factors was analyzed for the period 2001-2005. RESULTS: The incidence of AHB progressively decreased from 1991 to 2005, mainly for persons in the age groups targeted by the universal vaccination campaign: there was a 24-fold and 50-fold decrease in the 15-24-year and 0-14-year age groups, respectively; for the > or =25-year age group, the incidence halved. Owing to the persons' ages, approximately 3% of total AHB cases should have been the target of vaccination campaign. In 2004-2005, foreigners accounted for 14% of total cases and for 57% of persons who should have been targets for vaccination. Missed opportunities for immunization were documented for approximately 50% of patients with AHB who reported cohabitation with HBV carriers and for 70% of those who reported injection drug use. The strongest associations with AHB were found for blood transfusion (adjusted odds ratio [OR(adj)], 8.4; 95% confidence interval [CI], 2.7-26), cohabitation with HBV carriers (OR(adj), 5.3; 95% CI, 3.6-7.7), injection drug use (OR(adj), 3.8; 95% CI, 2.5-5.8), and unsafe sexual practices (OR(adj), 2.8; 95% CI, 1.9-4.2). CONCLUSION: Universal vaccination has contributed to a decreasing AHB incidence in Italy, especially by reducing the risk of infection among persons aged 15-24 years. Most infections occur in persons aged > or =25 years in association with injection drug use, unsafe sexual activity, percutaneous treatment, and iatrogenic exposure. Improvement of vaccine coverage in high-risk groups and adherence to infection control measures during surgery and percutaneous treatment are needed. The high risk still associated with blood transfusion needs to be further investigated, with consideration of occult HBV infection in blood donors. The potential spread of HBV infection from the immigrant population deserves adequate health policy prevention programs.

Acute hepatitis delta virus infection in Italy: incidence and risk factors after the introduction of the universal anti-hepatitis B vaccination campaign.

BACKGROUND: Updates on the incidence of and risk factors for acute hepatitis delta virus infection in Italy, as well as in other countries, are lacking, and the impact of the mandatory anti-hepatitis B vaccination has not been evaluated. METHODS: We performed a case-control study within a population-based surveillance for acute viral hepatitis. RESULTS: During 1993-2004, 344 cases of acute hepatitis delta virus infection were reported. After a peak in 1993 (2.8 cases per 1 million population), the incidence decreased from 1.7 to 0.5 cases per 1 million population. Coinfections were prevalent. The decrease in incidence particularly affected young adults, and it paralleled the decrease in incidence of acute hepatitis B. In 1993, being an injection drug user (adjusted odds ratio [OR(adj)], 67.9; 95% confidence interval [CI], 18.1-254.5) or being a member of a household with a carrier of hepatitis B surface antigen (OR(adj,) 14.8; 95% CI, 3.0-72.9) were the only independent predictors of infection. During 1994-2004, being an injection drug user (OR(adj), 36.8; 95% CI, 20.7-65.4), cohabitation with an injection drug user (OR(adj), 4.2, 95% CI, 1.7-12.3), hospitalization (OR(adj), 3.5; 95% CI, 1.9-6.6), receipt of dental therapy (OR(adj), 2.3; 95% CI, 1.4-3.6), promiscuous sexual activity (OR(adj), 2.2; 95% CI, 1.4-3.6), and receipt of beauty treatment (OR(adj), 2.0; 95% CI, 1.3-3.2) were independently associated with infection. CONCLUSIONS: Incidence of acute hepatitis delta infection is markedly decreasing in Italy. Undergoing invasive medical procedures, engaging in promiscuous sexual activity, and receiving beauty treatments are emerging, in addition to injection drug use, as important risk factors for infection. Further efforts are needed to increase vaccine coverage in high-risk groups and to implement the safety of invasive procedures performed both inside and outside health care facilities.

[Temporal trends in AIDS incidence and mortality in Tuscany (1987-2000)]. / Andamenti temporali di incidenza e mortalità per AIDS in Toscana (1987-2000).

OBJECTIVE: To describe temporal trends in AIDS incidence and mortality in an Italian region. DESIGN: Descriptive study based on incidence and mortality registries. SETTING: Tuscany. MAIN OUTCOME MEASURES: AIDS incidence and mortality annual truncated rates, age-standardized; joinpoint analysis highlighted significant changes in the temporal trends. RESULTS: AIDS incidence rose until 1995 and then decreased by 30% every year; AIDS mortality rose in men until 1995 and in women until 1996, then decreased by 35.9% and 49.7% every year respectively. Differences in AIDS mortality have been found between the residents of the coastline municipalities and those of other municipalities. CONCLUSION: Differences in the temporal trends may mirror differences in risk group composition and in health-care access.

Impact on disease incidence of a routine universal and catch-up vaccination strategy against Neisseria meningitidis C in Tuscany, Italy.

BACKGROUND: Invasive infections due to Neisseria meningitidis are still an important public health issue worldwide. In Europe, meningococcal meningitis is differently distributed in the EU countries, but most cases of meningococcal diseases are caused by serogroups B and C. In Italy, each year about 900 cases of bacterial meningitis occur, of whom one third are caused by N. meningitidis. In March 2005, the Regional Health Authority of Tuscany approved a policy of active offer of conjugate meningococcus C (MCC) vaccination with three doses to all newborns at 3, 5 and 13 months of age (subsequently turning to a single dose at 13 months as of 2008) and a catch-up until age 6 years with a single dose. OBJECTIVE: The aim of the present study was to evaluate the effectiveness of the vaccination strategy adopted by Tuscany in preventing cases of invasive meningococcal C disease. METHODS: Surveillance data for the calculation of disease incidence, immunization coverage with MCC vaccine and vaccination status of meningitis cases were collected from 2005 to 2011. RESULTS: Incidence rates of meningococcal meningitis and septicemia decreased in all age groups involved in the immunization campaign, as a result of the progressively increasing vaccination coverage. Since 2006, no cases of invasive meningococcal C infection in vaccinated subjects were observed in Tuscany. A herd immunity effect was measured in unvaccinated age groups. CONCLUSION: MCC vaccination implementation in Tuscany was successful in the prevention of meningococcal C disease. Our results should prompt all Italian Regions to consider introducing MCC vaccination in order to protect their population.