The Italian Mandatory Notification System: An Important Public Health Tool For Continuous Monitoring Of Infectious Diseases.

Infectious diseases still register significant morbidity and mortality worldwide. Surveillance through a mandatory notification system allows the continuous analysis of the situation even at a local level and its importance has been highlighted by the recent COVID-19 pandemic. This paper aimed to outline the importance of the mandatory notification system as a Public Health tool in the continuous monitoring of infectious diseases. To this aim, we carried out a cross-sectional study examining the notifications reported in the Italian territory of Messina, Sicily, in the period 2001-2020. The institutional websites were examined and the notification data were used to obtain the incidences. Overall, a significant reduction of the incidence notification trend was observed. Chickenpox was by far the most notified infectious disease, followed by scabies, pediculosis, and brucellosis. Outbreaks of brucellosis, measles and hepatitis A occurred. All the diseases decreased over time, except syphilis, for which a significant increase was observed. Surveillance of infectious diseases through a mandatory notification system remains a bulwark of public health despite underreporting. Our study reflects the situation of a typical high-income area, although some unexpected criticisms are highlighted. Continuous information about correct behaviors through education campaigns are crucial in order to improve the situation. Keywords: mandatory notifications, infectious diseases, surveillance, public health Corresponding author: Alessio Facciolà, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy. Email: afacciola@unime.it.

The burden of Tuberculosis in a low-incidence territory: contribution of foreign population in the disease epidemiology.

Tuberculosis (TB) still represents one of the most important causes of death worldwide. In Italy, TB is a relatively rare disease. This research aimed to evaluate the TB cases reported in the provincial territory of Messina, Italy, in order to assess the contribution of the different groups of the local population. We conducted a review of existing epidemiological data evaluating the trend of all TB notifications reported from 2001 to 2019. For the collection of the data, all the notifications were evaluated by analyzing the local and national computerized records. From 2001 to 2019, 475 cases of TB were notified, 67.6% in Italian citizens and 32.4% in foreigners of which 75.3% resident and 24.7% irregularly residing (i.e., migrants landed in Messina). The incidence rate was remarkably higher in foreigners compared to Italian citizens, with average values of 31.7 and 2.7 per 100,000 inhabitants respectively. The average age was 48.4 years in Italian citizens, 32.7 years in resident foreigners and 19.6 years in irregularly residing foreigners. In the epidemiology and maintenance of TB in our territory, the incidence of TB in foreigners surely played an important role. However, the incidence in Italian citizens remained stably low for all of the period considered, showing that there seems to be no immediate danger of spreading the infection.

Outbreak of Brucella melitensis infection in Eastern Sicily: risk factors, clinical characteristics and complication rate.

Brucellosis is one of the most common zoonoses in the world, especially in Southern Italy, where many cases are still recorded every year. 128 cases of brucellosis were observed in Messina (Sicily) in 2016, representing a tenfold increase in the number of cases of brucellosis expected. The aim of this multicenter retrospective study was to analyze clinical and microbiological aspects of a brucellosis outbreak in the province of Messina in 2016, the incidence of its complications and the treatment combinations applied. The principal transmission route was through the ingestion of unpasteurized fresh cheese. The mean latency period between the onset of the symptoms and diagnosis was 35.58±42.75 days. A late diagnosis increases the risk of developing complications. Drug-resistant strains of B. melitensis to Trimethoprim/ Sulfamethoxazole and Ciprofloxacin were found in blood cultures of 58.4% patients. Brucellosis is still present in Sicily. A diagnostic delay predisposes to complications requiring prolonged therapies. The finding of Brucella melitensis strains resistant to the most widespread treatments is worrisome and needs further investigation. Moreover, the use of alternative combination antibiotic therapy is recommended.

Outbreak of Brucella melitensis infection in Eastern Sicily: risk factors, clinical characteristics and complication rate.

Brucellosis is one of the most common zoonoses in the world, especially in Southern Italy, where many cases are still recorded every year. 128 cases of brucellosis were observed in Messina (Sicily) in 2016, representing a tenfold increase in the number of cases of brucellosis expected. The aim of this multicenter retrospective study was to analyze clinical and microbiological aspects of a brucellosis outbreak in the province of Messina in 2016, the incidence of its complications and the treatment combinations applied. The principal transmission route was through the ingestion of unpasteurized fresh cheese. The mean latency period between the onset of the symptoms and diagnosis was 35.58 ± 42.75 days. A late diagnosis increases the risk of developing complications. Drug-resistant strains of B. melitensis to Trimethoprim/Sulfamethoxazole and Ciprofloxacin were found in blood cultures of 58.4% patients. Brucellosis is still present in Sicily. A diagnostic delay predisposes to complications requiring prolonged therapies. The finding of Brucella melitensis strains resistant to the most widespread treatments is worrisome and needs further investigation. Moreover, the use of alternative combination antibiotic therapy is recommended.

Impact of the COVID-19 pandemic on the infectious disease epidemiology.

Introduction: COVID-19 pandemic has exerted a huge impact on different aspects of public health. Mandatory notifications are a fundamental tool to have a general picture of infection disease spread in a population. The aim of this study was to evaluate the impact the COVID-19 pandemic had on infectious disease epidemiology. Methods: We collected and analyzed all the infectious disease notifications made in the pre-pandemic (2017-2019) and the pandemic (2020-2022) three-years periods in the provincial territory of Messina, Italy. Results: The total number of notifications significantly decreased by 41% in the pandemic period compared to the pre-pandemic one, with very high reduction of certain disease notifications such as measles and varicella. Similarly, other airborne infections, such as meningococcal meningitis and tuberculosis, underwent an important decrease. Conversely, an increase was found for some infections such as syphilis and, especially, scabies that reported a percentage value of +159.9%. Conclusions: The COVID-19 pandemic, reducing the possibility of microbial spread following to the lockdown and, in addition, to the constant use of face masks and other personal protective equipment, the frequent hand-washing, more ventilation of the living locals, and less gathering, surely reduced the occasions and the possibility to get many infections. On the other hands, the pandemic had a negative impact on scabies diffusion probably due to different causes among which the worsening of some poor realities, the restrictions that forced people to live in strict contact and, especially, the worsening of the conditions of the elderly living in care homes.

Prevention of cardiovascular diseases and diabetes: importance of a screening program for the early detection of risk conditions in a target population.

Introduction: Cardiovascular diseases and diabetes are two of the main causes of morbidity and mortality worldwide. In their genesis, an important role is played by some behavioural risk factors that may induce the onset of further risk factors represented by hypertension, prediabetes, overweight and obesity. This study aimed to show the importance of the screening methodology for early detection of these risk conditions in order to reduce the burden of cardiovascular diseases and diabetes complications. Methods: We carried out a screening programme involving a cohort of people aged 45-60 in which risk factors for cardiovascular diseases and diabetes were evaluated. The subjects were then classified into four groups according to the risk conditions. Results: A high percentage (27.0%) of the sample had some alteration in the detected anthropometric and/or clinical-laboratory parameters but were unaware of this condition and, consequently, not under therapeutic treatment. Conclusions: The screening programme allowed the early detection of hypertension and prediabetes or full-blown diabetes conditions in subjects who were unaware they had a pathological condition, and consequently to proceed with adequate investigations and start healthy lifestyles/pharmacological therapies. Overall, the results highlight the need to anticipate these screening campaigns, especially in men, to increase the effectiveness of the prevention programmes.

Brucellosis is a public health problem in southern Italy: Burden and epidemiological trend of human and animal disease.

BACKGROUND: Brucellosis is the most common global bacterial zoonotic disease. Italian annual 2015 report on animal brucellosis control that was submitted to the Integrated National Plan of the Italian Health Ministry showed that the Italian region with the highest prevalence and incidence of brucellosis was Sicily (3.3%). This study aims to demonstrate the burden of disease and the epidemiological trend of human and animal brucellosis in Messina, Sicily, from 1997 to 2016. METHODS: The analysis was conducted in the twenty-years 1997-2016. We examined the computerised and paper registers of the Messina Provincial Health Agency n.5 to evaluate human and animal brucellosis reports. RESULTS: 1462 cases of human brucellosis were reported with an important outbreak in 2016 in which were reported 137 cases while the prevalence of infected cattle and sheep/goats decreased from 3.8% and 8%, respectively, in 1997 to 1.7% for both in 2016. A statistically significant correlation was observed between the decrease of both animal and human cases during the considered period. CONCLUSIONS: Our study demonstrate that brucellosis is still present in Sicily with a number of cases identified in both animals and humans and it hypothesises a large number of probable underreported cases. Our findings confirm the need to improve knowledge of the risks associated with consuming raw milk and its derivatives, mainly from sheep and goats, and demonstrates that public health would benefit from cooperation between human and veterinary health services.