Tegumentary Leishmaniasis in Northeastern Italy from 2017 to 2020: A Neglected Public Health Issue.

Tegumentary leishmaniasis (TL) includes cutaneous (CL) and mucosal (ML) leishmaniasis; despite being endemic in southern Europe, it is often underdiagnosed and underreported. This study aimed to retrospectively examine data collected from patients with TL in a selected area of northeastern Italy (Emilia-Romagna region, RER). A network of 10 diagnostic units within RER was established, and TL cases diagnosed in RER from 2017 to 2020 were evaluated. A total of 135 TL cases were collected (62% male, 38% female); patients ranged from 1 to 84 years, with a median age of 57. Among these cases, 113 (84%) were notified to the public health authorities. The average annual incidence of TL was 0.76 cases per 100,000 inhabitants. Infections were acquired within the RER in 84% of cases; the 113 autochthonous cases were distributed in the foothills areas of the region. We provide evidence of a defined spatial distribution of TL cases in a selected area of northeastern Italy, as well as a relevant number of ML cases. Our observations suggest the need to raise awareness about TL among clinicians and pathologists, promote the molecular confirmation of cases by reference laboratories, and encourage the establishment of surveillance networks for this neglected disease.

Economics of One Health: Costs and benefits of integrated West Nile virus surveillance in Emilia-Romagna.

Since 2013 in Emilia-Romagna, Italy, surveillance information generated in the public health and in the animal health sectors has been shared and used to guide public health interventions to mitigate the risk of West Nile virus (WNV) transmission via blood transfusion. The objective of the current study was to identify and estimate the costs and benefits associated with this One Health surveillance approach, and to compare it to an approach that does not integrate animal health information in blood donations safety policy (uni-sectoral scenario). Costs of human, animal, and entomological surveillance, sharing of information, and triggered interventions were estimated. Benefits were quantified as the averted costs of potential human cases of WNV neuroinvasive disease associated to infected blood transfusion. In the 2009-2015 period, the One Health approach was estimated to represent a cost saving of €160,921 compared to the uni-sectoral scenario. Blood donation screening was the main cost for both scenarios. The One Health approach further allowed savings of €1.21 million in terms of avoided tests on blood units. Benefits of the One Health approach due to short-term costs of hospitalization and compensation for transfusion-associated disease potentially avoided, were estimated to range from €0 to €2.98 million according to the probability of developing WNV neuroinvasive disease after receiving an infected blood transfusion.

[Tuberculosis among children and young adults in Emilia-Romagna Region (Northern Italy): surveillance system and integration with socioeconomic data]. / La tubercolosi nei bambini e nei giovani adulti in Emilia-Romagna: sistema di sorveglianza e integrazione con dati socioeconomici.

OBJECTIVES: to characterise the cases of tuberculosis (TB) aged 0-24 years reported in Emilia-Romagna (Northern Italy) Region between 2001 and 2010 through an ecological approach and from a sociodemographic perspective. DESIGN: observational study on notified TB cases, with data integration and subsequent location through geocoding and ecological deprivation index. SETTING AND PARTICIPANTS: notification records of TB cases identified by the current surveillance system. Cases were geocoded where address details were available and, through spatial intersection with census block polygons, the related deprivation index (DI) was attributed to them. MAIN OUTCOME MEASURES: deprivation index distribution of the observed cases. RESULTS: in the considered decade, 686 cases of tuberculosis in the age group 0-24 years were reported, 14.5% of the overall number of cases in the Emilia-Romagna Region. The DI was attributed to the 90.4% of cases. Notified TB cases were more frequently located in the most deprived areas. CONCLUSIONS: as other TB international surveillance systems, this study shows that it is possible to locate TB cases, to link them with census data and, therefore, to characterise with socioeconomic information. Looking ahead, the extension of the analysis to all age classes, the updating of socioeconomic data and the use of qualitative methodologies can integrate surveillance system data to better describe the social disadvantage among TB cases.

[The ideation of the Emilia-Romagna surveillance system for arbovirosis following the experience from the Chikungunya outbreak 2007]. / La costruzione di un sistema di sorveglianza delle arbovirosi in seguito all'epidemia Chikungunya 2007 in Emilia-Romagna.

Since 2008 the Emilia-Romagna Regional public health authority activated a regional Plan for arbovirosis surveillance and control, focused on Chikungunya, Dengue and West Nile. The Plan integrates sanitary, entomological and veterinary surveillance allowing a prompt adoption of efficient measures, aiming at the prevention and reduction of arbovirosis transmission risk. Following the 2007 Chikungunya outbreak, no autochthonous Chikungunya or Dengue cases has been registered, while an increase of confirmed imported cases of Dengue and Chikungunya has been observed. The integrated surveillance system allowed a prompt, appropriate and efficient intervention in 98.2% of imported suspected cases. The humanWNND (West Nile Neuroinvasive Disease) surveillance reported confirmed cases in 2008, 2009 and then in 2013 and 2014. In all cases the entomological and ornithological surveillance detected WNV circulation well in advance respect to the appearance of the first human case. The integration of information provided by different surveillance sources allows to evaluate, even through the vector index (VI) calculation, the risk of transmission, to optimize preventive measures on blood, tissues and organs donation and to implement further measures of vector fight.

Seroprevalence of West Nile virus-specific antibodies in a cohort of blood donors in northeastern Italy.

IgG and IgM levels against West Nile virus (WNV) were measured in 20,033 serum samples that were obtained between October 2008 to September 2009 from 9913 blood donors in the district of Ferrara, northeastern Italy. As confirmatory test, a microneutralization assay was used to detect the presence of neutralizing antibodies against WNV. Sixty-eight subjects (0.69%) were positive for anti-WNV by immunofluorescence assay. Large differences in the prevalence of antibodies to WNV were noted between towns in the area evaluated.

Chikungunya virus in North-Eastern Italy: a seroprevalence survey.

After an outbreak of Chikungunya infection in Emilia-Romagna Region (North-eastern Italy), a survey was performed to estimate the seroprevalence of antibody to Chikungunya virus and the proportion of asymptomatic infections, to identify factors associated with infection, and evaluate the performance of the surveillance system. The method used was a survey on a random sample of residents of the village with the largest number of reported cases. The prevalence was 10.2% (33 of 325), being higher in older people and males, and lower when window screens and insect repellents were used. Only 18% of infected persons were fully asymptomatic, 85% of the 27 symptomatic confirmed cases satisfied the surveillance case definition, and 63% of the persons meeting the criteria for suspect case were identified by the active surveillance system. This study provides basic parameters for modeling the transmission potential of outbreaks and planning control measures for Chikungunya infection in temperate settings.

The Chikungunya epidemic in Italy and its repercussion on the blood system.

BACKGROUND: The Chikungunya virus (CHIKV) is transmitted by Aedes mosquitoes and recently caused a massive epidemic on La Réunion Island, in the Indian Ocean. Between July and September 2007 it caused the first autochthonous epidemic outbreak in Europe, in the Region of Emilia-Romagna in the north-east of Italy. MATERIALS AND METHODS: After the first reports of an unusually high number of patients with a febrile illness of unknown origin in two contiguous villages, an outbreak investigation was carried out to identify the primary source of infection, the modes of transmission and the dynamics of the epidemic. An active surveillance system was also implemented. Laboratory diagnosis was performed through serology and polymerase chain reaction (PCR) analysis. Blood donation was discontinued in the areas involved from September to October 2007 and specific precautionary blood safety and self-sufficiency measures were adopted by the regional health and blood authorities and the National Blood Centre. An estimate method to early assess the risk of viraemic blood donations by asymptomatic donors was developed, as a tool for "pragmatic" risk assessment and management, aiming at providing a reliable order of magnitude of the mean risk of CHIKV transmission through blood transfusion. RESULTS: Two hundred and seventeen cases of CHIKV infection were identified between 4th July and 28th September. The disease was fairly mild in most of the cases. The precautionary measures adopted in the blood system caused a considerable reduction of the collection of blood components and of the delivery of plasma to the pharmaceutical industry for contract manufacturing. The estimated risk of CHIKV transmission through blood transfusion peaked in the third week of August. CONCLUSION: ACHIKV epidemic poses considerable problems for public health authorities, who not only need good routine programmes of vector control and epidemiological surveillance but also local and national emergency plans to sustain the blood supply, so as to promptly deal with the potentially severe effects of an epidemic outbreak, especially when affected areas locally require a significant blood inventory and at the same time represent a critical resource for other areas depending on external supplies of blood components.

[Chikungunya emergency in Emilia-Romagna: learning through experience]. / L'emergenza Chikungunya in Emilia-Romagna: apprendere dall'esperienza.

This paper summarizes the Emilia-Romagna strategy to face the 2007 emergency, caused by a Chikungunya epidemic outbreak with local virus transmission by Ae. albopictus. The paper describes the trend of epidemic and the interventions adopted to face toward the event. The first cases were in Ravenna and Cervia and then the outbreak spread toward other areas: the Provinces of Forlì-Cesena, Rimini and Bologna. Last case was notified 2007 28th September; Health Ministry declared over the outbreak on 2007 20th November. Emilia-Romagna Region did not consider over the trouble and prepared a Plan for the fight against the asian tiger mosquito and the prevention of Chikungunya and Dengue fever for 2008, activating an health surveillance system and optimizing the entomological control of the territory.