Antibacterial activity of nanoparticles and nanomaterials: a possible weapon in the fight against healthcare-associated infections.

Healthcare-associated infections are a serious threat in terms of morbidity and mortality for all patients receiving healthcare. The problem is aggravated by the increasingly widespread phenomenon of antibiotic resistance, with some microorganisms now resistant to all or almost all the currently available antibiotics. Nanomaterials are compounds used by many different industrial fields and they are currently studied for their intrinsic antimicrobial properties. To date, many researchers have considered using many different nanoparticles and nanomaterials to produce surfaces and medical devices with intrinsic antimicrobial features. Many compounds have shown very interesting and effective antimicrobial capacities and could be used, in the future, to manufacture new hospital surfaces and medical devices. However, many studies have to be carried out to evaluate the effective potential use of these compounds. The aim of this paper is to review the main literature regarding this topic, focusing on the main types of nanoparticles and nanomaterials studied for this purpose.

COVID-19 and pregnancy: clinical outcomes and scientific evidence about vaccination.

Pregnant women and their infants are at high risk to develop a severe COVID-19, with increased rates of hospitalisation to intensive care units, need for mechanical ventilation and mortality. Preterm birth, fetal vascular malperfusion, and premature rupture of membrane have been the most reported adverse pregnancy outcomes and these effects have been especially associated with the onset of the disease at early gestational age. The early expression of ACE2 and TMPRSS2 in human embryos has been proven, determining an increased susceptibility to SARS-CoV-2. Preterm infants born to women infected by SARS-CoV-2 have a higher risk of need for specialist neonatal care with prolonged hospitalization. Moreover, inflammation of developing embryos could cause long-term defects, regardless of vertical transmission of SARS-CoV-2. Due to Maternal Immune Activation (MIA), in utero inflammation is associated with neurodevelopmental, cognitive and psychiatric disorders in affected offspring. Despite risks that COVID-19 could induce in pregnancy, there are not many published data describing the safety and/or efficacy of COVID-19 vaccines in pregnant women, commonly not included in vaccine research. The evidence from the few pregnant women unintentionally enrolled in clinical trials and vaccinated suggests that COVID-19 vaccines, both based on mRNA and viral vectors, do not pose significant risks to the fetus or breastfeeding infants. Moreover, human studies using mRNA-based vaccines against Zika virus, influenza, and rabies have reported good safety and immunogenicity during pregnancy. In this review, we evaluate the role of COVID-19 in adverse pregnancy and neonatal outcomes and the need to vaccinate pregnant women.

Health conditions of migrants landed in north-eastern Sicily and perception of health risks of the resident population.

OBJECTIVES: In Italy, a recent irregular movement of people raised concerns among the host population on possible introduction of diseases that have long been controlled in the host countries. This study evaluates the health conditions of illegal immigrants landed on the north-eastern Sicilian territory, to provide information on the clinical and epidemiologic burden of infectious diseases among migrants and how the local population feel about these landings. STUDY DESIGN: The study design is a cross-sectional study. METHODS: The study considered all migrants landed illegally in the city of Messina, Sicily, between January 2014 and July 2018. Analysing the data of hospital admissions and disease notifications, we calculated the frequency of infectious diseases among migrant population. Furthermore, through a survey conducted by a well-known online newspaper, we analysed the perception that the local population has about the health risk represented by migrants. RESULTS: In the considered five-year period, 108 landings, for a total of 38,608 migrants occurred at the Messina port. The percentage of hospitalisation was rather low (3.5%), and it concerned mainly pregnant women. The notifications of infectious diseases were contained, with exception of scabies and tuberculosis. Finally, from the online survey, resulted that there is a large part of local population that considers migrants a potential danger to community health. CONCLUSIONS: Our data show that the presence of migrants should not have to date any impact on the health conditions of the resident population. However, monitoring over time the health of migrants and screening for infectious diseases as soon as possible after landing are advantageous for both migrants and host country.

The treatment of Kaposi's sarcoma: present and future options, a review of the literature.

Kaposi's Sarcoma (KS) is an angiogenic tumor involving skin, mucosa and splanchnic organs. It is caused by Human Herpes Virus 8 (HHV8), when in the presence of other cofactors, such as an immune dysregulation. KS is particularly frequent in HIV-infected individuals. The major goals of treatment are to prevent disease progression, to reduce tumor and edema, to avoid organ compromise, and to relieve psychological stress. The importance and the high cancer risk offered by this co-infection, together with the spread of both these viruses, and the fact that angiogenesis is such an important characteristic of KS led to a lively interest in finding a definitive therapy. Most of the ongoing studies are focused on finding an application of old drugs in KS. Unfortunately, given the number of studies with different targets, it seems we are still far from completely understanding this disease and obtaining a "cure" which could be effective and safe for everyone. Further studies will hopefully offer new and definitive solutions.

The new era of vaccines: the "nanovaccinology".

Vaccinations are the most effective preventive methods against infectious diseases and represent one of the most relevant successes of medicine. Vaccine development is constantly evolving; therefore, the number of vaccine candidates is progressively increasing. However, most of new potential vaccines are characterized by a lower immunogenicity, with the inability to stimulate powerful and long-lasting immune responses. Hence, to get modern and effective vaccines, we need adjuvants and innovative delivery systems that increase their immunogenicity. The use of nanotechnology in vaccinology is providing the opportunity to contrast these difficulties and develop effective vaccines. Particularly, nanoparticles used as vehicles of vaccine components, are able to increase the host's immune responses and, due to their size, to reach specific cellular districts. To date, a certain number of nanovaccines has been approved for human health and many are studied in clinical or pre-clinical trials. There are several types of nanoparticles considered as possible delivers of vaccine antigens. These nanoparticles-based synthetic delivery systems, in the size range of 20-200 nm, protect antigen from degradation, enhance its presentation and facilitate its uptake by professional antigen-presenting cells. Virus-like particles, self-assembled proteins, micelles, liposomes, inorganic nanoparticles, and polymers are the most studied of these systems. In this review, we provide a general overview of different types, methods of synthesis, characterizations, properties and applications of nanoparticles in vaccine production.

Knowledge of sexually transmitted infections and risky behaviours: a survey among high school and university students.

INTRODUCTION: STIs are a serious public health problem. Worldwide, 500 million people a year acquire a STI, and young are the most affected. METHODS: This study was conducted administering an anonymous questionnaire to 1228 Sicilian students of high school and university. RESULTS: The students had variable understanding of STIs and their complications. The results demonstrate an extreme variability in the knowledge of STIs. Multiple linear regression showed that sexual health knowledge was associated with age and sexual orientation. CONCLUSIONS: Our results show that knowledge of STIs is poor and inadequate. This finding can put students at risk of STIs.

Today's vaccination policies in Italy: The National Plan for Vaccine Prevention 2017-2019 and the Law 119/2017 on the mandatory vaccinations.

The National Plan for Vaccine Prevention 2017-2019 has expanded the vaccination offer including new vaccines, enlarging the target population and introducing for the first time in Italy a life-course approach to vaccination. A "lifetime immunization schedule" is aimed to reduce the burden and the related costs of vaccine-preventable diseases through effective vaccination programs. However, to counteract the national steady downward trend in the uptake of vaccinations that caused a drop of the vaccination coverage below the 95% threshold to allow herd immunity, it was decided to make 10 vaccinations mandatory by the law 119/2017. In particular, in addition to already mandatory vaccinations against diphtheria, tetanus, hepatitis B and poliomyelitis, those against measles, mumps, rubella (MMR), varicella, pertussis and Haemophilus influenzae type b (Hib) were added to the list. According to the law, all unvaccinated children cannot attend preschool services until the age of 6 years and fines (from 100 to 500 Euros) are provided for parents. Moreover, this law provided, in its first application, a catch-up campaign for children up to the age of 16 years and the free-of-charge offer of all mandatory and recommended vaccines to each child not yet vaccinated according to the previous NPVP. The NPVP includes also several at risk categories, such as pregnant women, healthcare workers and subjects suffering from chronic diseases, to whom specific vaccinations, free of charge, are offered. The vaccinations of pregnant women have different purposes. In order to decrease the pertussis risk in newborns in the first months of life, a booster immunization of DTPa is recommended, at every pregnancy, between week 27th and 36th. Instead, the influenza vaccine administration to pregnant women during the second or third quarter is mainly aimed to avoid the risk of serious disease complications for both the mother and the fetus. Another group of at risk subjects included in the NPVP is that made up by healthcare workers. According to the plan, "an adequate immunization of the healthcare workers is essential for the prevention and control of infections (anti-hepatitis B, anti-influenza, anti-measles-mumps-rubella, anti-varicella, anti-pertussis)". Finally, almost all the vaccinations foreseen by the NPVP are offered free of charge to subjects suffering from specific diseases. These include cardiovascular, respiratory, hepatic, neoplastic, renal and metabolic disorders, in addition to immunosuppression that exposes them to an increased risk of contracting invasive infectious diseases.

Perception of rubella risk in pregnancy: an epidemiological survey on a sample of pregnant women.

BACKGROUND: Rubella is a common exanthematous viral disease all over the world. The disease can be prevented by administering a safe and effective vaccine, and in Italy it is subject to reporting obligations. A national plan for the elimination of measles and congenital rubella (in Italian "PNEMoRC") was approved in 2003 and updated in 2010. This plan originally aimed at reducing the susceptible target population (women in fertile age, 15-49 years old) to below 5% and at eliminating the congenital form of rubella by 2015, a goal which has not been achieved yet. STUDY DESIGN: Our research work was focused on a convenience sample of pregnant women attending the antenatal classes at the two main hospitals in Messina, Sicily (Italy). METHODS: After we obtained an informed consent, we administered to 200 Italian and foreign pregnant women an anonymous questionnaire reporting socio-demographic characteristics, type of gynaecological assistance and information received about Rubella serological statu. RESULTS: The mean age was 30.6 years ± 5.45. The majority of these women were married, at work and with a high educational level. Most of them (75.3%) reported to be assisted by a private gynaecologist, while only 24.7% used a public facility. A remarkable percentage (62.8%) of these women reported to be serologically negative at the anti-rubella antibodies test, but, only 7.5% of them reported to have passed the anti-rubella antibody test before the conception. CONCLUSION: Our results clearly show that we are still far from achieving the elimination of rubella risk in pregnancy. We are facing a cultural gap perhaps also due to a generalized loss of "historical memory" about the impact that infectious diseases have had in the past in terms of mortality and morbidity. In fact, alongside the considerable drop in vaccination coverage in the recent years, our research also reveals a reduced focus on pre-conceptional testing and limited awareness of associated risks. Furthermore, we correlated the serological status with the sociodemographic characteristics of these women and found a statistically significant correlation with their age and their educational level (P<0.05). A lot still needs to be done to improve the situation; in particular, better education at various levels could considerably increase the awareness among women about this relevant public health issue.

Breast cancer in women living with HIV.

With the introduction of HAART, the life expectancy of the patients infected with HIV almost approached that of the general population. The incidence of certain HIV-Associated cancers as Kaposi Sarcoma (KS) and Non-Hodgkin Lymphoma (NHL) decreased, while an increase in Non-AIDS-Defining cancers (NADCs) has been documented. HIV infection is a risk factor for numerous cancers in PLWH. Breast cancer is the most common cancer worldwide among all women. The association between HIV infection and breast cancer has not been thoroughly investigated: when compared to the general population, people living with HIV/AIDS (PLWHA) have a similar or slightly lower risk of breast cancer. Screening tests are essential weapons to fight cancer burden and more effective therapeutic and preventive strategies are needed, especially among PLWHA. Further and more comprehensive studies are needed to better characterize breast cancer among PLWH.

The role of the hospital environment in the healthcare-associated infections: a general review of the literature.

Healthcare-associated infections (HAIs) are one of the most relevant public health problems worldwide. The role of the hospital environment as a reservoir of pathogens causing HAIs is still debated. These pathogens are common in several hospital environments, where they are able to persist from hours to months and their circulation is favored by healthcare workers (HCWs). Hospital surfaces at close contact with patients such as bed bars and header, bedside table, taps, and handles in wards ("high-touched surfaces"), are considered easily contaminable and at risk to transfer pathogens to patients. However, some studies showed the possible role played by "non-classical" surfaces such as healthcare workers' (HCWs) mobile phones and personal computers as well as oxygen humidifiers and protective lead garments used in operating rooms. HCWs' hands play a fundamental role in patient-to-patient transmission by touching contaminated surfaces or patients during care activities. The aim of this review is to evaluate the role of the hospital environment in the transmission of nosocomial pathogens, focusing on single pathogens causing HAIs and the importance of hospital surfaces as reservoirs.

Herpes zoster vaccine: a protection for the elderly.

The Herpes Zoster vaccine is strongly recommended by the World Health Organization to promote healthy aging by preventing the corresponding age- related disease, also named shingles. The disease is due to the endogenous reactivation of Varicella Zoster Virus, the causal agent of chickenpox, that becomes latent at the peripheral nervous system level. Here, owing to the host's cell-mediated immunity, it may be confined for several decades. However, the immune senescence allows the possibility of virus reactivation, causing the onset of neuropathic pain and skin rash that characterize the acute disease. Sometimes, the neuralgia becomes chronic causing postherpetic neuralgia that has a significant impact on the quality of patient life, analogously to the ophthalmic HZ, a particularly feared form of disease. Due to the causal relationship between decreasing immune defenses and virus reactivation with disease onset, the incidence of Herpes Zoster, in Italy now equal to 6.42 (95%CI: 5.93-6.95) cases per 1,000 people per year will increase steadily in the future due to the longevity rise of the population. Considering epidemiological impact, complications and sequelae in the short- and long-term, costs of clinical-therapeutical management of patients, and, above all, the poor effectiveness of available therapy the only effective intervention is vaccination of the elderly. Currently in the European Union, there is only one vaccine for Herpes Zoster prevention, formed by live attenuated OKA-Merck virus strain that is also used for paediatric vaccine. According to the Health Technology Assessment surveys, the intervention cost (based on "Quality Adjusted Life Years") is clearly below the discriminating threshold value to judge the feasibility and, as predicted by the Italian National Plan of Vaccinal Prevention 2017-2019, the vaccine is offered free to all subjects >65 years.

Measles outbreak from February to August 2017 in Messina, Italy.

INTRODUCTION: Measles continues to be a major public health issue worldwide, with high morbidity and mortality rates. The disease remains endemic in 14 European countries, including Italy where, from 2013 to 2016, over 5,000 cases have been reported. In 2017, many Italian regions, including Sicily, have reported many cases of measles. In this study, we described the latest measles outbreak in the city of Messina, from 1st February to 31st August 2017. METHODS: We considered all reported measles cases that came to the "Public Health, Epidemiology and Preventive Medicine" Operative Unit of the Messina Provincial Health Agency Prevention Department, which receives all reported cases of measles in the Messina province. RESULTS: From 1st February to 31st August 2017, a total of 59 measles cases were reported, of which 44 were confirmed, nine were classified as possible, four were probable and two cases were discarded. Of the 57 possible, probable and confirmed cases, 31 (54%) were males and 26 (46%) were females. Moreover, 54 (95%) had not been previously vaccinated while the remaining cases had documented evidence of one (two cases) or two doses (one case). Genotype B3 was identified in 39/44 cases (88,6%) by the regional reference laboratory in Palermo. CONCLUSIONS: Despite the development of an effective vaccination, unfortunately measles continues to threaten the lives of millions of children worldwide each year. The suboptimal immunization level in Italy has led to an increase in the transmission of measles with detrimental effects on both public health and ongoing measles elimination efforts.

Risk factors for voluntary interruption of pregnancy and possible preventive public health actions.

INTRODUCTION: Voluntary interruption of pregnancy (VIP) is one of the most frequent healthcare procedures in the world and a Public Health concern in many countries, especially after liberalization of the abortion laws. The study has been carried out to identify the factors that still influence a fraction of female population towards abortion in the absence of fetal malformations. METHODS: We conducted a cross-sectional study in the period 2012-2016. The survey was carried out on all VIPs performed at the Gynecology and Obstetrics Unit of the University Hospital "G. Martino" in Messina, Italy. RESULTS: The analyzed sample consisted of 1131 women, aged between 16 and 50 years. Only 4% of VIPs was due to a diagnosis of fetal malformation. In relation to the presence or absence of fetal malformations as the possible reason for VIP, the sample was split up into two groups and the socio-demographic characteristics were considered. VIPs in the absence of malformations were significantly more frequent in younger women with a lower educational level, in unmarried and unemployed women and in women who already had children. These results were confirmed to Pearson test that indicated that all these variables were related to VIP in the absence of malformations. CONCLUSIONS: Based on our results, it is crucial to further prevent requests for VIPs through information and sex education programs for adolescents in schools and consultants, and responsible procreation promotion programs.

Hepatitis C-related hepatocellular carcinoma: diagnostic and therapeutic management in HIV-patients.

The efficacy of the current HIV therapy has led to increased survival and prolongation of the average life expectancy of people living with HIV (PLWH), as well as the emergence of comorbidities and non-AIDS related cancer. Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Current evidence suggests that HCC is an important cause of morbidity and mortality in HIV infected patients. In fact, HCC prevalence rate is indeed higher with respect to the general population average. In this paper, we review the diagnostic and therapeutic management of Hepatitis C-related hepatocellular carcinoma in HCV-HIV co-infected patients. Several therapeutic options are available depending on several factors as HCC stage, liver functions, comorbidities and they have been divided into three groups: potentially curative, proven effective but not curative, and unproven or ineffective therapy. In HIV-infected patients, surgical options are preferred compared to non-surgical therapies. Further studies, especially multicenter ones, are needed in order to define the most appropriate, evidence-based therapeutic approach to PLWH suffering from HCC. It also appears necessary to develop appropriate care guidelines for PLWH.

Kaposi's sarcoma in HIV-infected patients in the era of new antiretrovirals.

Kaposi's Sarcoma (KS) is a multicentric angioproliferative cancer of endothelial cells (ECs) caused by Human Herpesvirus 8 (HHV8) characterized by clinical heterogeneity depending on the host immune conditions. Despite its incidence has dramatically decreased in developed countries after the introduction of Highly Active Antiretroviral Therapy (HAART), KS remains the most frequent tumor in HIV-infected patients worldwide. Clinical presentation varies from an indolent slowly progressive behavior, generally limited to the skin, to an aggressive and rapidly progressing disease. In more than 50% of cases, the skin lesions are often associated with a more or less important visceral involvement, particularly to the oral cavity and the gastrointestinal tract that are involved in 35% and 40% of cases respectively. A large number of treatments can be used both as local and as systemic therapy. Particularly, HAART represents the first treatment in patients with moderate lesions limited to skin, and it can be sufficient to reduce significantly the size of lesions and, often, the complete disappear in 35% of cases after 3-9 months of treatment. In case of a rapidly progressive disease with extensive cutaneous and/or visceral involvement systemic drugs are used such as the liposomal anthracyclines pegylated liposomal doxorubicin (PLD) and daunorubicin citrate liposome (DNX), the combined treatment adriamycin-bleomycin-vincristine (ABV) and bleomycin-vincristine (BV), Paclitaxel and Interferon-alfa. In patients with limited skin localization, the local treatment can play an important role. Local medical therapy is based on the use of alitretinoin, antineoplastic drugs vincristine, vinblastine and bleomycin and Sodium Tetradecyl Sulfate (STS). In addition to medical therapy, physical treatment, such as cryotherapy and radiotherapy, are also commonly used.

Campylobacter: from microbiology to prevention.

In last years, Campylobacter spp has become one of the most important foodborne pathogens even in high-income countries. Particularly, in Europe, Campylobacteriosis is, since 2005, the foodborne disease most frequently notified and the second in USA, preceded by the infection due to Salmonella spp. Campylobacter spp is a commensal microorganism of the gastrointestinal tract of many wild animals (birds such as ducks and gulls), farm animals (cattle and pigs) and companion animals (such as dogs and cats) and it is responsible for zoonoses. The transmission occurs via the fecal-oral route through ingestion of contaminated food and water. The disease varied from a watery diarrhea to a severe inflammatory diarrhea with abdominal pain and fever and can be burdened by some complications. The main recognized sequelae are Guillain-Barré Syndrome (GBS), the Reactive Arthritis (REA) and irritable bowel syndrome (IBS). Recently, many cases of Campylobacter spp isolated from human infections, showed an important resistance to various antibiotics such as tetracyclines and fluoroquinolones. For these reasons, the prevention of this infection plays an essential role. Many preventive measures exist to limit the transmission of the pathogens and the subsequent disease such as the health surveillance, the vaccination of the poultry and the correct food hygiene throughout the entire production chain. A global surveillance of Campylobacteriosis is desirable and should include data from all countries, including notifications of cases and the microbiological data typing of strains isolated from both human and animal cases.

Humidifiers for oxygen therapy: what risk for reusable and disposable devices?

INTRODUCTION: Nosocomial pneumonia accounts for the vast majority of healthcare-associated infections (HAI). Although numerous medical devices have been discussed as potential vehicles for microorganisms, very little is known about the role played by oxygen humidifiers as potential sources of nosocomial pathogens. The purpose of this research was to evaluate the safety of the reuse of humidifiers by analysing the rate of microbial contamination in reusable and disposable oxygen humidifiers used during therapy, and then discuss their potential role in the transmission of respiratory pathogens. METHODS: Water samples from reusable and disposable oxygen humidifiers were collected from different wards of the University Hospital of Messina, Italy, where nosocomial pneumonia has a higher incidence rate due to the "critical" clinical conditions of inpatients. In particular, we monitored the Internal Medicine and Pulmonology wards for the medical area; the General Surgery and Thoracic and Cardiovascular Surgery wards for the surgical area and the Intensive Care Unit and Neonatal Intensive Care Unit for the emergency area. The samples were always collected after a period of 5 days from initial use for both types of humidifiers. Samples were processed using standard bacteriological techniques and microbial colonies were identified using manual and automated methods. RESULTS: High rates of microbial contamination were observed in samples from reusable oxygen humidifiers employed in medical (83%), surgical (77%) and emergency (50%) areas. The most relevant pathogens were Pseudomonas aeruginosa, amongst the Gram-negative bacteria, and Staphylococcus aureus, amongst the Gram-positive bacteria. Other pathogens were detected in lower percentage. The disposable oxygen humidifier samples showed no contamination. CONCLUSIONS: This research presents evidence of the high rate and type of microbial contamination of reusable humidifiers employed for oxygen therapy. These devices may thus be involved in the transmission of potential pathogens. It could be important, for the prevention of nosocomial pneumonia, to replace them with singleuse humidifiers for which the absence of microbial contamination has been confirmed.

Five-year microbiological monitoring of wards and operating theatres in southern Italy.

INTRODUCTION: Nosocomial infections are one of the greatest problems in public health. Several studies have highlighted the role played by the hospital environment as a possible source of transmission of nosocomial pathogens. METHODS: A five-year monitoring of bacterial contamination on healthcare workers hands, surfaces most closely in contact with inpatient wards, operating theatres and "at rest" and "in use" operating theatre air samples. For the samples, we used sterile swabs, contact slides, manual API, and automated VITEK systems for identification. RESULTS: In the five-year period, a total of 9396 samples were collected and analysed. In ward patients, 4398 samplings were carried out with 4.7%, 9.4%, 7%, 10.8% and 7.9% positive results respectively from 2010 to 2014. For hands, 648 samplings were carried out, with a positivity of 40.74%. In operating theatres, 4188 samples were taken, with a positivity of 11.9%. Regarding air in empty and full theatres, 1962 samplings were carried out with a positivity rate equal to 31.9%. The monitoring showed a low rate of contamination with a progressive decrease in the fiveyear period on operating theatres surfaces and hands, while there was an increase in the surgical site wards and in the air of operating rooms. CONCLUSIONS: Our investigation has revealed the presence of pathogens on the assessed surfaces and the need for environmental monitoring, which can be a valuable tool for reducing contamination.

Management of two influenza vaccination campaign in health care workers of a university hospital in the south Italy.

BACKGROUND: In Europe, flu remains one of the major public health problems. Healthcare workers (HCWs) are a category at high-risk of contracting the infection and infecting their patients; consequently, for this category, vaccination is highly recommended. Unfortuntely, coverage levels remain insufficient with rates ranging between 4 and 40. STUDY DESIGN: The purpose of our work was to evaluate the adherence of HCWs to the influenza vaccination and to carry out a combination of educational and motivational interventions in order to increase the rate of adherence to the vaccination in this workers' category. METHODS: We conducted two different influenza vaccination campaigns, 2014-2015 and 2015-2016. The study was divided in two steps. In the first, preliminary step, an anonymous questionnaire was administered to HCWs containing a set of questions in order to gain information about the number of subjects willing to undergo the vaccination and the reasons that led others toits rejection. In the second step, vaccination campaigns were carried out preparing an appropriate vaccination calendar that was communicated to all interested Units and vaccination points located in various wards. RESULTS: We found a slightly improved compliance trend, from an average of 2.3% in the previous years to 3.3% in 2014 and 7.4% in 2015. CONCLUSIONS: Despite the observed increase, the adherence remains very low. We found that the main causes of this result are the fear of adverse effects, the negligence and indolence of the same workers and a lack of risk perception of contracting the disease and transmitting it to patients. Our work stressed the importance of offering correct information and of meeting the needs of HCWs, often unable to leave their ward for the excess workload. This could be, in future years, one of the possible solutions to increase vaccination adherence.

Seroprevalence of hev antibodies in a sample of pregnant women in the city of Messina.

BACKGROUND: Hepatitis E virus (HEV) is widespread in developing countries and the disease is also increasing in the developed ones. This infection in pregnancy can cause spontaneous abortion and neonatal death in 56% of newborns. STUDY DESIGN: The study was conducted on a sample of 352 pregnant women, 326 Italian and 26 foreign, in order to confirm the presence of HEV in our territory, to analyze wrong habits of the population and to suggest preventive actions against the risk to contract the infection during pregnancy. METHODS: We asked all women under study to fill an anonymous questionnaire immediately before taking a venous blood samples to determine the presence of anti-HEV antibodies. The questionnaire contained a set of questions to gain information about lifestyles and risk factors to contract HEV. RESULTS: The questionnaire revealed that a portion of the tested women have risk behaviours, as consumption of raw or undercooked food, eating unwashed food and traveling to endemic areas. The percentage of women positive for HEV antibodies was 3.4%, in agreement with national data; all the women were Italian. CONCLUSIONS: This study confirms the circulation of HEV in the city of Messina. For this reason, it is highly recommended to disseminate hygienic and appropriate behaviours and feeding habits in order to prevent the risk to contract the infection.