HEV prevalence in the general population and among workers at zoonotic risk in Latium Region.

Hepatitis E Virus (HEV) infections are responsible for large waterborne outbreaks in developing countries. Sporadic cases in the developed world are mainly imported from endemic areas. HEV has been suggested to be a zoonotic infection, for which pigs may be the reservoir; specific swine strains of HEV have been identified. Humans are susceptible to infections with swine strains. The aim of this study was to analyse whether Italian pig farmers, veterinarians and abattoir workers are more exposed than persons with other occupations. A total of 92 workers at zoonotic risk and 3511 controls from the general population of two Latium cities, Rome and Rieti, were tested for IgG-HEV antibodies. No significant difference in anti-HEV prevalence was observed between the two groups. The prevalence of general population was 2.9% against 3.3% of pig breeders, while there was a statistically significant difference (p = .0004) between subjects recruited in Rome (prevalence 2.5%) and those recruited in Rieti (prevalence 5.5%). Moreover, in some subgroups of general population and in a subgroup of pig breeders, the prevalence was higher than that previously reported in Italy and in other European countries. The highest value (33%) was found in male housekeepers enrolled in Rome; an analogous value was found in the employees of abattoirs (33%). Further studies are needed to elucidate the transmission routes.

[Osteoporosis: problems and considerations of economical nature]. / Osteoporosi: problematiche e considerazioni di carattere economico.

In 1991 WHO classified osteoporosis as a major social disease, on the basis of its high prevalence, expected to rise in the future, its physical and psychological consequences and its economical costs for both the society and the individual. In the past, costs, especially the undirected and intangible ones, have been largely underestimated, due to their complex quantification. A more accurate and a deeper evaluation of the pathology and its economical burden on National Health Services will lead to a better planning of prevention strategies.

Environmental surveillance of poliovirus in Italy: pilot study.

A pilot study on environmental surveillance of poliovirus included one hundred ninety-six samples (drinking water, surface water, seawater and sewage), collected between 1996 and 1998 in different regions of Italy. Samples were screened for the presence of poliovirus and other enteric viruses. Twelve polioviruses, 35 non polio enteroviruses (NPE) and 51 enteric non entero (NE) viruses were isolated. All poliovirus isolates, namely four type 1, four type 2 and four type 3, were characterised as Sabin-like strains. Thirty-one Coxsackie B and 4 Echo viruses were also detected. The presence of Sabin-like polioviruses in the environment is not unexpected since immunization with only oral poliovirus vaccine was performed in Italy until May 1999, when a sequential schedule consisting of two doses of inactivated polio vaccine (IPV) and two of oral polio vaccine (OPV) was adopted; in July 2002 a schedule consisting of four doses of IPV was adopted. Although this is only a pilot study and the number of samples analysed is limited, so far data from this study so far supports once again evidence of lack of circulating wild poliovirus and is in line with results from AFP surveillance in Italy and stool survey on healthy children.

[Viral zoonoses]. / Le zoonosi da virus.

In different areas of the World, whether in industrialized or developing countries, zoonoses represent an emerging Public Health concern either as known agents appear in areas or species in which they had not been reported or as new pathogens parasite Human as consequence of successful host switching. Epidemiological data outlined that vectorborne viral zoonoses are of particular relevance. This paper review the changes in epidemiology of bat rabies and arbovirus encephalitis.

Enterovirus surveillance of Italian healthy children.

Surveillance of acute flaccid paralysis (AFP) is the golden strategy recommended by the WHO to verify the condition of polio eradication in a country. Because of the difficulty to detect all of the expected AFP cases and to reach the target incidence of 1/100,000 requested by WHO, the surveillance of enteroviruses in the population has been adopted by several countries as an important additional method to verify the absence of wild-poliovirus circulation. To complete the results of AFP surveillance set up in Italy in 1996, we have conducted a wild poliovirus surveillance by examining stool samples from 1551 healthy children aged less than 5 years, collected during the period January 1997 to January 1998. The children were from three cities (Parma, Rome and Bari) located in northern, central and southern Italy. Thirty-nine polioviruses, 72 non-polio enteroviruses and 50 enteric, nonentero (NE), viruses were isolated from stool specimens. Polioviruses identified were nine type 1, seven type 2 and twenty-three type 3. Characterization of isolates by both antigenic and molecular methods showed that all polioviruses were of vaccine origin. As expected, most polioviruses, especially types 2 and 3, presented retromutations known to be associated with loss of the Sabin attenuated phenotype. The results of this study support the data obtained from the active AFP surveillance conducted in Italy in the same period--on the absence of paralytic disease due to wild poliovirus--and altogether demonstrate the effectiveness of the vaccination program.

[Flaccid paralysis surveillance in the Latium Region]. / La sorveglianza della paralisi flaccida nella Regione Lazio.

The goal of World Health Organization is to reach the global eradication of poliomyelitis during the first decade of the third millennium. To achieve the certification of the eradication of the disease the main strategy is the Acute Flaccid Paralysis (AFP) surveillance. In Italy the active AFP surveillance was performed at national level since 1997. In the Latium region the active surveillance was performed since January 1997 by the laboratory of virology of Institute of Hygiene G Sanarelli which established a regional hospital network. During the years of survey 7 cases were found in 1997 (0.87/100,000), 4 in 1998 (0.5/100,000), 2 in 1999 (0.25/100,000) and 2 in 2000. No wild polioviruses were detected.

Diphtheria antitoxin levels in the 14-30-year age group in Italy.

In order to verify diphtheria immunity a seroepidemiological survey was performed in 1996-1997. Serum samples were obtained from 501 subjects 14 years old, recruited at 8 schools in Rome, and from 490 subjects 20-30 years old recruited from 15 Italian regions. Serum diphtheria antitoxin was titrated using the Vero cell assay. The minimum protection level of antitoxin was set at 0.01 IU ml-1. The results show that the younger population have a good immunity to diphtheria while a large proportion of young adults is devoid of protective levels of diphtheria antitoxin. Out of the 501 subjects 14 years old, 495 (98.8%) had a diphtheria antitoxin titre > or = 0.01 IU ml(-1). Only 6 (1.2%) teenagers were susceptible. Out of the 490 subjects 20-30 years old, 109 (22.2%) were susceptible, 381 (77.8%) had a diphtheria antitoxin titre > or = 0.01 IU ml(-1). The data stress for booster immunization at the end of junior high school.

Immunity status against poliomyelitis in persons 13-14 years old living in Rome.

The immunity against poliomyelitis in 1000 subjects 13-14 years old was evaluated. Neutralizing antibodies against poliovirus type 1, 2 and 3 were detected in 97.6%, 95.8% and 70% of samples, respectively. 3/1000 (0.3%) subjects were simultaneously seronegative to the three types. WHO does not suggest a protective level of International Units (IU), but our data indicate that such level is 0.45 IU for polio type 1, 0.65 IU for the type 2 and 0.138 for the type 3. A booster dose of vaccine in adolescence to ensure personal and herd immunity is recommended.

Viral hepatitis and drugs: a continuing problem.

A seroepidemiological survey of a group of drug abusers has been carried out to determine the prevalence of hepatitis C virus and hepatitis B virus, hepatitis D virus, hepatitis A virus infection markers in sera, as well as to evaluate the role of potential risk factors. A total of 645 symptomless subjects with a history of injecting heroin were recruited as volunteers from methadone maintenance centres in Rome. For all hepatitis viruses the total figures showed high prevalence rates giving considerable viral circulation in this group. Among heroin addicts the prevalence was 63.4% for HCV, 65% for HBV, 13.3% for HDV and 50.9% for HAV. Anti-HCV prevalence correlated with serological evidence of HBV infection. A significant correlation was also found between presence of HCV antibodies and exposure time to drug addiction > 5 years earlier. The data reveal the important role played by needle sharing in the spreading of multiple infections among intravenous drug abusers (IVDA).