Sporadic isolation of sabin-like polioviruses and high-level detection of non-polio enteroviruses during sewage surveillance in seven Italian cities, after several years of inactivated poliovirus vaccination.

Sewage surveillance in seven Italian cities between 2005 and 2008, after the introduction of inactivated poliovirus vaccination (IPV) in 2002, showed rare polioviruses, none that were wild-type or circulating vaccine-derived poliovirus (cVDPV), and many other enteroviruses among 1,392 samples analyzed. Two of five polioviruses (PV) detected were Sabin-like PV2 and three PV3, based on enzyme-linked immunosorbent assay (ELISA) and PCR results. Neurovirulence-related mutations were found in the 5'noncoding region (5'NCR) of all strains and, for a PV2, also in VP1 region 143 (Ile>Thr). Intertypic recombination in the 3D region was detected in a second PV2 (Sabin 2/Sabin 1) and a PV3 (Sabin 3/Sabin 2). The low mutation rate in VP1 for all PVs suggests limited interhuman virus passages, consistent with efficient polio immunization in Italy. Nonetheless, these findings highlight the risk of wild or Sabin poliovirus reintroduction from abroad. Non-polio enteroviruses (NPEVs) were detected, 448 of which were coxsackievirus B (CVB) and 294 of which were echoviruses (Echo). Fifty-six NPEVs failing serological typing were characterized by sequencing the VP1 region (nucleotides [nt] 2628 to 2976). A total of 448 CVB and 294 Echo strains were identified; among those strains, CVB2, CVB5, and Echo 11 predominated. Environmental CVB5 and CVB2 strains from this study showed high sequence identity with GenBank global strains. The high similarity between environmental NPEVs and clinical strains from the same areas of Italy and the same periods indicates that environmental strains reflect the viruses circulating in the population and highlights the potential risk of inefficient wastewater treatments. This study confirmed that sewage surveillance can be more sensitive than acute flaccid paralysis (AFP) surveillance in monitoring silent poliovirus circulation in the population as well as the suitability of molecular approaches to enterovirus typing.

Immunity status against poliomyelitis in childbearing women in a province of northern Italy. A cross-sectional analysis.

This cross-sectional seroprevalence study was carried out in 2007 to estimate the immunological status associated with poliomyelitis among fertile women , according to demographic changes. We consecutively enrolled 493 healthy mothers at the time of delivery in order to assess immunity against poliomyelitis by a neutralisation inhibition test. Despite the lack of seronegative subjects, our investigation showed low GMTs, which confirmed a reduction in the "booster effect". The GMTs against poliovirus 1, poliovirus 2 and poliovirus 3 were 25.20, 14.79 and 8.80, respectively. The data that emerged from our survey showed that GMTs have decreased significantly since 1983 and reached low-to-medium values over the past 25 years. The serum prevalence studies, together with the vaccination coverage estimates, are useful and are strongly recommended in order to highlight and identify the possible scenarios in which susceptible subject groups may be present simultaneously as well the possibility of the reintroduction of wild virus in an area that was previously free of polio.

Mother to child transmission of hepatitis C virus in a province of northern Italy.

INTRODUCTION: Study reports of mother to child transmission of hepatitis C virus (HCV) have shown transmission rates ranging from 3 to 37%, according to maternal viremia and HIV-1 coinfection. The present study evaluated the prevalence of the HCV infection in the general population and the incidence of vertical transmission, from women who delivered in the Obstetric Clinic of the Hospital of Parma from January 1st 1996 to 31st 2001 December. METHODS: Mothers and children were tested for the presence of HCV-RNA within one week after delivery. Children were considered to be infected when they were found positive at least twice for viral RNA or antibodies were still detectable at the end of the follow-up period (18 months) in blood. RESULTS: Out of 13,025 women, 110 (0.8%) were found positive for anti-HCV antibodies; 72 of them (65.4%) were HCV-RNA positive. All 110 children were positive for anti-HCV antibodies in the first blood sample (time 0); 8 of them were HCV-RNA positive. Three children were still viremic at the end of the follow-up whereas 5 showed a clearance. No significant differences were found between viremic and nonviremic children with respect to gestational week, maternal alanine aminotransferase (ALT) levels and newborns weight at birth. CONCLUSION: This investigation shows that vertical transmission may occur in a general obstetric population despite a low prevalence of HCV-positive subjects.

[Pilot study on the presence of Legionella spp in 6 Italian cities' dental units]. / Studio pilota sulla presenza di Legionella spp nei riuniti odontoiatrici di 6 città italiane.

Among the microorganism involved in environmental contamination, Legionella spp is actually considered an important infectious hazard. The aim of this study is to evaluate the incidence of Legionella spp in water samples collected from 138 dental unit selected from public outpatient clinics of 6 Italian cities. The samples were taken from oral rinsing cup, air-water syringe, ultrasonic scaler and the turbine to investigate Legionella spp, Pseudomonas aeruginosa and the total heterotrophic count at 36 degrees and 22 degrees. Legionella spp was present in 33,3% dental unit water; but a significant difference was shown among the enrolled cities. In 43,5% of water sample Legionella concentration was 1.000-10.000 CFU/L and in 30,4% was >10.000 CFU/L. L. pneumophila 1 was found in 23,9% of water samples. The results demonstrate that the concentration of Legionella spp in dental unit water lines could be high and this suggests that the exposure to these micoorganism during the dental practise could be a potential health risk both for dental personnel and for the patients too, especially when immunocompromised.

[Sensorineural hearing loss in childhood: evaluation of economic impact in view of vaccine prevention of cases due to congenital cytomegalovirus infection]. / Sordità neurosensoriale infantile: valutazione dell'impatto economico nella prospettiva della prevenzione vaccinale dei casi da infezione congenita da Cytomegalovirus.

Sensorineural hearing loss (SNHL) is a serious public health problem which affects 1-3% per hundred live born babies in developed countries. The congenital cytomegalovirus (CMV) infection is its most important non-genetic cause. The evaluation of the effectiveness of future programs of anti-CMV vaccination requires an assessment of the present costs of SNHL. Direct costs for the Italian public system were calculated per prosthesis child until his full age and turned out to add up to 260,000 euro. Private costs are difficult to be assessed and anyhow are highly dependent from the socio-economic level. This preliminary assessment suggests that the vaccination would be cost-saving if SNHL cases due to congenital CMV were more than 21 per year, corresponding to a congenital infection prevalence higher than 0.21%o.

[Air pollution and mortality and hospital admission for respiratory disease in Parma on 1992-2001 period]. / Studio sulle associazioni tra inquinamento atmosferico, mortalità e ricoveri nella città di Parma. Periodo 1992-2001.

A study into the effects of atmospheric pollution on the health of people living in the city of Parma (population 170,000) shows motor vehicle traffic of average density and light industrial activities that have little impact on air pollution. General mortality and hospitalisation for all causes and for DRG specific were considered as sanitary events. The day values of the total PT, PM10, SO2 and NO2, CO and benzene were analysed. In addition, atmospheric conditions and outbreaks of flu were considered. The study results for the period 1992-2001 show quite moderate pollution levels with the sole exception of PM10 that shows average values often higher than 40 microg/l. An analysis of the associations between mortality and climatic parameters shows the role of temperature with RR equal to 1.0064 (CI95% 1.0046-1.0082) and epidemics of influenza with RR 1.042 (CI95% 1.0219-1.0671). As regards the pollution parameters, the total PT and SO2 turned out to be related to increases in mortality of respectively 0.6% for 100 microg/m3 of PT and 1.72% for 50 microg/m3 of SO2 while the NO2 turned out to be related to an increase in hospitalisations of 1.9% for 10 microg/m3 of NO2.

[Multicentric survey on hygienic aspects in private dental practice]. / Indagine multicentrica sugli aspetti igienico-sanitari legati all'assistenza odontoiatrica privata.

The aim of this research was to evaluate the knowledge of cross-infection hazards in private dental practices, and their control procedures. The survey, carried out by questionnaire in 11 Italian cities, showed that dental personnel do not completely follow the main procedures for infection control. The interviewed subjects usually wear gloves (95.5%), masks (90.1%) and glasses (91.2%), less frequently caps (23.9%) and coats (54.9%). They use steam sterilizers (92.9%) and periodically check the effectiveness (80.6%). Regarding individuals protection, 20.5% is not vaccinated against HBV and only 55.2% of those previously vaccinated has checked their immunity. Moreover, the majority of subjects underestimate the infection hazards especially for air-transmitted diseases.

[Evaluation of the immune status against poliomyelitis in a group of young immigrants]. / Valutazione dello stato immunitario verso la poliomielite in un campione di giovani immigrati.

The immunity state towards poliomyelitis has been evaluated in 506 young immigrants coming from European and extraeuropean countries without immunization history. Polioviruses 1, 2 and 3 antibodies were detected in 97% of the serum samples. 15 subjects did not have detectable antibodies at 1:2 dilution for one or two polioviruses. Out of these subjects, 6 (coming mostly from East European Region) were negative in the undiluted serum too. On the whole, GMTs for type 1 (43,29) and 2 (41,9) appeared higher than those for type 3 (33,6). Moreover there are differences among the origin countries; in fact, GMTs more elevated for type 1 and 3 (74,6 and 49,6 respectively) have been observed in the subjects coming from the African region, as well in those coming from the American region.

[Vertical transmission of the hepatitis C virus]. / La trasmissione verticale del virus dell'epatite C.

The incidence of hepatitis C in childhood is approximately 0.4%. The mode of transmission can be parenteral, sexual, occupational and also vertical. The latter has an incidence that varies widely and it increases in the case of human immuno-deficiency virus (HIV) coinfection and high titers of HCV in the mother. The vertical transmission is not influenced by breast feeding, however, data are discrepant with regard to child delivery (cesarean section vs vaginal delivery). Ninety-seven babies born from mothers with hepatitis C from 1996 to 1999, were evaluated prospectively in the Day Hospital of the Pediatric Department of Parma. The protocol of observation established a blood sampling for titers of antibodies anti-HCV and HCV-RNA at the 3rd trimester of pregnancy and subsequent clinical and biochemical controls at 3-6-9-12-15 and 18 months. Thirty (31.2%) out of the 96 mothers evaluated were positive for antibodies anti-HCV and 66 (68.8%) were positive for antibodies anti-HCV and HCV-RNA. Five (5.15%) out of the 97 babies evaluated were infected by HCV. Of these 4 were delivered vaginally and 1 by cesarean section. Of the 3 babies born to mothers with HIV coinfection, none was infected by HIV, but 1 was infected by HCV. Vertical transmission is increased by HCV viral load or HIV coinfection in the mother. The vaginal delivery and breastfeeding do not represent an additional risk factor.

[Measurement of anti-HBs antibodies in a population of 18-year-olds 6 years after the primary vaccination series]. / Valutazione degli anticorpi anti-HBs in un campione di diciottenni a 6 anni dal ciclo vaccinale primario.

We have analized the persistence of vaccine-induced antibodies to hepatitis B surface antigen, in a cohort of 445 eighteen-year-old males, who had been immunized against hepatitis B six years earlier (when they were 12 years old, according to the Italian law). These young men were about to begin their military service and were going through the routine check-up. They came from two different towns Reggio Emilia and Mantova, in the north of Italy, and were divided into two groups (group A no 258 men, group B no 187 men) depending on where they had been vaccinated. The serologic results showed that 97% of subjects had anti-HBs and 94% anti-HBs protective levels (> or = 10 mIU/ml). Moreover 81% of responder subjects showed titles > or = 100 mIU/ml, and 25% showed titles even > or = 1000 mIU/ml. Anti-HBs GMT of the total responders was 367.1. Differences have been found in the anti-HBs levels of men vaccinated in the two different towns.

Antipoliomyelitis neutralizing antibodies in maternal and neonatal serum.

During 1993 blood samples were taken from 1251 women consecutively admitted to the Maternity Ward of the University of Parma. Samples were also taken from all the newborn babies. Absence of antipolio neutralizing antibodies in serum diluted 1/2 was shown in 6 mothers; 4 mothers for polio 1, 1 mother for polio 2 and 1 simultaneously for the poliovirus 1 and 3. If one considers only the cases of absence in undiluted serum, there were 2 negative subjects (0.16%). One of these was for antibodies against polio 1 and the other for antibodies against polio 2. In the cord blood samples the frequency of negative results in serum diluted 1/2 is higher: 42 in all with 13 babies negative for polio 1. 17 babies for polio 2, 8 for polio 3 and 2 babies simultaneously for polio 1 and polio 3. If one considers just the babies without antibodies even in undiluted serum, the fraction of seronegatives is 9 (0.7%) with 1 for polio 1, 6 for polio 2 and 1 for types 1 and 3. The Geometric Mean Titres of the antibodies are significantly higher in mothers born before 1964 (year of introduction of mass vaccination with OPV) compared with those born after that year. Likewise, the same phenomenon was observed in the respective children.