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).

[Tetravalent anti-meningococcal vaccine: serologic and clinical evaluation]. / Vaccino antimeningococcico tetravalente: valutazione sierologica e clinica.

Meningococcal disease is the only bacterial meningitis able to cause an epidemic and the mortality due to this disease is all but negligible; therefore the active immunization induced by a vaccine that includes a large portion of Neisseria meningitidis serogroups responsible for the immunization of subjects at risk. Tetravalent vaccine containing polysaccharides of the serogroups A, C, Y, W135 has given good results both for tolerability and immune response. Considering the epidemic situation in Italy, this vaccine could be an excellent strategy "to behead" possible epidemics and/or hyperendemics due to a known serogroups.

[Persistence of antibody levels for 5, 10 or more years after tetanus vaccination and immunological response to a "booster" immunization]. / Persistenza dei livelli anticorpali a distanza di 5, 10 e piu' anni dalla vaccinazione antitetanica e movimento immunitario indotto dalla "booster".

By means of the indirect haemagglutination test the rate of antitetanic antibodies in male individuals (532 subjects), vaccinated from 5 or more years has been estimated. According to the time elapsed from the last administration of the vaccine three groups have been formed: vaccinated from 5 to 10 years (353 subjects), from 11 to 15 years (133 subjects), from over 15 years (46 subjects). According to the previous vaccine history, the group, being considered, resulted as being composed of: 86% vaccinated with 3 doses, 13% vaccinated with 2 doses, while the vaccinated rate with 1 dose (8 men) appeared practically negligible. 79.0% of this population resulted as being completely protected (limit 0.1 I.U./ml) and 94.2% resulted as being protected at the minimum limit (0.01 I.U./ml) The number of those protected diminished as the time elapsed from the vaccination increased. Considering the limit 0.1 I.U./ml, there are values of 87.9% for the group 5-10 years, 80.1% for the group 11-15 years and 76.0% for the one of those over 15 years. Considering the limit 0.01 I.U./ml the above-mentioned values result respectively equivalent to 95.3%; 94.1%; 87.0%. The administration of the booster has determined effective increases of the antibody rates; after one month from the inoculation the number of the non protected (less than 0.01 I.U./ml) appears completely nonexistent and the number of those protected at the minimum limit results contained in 1.2%. In conclusion we suggest the extension of the interval for the booster from 4 to 8-10 years as well as we suggest a review of the legislation which provides complete vaccination for all those who undertake a wide range of agricultural or industrial works prescinding completely, at the time of their engagement, from the state of immunity of the subjects to be treated.

[Findings on the occurrence of complications caused by DEV and HDVC (delta) vaccines]. / Rilievo della incidenza delle complicanze da vaccini DEV e HDCV (delta).

The complications arising from two different anti-rabies vaccines were compared: DEV (duck embryo vaccine; the schedule included 14 daily doses plus 3 boosters) and HDCV (human diploid cells vaccine; the schedule included 5 doses plus 1 booster). 2646 patients were immunised, following a post-exposure prophylaxis, at the Antirabies Unit of the Institute of Hygiene of Rome. Among the 1434 patients immunised with DEV, 364 (25.38%) developed side-effects, whilst among the 1212 subjects immunised with HDCV only 47 (3.88%) developed side-effects. Using DEV the more frequent complications were as follows: fever (48.62%), regional adenopathy (49.45%), erythema (89.29%), local induration (41.48%). Using HDCV the main complication was fever (65.96%). The principal association of complication in DEV were: erythema + induration + edema + adenopathy + fever; general malaise + asthenia + adenopathy; dizziness + headache. Hyperthermia resulted often associated with regional adenopathy and the general malaise with the headache in the vaccinated with HDCV. All complications were widely distributed during the period of immunisation. However most side-effects arose following the 5th DEV dose or the 2nd HDCV dose. Regional adenopathy, was the more persistent and less tolerated symptom, also local erythema showed a long persistence, whilst the other symptoms regressed within 48-72 hours with proper therapy and rest. Sex and age did not influence the incidence nor the type of complications. Neither neuroparalysis was detected nor serious impairment of health. In our study the coincidence of unwanted effects, following an antirabies immunisation, seems lower than that described in the literature. This was probably due to the high level of purification of the vaccine and possibly to the different recording of the minor symptoms.

Case Report. Multiple etiology post-surgery endophthalmitis.

The case describes a septic endophthalmitis arisen in a convalescence period following surgery of cataract extraction. The infection was due to Staphylococcus aureus and three fungal components, Candida albicans, Candida glabrata and Acremonium kiliense, which were subsequently isolated. A careful and prompt laboratory investigation allowed the clinicians to adjust the antimycotic therapy and attain an excellent clinical result.