C. Germinario

PREVALENCE RATES OF VIRAL HEPATITIS INFECTIONS IN REFUGEE KURDS FROM IRAQ AND TURKEY

Abstract.Background: Since little is known about the burden of viral hepatitis in Kurds, the prevalence of infection with hepatitis A virus (HAV), hepatitis E virus (HEV), hepatitis B virus (HBV) and hepatitis C virus (HCV) was investigated in a sample of refugee Kurds from Iraq and Turkey. Patients and Methods: A cross-sectional study was carried out. Serological markers to hepatitis viruses were determined for 1,005 subjects from all age-groups of which 36.6% were from Turkey and 63.4% from Iraq. Results: Overall seroprevalence for anti-HAV was 94.4% and 14.8% for anti-HEV. A significantly higher prevalence for anti-HEV was found among Iraqis (17.5%) compared to Turkish immigrants (10.0%). The prevalence of hepatitis B surface antigen (HBsAg) and total anti-HBc (core) was 6.8% and 35.6% in Turkish Kurds and 2.2% and 12.7% in Iraqis, respectively. Only 10% of children aged up to 10 years and 2.8% of subjects aged 11–20 years had been vaccinated against HBV, the majority of them coming from Iraq. One subject was confirmed as positive for anti-HCV (0.1%) and HCV-RNA and analysis showed a 4c/4d genotype. Conclusion: This survey shows a high prevalence of enterically transmitted viral hepatitis in Kurds. HBV infection is moderately endemic, while the prevalence of HCV infection is low. There is a need for a universal immunization strategy for HBV in the Kurd population.

HBV, HCV and HDV infections in Albanian refugees in Southern Italy (Apulia region)

The seroprevalence of hepatitis B, C and D markers was assessed in a sample of 670 Albanian refugees in Southern Italy in 1997. The mean age was 25 years (S.D. = 12.3). Of study subjects 62.1% (95% CI: 58.4-65.7) were positive for anti-HBc antibodies and 13.6% (95% CI: 10.9-16.1) for HBsAg. The prevalence of anti-HBs was 47.6% (95% CI: 43.8-51.3). Among HBsAg carriers the prevalence of HBeAg was 7.7% (95% CI: 2.2-13.1). The highest carrier rate for HBsAg (25.5%; 95% CI: 16.7-34.3) was found in the age group 21-25 years. A relevant finding was a prevalence of HBsAg of 8.1% in children 10 years and under. The prevalence of anti-HCV antibodies was 0.3% (95% CI: 0.0-0.7) while only one of the HBsAg carriers was positive for anti-HDV (1.1%, 95% CI: 0-3.2). In Albania, hepatitis B infection represents a public health priority that should be addressed by a universal vaccination campaign.

Prevalence of hepatitis virus infections in Albanian refugees

A sample of 393 Albanian refugees, including both children and adults, was tested for serological HAV, HBV, HDV and HCV markers. A high prevalence of infection with both the hepatitis A and B viruses was found, while HDV and HCV infections were uncommon. The overall prevalence of anti-HAV was 96%; it was very high in children 0-10 years, suggesting that HAV infection is largely acquired during childhood and that poor ambiental conditions influence the spreading of this viral infection.One or more serological markers of HBV infection were found in 295 Albanians (75%), confirming the endemic nature of this virus in the Albanian community. The overall prevalence of HBsAg was 19%, and the carrier rate was higher in males than in females. The high HBsAg prevalence among children suggests that HBV infection is usually acquired in early childhood.The serological data obtained in the Albanian sample examined clearly indicate the urgent need for measures to reduce the incidence of HAV and HBV infections and to avoid the further spread of HDV and HCV infections.Finally, the high prevalence of type B hepatitis indicates the necessity of vaccination against HBV for all risk groups and for all children at birth.

Seroimmunity to poliomyelitis in an Albanian immigrant population

The immunity against poliomyelitis in a representative sample of the Albanian population recently immigrant to Italy was evaluated. A significant number of the subjects examined lacked protective antibodies against one or more polioviruses. The most prevalent seronegativity related to poliovirus type 3 (41.3%), followed by poliovirus type 1 (21.5%). This result was more consistent in the younger age groups. Our data suggest the hypothesis that this problem arises from the use of a vaccine of discontinuous efficacy caused by defective preservation. A poliovaccine booster dose for all emigree subjects aged less than 15 years is suggested.

Communication skills in HPV prevention: an audit among Italian healthcare workers.

This study aims to investigate the knowledge, the attitudes and practices on HPV vaccination of health professionals of Mother and Child Service of Puglia Region (Italy). The study was conducted through a standardized questionnaire. Of 455 respondents, 74.2% judged HPV vaccine very important for immunization calendar. 88.9% did not believe that the administration of HPV vaccine implies consent to the initiation of sexual activity but 34.2% sustained that vaccine can give a false sense of protection against sexually transmitted diseases. 62.2% believed that boys should also be vaccinated. Skills necessary in the implementation of strategies in the promotion of health are partially inadequate and appropriate ongoing education should be carried out for health care workers.

Outbreak of Salmonella infantis gastroenteritis among people who had eaten at a hash house in southern Italy.

OBJECTIVES To describe an outbreak of acute gastroenteritis in people who had eaten at a hash house in southern Italy. STUDY DESIGN Case-control study. METHODS A clinical case of gastroenteritis was defined as a person who had eaten at the hash house from 29 August to 4 September 2011 and who experienced defined gastrointestinal symptoms within 72 hours, or a person with a laboratory-confirmed salmonella infection without symptoms. A convenience sample was enrolled as the control group. Environmental and human samples were collected, and Salmonella infantis was identified by polymerase chain reaction. Univariate analysis was performed for each food type, and multivariate analysis was performed for each food type and demographic variable (gender, age). RESULTS Twenty-three cases of gastroenteritis were notified between 1 and 4 September 2011, two of which were admitted to the local hospital. Multivariate analysis showed that porchetta [odds ratio (OR) 22.0, 95% confidence interval (CI) 3.2-152.6, z = 3.13, P = 0.002] and roasted meat (OR 14.4, 95% CI 1.7-122.0, z = 2.45, P = 0.014) were associated with gastrointestinal symptoms. Environmental and human isolates exhibited the same sequence type (ST 32). CONCLUSIONS This experience highlighted that, in the control of a foodborne outbreak, integrated epidemiological and laboratory surveillance enables rapid identification of the source of infection, thus reducing the risk of an epidemic.

An outbreak of hepatitis A in Southern Italy: the case for vaccinating food handlers.

We report an outbreak of hepatitis A that occurred in the city of Bari (Apulian region) in June 2002. Overall, 26 cases were observed over a 4-week period. These were traced back to the index case, a food handler who prepared various food products for sale over the counter at a store in the district (OR 5.36, CI 95% 1.58-19.25). Laboratory investigations confirmed that the outbreak was due to a point source and identified a new genotype IB variant. There is a possible indication for administration of hepatitis A vaccine to food handlers, although further evidence of an acceptable cost-benefit ratio needs to be ascertained.

Italian healthcare workers' views on mandatory vaccination

BackgroundMandatory vaccination has contributed to the success of immunisation programmes but voluntary vaccination allows people to be responsible for their own health. There are benefits from both policies and the arguments between them remain subject to debate within and without the scientific community, both nationally and internationally. The aim of this study is to assess the opinions of those who actually work in the Vaccination Service.MethodsThe survey was carried out using a self-administered standardised anonymous questionnaire given to all of the Vaccination Service employees in the Apulia Region.ResultsOf 302 completed questionnaire replies, 4.4% stated that mandatory vaccination should be abandoned now, 21.2% that it should be phased out, and 74.4% that it should be retained.ConclusionAn educational program should be set up to explain to Vaccination staff the value and worth of voluntary compared to mandatory vaccination and why high vaccination rates do not have to depend on compulsion.

Monitoring the process of measles elimination by serosurveillance data: The Apulian 2012 study.

In 2003 Italy adopted the National Plan for Measles and Congenital Rubella Elimination, but some outbreaks of measles are still occurring, as the target coverage rate (≥ 95%) for new-borns has currently not been achieved. In order to support the monitoring of the measles elimination programme, the authors carried out a survey about the seroprevalence of measles among Apulia young adults. The study was carried out from May 2011 to June 2012 among blood donors of the Department of Transfusion Medicine of Policlinico General Hospital in Bari. Subjects were enrolled by a convenience sampling. For each enrolled patient we collected a 5 mL serum sample. Collected sera were tested by chemiluminescence (CLIA) for anti-Measles IgG. We enrolled 1764 subjects; 1362 (77.2%) were male with a mean age of 38.4 ± 11.7 years. Anti-Measles IgG titre was >16.5UA/mL in 95.1% (95% CI=94.1-96.1) of enrolled subjects with a Geometric Mean Titre (GMT) of 2.3 ± 0.4, which did not differ dividing the enrolled subjects into age groups. As our data showed, the universal routine vaccination changed the epidemiological pattern among adults, in particular young adults (18-24 years), who showed lowest seropositivity rates; in these groups of population there is a risk of the onset of outbreaks due to the presence of susceptible population. This is a paradox linked to the vaccination strategy: when coverage rates keep sub-optimal, measles is more likely to affect young adults and a higher percentage of complications is expected. According to our data, health authorities have to plan a mop-up strategy to actively offer measles vaccination to susceptible young adults.