F. Rosmini

Integrated epidethiological system for acute viral hepatitis in Italy (SEIEVA): Description and preliminary results

An integrated epidemiological system for the surveillance of acute viral hepatitis SEIEVA which linked notifications to available serology results and used a standard risk factor questionnaire is described. Results of over 1300 cases reported by 35 participating local health units (USLs) during the first 18 months of the programme are presented.Overall the annual reported incidence of acute viral hepatitis was 70 per 100,000. There were marked regional and age specific differences m the incidence of each type of viral hepatitis. The annual incidence per 100,000 of hepatitis A in southern children was 133 while in northern young adults the incidence of hepatitis B was 88 and hepatitis non-A non-B was 43. The possible roles of shellfish consumption in the transmission of non-A non-B hepatitis at all ages were highlighted.

Survey on the prevalence of leptospira infections in the Italian population

This investigation is the first nationwide survey on the circulation of leptospira infections in human beings in Italy. In nine out of twenty Italian regions, representative samples of the population were investigated for the presence of leptospira infections. Unexpectedly, leptospira infections were found to be widespread, the number of cases being much higher than the diagnosed clinical cases. There were found to be high, medium, and low risk areas. On the whole, the risk for the rural population was no higher than the risk for urban dwellers; leisure activities, contact with animals and residence on the plain versus residence in the hills were important risk factors. There was an unidentified risk factor in urbanites which was absent in the rural population. A changing pattern in infecting serovars was observed, with infections from serogroups Sejroe, Javanica and Australis prevailing over infections from the Icterohaemorrhagiae and Bataviae serogroups, which were the main agents of human leptospirosis during the 1950s. The mechanisms of these changes, the need for epidemiological surveys and improved diagnostic methods of screening are discussed.

A community survey on maternal and child health services utilization in rural Ethiopia

A household health interview survey on MCH services utilization was carried out in 22 villages of a rural district of Arsi region, Ethiopia, before the launching of an integrated MCH programme. Coverage of antenatal services was 26%, and 61% of the women who received antenatal care reported having had 3 or more visits.Antenatal care was positively associated with living within 10 km of the Health Centre. Twenty-eight percent of the mothers attended the under-5 clinic and most returned for 3 or more visits. In addition, 99% reported having breast-fed their last child but more than 25% started weaning only after the seventh month of age. Differences in practice of treating diarrhoea according to knowledge of ORS were found. Of the 33% of those with knowledge of ORS, almost 90% reported use of ORS for treating childs dirrhoea, showing a positive attitude towards modern health care. The proportion of women using family planning was 5%, with no difference found between Christians and Muslims. Results on EPI coverage validated data from routine reporting. Integration of MCH services including out-reach activities may increase access and coverage of MCH services.

Immunity to tetanus among Italians born between 1956 and 1963

Systematic mandatory immunization of children against tetanus begun in Italy in 1968. Preceeding birth cohorts, accounting for almost 80% of present Italian population, were poorly immune or totally non-immune; around 90% of cases of tetanus occurring in Italy in recent years are observed among them.In a national sample of 4770 young males born between 1956 and 1963, about one third was not protected. Prevalence of non-immune subjects was greater in the Southern Regions and the Islands, in rural areas, among the unemployed, among the older birth cohorts.

A one year survey of meningococcal disease in Italy

For the last ten years, meningoooccal disease has been endemic in Italy with an annual average of 900 cases (rate of 1.6/100,000). The age specific attack rate has been highest for children under one year of age, and the majority of cases have been due to serogroup B. During 1985, the epidemiology of meningococcal disease changed substantially: twice as many cases were observed in males as in females. There was a shift toward older age groups, with the highest number of cases occurring in the 15–24 year old age group (25%). The treauency in army recruits was 17.31100;000, as opposed to 1/100,000 for the general population. Sero-group C caused the majority of cases (75.8% of the isolates). The proportion of strains resistant to sulfonamides was 71.1%, while only one strain was resistant to rifampin and none to minocyclin. Seven secondary cases occurred (2%): in five, chemoprophylaxis was inappropriate (sulfonamide), and in two, no drug was given. A single co-primary case was seen.We conclude that in Italy, the use of sulfa drugs as chemoprophylactic agents is not warranted at present, compulsory vaccination of army recruits with bivalent vaccine (A+C) is advisable, and the shift in age distribution of cases and the high predominance of serogroup C increases the need for careful surveys.

An outbreak of cholera in a refugee camp in Africa

A total of 541 cases of cholera were observed between May 7 and July 19, 1985 among the 9,929 displaced persons present in a refugee camp in Africa.In spite of malnutrition and other diseases affecting this population, only 12 deaths occurred.Antiepidemic measures consisted of preparation of isolation-wards, treatment of contaminated materials, training of refugees and patient care. Mass prophylaxis, initially considered, was dropped before the end of the epidemic.

Year of birth, sex and residence, as "determinants" of tetanus incidence and immunity in Italy.

Regional results of a seroepidemiological study and official notification data are evaluated to describe the situation of tetanus in Italy. Tetanus incidence has been decreasing during the past years. Vaccination has been the principal means of tetanus prevention. Trend analyses for sex- and age-specific rates suggest a change of exposure, presumably linked to the transformation of the Italian society after the World War II, a higher incidence among the elderly as a function of poor coverage and vanishing immunity. Regional data show remarkable variability in prevalence of susceptible population. Reported rates by region are different. Different degrees of regional underreporting in case notification is suggested.

Tetanus immunity in a partially vaccinated population of children in a district of Naples (Secondigliano)

A general opinion is that compliance with the compulsory immunization programme of children is excellent in Italy.We have studied antitetanus immunity in relation to vaccination history in a sample of 444 school children born between 1977 and 1981 in a district of Naples. Information on vaccination history was collected by interviewing the parents and validated using the official vaccination certificates. Titration of antibodies against tetanus was carried out by the immunoenzymatic method. 0.9% of our study subjects had not been vaccinated at all and only 21.2% had received 4 vaccine doses. In 18 children the presence of antitetanus antibodies was not detected; 14 of them had received one or more doses of vaccine. The lack of compliance with the vaccination programme was associated with a remarkable delay in administering the tetanus vaccine.In the population reported here, the percentage of subjects only partially covered is higher than that found in other regions of Italy.

Isolation in Italy of a verotoxin-producing strain of Escherichia coli 0157:H7 from a child with hemolytic-uraemic syndrome

Verotoxin-producing Escherichia coli 0157:117 was isolated for the first time in Italy from a child with hemolytic-uremic syndrome and his asymptomatic sister. Both parents remained asymptomatic, and neither had evidence of this infection. The source of the infection was not identified, but the children had eaten ground beef during the 15 days prior to the onset of symptoms.

Census in a rural area of ethiopia: Methodology and results

A census and an ecologic survey were performed in 39 villages of a rural district of Arsi Region, Ethiopia, in difficult field circumstances. Information on age, ethnic group, education and family relationship, as well as data on health facilities and availability of basic serivices were collected. Supervised students, working in teams, were used as interviewers. Communities were involved through plenary meetings and community health agents participated in the data collection process.A total of 64,714 people in 12,152 households were registered.The repeatibility of age assessment was investigated by comparing the results from two villages with data obtained in a pilot study carried out 6 months earlier. The technical error was only 0.80 and 1.67 in the 0-5 and 6-15 age-groups, respectively.Three percent of the total population was under one year, less than previously estimated. This may, in part, be due to the family planning programme in the region.Eighteen percent of the households were headed by females. School attendance was less common among females and in the Oromo ethnic group.The availability of basic services, including safe water and basic sanitation supplies, was very poor in the area.