Franco E

Risk groups for hepatitis A virus infection

We report the conduct and results of a systematic search for evidence of risk of infection with hepatitis A virus (HAV) among blood transfusion recipients, travellers, the military, healthcare workers, sewage workers, foodhandlers, day care assistants, institutionalised subjects, blood transfusion recipients, drug addicts, homosexuals, prisoners and other risk groups such a liver transplantees. We report our recommendations for the use of the HAV vaccine in these groups.

Vaccination strategies against hepatitis A in southern europe

Hepatitis A virus (HAV) infection is decreasing in southern European countries, where epidemiological conditions vary among regions depending on the social and health-care system development. In high endemic settings, HAV infection has not heavy social and economic weight while in countries with a moderate/low degree of endemia there is a call for targeted vaccination policy. In countries, like Spain and in Italy, where several studies confirm an increase in susceptible adults, vaccination strategies have been applied and recommendations have been published about hepatitis A prevention. Universal hepatitis A immunization seems economically unattractive and most evidences for targeted vaccination have not yet been sufficiently investigated. Vaccine should be used to protect travellers to countries where HAV infection is a major risk and in preventing secondary cases and outbreaks.

Depuration of Mytilus galloprovincialis experimentally contaminated with hepatitis A virus

Mussels (Mytilus galloprovincialis) were contaminated with known amounts of laboratory strains of hepatitis A virus and Poliovirus 1 and the effectiveness of a self-cleansing mechanism was studied using a pilot depuration system. Both viruses were rapidly bioaccumulated by mussels and the maximal concentration of about 10(4) TCID50/ml was reached within 1.5 hours. Depuration was carried out up to 24 h; infectivity titer decreased to 10(2) TCID50/ml and 10(3.2) TCID50/ml within 6 h in hepatitis A virus and Poliovirus 1 contaminated mussels, respectively, but only a very slight further decrease was obtained after 24 h. E. coli was used as a control; within 24 h the concentration decreased from 40 to 2 bacteria/ml of mussel (MPN). The elimination of bacteria is not a reliable parameter to control the effectiveness of viral depuration.

Hepatitis B and Delta virus infection among heterosexuals, homosexuals and bisexual men

The hepatitis B virus (HBV) and hepatitis Delta virus (HDV) infection rates were estimated in patients attending a venereal disease outpatient clinic: 759 heterosexuals and 154 homosexual-bisexual men. The anti-HBC prevalence was higher in homo-bisexual men (68.8 per 100) than in heterosexuals (41.8 per 100), whereas HBsAg was roughly the same in the two groups (about 6 per 100). The anti-HBc prevalence rate among heterosexuals was higher than that estimated in hospital personnel from the same geographical area. A positive association between anti-HBc prevalence and present or past sexually transmitted diseases (STD) was found among homo-bisexual men. Anti-HBc was also positively associated with herpes simplex type 2 antibodies in both heterosexuals and homo-bisexual men. These data are consistent with the hypothesis that sexual behavior also plays a role in the spread of infection among heterosexuals. Ten of the 46 HBsAg-positive subjects were anti-HDV positive: 6 of the 36 heterosexuals and 4 of the 10 homosexuals. All HDV-positive subjects had present or past STDs. These findings suggest sexual transmission of HDV infection.

Persistence of anti-HBs 5 years after the introduction of routine infant and adolescent vaccination in Italy.

A population survey was conducted to assess the duration of anti-HBs levels > 10 IU/l in vaccinees living in Lazio Region (Italy) 5 years after the introduction (15 June 1991) of compulsory vaccination of new-borns and 11-year-old children. A random sample of 1192 (533 children born in 1991--92 and 659 adolescents born in 1979--81) was selected. In 92.9% of children and 94.1% of adolescents anti-HBs titres were protective (> or = 10 IU/l). These subjects with protective titres were divided into three categories: low responders (anti-HBs titres = 10--500 IU/l), medium responders (anti-HBs titres = 501--2000 IU/l) and high responders (anti-HBs titres > 2000 IU/l). Factors associated with the level of response were analysed, using a multiple politomic logistic regression analysis. Greater age at first dose (11--12 years) was associated with higher titres (OR = 2.1, 95% CI = 1.4--3.2 for medium responders and OR = 3.0, 95% CI = 1.9--4.8 for high responders). Simultaneous administration of DT vaccine was associated with lower titres (OR = 0.4, 95% CI = 0.2-0.8 for medium responders and OR = 0.3, 95% CI = 0.1--0.7 for high responders).

Hepatitis A virus infection in children in Sardinia, Italy.

Possible hepatitis B immunization of all newborns, regardless of the mothers HBsAg status, is a strategy under consideration for selected hyperendemic areas in Italy. Sardinia is one such area. However, in 1987 in Sardinia, the prevalence of hepatitis B markers in children under 11 years was estimated at 1.7% and the prevalence of hepatitis B surface antigen (HBsAg) at 0.2%. A much higher prevalence of HBsAg was recently observed among adults in this area: 8.7% among men and 5.2% among pregnant women. This contrasting pattern is unlikely to be due to bias: the sampling procedures adopted were appropriate and the percentage of refusals was very low (2.2%). The observed low hepatitis B marker prevalence in young age groups might be the result of a cohort effect due to the improved socio-economic conditions and changes in behaviour that have occurred in Sardinia over the last few years.The finding of only 3 HBsAg+ individuals out of 1,826 children tested, in spite of the 5.2% HBsAg prevalence among pregnant women in that region, is probably attributable to the low proportion of HBeAg positive individuals among the HBsAg+ carrier mothers in this area.At present, immunization of all newborns in Sardinia cannot be recommended.

Genital herpes infection in outpatients attending a sexually transmitted disease clinic in Italy.

Prevalence of Herpes Simplex, type 2, specific antibodies was estimated in sexually transmitted disease outpatients: 783 heterosexuals and 158 homosexual-bisexuals. The anti-HSV-2 prevalence rates were 69% in the homosexual-bisexuals and 35% in the heterosexuals. In both groups positive association with age of anti-HSV-2 prevalence was found: only in the homosexual-bisexuals negative as sociation with education level was detected. No difference exists between the two groups regarding the symptomatic/asymptomatic ratio of HSV-2 infection.

HIV is associated with thrombophilia and high D-dimer in children and adolescents.

Background and objective:Atherosclerosis and other cardiovascular diseases associated with thrombosis appear more relevant and anticipated in HIV-infected patients after combination antiretroviral therapy (cART) has reduced AIDS-related diseases and has improved survival. The association between viral replication and coagulation abnormalities in a cohort of HIV-infected children and adolescents was investigated here. Methods:Protein S, protein C anticoagulant and antithrombin activity, together with fibrinogen, D-dimer, high-sensitive C-reactive protein and homocysteine were assayed in a cross-sectional study among a cohort of HIV-infected children and adolescents. Results in patients with high viral load (HVL, HIV-RNA > 1000 copies/ml) were compared with those in patients with a lower replication (LVL), adjusting for other demographic, clinical and therapeutic covariates. Results:Eighty-eight patients (mean age 13.5 years, CD4 30%, 72% with LVL) were enrolled. A prevalence of protein S and protein C deficiency of 51 and 8% was, respectively, found. HVL group compared to LVL showed a significant reduction of protein S, protein C and antithrombin activities, and an increase of D-dimer levels. The independent association of HVL with decreased protein S activity (−11.2%, P = 0.04) and increased D-dimer levels (+0.13 μg/ml, P = 0.004) was confirmed in the multivariate model. Conclusions:HIV-infected children and adolescents present high prevalence of thrombophilic abnormalities. The multivariate model confirmed that high viral replication is independently associated with decrease of protein S and increase of D-dimer, suggesting the advantage of suppressive therapy on coagulation homeostasis and the opportunity of an active control of cardiovascular risk factors starting at a younger age.

Analisi di costo-efficacia della vaccinazione universale in Italia con il vaccino Rix4414 contro i rotavirus.

SummaryObjectives: Rotavirus (RV) is the most common etiological agent of gastroenteritis in children. The oral vaccine Rix4414 was recently commercialized in Italy for prevention of RV infections. The health outcomes and the economic impact of a national RV immunization program were assessed. Design: A Markov model simulated the flow of a birth cohort on RV disease burden and costs up to age 5, comparing a RV vaccination programme with no vaccination. Lifetime cost-effectiveness for the national healthcare system (NHS) and the society (S) with a benchmark of 50,000 €/QALY was analysed. Main results: Disease’s medical direct costs exceeded 30 million €/year, while indirect costs approached 112 million €/year. A routine, universal RV immunization program, for a birth cohort of 550,000 children, would prevent 80% of RV diarrhoea, 97% of severe RV cases, 87% of medical consultations and 98% of hospitalizations. In the NHS perspective, the incremental cost/QALY would be € 14,829 and it would decrease to € −17,030 (cost-saving) in the S perspective. In the private market scenario, the incremental cost/QALY (€ 24,687) would remain far below the threshold. Conclusion: A national immunization program with Rix44141 in Italy would be cost-effective both from the S and the NHS perspective.

Influenza vaccination coverage among medical residents: an Italian multicenter survey

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011–2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the 2 previous seasons (P < 0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011–2012 season (P < 0.001). “To avoid spreading influenza among patients” was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future.