Giada Minelli

Mesothelioma mortality surveillance and asbestos exposure tracking in Italy

INTRODUCTIONnSpatial distribution of mortality from pleural mesothelioma (which in the ICD-10 Revision has a specific code: C45.0) in Italy for the period 2003-2009 is described. Previous mortality studies at national level employed the topographic code Malignant neoplasms of pleura, because of unavailability of a specific code in ICD-9 Revision for pleural mesothelioma.nnnMETHODSnStandardized mortality ratios were computed for all municipalities, using each regional population as reference; for municipalities in Regions with rate higher than the national rate, the latter has been used as reference. SMRs were computed specifically also for each Italian Polluted Sites of national concern for environmental remediation (IPS) with asbestos exposure sources, composed by one or more municipalities, using regional rate as reference. Spatial Scan Statistics procedure, using SatScan software, was applied in cluster analysis: the country was divided into geographic macro-areas and the relative risks (RR) express the ratio of risk within the cluster to the risk of the macro-area outside the cluster. Clusters with p-value < 0.10 were selected.nnnRESULTSnThe national standardized annual mortality rate was 1.7 cases per 100 000. Several areas with evident burden of asbestos-related disease were detected. Significant clusters were found in correspondence to asbestos-cement industries (e.g. Casale Monferrato, women: RR = 28.7), shipyards (e.g. Trieste, men: RR = 4.8), petrochemical industries (e.g. Priolo, men: RR = 6.9) and a stone quarry contaminated by fluoro-edenite fibres (Biancavilla, women: RR = 25.9). Some of the increased clusters correspond to IPS.nnnCONCLUSIONSnThe results may contribute to detect asbestos exposure and to set priorites for environmental remediation.

Pleural mesothelioma mortality and asbestos exposure mapping in Italy

BACKGROUNDnAn epidemic of asbestos-related diseases is ongoing worldwide. Mortality from malignant pleural neoplasms in Italy was analyzed, to estimate the health impact of asbestos at national and local level.nnnMETHODSnMortality from ICD-9 code 163 was considered, in the time-window 1995-2002, using National Bureau of Statistics data. National and regional standardized rates and municipal Standardized Mortality Ratios (SMR) were calculated. Municipal clusters were identified by applying Spatial Scan Statistics procedure. Relative risks (RR) express the ratio of risk within the cluster to the risk outside the cluster.nnnRESULTSnThe national standardized annual mortality rate was 1.9 per 100,000. Significant clusters corresponded to asbestos-cement industries (Casale Monferrato: RR = 11.63), shipyards (Monfalcone, RR = 7.43), oil refineries (Falconara, RR = 2.52), petrochemical industries (Priolo, RR = 3.81).nnnCONCLUSIONSnThe present study confirms malignant pleural neoplasms mortality as a suitable indicator of asbestos exposure at geographic level. In addition to asbestos-cement industries and shipyards, other industrial settings are associated with pleural neoplasm mortality.

Experimental studies on comparison of the vector competence of four Italian Culex pipiens populations for West Nile virus

BackgroundWest Nile virus (WNV) is a vector-borne disease responsible for causing epidemics in many areas of the world. The virus is maintained in nature by an enzootic bird-mosquito-bird cycle and occasionally transmitted to other hosts, such as equines and humans. Culex species, in particular the ubiquitous species Culex pipiens is thought to play a major vector role both in enzootic and epizootic maintenance and transmission of WNV. Introduced in Europe in recent years, since 2008 WNV has been stably circulating mainly in the Northeastern regions of Italy, although sporadic equine and/or human cases, as well as WNV infected Cx. pipiens pools, have been recorded in other Italian areas. The scope of our study was to evaluate the potential competence of some Italian populations of Cx. pipiens to transmit WNV and to assess their ability for vertical transmission of the virus. For this purpose four Italian populations, from different areas, were experimentally infected.MethodsAfter the infectious blood meal, fed females were monitored for 32xa0days to determine the length of viral extrinsic incubation period. WNV titre of infected mosquitoes was evaluated both by quantitative Real Time PCR and viral titration by Plaque Forming Units/ml (PFU/mL) in VERO cells. Potential Infection, Dissemination, Transmission rates (IR, DR, TR) were assessed by detection of the virus in body, legs plus wings and saliva of the fed females, respectively.ResultsAll tested populations were susceptible to the WNV infection. The viral presence in legs and wings demonstrated the ability of WNV to disseminate in the mosquitoes. Viral RNA was detected in the saliva of tested populations. No significant differences in TR values were observed among the four studied populations. The offspring of the Cx. pipiens infected females were WNV negative.ConclusionsOur study addressed an important issue in the knowledge on the complex WNV-vector relationships in Italy, indicating that all Italian Cx. pipiens populations tested exhibited vector competence for WNV. Further studies should be performed in order to better clarify the role of other factors (vector density, climatic conditions, reservoir presence etc.) in order to predict where and when WNV outbreaks could occur.

Humoral immunity in natural infection by tick-borne encephalitis virus.

Tick‐borne encephalitis (TBE) virus is one of the most important flaviviruses associated with neurological disease in Europe. Cross‐reactive antibodies elicited by different flaviviruses can make difficult the interpretation of ELISA and hemagglutination‐inhibition (HI) tests for the diagnosis of TBE. Neutralization tests, which are more specific, are not in common use because they are difficult to perform and standardize. A plaque reduction neutralization test (PRNT), optimized previously in vaccinated children, was evaluated in sera from acute cases of TBE, collected for diagnostic purposes, and from healthy human population and wild ruminants, collected for serosurvey purposes. The PRNT results were compared with the results of ELISA and HI tests. In acute TBE disease, most sera were positive for IgM antibodies by ELISA and with high HI antibody titers; neutralizing antibodies were detected in 71.4% of patients, at a very low titer (1:10 NT50) in almost all cases. Seroprevalences of 8% and 6.5% for anti‐TBE ELISA antibodies were found in healthy subjects and wild ruminants, respectively. Among anti‐TBE positive healthy subjects, a very low 1:10 NT50 titer was detected in 17.4% of cases, while NT80 titers ranging from 1:10 to 1:80 were detected in 65.2% of cases. Among wild ruminants, 90.9% of ELISA and HI positive samples showed a positive, ≥1:10 NT80 titer. In conclusion, neutralization assays can be useful for the diagnosis and serosurveys of TBE. J. Med. Virol. 81:665–671, 2009

Ecological Distribution and CQ11 Genetic Structure of Culex pipiens Complex (Diptera: Culicidae) in Italy.

Mosquitoes in the Culex pipiens complex are considered to be involved in the transmission of a range of pathogens, including West Nile virus (WNV). Although its taxonomic status is still debated, the complex includes species, both globally distributed or with a more limited distribution, morphologically similar and characterised by different physiological and behavioural traits, which affect their ability as vectors. In many European countries, Cx. pipiens and its sibling species Culex torrentium occur in sympatry, exhibiting similar bionomic and morphological characters, but only Cx. pipiens appears to play a vector role in WNV transmission. This species consists of two biotypes, pipiens and molestus, which can interbreed when in sympatry, and their hybrids can act as WNV-bridge vectors, due to intermediate ecological features. Considering the yearly WNV outbreaks since 2008 and given the morphological difficulties in recognising species and biotypes, our aim was to molecularly identify and characterised Cx. pipiens and Cx. torrentium in Italy, using recently developed molecular assays. Culex torrentium was not detected; as in other European countries, the pipiens and molestus biotypes were widely found in sympatry with hybrids in most environments. The UPGMA cluster analysis applied to CQ11 genotypic frequencies mainly revealed two groups of Cx. pipiens populations that differed in ecological features. The high propensity of the molestus biotype to exist in hypogean environments, where the habitat’s physical characteristics hinder and preclude the gene flow, was shown. These results confirmed the CQ11 assay as a reliable diagnostic method, consistent with the ecological and physiological aspects of the populations analysed. Since the assessment of the actual role of three biotypes in the WNV circulation remains a crucial point to be elucidated, this extensive molecular screening of Cx. pipiens populations can provide new insights into the ecology of the species and may give useful indications to plan and implement WNV surveillance activities in Italy.

Health impact of the exposure to fibres with fluoro-edenitic composition on the residents in Biancavilla (Sicily, Italy): mortality and hospitalization from current data

INTRODUCTIONnThe objective of this chapter is to study the health impact of the exposure to fibres with fluoro-edenitic composition on the residents in Biancavilla (Sicily, Italy), in terms of mortality and hospitalization. The diseases which international scientific literature indicates as associated with asbestos exposure were taken into consideration: mesothelioma of pleura, peritoneum, pericardium and tunica vaginalis testis, malignant neoplasm of larynx, malignant neoplasm of trachea, bronchus and lung, malignant neoplasm of ovary, pneumoconiosis; moreover, in order to describe the health profile of the study population, large groups of diseases were taken into consideration.nnnMATERIAL AND METHODSnCurrent data (available in the Data Bases of the Unit of Statistics of ISS) regarding mortality and hospitalization were analyzed. Standardized Mortality Ratios, Standardized Hospitalization Ratios and Age-standardized Death Rates were calculated. The demographic background of the population residing in Biancavilla was also outlined.nnnCONCLUSIONSnOur findings support the etiologic role of fibres with fluoro-edenitic composition in the occurrence of the above mentioned diseases, already observed in other studies.

Merkel cell carcinoma: a population-based study on mortality and the association with other cancers

BackgroundFew population-based epidemiological data are available on Merkel cell carcinoma (MCC), a rare lethal non-melanoma skin cancer. We analysed multiple-cause-of-death records to describe MCC mortality and trends and the association with other primary cancers.MethodsWe reviewed all 6,713,059 death certificates in Italy (1995–2006) to identify those mentioning MCC. We evaluated the association with other primary cancers by calculating the ratio of observed to expected deaths, using a standardized mortality ratio (SMR)-like analysis. We also evaluated the geographic distribution of deaths.ResultsWe identified 351 death certificates with the mention of MCC. The age-adjusted mortality was 0.031/100,000, with a significant trend of increase and a slight north–south gradient. There was a significant deficit for solid cancers (SMRxa0=xa00.15) and a non-significant excess for lymphohematopoietic malignancies (SMRxa0=xa01.62). There were significant excesses for chronic lymphocytic leukemia (SMRxa0=xa04.07) and Waldenström’s macroglobulinemia (SMRxa0=xa027.2) and a non-significant excess for chronic myeloid leukemia (SMRxa0=xa05.12).ConclusionsThe increase in MCC mortality reflects the incidence trend in the literature. The association with chronic lymphocytic leukemia confirms the importance of immunologic factors in MCC. Regarding Waldenström’s macroglobulinemia, an association with MCC has never been reported.

Epidemiologic Study of Mortality During Summer 2003 in Italian Regional Capitals: Results of a Rapid Survey

Following the unusually hot summer in 2003 and the dramatic news from neighbouring countries such as France, the Italian Minister of Health commissioned an epidemiologic mortality study to investigate whether there had been an excess of deaths in Italy, particularly for the elderly population. Communal offices, which provide vital statistics, were asked to provide data on the number of deaths among residents between June 1 and August 31, for the years 2003 and 2002, for the 21 capital cities of Italy’s regions. A mortality increase of 3,134 deaths was observed, most of which (92 %) occurred among persons aged 75 years and older. The highest increases were observed in northwestern cities (Turin, Milan, Genoa). A clear correlation was observed between mortality and climatic indexes (maximum temperature, Humidex).

Peritoneal mesothelioma in Italy: Trends and geography of mortality and incidence

INTRODUCTIONnPeritoneal mesothelioma, a very rare and lethal malignancy, has not been investigated as extensively as pleural mesothelioma, although the role of asbestos exposure in its occurrence is well-known. Data from Italy are relevant, as it was the largest European asbestos producer, and asbestos was widely used in many economic activities.nnnMETHODSnA population-based mortality and incidence analysis was performed in Italy. Data sources were the National Multiple-causes-of-death Database (1995-2010) and the Italian Mesothelioma Register (1993-2008).nnnRESULTSnWe found an increasing trend of age standardized mortality rates in men, but no clear trend in women; moreover, we showed significant risks of death in several northern regions, formerly heavy asbestos users; finally, mortality/incidence ratios similar for both genders (about 0.8) were estimated.nnnCONCLUSIONSnThe study, based on national data, showed a higher risk of mortality from and incidence of peritoneal mesothelioma in areas with formerly heavy exposure to asbestos.

Anti-tick-borne encephalitis (TBE) virus neutralizing antibodies dynamics in natural infections versus vaccination

Tick-borne encephalitis (TBE) virus infection elicits a life-long lasting protection. However, little is known about the neutralizing antibodies titres following natural infection. In this study, subjects with past TBE disease (n = 62) were analysed for the presence and titre of anti-TBE neutralizing antibodies, and compared with a vaccinated cohort (n = 101). Neutralizing antibody titres were higher in individuals with past TBE and did not show an age-dependent decrease when compared with vaccinees.