Giuseppe Giammanco

The impact of climate and traffic-related NO2 on the prevalence of asthma and allergic rhinitis in Italy

Background Environmental factors are likely to be involved in explaining the wide geographical variation in asthma and atopic diseases that has been documented in many recent epidemiological studies.

The control of asthma in Italy. A multicentre descriptive study on young adults with doctor diagnosed current asthma

Background:  Few data are available on the management of asthma in the general population. The aim of this study was to evaluate the level of asthma control in Italian patients, a decade after the publication of the international guidelines.

MAJOR AND TRACE ELEMENTS GEOCHEMISTRY IN THE GROUND WATERS OF A VOLCANIC AREA: MOUNT ETNA (SICILY, ITALY)

Thirty-five ground-water samples have been collected from wells, springs and drainage galleries on Mt Etna volcano for the determination of major, minor and trace elements in solution. Attention has been focused in particular on dissolved minor and trace elements, for most of which no data were available in the studied area. In general, dissolution of solids into Etnas ground waters follows from strong interaction between water of meteoric origin, CO2 gas of magmatic origin and the volcanic rocks of the aquifers. However, the R-mode analysis allowed to distinguish several sources of solutes: Al, Co, Ni, Fe, Si, As would derive mainly from alteration of the volcanic rocks of Etna; SO4=, K, Na, V, Sr, Mo, Cr and calculated p(CO2) would instead indicate a major contribution of volcanic gases (mostly CO2 and SO2); and TDS, HCO3=, Li Mg, B and Cl− would indicate a derivation from both these sources. Se, Hg, Cu and Mn would derive from hydrothermal fluids, and Ca would derive both from this latter contribution and from rock alteration. The comparison between trace elements abundance in Etnas ground waters and that in the ground waters of other areas of Italy showed that, in general, Etnas waters, like other volcanic ground waters, are enriched in Li, Mn, Si, V, As and Mo. Furthermore, in the areas of Mt Etna where the contribution of volcanic gas to the aquifers is greatest, ground waters are also enriched in B, Se, Co, Hg, Al, Fe and Ni. The obtained results show clearly that, in active volcanic areas, many dissolved elements can attain levels that can be appreciably different from those indicated by WHO for drinking water. Therefore, the local geological factors which can influence the geochemical behavior of these elements in solution should be taken into account when establishing national standards for drinking-water quality. In consideration of the local natural background values, concentrations of dissolved elements that differ from the guideline values should be accepted in areas with peculiar geological characteristics, provided that the elements under consideration do not have a direct influence on health.

Mg, Mn, Fe, and V concentrations in the ground waters of Mount Etna (Sicily)

Mount Etna, the largest volcano in Europe and one of the most active in the world, is the site of an important circulation of ground waters that as, a consequence of the peculiar geological, hydrogeological and petrological features of Etna volcanics, are enriched in certain chemical species (i.e. HCO−3, Na+, Mg2+, Ca2+ and many trace elements). This is mainly due to the interaction between ground waters and volcanic gases, mainly CO2, that are present in the underground atmosphere. CO2 is dissolved into water thus making it very aggressive towards the host volcanic rocks so that cations are gradually brought into solution. Mg, Mn, Fe and V concentrations above the Maximum Admissible Concentrations (MACs) fixed by the European standards were found in most of the potable waters of Etna, especially in those from its eastern and western flanks, where the amount of CO2 dissolved in the ground water is greatest. Therefore, about 700,000 people have used potable waters with Mg contents exceeding the European MACs, 90,000 have used those with Mn exceeding MACs, 63,000 have used those with Fe exceeding MACs and more than 600,000 have used waters with V above the EPA acceptability level. Considering that these elements are essential for humans and that Mg, Mn and Fe contents in Etna waters account for only a small percentage of their total dietary intake, it is unlikely that direct health consequences can derive from drinking such waters. As this problem can be present in all the geographical areas where waters are naturally enriched in dissolved minerals, a revision of current standards for drinking waters is desirable.

Immune response to simultaneous administration of a recombinant DNA hepatitis B vaccine and multiple compulsory vaccines in infancy.

The reactogenicity and immunogenicity of simultaneous administration of recombinant DNA hepatitis B vaccine with diphtheria and tetanus toxoids (DT) and oral poliovirus vaccine (OPV) in 111 infants were compared with those of DT and OPV alone in a control group of 21 infants. All subjects received three doses of the vaccine according to one of three different schedules of vaccination. Reactions following simultaneous administration of vaccines were all but absent, with mild pain reported for four out of 111 subjects, compared with one of 21 in the control group. Seroconversion rates of 98-100% and high anti-HBs geometric mean titres (GMTs) were observed in all study groups after three doses of hepatitis B vaccine. Significantly higher anti-HBs were seen in Group III, where six months is allowed between the second and the third hepatitis B vaccine doses, compared with Group I and II, where only 1-2 months separate the second and third doses. A fourth dose of vaccine was needed in both these groups to obtain anti-HBs levels as high as seen in Group III after three vaccine doses at 3, 4 and 10 months of age. The immune response to DT and OPV was similar in the study groups and the control group. It is concluded that a course of 10 micrograms doses of recombinant hepatitis B vaccine given simultaneously with DT and OPV elicits a strong anti-HBs response and does not interfere with the immune response to the other antigens.

Persistent Endemicity of Salmonella bongori 48:z35:− in Southern Italy: Molecular Characterization of Human, Animal, and Environmental Isolates

ABSTRACT From 1984 to 1999, we collected 31 isolates of the rare serovar Salmonella bongori 48:z35:− in southern Italy. Twenty-four of the isolates were from cases of acute enteritis in humans. Pulsed-field gel electrophoresis analysis showed that all but one of our isolates were at least 80% similar. Our findings suggest that genetically related S. bongori 48:z35:− strains are endemically circulating in southern Italy.

Phylogenetic analysis of the genera Proteus, Morganella and Providencia by comparison of rpoB gene sequences of type and clinical strains suggests the reclassification of Proteus myxofaciens in a new genus, Cosenzaea gen. nov., as Cosenzaea myxofaciens comb. nov.

Phylogenetic analysis of partial rpoB gene sequences of type and clinical strains belonging to different 16S rRNA gene-fingerprinting ribogroups within 11 species of enterobacteria of the genera Proteus, Morganella and Providencia was performed and allowed the definition of rpoB clades, supported by high bootstrap values and confirmed by ≥2.5 % nucleotide divergence. None of the resulting clades included strains belonging to different species and the majority of the species were confirmed as discrete and homogeneous. However, more than one distinct rpoB clade could be defined among strains belonging to the species Proteus vulgaris (two clades), Providencia alcalifaciens (two clades) and Providencia rettgeri (three clades), suggesting that some strains represent novel species according to the genotypes outlined by rpoB gene sequence analysis. Percentage differences between the rpoB gene sequence of the type strain of Proteus myxofaciens and other members of the same genus (17.3-18.9 %) were similar to those calculated amongst strains of the genus Providencia (16.4-18.7 %), suggesting a genetic distance at the genus-level between Proteus myxofaciens and the rest of the Proteus-Providencia group. Proteus myxofaciens therefore represents a member of a new genus, for which the name Cosenzaea gen. nov., is proposed.

An economic analysis of rotavirus vaccination in Italy

We have evaluated health and economic benefits of a universal infant vaccination with two rotavirus vaccines registered in Italy, on the bases of the burden of rotavirus gastroenteritis (RVGE) in a birth cohort of 520,000 Italian infants followed until 5 years of age. Estimates from published and unpublished sources of disease burden, costs, vaccine coverage, efficacy trials of both vaccines, and price were used to estimate cost-effectiveness from the perspectives of the Italian National Health Service (NHS) and society. According to our estimates, a universal rotavirus vaccination program would avoid 10,679 hospitalizations, 39,202 emergency visits, and 44,223 at home visits. At 65.6 euro per vaccination courses, the program would cost 30,700,800 euro and realize a net loss of 9,057,928 euro from the Italian NHS perspective. On the contrary, the program would provide a net savings of 24,324,198 euro from the societal perspective. From the Italian NHS perspective, the break-even price per vaccination course should be reduced at least to 46.25 euro to achieve a zero cost-effectiveness ratio.

Characterization of Shiga Toxin-Producing Escherichia coli O157:H7 Isolated in Italy and in France

ABSTRACT Twenty-one Escherichia coli O157:H7 strains isolated in northern Italy from sporadic cases of hemolytic-uremic syndrome and from cattle and food were characterized by virulence gene analysis, pulsed-field gel electrophoresis (PFGE) of XbaI-digested DNA, enterobacterial repetitive intergenic consensus (ERIC) sequence-based PCR (ERIC-PCR), and antibiotic resistance patterns and compared to 18 strains isolated in France from human cases of diarrhea, cattle, and the environment. Strains isolated in Sicily (southern Italy) from a local farm (one strain) and from calves just imported from France (11 strains) and Spain (six strains) were also typed. Whereas the eae and hlyA genes were always detected, Shiga toxin gene (stx) analysis showed some differences related to geographic areas. Isolates from northern Italy showed a high frequency of stx1 and stx2, while strains isolated in France and from French and Spanish calves imported to Sicily more frequently possessed the stx2c gene. The majority of the strains isolated in northern Italy were also resistant to one or more antibiotics, while most of the strains isolated in France and Sicily were fully susceptible. ERIC-PCR analysis was not able to differentiate the strains. PFGE typing after XbaI DNA digestion produced a total of 54 distinct restriction endonuclease digestion profiles (REDPs) among the 57 strains. Phylogenetic analysis was unable to cluster REDPs according to geographic origin. All epidemiologically related isolates showed either identical or ≥91% similar REDPs. Our findings suggest a peculiar circulation of antibiotic-resistant, genetically unrelated strains in northern Italy.

Safety and immunogenicity of a combined diphtheria-tetanus-acellular pertussis-hepatitis B vaccine administered according to two different primary vaccination schedules

The reactogenicity and immunogenicity of a tetravalent diphtheria-tetanus-acellular pertussis-hepatitis B (DTPa-HB) vaccine (SmithKline Beecham) were studied in 565 infants immunized according to one of two different schedules, at 2, 4 and 6 months of age (group A n = 208) or at 3, 5 and 11 months of age (group B n = 357). The incidences of local and general reactions within the first 8 days after vaccination were similar in the two groups of infants, the vast majority being mild in intensity and occurring within 2-3 days of vaccine administration. Severe local symptoms were rare: pain after 0.6% of all doses, redness after 0.5% and 1.3%, and swelling after 0.3% and 1.5%, in group A and B, respectively. Only one infant in group A and one in group B had a temperature > 39.0 degrees C. Both schedules proved satisfactory in obtaining high levels of antibodies against all antigens. The rates of serologic response against the different antigens reached 100% in both groups. Antibody titres against all vaccine components were elevated following both schedules, but after the third dose of vaccine geometric mean antibody titres (GMTs) against D toxoid, filamentous haemagglutinin (FHA), pertactin (PRN) and hepatitis B (HB) were significantly higher in the 3, 5, 11 group than after the 2, 4, 6 schedule. Antibody titres measured at 7 months of age in the group immunized at 2, 4 and 6 months were higher than those reached at 6 months of age in infants immunized at 3, 5 and 11 months, but FHA and PRN were within the range of DTPa vaccine with proven efficacy. We conclude that DTPa-HB vaccine was safe, well tolerated and highly immunogenic. Both vaccination schedules (2, 4, 6 and 3, 5, 11) can be considered suitable for mass immunization programmes.