Maria Anna Coniglio

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 Estimates from published and unpublished sources of disease burden, costs, vaccine coverage, efficacy trials of both vaccines, and price were used to estimate cost-effectiveness from the perspectives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.

Molecular Epidemiology of Ampicillin Resistance in Salmonella spp. and Escherichia coli from Wastewater and Clinical Specimens

Molecular epidemiology at local scale in Sicily (Italy) of ampicillin resistance in Salmonella spp. isolates from municipal wastewater (n = 64) and clinical specimens (n = 274) is described in comparison with previously examined Escherichia coli isolates (n = 273) from wastewater. High prevalence of antibiotic resistance (28.9%) with highest resistance rates against ampicillin (22.7%) was observed in E. coli isolates. Different resistance rates were observed in Salmonella according to the serovars, with prevalences of the same order in both wastewater and clinical isolates belonging to the same serovar (e.g., 91.7% ampicillin resistance in wastewater isolates vs. 70.8% in clinical isolates of the Salmonella serovar Typhimurium and 0% ampicillin resistance in both wastewater and clinical isolates of the Salmonella serovar Enteritidis). The beta-lactam resistance gene bla(TEM) was present in both wastewater and clinical Salmonella spp. isolates, with the exception of Salmonella enterica serovar Typhimurium isolates with a typical six-drug resistance pattern AmpChlSulTeStrSp that had the bla(PSE-1) gene. The bla(TEM) gene was present in all the E. coli isolates but one had the bla(SHV) gene. Several E. coli and some Salmonella isolates were positive for class 1 integrons with variable regions of 1.0 or 1.5 kb containing aadA1, dfrA17-aadA5, or dfrA1-aadA1 gene cassettes, whereas Salmonella serovar Typhimurium isolates with the six-drug resistance pattern were positive for both 1.0 and 1.2 kb integrons. Polymerase chain reaction replicon typing demonstrated the presence of multireplicon resistance plasmids in several isolates of E. coli, containing two to four of the replicons IncF, IncI1, IncFIA, and IncFIB, whereas other isolates showed resistance plasmids with only IncF, IncP, or IncK replicons. Replicon IncI1 was detected in one Salmonella isolate, whereas other isolates belonging to different serovars had IncN replicons. Analysis of isolates from wastewater can be a useful epidemiologic tool to monitor the prevalence of antibiotic resistance and genetic elements related to antibiotic resistance in Salmonella clones circulating in the human population.

Evaluation of Legionella Air Contamination in Healthcare Facilities by Different Sampling Methods: An Italian Multicenter Study

Healthcare facilities (HF) represent an at-risk environment for legionellosis transmission occurring after inhalation of contaminated aerosols. In general, the control of water is preferred to that of air because, to date, there are no standardized sampling protocols. Legionella air contamination was investigated in the bathrooms of 11 HF by active sampling (Surface Air System and Coriolis®μ) and passive sampling using settling plates. During the 8-hour sampling, hot tap water was sampled three times. All air samples were evaluated using culture-based methods, whereas liquid samples collected using the Coriolis®μ were also analyzed by real-time PCR. Legionella presence in the air and water was then compared by sequence-based typing (SBT) methods. Air contamination was found in four HF (36.4%) by at least one of the culturable methods. The culturable investigation by Coriolis®μ did not yield Legionella in any enrolled HF. However, molecular investigation using Coriolis®μ resulted in eight HF testing positive for Legionella in the air. Comparison of Legionella air and water contamination indicated that Legionella water concentration could be predictive of its presence in the air. Furthermore, a molecular study of 12 L. pneumophila strains confirmed a match between the Legionella strains from air and water samples by SBT for three out of four HF that tested positive for Legionella by at least one of the culturable methods. Overall, our study shows that Legionella air detection cannot replace water sampling because the absence of microorganisms from the air does not necessarily represent their absence from water; nevertheless, air sampling may provide useful information for risk assessment. The liquid impingement technique appears to have the greatest capacity for collecting airborne Legionella if combined with molecular investigations.

Knowledge, attitudes and practices towards patients with HIV/AIDS in staff nurses in one university hospital in Sicily

them knew what is the ‘window period’ (62%) and were acquainted with HIV pathophysiology (65%). no statistically significant differences in terms of risk perception were found between nurses who had previously attended an HIV/aIdS workshop, lecture or specific course (43%) and nurses who did not (57%). level of knowledge was positively associated to age (P=0.000) and to education (P=0.016), and it was found higher in nurses working in a o.u. of Infectious diseases. concluSIonS: data from our study show that also in developed countries, such as Italy, nurses could have some misconceptions and concerns about HIV/aIdS. the importance of examining the impact of continuing education on nurses’ preparedness to care for patients with HIV/aIdS and to prevent the risks of occupational HIV transmission is discussed.

A pilot study of Internet usage patterns in a group of Italian university students

enrolled university students met the criteria of definite Iad, although a fairly high level of at-risk Internet attitudes and behaviors was found. Finally, some gender differences in Internet attitudes and behaviors were found. conclus Ions: the implications drawn from this study, including the adequacy of the available measurement instruments for I ad, are discussed.

Knowledge, beliefs and attitudes of Italian female undergraduate students towards HIV infection and risky sexual behaviour. Do female medical students make good peer educators?

Background : The main purpose of this study was to identify and describe knowledge, beliefs and attitudes towards HIV infection and risky sexual behaviour in female medical freshmen in order to evaluate the possibility of female medical student-based peer education. Methods : Researchers surveyed 560 freshmen: 280 medical students and 280 non medical students at two Italian Universities, collecting the data through anonymous, self administered questionnaires. Data were codified and statistical analysis was computed using Statistica and Openstat 4 software. Results : Female medical freshmen showed higher levels of knowledge and risk perception about HIV infection, and higher levels of self-awareness in preventing infection when compared with non-medical freshmen. Moreover, medical student’s had a lower rate of sexual activity and a higher rate of condom usage. Conclusions : Our data leads to the hypothesis that the involvement of female medical students in developing and providing safe sex education may be an important and effective way of better enhancing young people’s knowledge, attitude and behaviour towards the prevention of HIV and other sexually transmitted infections.

Antimicrobial Potential of Sicilian Honeys Against Staphylococcus aureus and Pseudomonas aeruginosa

The purpose of this study was to investigate the antibacterial effect of 71 organic Sicilian honeys of different botanical origins against Staphylococcus aureus [American Type Culture Collection (ATCC) 9144™] and Pseudomonas aeruginosa (ATCC 27853™). The antimicrobial activity was determined by means of an agar diffusion assay from the estimation of the diameter of the inhibition zone produced by the honeys. S. aureus was more inhibited than P. aeruginosa (chi-square value 11.2698, P value 0.000788). In particular, a statistically significant inhibition growth against S. aureus was exhibited by the polyfloral (chi-square value 6.1714, P value 0.012983) and the eucalyptus honeys (chi-square value 4, P value 0.0455). Results partially suggest Sicilian organic polyfloral and eucalyptus honeys as possible alternatives to antimicrobial agents when S. aureus resistance causes failure of initial conventional antibiotic treatment.

Preventing Healthcare-Associated Legionellosis: Results after 3 Years of Continuous Disinfection of Hot Water with Monochloramine and an Effective Water Safety Plan

The purpose of this study is to report the experience of the implementation and application of a 3-year Water Safety Plan (WSP) together with the secondary disinfection of water by monochloramine to control and prevent healthcare-associated legionellosis in an Italian hospital strongly colonized by Legionella. Risk assessment was carried out by the WSP team. The main critical control points focused on in developing the WSP for the control of Legionella was the water distribution system. A sampling plan for the detection of Legionella was implemented. A widespread contamination of the hot water distribution system by L. pneumophila sg5 was found. Results after 3 years of the continuous disinfection of hot water with monochloramine indicate the eradication of Legionella. The implementation and application of a WSP in a hospital, together with the disinfection of the water distribution system with monochloramine, can be effective in controlling the growth of Legionella and in preventing nosocomial legionellosis.