Awareness towards Chikungunya virus infection risk by general practitioners in Rome: a questionnaire based survey before the 2017 outbreak

Autochthonous cases of Chikungunya (CHIKV) have been recently detected in Rome. A survey was conduct- ed prior to the 2017 outbreak to assess knowledge, attitude, and practices towards CHIKV infections on 103 randomly selected general practitioners (GPs), practicing in the centre of Rome. Only 24.3% were aware of CHIKV and completed the interview. Among completers, the knowledge of basic elements of CHIKV in- fection was insufficient. Only two thirds of them were able to identify possible CHIKV cases in hypothetical clinical scenarios presented by the interviewer. Our study highlights the need to improve GP knowledge to- wards CHIKV, as a necessary step to establish an efficacious epidemic surveillance

Temporal pattern of Klebsiella pneumoniae carbapenemase (KPC) on surface of an intensive care unit of a large hospital

Background: Carbapenem-resistant Enterobacteriaceae are an increasing cause of healthcare-associated infections worldwide. Patients with infections caused by Klebsiella pneumoniae resistant to carbapenems (KPC) have significant increases in both allcause mortality and 30-day mortality. The aims of this study was to investigate the prevalence of KPC on environmental samples collected during and after an outbreak caused by KPC in an intensive care unit (ICU) of a teaching hospital. Methods: Between 2010 and 2014 we conducted a total of 132 environmental monitoring campaigns from different critical surface of ICU ward in a Teaching Hospital Policlinico Umberto I. Samples were collected on surfaces in patient rooms and health care area. All samples were cultured and K. pneumoniae isolates were identified by standard microbiological techniques. The presumptive colonies were confirmed and tested for antibiotic resistance by an automated system. K. pneumoniae resitant to carbapenems were tested for carbapenemase production by modified Hodge test. Results: A total of 2526 environmental samples were collected from November 2010 to July 2014. Of those, 111 resulted positive for K. pneumoniae while KPC were 95 (85.6% of all K. pneumoniae, 3.8% of total samples). KPC was recovered in all patient rooms with similar proportion (5.1-5.6%) with the exception of patient 6 bed room where it was lower (2.4%). The pathogen was not recovered in rooms dedicated to healthcare personnel and doctors. Among surfaces, the highest proportion of KPC resulted on bedrail (6.8%), more than double than other surfaces. Washbasins had nearly half of samples KPC positive (1.2%). Conclusions: Despite previous studies suggested that environment plays a minor role in the transmission of carbapenem-resistant enterobacteriaceae, our data highlighted that surfaces represents a significant reservoir for KPC possibly supporting transiently contamination of hands of healthcare workers in our ICU. Our results confirm that KPC are more likely found on surfaces closer to the patient than on those situated further away

Spatial and temporal hot spots of Aedes albopictus abundance inside and outside a South European metropolitan area

Aedes albopictus is a tropical invasive species which in the last decades spread worldwide, also colonizing temperate regions of Europe and US, where it has become a public health concern due to its ability to transmit exotic arboviruses, as well as severe nuisance problems due to its aggressive daytime outdoor biting behaviour. While several studies have been carried out in order to predict the potential limits of the species expansions based on eco-climatic parameters, few studies have so far focused on the specific effects of these variables in shaping its micro-geographic abundance and dynamics. The present study investigated eco-climatic factors affecting Ae. albopictus abundance and dynamics in metropolitan and sub-urban/rural sites in Rome (Italy), which was colonized in 1997 and is nowadays one of the most infested metropolitan areas in Southern Europe. To this aim, longitudinal adult monitoring was carried out along a 70 km-transect across and beyond the most urbanized and densely populated metropolitan area. Two fine scale spatiotemporal datasets (one with reference to a 20m circular buffer around sticky traps used to collect mosquitoes and the second to a 300m circular buffer within each sampling site) were exploited to analyze the effect of climatic and socio-environmental variables on Ae. albopictus abundance and dynamics along the transect. Results showed an association between highly anthropized habitats and high adult abundance both in metropolitan and sub-urban/ rural areas, with “small green islands” corresponding to hot spots of abundance in the metropolitan areas only, and a bimodal seasonal dynamics with a second peak of abundance in autumn, due to heavy rains occurring in the preceding weeks in association with permissive temperatures. The results provide useful indications to prioritize public mosquito control measures in temperate urban areas where nuisance, human-mosquito contact and risk of local arbovirus transmission are likely higher, and highlight potential public health risks also after the summer months typically associated with high mosquito densities

WISER Deliverable D3.3-2: The importance of invertebrate spatial and temporal variation for ecological status classification for European lakes

European lakes are affected by many human induced disturbances. In principle, ecological theories predict that the structure and functioning of benthic invertebrate assemblage (one of the Biological Quality Elements following the Water Framework Directive, WFD terminology) change in response to the level of disturbances, making this biological element suitable for assessing the status and management of lake ecosystems. In practice, to set up assessment systems based on invertebrates, we need to distiguish community changes that are related to human pressures from those that are inherent natural variability. This task is complicated by the fact that invertebrate communities inhabiting the littoral and the profundal zones of lakes are constrained by different factors and respond unevenly to distinct human disturbances. For example it is not clear yet how the invertebrates assemblages respond to watershed and shoreline alterations, nor the relative importance of spatial and temporal factors on assemblage dynamics and relative bioindicator values of taxa, the habitat constraints on species traits and other taxonomic and methodological limitations. The current lack of knowledge of basic features of invertebrate temporal and spatial variations is limiting the fulfillment of the EU-wide intercalibration of lake ecological quality assessment systems in Europe, and thus compromising the basis for setting the environmental objectives as required by the WFD. The aim of this deliverable is to provide a contribution towards the understanding of basic sources of spatial and temporal variation of lake invertebrate assemblages. The report is structured around selected case studies, manly involving the analysis of existing datasets collated within WISER. The case studies come from different European lake types in the Northern, Central, Alpine and Mediterranean regions. All chapters have an obvious applied objective and our aim is to provide to those dealing with WFD implementation at various levels useful information to consider when designing monitoring programs and / or invertebrate-based classification systems

Spatial modes for transmission of chikungunya virus during a large chikungunya outbreak in Italy. A modeling analysis

Background The spatial spread of many mosquito-borne diseases occurs by focal spread at the scale of a few hundred meters and over longer distances due to human mobility. The relative contributions of different spatial scales for transmission of chikungunya virus require definition to improve outbreak vector control recommendations. Methods We analyzed data from a large chikungunya outbreak mediated by the mosquito Aedes albopictus in the Lazio region, Italy, consisting of 414 reported human cases between June and November 2017. Using dates of symptom onset, geographic coordinates of residence, and information from epidemiological questionnaires, we reconstructed transmission chains related to that outbreak. Results Focal spread (within 1 km) accounted for 54.9% of all cases, 15.8% were transmitted at a local scale (1–15 km) and the remaining 29.3% were exported from the main areas of chikungunya circulation in Lazio to longer distances such as Rome and other geographical areas. Seventy percent of focal infections (corresponding to 38% of the total 414 cases) were transmitted within a distance of 200 m (the buffer distance adopted by the national guidelines for insecticide spraying). Two main epidemic clusters were identified, with a radius expanding at a rate of 300–600 m per month. The majority of exported cases resulted in either sporadic or no further transmission in the region. Conclusions Evidence suggest that human mobility contributes to seeding a relevant number of secondary cases and new foci of transmission over several kilometers. Reactive vector control based on current guidelines might allow a significant number of secondary clusters in untreated areas, especially if the outbreak is not detected early. Existing policies and guidelines for control during outbreaks should recommend the prioritization of preventive measures in neighboring territories with known mobility flows to the main areas of transmission

Spatial modes for transmission of chikungunya virus during a large chikungunya outbreak in Italy: a modeling analysis

14openInternationalBothBackground The spatial spread of many mosquito-borne diseases occurs by focal spread at the scale of a few hundred meters and over longer distances due to human mobility. The relative contributions of different spatial scales for transmission of chikungunya virus require definition to improve outbreak vector control recommendations. Methods We analyzed data from a large chikungunya outbreak mediated by the mosquito Aedes albopictus in the Lazio region, Italy, consisting of 414 reported human cases between June and November 2017. Using dates of symptom onset, geographic coordinates of residence, and information from epidemiological questionnaires, we reconstructed transmission chains related to that outbreak. Results Focal spread (within 1 km) accounted for 54.9% of all cases, 15.8% were transmitted at a local scale (1–15 km) and the remaining 29.3% were exported from the main areas of chikungunya circulation in Lazio to longer distances such as Rome and other geographical areas. Seventy percent of focal infections (corresponding to 38% of the total 414 cases) were transmitted within a distance of 200 m (the buffer distance adopted by the national guidelines for insecticide spraying). Two main epidemic clusters were identified, with a radius expanding at a rate of 300–600 m per month. The majority of exported cases resulted in either sporadic or no further transmission in the region. Conclusions Evidence suggest that human mobility contributes to seeding a relevant number of secondary cases and new foci of transmission over several kilometers. Reactive vector control based on current guidelines might allow a significant number of secondary clusters in untreated areas, especially if the outbreak is not detected early. Existing policies and guidelines for control during outbreaks should recommend the prioritization of preventive measures in neighboring territories with known mobility flows to the main areas of transmission.openGuzzetta, Giorgio; Vairo, Francesco; Mammone, Alessia; Lanini, Simone; Poletti, Piero; Manica, Mattia; Rosa, Roberto; Caputo, Beniamino; Solimini, Angelo; Torre, Alessandra Della; Scognamiglio, Paola; Zumla, Alimuddin; Ippolito, Giuseppe; Merler, StefanoGuzzetta, G.; Vairo, F.; Mammone, A.; Lanini, S.; Poletti, P.; Manica, M.; Rosa, R.; Caputo, B.; Solimini, A.; Torre, A.D.; Scognamiglio, P.; Zumla, A.; Ippolito, G.; Merler, S

A general wavelet-based profile decomposition in the critical embedding of function spaces

We characterize the lack of compactness in the critical embedding of functions spaces $X\subset Y$ having similar scaling properties in the following terms : a sequence $(u_n)_{n\geq 0}$ bounded in $X$ has a subsequence that can be expressed as a finite sum of translations and dilations of functions $(\phi_l)_{l>0}$ such that the remainder converges to zero in $Y$ as the number of functions in the sum and $n$ tend to $+\infty$. Such a decomposition was established by G\'erard for the embedding of the homogeneous Sobolev space $X=\dot H^s$ into the $Y=L^p$ in $d$ dimensions with $0<s=d/2-d/p$, and then generalized by Jaffard to the case where $X$ is a Riesz potential space, using wavelet expansions. In this paper, we revisit the wavelet-based profile decomposition, in order to treat a larger range of examples of critical embedding in a hopefully simplified way. In particular we identify two generic properties on the spaces $X$ and $Y$ that are of key use in building the profile decomposition. These properties may then easily be checked for typical choices of $X$ and $Y$ satisfying critical embedding properties. These includes Sobolev, Besov, Triebel-Lizorkin, Lorentz, H\"older and BMO spaces.Comment: 24 page