Vaccinazione anti-Rotavirus: razionale, efficacia, impatto

L\u2019impatto delle gastroenteriti da Rotavirus (GERV) a livello mondiale \ue8 drammatico, determi-nando importanti ricadute di tipo organizzativo ed economico sui sistemi sanitari dei Paesi ad elevato income sia elevati tassi di letalit\ue0 nei Paesi in via di sviluppo. I due vaccini attualmente disponibili sono i preparati monovalente e pentavalente. I dati disponibili in letteratura mostrano ottimi livelli di efficacia e sicurezza per entrambi i vaccini. Tuttavia, alla luce dell\u2019aumentata incidenza di intussuscezione intestinale osservata nella sorveglianza post-marketing dei bambini vaccinati con Rotashield\uae, ritirato dal commercio nel 1999, \ue8 stata posta particolare attenzione a rilevare un eccesso di incidenza di questo evento avverso. Tuttavia, nei Randomized Clinical Trial (RCT) condotti sia per RV1 sia per RV5, la frequenza di invaginazione intestinale \ue8 risultata uguale nei due gruppi di trattamento. La strategia di vaccinazione universale rivolta a tutti i nuovi nati, raccomandata dall\u2019Organizza-zione Mondiale della Sanit\ue0 (OMS) e dalle pi\uf9 autorevoli societ\ue0 scientifiche, rappresenta l\u2019approccio di Sanit\ue0 Pubblica in grado di garantire il contenimento del burden delle GERV, consentendo anche un notevole risparmio di risorse economiche e sociali da parte sia del Sistema Sanitario Nazionale (SSN) che della popolazione general

New approaches for the control of influenza: the intradermal vaccination

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Influenza vaccination in HIV-positive subjects: latest evidence and future perspective

nnual influenza vaccination is recommended for persons with human immunodeficiency virus (HIV) infection. Recent reports indi- cate that immunizations may increase HIV replication in infected individuals. Generally, vaccination against influenza is well toler- ated in both children and adult individuals with HIV and does not induce significant changes in viral load and CD4+ cell counts. The observed increase in viral replication is usually transient and a clear, measurable progression of the underlying HIV disease is hard to be determined. Several studies reported immunogenicity data in HIV+ population, by comparing different influenza vaccines, adju- vanted or not, and different administration routes. Data are encour- aging because an adequate immune response is shown, although split/subunit vaccines do not elicite an efficient immune response in these subjects. New strategies have been evaluated to increase the immune response in immunocompromised patients.The aim of this review is to evaluate tolerability, safety, immunogenicity and effi- cacy of vaccines actually approved for human use and to consider latest evidence and future perspective in HIV positive subjects

Determinants of invasiveness and ability to cause invasive pneumococcal disease, pneumonia and acute otitis media of different serotypes of Streptococcus pneumoniae

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State of the Art, Unresolved Issues, and Future Research Directions in the Fight against Hepatitis C Virus: Perspectives for Screening, Diagnostics of Resistances, and Immunization

Hepatitis C virus (HCV) still represents a major public health threat, with a dramatic burden from both epidemiological and clinical points of view. New generation of direct-acting antiviral agents (DAAs) has been recently introduced in clinical practice promising to cure HCV and to overcome the issues related to the interferon-based therapies. However, the emergence of drug resistance and the suboptimal activity of DAAs therapies against diverse HCV genotypes have been observed, determining treatment failure and hampering an effective control of HCV spread worldwide. Moreover, these treatments remain poorly accessible, particularly in low-income countries. Finally, effective screening strategy is crucial to early identifying and treating all HCV chronically infected patients. For all these reasons, even though new drugs may contribute to impacting HCV spread worldwide a preventive HCV vaccine remains a cornerstone in the road to significantly reduce the HCV spread globally, with the ultimate goal of its eradication. Advances in molecular vaccinology, together with a strong financial, political, and societal support, will enable reaching this fundamental success in the coming years. In this comprehensive review, the state of the art about these major topics in the fight against HCV and the future of research in these fields are discussed

The impact of 10-valent and 13-valent pneumococcal conjugate vaccines on hospitalization for pneumonia in children: A systematic review and meta-analysis

Abstract Background This systematic review and meta-analysis aimed at summarizing available data on the impact of PCV10 and PCV13 in reducing the incidence of CAP hospitalizations in children aged Methods A systematic search of the literature was conducted. We included time-series analyses and before-after studies, reporting the incidence of hospitalization for pneumonia in the periods before and after the introduction of PCV10 or PCV13 into the immunization program. Pooled estimates of Incidence Rate Ratio (IRR) were calculated by using a random-effects meta-analytic model. Results were stratified according to age-groups ( Results A total of 1533 potentially relevant articles were identified. Of these, 12 articles were included in the analysis. In children aged In children aged 24–59 months, the meta-analysis showed a reduction of 9% (95%CI: 5–14%, p-value High heterogeneity was detected among studies evaluating the hospitalization rate for clinically and radiologically confirmed pneumonia. Conclusions The results of this study revealed a significant impact of PCV10 and PCV13 in reducing the hospitalizations for pneumonia, particularly in children age

Adjuvants and alternative routes of administration towards the development of the ideal influenza vaccine.

Vaccination is universally considered as the principal measure for the control of influenza, which represents a significant burden worldwide, both from a health-care and a socio-economic viewpoint. Conventional non-adjuvanted trivalent influenza vaccines (TIVs) have been recognized as having some deficiencies, such as suboptimal immunogenicity particularly in the elderly, in patients with severe chronic diseases and immunocompromized, indeed, those groups of the population at higher risk of developing severe complications following influenza infection, when compared to healthy adults. Moreover, the protection offered by conventional vaccines may be reduced by periodic antigenic drifts, resulting in a mismatch between the circulating and vaccinal viral strains. Another gap regarding currently available vaccines is related to the egg-based manufacturing system for their production: not only the length of time involved with the latter but also the limited capacity of this platform technology represent a major limitation for the active prevention of influenza, which is particularly important in the case of a new pandemic strain. New technologies used in vaccine composition, administration and manufacture have led to major advances during the last few years, and clinical researchers have continued to work hard, investigating several different strategies to improve the performance of influenza vaccines: namely, the addition of different adjuvants (i.e., MF59- and AS03-vaccines, virosomal formulations), the use of alternative routes of administration or manufacture (i.e., intradermal, nasal and oral vaccines and cell culture- and reverse genetic-based vaccines) or of high doses of antigen, and the development of DNA-vaccines, or the use of conserved viral epitopes (i.e., the extracellular portion of the M2 protein, the nucleoprotein and some domains of the hemagglutinin), in the attempt to produce a "universal target" antigen vaccine. The knowledge acquired represents a fundamental challenge for the control of influenza. An overview of the most recent and interesting results, some of which gained from our own research experience, particularly concerning two successful approaches, of those outlined above, namely the use of: (i) the oil-in-water MF59-adjuvant, and (ii) the intradermal (ID) route for vaccine administration, through a novel microinjection system, will be reported and discussed, together with the possible implications and perspectives to optimize immunization policies against influenza in the near future

Clinical and therapeutic aspects of candidemia: A five year single centre study

B ackground Candida is an important cause of bloodstream infections (BSI) in nosocomial settings causing significant mortality and morbidity. This study was performed to evaluate contemporary epidemiology, species distribution, antifungal susceptibility and outcome of candida BSI in an Italian hospital. Methods All consecutive patients who developed candidemia at Santa Maria della Misericordia University Hospital (Italy) between January 2009 and June 2014 were enrolled in the study. Results A total of 204 episodes of candidemia were identified during the study period with an incidence of 0.79 episodes/1000 admissions. C. albicans was isolated in 60.3% of cases, followed by C. parapsilosis (16.7%), C. glabrata (11.8%) and C. tropicalis (6.4%). Of all Candida BSI, 124 (60.8 %) occurred in patients admitted to IMW, 31/204 (15.2 %) in ICUs, 33/204 (16.2%) in surgical units and 16/204 (7.8%) in Hematology/Oncology wards. Overall, 47% of patients died within 30 days from the onset of candidemia. C. parapsilosis and C. glabrata candidemia were associated with the lowest mortality rate (36%), while patients with C. tropicalis BSI had the highest mortality rate (58.3%). Lower mortality rates were detected in patients receiving therapy within 48 hours from the time of execution of the blood cultures (57,1% vs 38,9%, P <0.05). At multivariate analysis, steroids treatment (OR= 0.27, p=0.005) and CVC removal (OR=3.77, p=0.014) were independently associated with lower and higher survival probability, respectively. Candidemia in patients with peripherally inserted central catheters (PICC) showed to be associated with higher mortality in comparison with central venous catheters (CVC, Short catheters and Portacath) and no CVC use. For each point increase of APACHE III score, survival probability decreased of 2%. Caspofungin (OR=3.45, p=0.015) and Amphothericin B lipid formulation (OR=15.26, p=0.033) were independently associated with higher survival probability compared with no treatment

Drug resistance among influenza A viruses isolated in Italy from 2000 to 2005: are the emergence of Adamantane-resistant viruses cause of concern?

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Economic Impact of Inter-Regional Health Mobility In The Oldest European Administrative Region: A Starting Point For Changing Organizational Model?

Objectives: The aim of this study is to evaluate the inter-regional mobility expenditures, with particular reference to oncology, in Liguria Region. Study design: A descriptive analysis of inter-regional mobility expenditures from 2008 to 2015 was carried out. Methods: The analysis involved a detailed assessment of global balance of interregional health mobility by means the DRGs; the flow of specialist outpatient and pharmaceutical was also used. Results: Since 2008 until 2012 an increase of negative balance of global healthcare expenditure in Liguria Region was observed [34.7 \u20ac mill (2008) and 62.3 \u20ac mill (2012)]; subsequently a quite stable trend was recorded between 2012 and 2015 [ranging between 59.8 \u20ac mill (2013) and 63.2 \u20ac mill (2014)]. The passive mobility was 15.1% on the total spending for hospital acute care in 2012 and a similar value was detected in 2015 (15.2%). The higher costs for passive mobility were attributable to the surgical DRGs (69.4% in 2012 and 69.8% in 2015) with a double estimate of the expenditure in comparison with medical ones (2012: 99.4 \u20ac mill vs 43.8 \u20ac mill, \u394= 55.6 \u20ac mill; 2015: 96.6 \u20ac mill vs 41.9 \u20ac mill, \u394= 54.7 \u20ac mill). The highest cost sources in the process of passive mobility are the surgical areas, particularly the surgical hospitalizations for orthopaedic and cardiologic interventions. The spending analysis for oncologic DRG, divided into surgical and medical for passive and active mobility, showed that the surgical DRG determined a negative balance of 3.8 \u20ac mill in 2012 and 4.3 \u20ac mill in 2015, while the medical DRG showed a positive balance of 0.5 \u20ac mill in 2012 and 0.7 \u20ac mill in 2015. Conclusions: Our evaluation highlights that the inter-regional mobility for hospital acute care is the most relevant issue for the economic regional balance and reveals an important flow of patients moving from Liguria Region to neighbouring regions. As the equity of access and distribution of the supply of care remains a priority of Regional Health System, the active mobility in oncologic field could be a marker of quality health planning