Recommendations for pneumococcal immunization outside routine childhood immunization programs in Western Europe

The global burden of pneumococcal diseases is high, with young children and adults ≥50 years of age at highest risk of infection. Two types of vaccine are available for the prevention of pneumococcal diseases caused by specific Streptococcus pneumoniae serotypes: the pneumococcal polysaccharide vaccine (PPV23) and the pneumococcal conjugate vaccine (PCV7, PCV10, and PCV13). Despite pneumococcal immunization programs in adults and children, the burden in adults has remained high. Most European countries have national or local/regional vaccination recommendations. The objective of this review was to provide an overview of the government recommendations for pneumococcal vaccination outside routine childhood vaccination programs for 16 Western European countries as of August 2014. We found that recommendations for pneumococcal immunization across Europe are complex and vary greatly among countries in terms of age groups and risk groups recommended for vaccination, as well as which vaccine should be administered. Clarifying or simplifying these recommendations and improving their dissemination could help to increase pneumococcal vaccine uptake and decrease the high burden of pneumococcal diseases in adults, both through a direct effect of the vaccine and via a herd effect in unvaccinated individuals

La Sorveglianza attiva delle paralisi flaccide acute (AFP)in Sardegna nell'obiettivo della eradicazione della poliomielite

Nella storia della salute pubblica, l’umanità sta per raggiungere un importante obiettivo nel controllo delle malattie infettive, obiettivo fino ad ora conquistato solo per il vaiolo. Nel 1988 l’Assemblea Mondiale della Sanità si è infatti proposta di perseguire, tra i suoi obiettivi, la eradicazione della poliomielite attraverso una strategia di base imperneata su a) garanzia di alti livelli di copertura nella popolazione al di sotto dei 5 anni di età con vaccinazione routinaria utilizzando vaccino antipolio orale tipo Sabin; b) attività supplementari di vaccinazione tipo NID (Giornate Nazionali di Immunizzazione) in quei Paesi in cui la copertura di cui al punto a) è inferiore al 90%; c) interventi di “mopping-up” (vaccinazione di tutti i bambini tra 0 e 5 anni, indipendentemente dal loro stato vaccinale) nelle zone in cui si verificano focolai epidemici; d) sorveglianza di tutte le paralisi flaccide acute (AFP) in modo da identificare con certezza ogni caso di poliomielite. Attualmente, i Paesi liberi dalla polio sono oltre 175* (Fig. 1), mentre rimangono ancora critiche le zone dell’Africa occidentale e centrale (comprese il Corno d’Africa) e il sub continente indiano che continuano a notificare il maggior numero di casi di polio. Per ottenere il riconoscimento della certificazione di “polio-free”, ciascun Paese deve documentare, per un periodo di almeno tre anni consecutivi, l’assenza di casi di malattia paralitica da ceppi selvaggi e l’assenza della circolazione ambientale di poliovirus selvagg

Applicazione della classificazione National Health Service Breast Screening Pathology (NHSBSP) nella comparazione cito-istologica dei tumori mammari della cagna = NHSBSP classification use in the correlation of canine mammary tumour cytology and histopathology

Canine mammary tumours (CMT) are the most common neoplasia in bitches. Fine needle aspiration cytology (FNAC) is a fast and inexpensive technique well-tolerated by animals. Few reports have shown how difficult cytological diagnosis of CMT is and how difficult benign or malignant tumours are to classify using FNAC. Cytological diagnosis has often been inconclusive in veterinary pathology. In the diagnosis of human breast cancer, FNAC efficacy is beyond doubt due to its high specificity. In this preliminary study, our aim is to evaluate the efficacy of NHSBSP classification, applied to CMT. Secondly, we wish to test the usefulness of H&H stain in FNAC for CMT diagnosis. 75 FNAC specimens, from 41 dogs with mammary tumours were examined. 72/75 underwent the NHSBSP classification Histological examination of the tumours was performed in each case for comparison purposes. All the CMTs fell under the five categories: C1 (3 cases), C2 (7 cases), C3 (38 cases), C4 (15 cases), C5 (9 cases). As regards H&H staining in our view it was more efficacious than M.G.G. staining in distinguishing morphological cell details. Our results showed that the NHSBSP classification gave a 94.4% correspondence level between cytological and histological findings

Epidemiology of hydatidosis in the province of Sassari, Italy

Cystic echinococcosis is endemic in certain parts of the world, including Sardinia, Italy. It was performed a study in the province of Sassari in order to evaluate the incidence of the infection in man and the effects of control programs since 1964 to 2002. Data obtained by surgical records, hospital discharge forms, radiological and pathological files were collected using a case report form. During the years 1964- 2002, 2702 new cases were identified (average annual incidence: 17 per 100,000) and 1981 (73.3%) were submitted to surgical treatment. In 57.3% municipalities no cases were observed during the years 1998- 2002. Males are more affected (56.2%), mostly farmers-shepherdess (68.6 per 100,000) and pensioners (59.6 per 100,000). Control measures led to a significant decline in the incidence rate of hydatidosis during the period 1964-2002, dropping by 27.6 per 100,000. The mean age of surgical patients increased during the years of surveillance, such as the surgical liver/lung ratio as a consequence of a cohort effect. The durability of control programs is the corner stone for obtaining a significant decrease of this infection

Distinctive HLA-II association with primary biliary cholangitis on the Island of Sardinia

Background: The HLA DRB1*08 allele associated with primary biliary cholangitis (PBC) among Caucasians is of low frequency in the Sardinian population. Objective: The aim of our study was to type a cohort of PBC patients from the island of Sardinia for HLA class II antigens. Methods: Twenty Sardinian patients affected by PBC, 14 with autoimmune hepatitis (AIH) and 89 healthy controls (HCs) were typed for HLA class II alleles by dot-blot analysis. Results: The PBC-associated HLA DRB1*08 allele was detected in none of the studied individuals. The DRB1*0301–DQB1*0201 was the prevalent HLA haplotype, detected in 19 (47.5%) out of 40 PBC haplotypes (OR = 3.0; 95% CI 1.5–6.2) and in 11 (39.3%) out of 28 AIH haplotypes (OR = 2.2; 95% CI 0.94–5.0), but in only 41 (23%) out of 178 HC haplotypes. Moreover, PBC patients showed an increased frequency of homozygosity for the DQB1*0201 allele (35% compared with 6.7% of the HCs; OR = 7.5; 95% CI 2.2–25.7). The frequency of the DRB1*11 allele in the PBC group was about half of that seen in the Sardinian HCs (7.5% vs 15.7%) (p = ns). Conclusions: Our study confirmed the low frequency of the HLA DRB1*08 allele among Sardinians, either in the general population or PBC patients. The high prevalence of the HLA DRB1*0301–DQB1*0201 haplotype is a distinctive genetic feature of PBC among Sardinians. Our study strengthens the hypothesis that still unknown genetic, epigenetic, and environmental factors must be involved in the pathogenesis of different HLA-associated liver diseases, and it represents a pathfinder that warrants exploration in a future extensive study

Detection and genotyping of human Papillomavirus in urine samples from unvaccinated male and female adolescents in Italy

The introduction of vaccination against Human Papillomavirus (HPV) in adolescent girls in 2006 has focused virological surveillance on this age group. As few studies have evaluated HPV infections in young populations, further data are needed in order to improve and extend prophylactic policy and to monitor epidemiological changes. The present study aimed at evaluating overall and type-specific HPV prevalence in both female and male adolescents in Italy. HPV DNA detection and genotyping was performed on urine samples collected from 870 unvaccinated adolescents (369 females, 501 males, 11-18 years of age) in five cities in Italy. Following DNA extraction by means of a commercial kit (NucliSENS®-miniMAG®, bioMérieux), the L1 gene fragment was PCR amplified and genotyped by restriction fragment length polymorphism analysis. HPV DNA was detected in 1.5% of all samples, and in 3% and 0.4% of samples from females and males, respectively. In approximately 70% of HPV DNA positive adolescents, the infection was due to a single genotype, with 88.9% of genotypes belonging to the HR-clade. The only two HPV-positive boys (14 and 18 years old) had HPV-70 genotype. Only one of the 11 HPV-infected girls was in the 11-14 age-group. HPV prevalence was 4.2% in girls aged 15-18 years and 60% of infections were due to vaccine types HPV-16 or HPV-6/-11. This is one of the few studies, the first conducted in Italy, on HPV infection in adolescents. Urine testing is the easier way of detecting HPV infection in younger populations. Our data revealed a very low HPV prevalence, and no infections were observed in the 12-year-old vaccine target population. The majority of infections were seen in females aged 15-18 years. Overall, more than 50% and 30% of the potentially persistent HPV infections detected in this group could have been prevented by the quadrivalent and the bivalent vaccines, respectively

HPV infection and triple-negative breast cancers: an Italian case-control study

Background: Breast cancer is one of the most important neoplasia among women. To reduce its incidence and mortality impact it would be desirable to early identify risk factors associated with its development. It was recently suggested that biological agents could be the etiological cause, particularly Human Papilloma Virus (HPV). No specific relationship with different breast cancer types has been demonstrated until now. In particular, the triple-negative breast cancer (TNBC), characterized by a receptor negative pattern (ER/PgR/HER2–negative) and poor prognosis, can represent one of the most relevant clinical and public health priority in terms of observational research. Findings: Aim of the study was to evaluate the HPV-positivity prevalence in two breast cancer series (TNBC vs. non-TNBC) in Northern Sardinia, Italy. The sample size of each group was represented by 40 formalin-fixed and paraffin-embedded specimens. The mean age was 60.3 years. The majority of the cancers were ductal (84%). The grading distribution was different: G2 was the most prevalent grade in the non-TNBC series, whereas G3 was the most frequent in the TNBC series (70% and 72%, respectively). Six biological samples were HPV-positive (7.5%): the positivity was assessed only in the TNBC group (15%; p-value: 0.026). The isolated genotypes were: 16, 31, 45, 52, 6, and 66. Only one co-infection was found (i.e., HPV-6 and -66). Conclusions: The prevalence of HPV-positivity in TNBC specimens was 15%. On the basis of its carcinogenetic ability, an etiological role in the pathogenesis of the cancer could be supposed. This association should be confirmed with longitudinal studies to better assess the role of the HPV infection in TNBC and non-TNBC tumors

Is there an authentic increased risk of pneumococcal pneumonia among young mothers whose children were fully vaccinated with PCV7? The role of methodological shortcomings

We read with interest the manuscript of Hak et al., who car-ried out a nested case-control study in the U.K. to assess the riskof pneumococcal pneumonia in young mothers, whose children were vaccinated with 3 doses of 7-valent pneumococcal-conjugate-vaccine (PCV7) by 24 months of age. The Authors hypothesizedthat the increased risk of pneumonia is a consequence of a serotypereplacement following pneumococcal vaccination. However, publichealth advantages related to prevention of pneumococcal diseasedue to vaccination were not adequately pointed out; consequently,the low impact of the maternal risk (i.e., only 6 cases/45,000 person-year in the group aged 20–24 years were registered) deserves tobe more emphasized, rather than focusing only on the strengthof the association. Furthermore, the incidence rate detected inthe age-group 20–24 years largely contributed to the changeof the overall incidence (from 61 to 81 cases per 100,000 in 2006 and 2010, respectively), but it was not possible to understand if the temporal trend of the incidence rates was statistically significant

The 'Significant Caries Index' (SiC): a critical approach

This study was designed to validate the SiC index in a 12-year-old population, and also considers the level of the disease, expressed as DMFS index, with the aim of comparing the capability of the two indices for preventive and prognostic goals. Data from a previous study (Campus et al, 2001) based on 403 12-year-old subjects (205 females and 198 males) were reconsidered, and the SiC was calculated both on DMFT and DMFS. Several background factors were evaluated: classified as socio-economic levels (SOCFAM), Oral Hygiene Habits (OHH), Onset of Toothbrushing Habits (OTH), and gingival conditions expressed as the presence of plaque or calculus. Several regression models were built-up to estimate the dependence of each index – DMFT, DMFT (SiC), DMFS and DMFS (SiC) – on background variables. The four groups, picked out by the 66th percentiles on the ranking series of DMFT and DMFS following the SiC method were compared. Mean ± standard deviation, median and percentiles (p25 – p75) were 5.5 ± 2.1, 5 (p25 = 4 – p75 = 6) for DMFT (SiC) and 8.9 ± 5.8, 8 (p25 = 5 – p75 = 11) for DMFS (SiC). Intrinsic variability in SiC groups was lower, but the distributions remained skewed. In the multiple regression procedure, using DMFT and DMFS scores as dependent variables, OTH, bleeding and calculus were statistically significant. OHH (p < 0.05)and calculus (p < 0.05) gave a significant contribution to DMFS in the SIC group, while the model for DMFT (SiC) was not significant. In a stepwise logistic regression model, OTH, bleeding and calculus played a significant role (p < 0.05) on DMFT (SiC) and DMFS (SiC), as the likelihood for an individual to have a value ≥ 66th percentile. The concordance between the two selected series was rather good (kappa = 0.82; 95%CI: 0.73 – 0.91). No association with background factors was found on the two discordant groups. However, a linear trend in proportions between the two groups across SOCFAM categories was observed (p = 0.027). The use of SiC may solve the problem related to skewed caries distribution. Nevertheless if only SiC is used, it can lead to a lack of relevant information especially in countries where high caries prevalence is still present

Multiple sclerosis prevalence among Sardinians: further evidence against the latitude gradient theory

A descriptive epidemiological survey was extended to the whole province of Sassari, northern Sardinia between latitudes 40°30' N and 41° N. Results showed a crude total prevalence rate of 144.4 per 100 000 on prevalence day (31 December 1997), and an onset-adjusted prevalence rate of 149.7 per 100 000. The total average annual incidence rate was 4.9 per 100 000 for the whole time interval studied (1968–1997), having increased from 2.0 in 1968–1972 to 6.8 in the last quinquennium considered. A substantial improvement in MS case ascertainment due to the introduction of new diagnostic procedures might account for such rates in Sardinia as well as in other Italian regions. However, when comparing our data with those obtained in the province of Ferrara, in the same time frames (1968–1997), a nine-fold versus a five-fold increase of MS prevalence was detected in Ferrara and Sassari, respectively. MS incidence temporal trend also notably increased in Sassari, but remained substantially stable in Ferrara. The progressive shortening of the time interval between clinical onset and diagnosis, and the proportion of benign-mild MS cases, were similar diagnostic accuracy. In our opinion, the repeatedly assessed increase of MS frequency in our province, at least partially does represent an actual rise of MS risk among Sardinians, thus disproving the latitude gradient-based theory (i.e. prevalence rates correlate with geographical latitudes) and supporting the hypothesis of a “Sardinian focus” of MS in a genetically susceptible population