Reduction in Neisseria meningitidis infection in Italy after Meningococcal C conjugate vaccine introduction: A time trend analysis of 1994-2012 series

The incidence of invasive meningococcal disease (IMD) In Italy is among the lowest in Europe. Meningococcal C conjugate vaccine (MCC) was introduced in 2005 for 12 onths old infants. The aim of this study was to describe the epidemiology of IMD in Italy from 1994 to 2012 and to evaluate the impact of MCC introduction. Data about Neisseria meningitidis (N. meningitidis) cases were drawn from the National Surveillance of Invasive Bacterial Diseases. The average incidence of IMD during 1994-2012 in Italy was 0.36 per 100,000 (95%CI 0.30-0.40). N. meningitidis B was the most frequent serogroup and infants less than 12 onths old were the most affected. Joinpoint analysis showed a statistically significant reduction in the incidence of N. meningitidis C related IMD after MCC introduction: the Annual Percentage Change declined from 21.8 (95%CI 15.1; 28.9) in 1994-2005 to -19.9 (95%CI -28.2; -10.7) afterwards. No changes were observed with respect to N. meningitidis B related IMD. Poisson regression showed a statistically significant reduction in the incidence of IMD both associated to N. meningitidis C (Incidence Rate Ratio 0.33; 95%CI 0.29-0.37) and due to all serogroups (Incidence Rate Ratio 0.70; 95%CI 0.65-0.75) in the post-vaccination period compared to the pre-vaccination one. On the other hand, the incidence of N. meningitidis B related IMD did not decrease. Our results suggest that MCC had an impact in decreasing the incidence of N. meningitidis C related IMD. However, data on typing are incomplete and efforts are needed to make them available for studying the need and the impact of other meningococcal vaccines

Telemedicine in the management of acute stroke:systematic review and meta-analysis of the literature

Background Acute ischemic stroke (AIS) is a leading cause of death and disability and recombinant tissue plasminogen activator (tPA) may significantly reduce the long-term impact if given timely. A rapid assessment of the patient is therefore required. Notwithstanding many hospitals lack the stroke expertise and resources to timely manage patients. In this context, telemedicine facilities could be useful. The aim of this study was to perform a systematic review and meta-analysis to assess if telemedicine can be used in order to manage patients with AIS with a specific focus on the impact on mortality. Methods Longitudinal studies dealing with telemedicine facilities in managing AIS conducted before April 15th 2014 and published in English were searched in PubMed, Web of Knowledge and Scopus. The meta-analysis was performed to assess the impact of telemedicine versus standard approach in reducing mortality. Relative risk (RR) with 95% Confidence Interval was used to report results and the I2 to evaluate heterogeneity. Results Six studies were considered for the review for a total of 3,987 patients managed by either telemedicine (2,283) or standard approach (1,704). Four articles were clinical trials and two were cohort studies. Three studies addressed in-hospital mortality while all six dealt with 90 days mortality. The meta-analysis yielded a RR of 1.68 (95% CI 0.68–4.10) and 0.96 (95% CI 0.83–1.11) for in-hospital mortality and 90 days mortality respectively, without heterogeneity. A subgroup analysis considering only trials released a RR of 0.72 (95% CI 0.14–3.58) and of 0.94 (95% CI 0.81–1.10) respectively. Conclusion Our review showed no significant differences in terms of mortality between telemedicine and control groups even though results may be not considered conclusive because of the small number of studies. Because of these results and in the light of current organizational shortages, telemedicine may be used in order to manage patients with AIS. Key messages Telemedicine does not improve survival of patients with acute ischemic stroke as no significant differences were shown in-hospital and 90 days mortality between telemedicine and standard approach Telemedicine is as an important tool in order to overcome organizational shortage but its impact on patients’ health outcomes deserves to be further addressed by appropriate studie

The management of multiple sclerosis by reference centers in south of Italy: a 2011 survey on health demands and needs in Campania region

This cross-sectional study has investigated the diagnostic and therapeutic management of patients suffering from multiple sclerosis (MS) in the Campania Region (Italy). A survey involving all the reference centers for MS in Campania Region was conducted from March to August 2011. Centers responded to a web-administered questionnaire on management and clinical characteristics of MS patients. In the study period, 3263 patients (mean age 37 years, 66 % females) accessed the centers. Patients received a first diagnosis of MS in 161 cases (4.9 %). About 37 % of the subjects without a previous diagnosis came to the centers on their own initiative. All patients underwent a complete neurological examination and expanded disability status scale. The other most common investigations were magnetic resonance imaging (44.0 %) and evoked potentials (22.1 %). The number of treated patients was 2797 (87.1 %). The most used drugs were interferon β and glatiramer acetate. The time between diagnosis and initiation of therapy exceeded 6 months in 32 % of cases. Second-line drugs were under-used: 16 % of patients who might benefit from them show high clinical and radiological disease activity despite treatment with immunomodulant drugs. The MS care management of the surveyed centers showed consistent margins for improvement in 2011. Even though these data do not represent the current situation, they can be used to monitor improvements in MS care