Immunization against Hepatitis B Surface Antigen (HBsAg) in a Cohort of Nursing Students Two Decades after Vaccination: Surprising Feedback

Health-care students can be exposed to biological risks during university training. The persistence of long-term immunogenicity against hepatitis B virus (HBV) was analyzed in a cohort of nursing students two decades after primary vaccination. A total of 520 students were enrolled at the University of Palermo and were evaluated for levels of anti-HBsAg antibodies. ThestudentswereexaminedduringthefirstyearoftheirDegreeCourseandwerecheckedtwoyears later. All students with anti-HBsAg <10 mIU/mL during their first or third year were boosted within onemonth. Theproportionofstudentsthatwerevaccinatedduringadolescenceshowinganti-HBsAg ≥10 mIU/mL was higher than that observed in students who were vaccinated during infancy (69% versus31.7%;p-value<0.001). ReceivingHBVvaccinationatadolescencewassignificantlyassociated with a fourfold increased possibility of having anti-HBsAg titers≥10 mIU/mL (adj-OR = 4.21, 95% CI: 2.43–7.30). Among the students who were checked at the third year and boosted after the first year (n = 279), those who were vaccinated during infancy showed a higher percentage of antibody titers <10 mIU/mL (20.3% versus 8.7% among vaccinated during adolescence; p < 0.01). This study confirms that HBV vaccination at adolescence might determine a higher long-term persistence of anti-HBsAg titers≥10 mIU/mL and that anti-HBV booster could increase levels of anti-HBsAg over a relatively short period, especially in subjects who were vaccinated during infancy

L’ESPERIENZA DELLA SICILIA QUALE REGIONE CAPOFILA NELLA INTRODUZIONE DELLA VACCINAZIONE UNIVERSALE CONTRO I ROTAVIRUS

La gastroenterite da rotavirus (GARV) rappresenta uno dei principali bisogni assistenziali durante l’età pediatrica. Purtroppo, in Italia, in assenza di notifica obbligatoria e di specifici sistemi di sorveglianza, le uniche valutazioni epidemiologiche disponibili sulle GARV sono rese possibili dall’analisi delle ospedalizzazioni. Il presente lavoro ha avuto l’obiettivo di valutare le ospedalizzazioni per GARV e per intussuscezione, avvenute in Sicilia in soggetti di età compresa tra 0 e 60 mesi, negli anni 2003-2012 (periodo prevaccinale) e 2013 (anno di introduzione della vaccinazione antirotavirus). Nel periodo in esame si sono osservate 9.886 ospedalizzazioni per GARV con una media annua di 899 casi. La maggior parte dei ricoveri (62,3%) è stata registrata nella fascia di età compresa tra 0 e 2 anni con una progressiva riduzione negli anni di vita successivi. Durante il 2013 si è osservata una copertura vaccinale regionale attestatasi tra il 30 ed il 40% per la prima dose ed il 25-35% per la seconda dose. Nello stesso anno si è assistito ad una riduzione dei casi di GARV di circa il 38,9% nei soggetti di età 0-5 anni (931 casi/anno nel 2003-2012 vs. 569 nel 2013) e superiore al 50% nella fascia di età 0-11 mesi (277 casi/anno nel 2003-2012 vs. 137 nel 2013). Diversamente, nel 2013 il numero di ospedalizzazioni per intussuscezione in soggetti di età compresa tra 0 ed 11 mesi si è mantenuta in linea con quanto osservato in epoca prevaccinale (15 casi nel 2013 vs. 15,4 casi/anno osservati in media tra 2003 e 2012). I dati presentati evidenziano l’importante peso assistenziale che le GARV hanno annualmente in Sicilia e supportano l’efficacia della vaccinazione nella riduzione significativa dei casi di ospedalizzazione per GARV in assenza di incrementi di rischio di intussuscezione

Estimating the burden of hospitalization for pneumococcal pneumonia in a general population aged 50 years or older and implications for vaccination strategies

Streptococcus pneumoniae is a major cause of human infectious diseases worldwide. Despite this documented evidence, data on pneumococcal disease rates among general populations are scant because of the frequent lack of cultural identification. In this study we propose a model for estimating the burden of pneumococcal pneumonia on hospitalizations. The study was performed by analyzing administrative and clinical data of patients aged 50 years or older, resident in Sicily, and hospitalized, from 2005 to 2012. Demographic information, admission/discharge dates, discharge status, and up to 6 discharge diagnoses coded according to ICD-9 CM were collected for each hospitalized patient. During the 8-year study period, a total of 72 372 hospitalizations with at least one ICD-9 CM diagnosis code suggestive of all-cause pneumonia were recorded. Of these, 1943 (2.7%) hospitalizations had specific ICD-9 CM diagnosis codes for pneumococcal pneumonia. According to the proposed model, 16 541 (22.9%) pneumonia out of all-cause pneumonia was estimated to be attributable to S. pneumoniae. Pneumococcal pneumonia and model-estimated pneumococcal pneumonia had mean hospitalization rates of 13.4 and 113.3/100 000, respectively, with a decreasing temporal trend. The risk of hospitalization for pneumococcal pneumonia was strongly correlated with age (P<0.001). Our model provides data usable to construct suitable decisional models for the decision-makers and could allow to the responsibles of healthcare facilities to assess the budget impact if they hypothesize to offer vaccination for pneumococcal disease to certain cohorts of subjects aged 50 years or older. In our area, the high estimated hospitalization rates among adults aged ≥65 years suggest the need to implement effective preventive strategies (e.g., vaccination) tailored for these groups

Invasive pneumococcal diseases in children aged 1-59 months in sicily, Italy: Importance of active family paediatrician surveillance and vaccination coverage

Purpose: Aim of this study was to analyze pediatric invasive pneumococcal disease rates several years after the implementation of infant pneumococcal vaccination. Methods: The study was carried out in Sicily and involved about 30,000 children, aged 1-59 months, actively monitored by 100 family pediatricians during 2010 and 2011. All children who met the inclusion criteria were considered eligible, recorded using a stan-dardized case report form and investigated for the presence of S. pneumoniae in speci-mens from sterile sites. Results: None of the 40 eligible children was confirmed as a case of invasive pneumococ-cal disease. The incidence rate of invasive pneumococcal disease cases was 0.0/100,000 in both years. Regional childhood pneumococcal vaccination coverage rates were 90.7% in 2010 and 92.0% in 2011. Conclusions: Our results show that during the study period invasive pneumococcal dis-ease cases were rare in Sicilian children, suggesting a very effective control of the disease in a region with very high vaccination coverage against S. pneumoniae

Analysis of hospitalizations due to intussusception in Sicily in the pre-rotavirus vaccination era (2003-2012)

Background: Intussusception is the most common cause of bowel obstruction in infants with an incidence ranging from 9-328 cases per 100,000 infants aged 0-11 months. Causes underlining this clinical manifestation are still unknown. Possible relationship with a withdrawn tetravalent rotavirus vaccine was not confirmed by post-licensure studies and actually no increased risk of intussusception was found between infants vaccinated with both the recently licensed rotavirus vaccines. Aim of this study is to analyze the intussusception hospitalizations in Sicily from 2003 to 2012 before the introduction of rotavirus universal vaccination and its possible relation with rotavirus gastroenteritis trend. Methods: Were collected data from hospital discharge records occurred from 1st January 2003 to 31st December 2012 in Sicily. Intussusception cases were defined as all hospitalizations with an ICD-9-CM code of 560.0 on any discharge diagnoses. As a proxy for the severity of cases were considered ICD-9-CM procedure codes accounting for surgical or radiologic reduction. Results: A total of 340 intussusception cases were hospitalized in Sicily from 2003 to 2012 in children aged 0-59 months. 46.8 % occurred in the age class 0-11 months. Hospitalization rate for intussusception was 11.4 cases per 100,000 per year (32.6 cases per 100,000 among 0-11 months children; 7.3 cases per 100,000 among 12-59 months children), with a M:F sex ratio of 1.8. During hospitalization only 25 % of intussusceptions had a spontaneous resolution, 56.5 % of cases required a surgical intervention. From 2003 to 2012 intussusception cases were equally distributed during the year without any seasonality, while gastroenteritis hospitalizations due to rotavirus infection have a typically late winter and spring distribution. Conclusions: In Sicily from 2003 to 2012 hospitalizations due to intestinal invagination were higher among children aged 0-11 months with observed rates similar to other European countries. Regional baseline data analysis of intussusception among 0-59 children is recognized as an evidence-based public health strategy by international health authorities. Indeed, this strategy is necessary to compare any post-licensure age or sex-related change in intussusception trend after universal rotavirus vaccination introduction

Biofilm production in Staphylococcus epidermidis strains isolated from the skin of hospitalized patients: Genetic and phenotypic characteristics

A major virulence factor of Staphylococcus epidermidis is its ability to form biofilms, permitting it to adhere to a surface and, in turn, to form a mucoid layer on polymer surfaces. Multiple factors have been found to influence bacterial attachment. Currently, this bacterium is commonly associated with hospital infections as a consequence of its ability to colonize, albeit accidentally, medical devices. This study investigated the genetic and phenotypic formation of biofilm in 105 S. epidermidis strains isolated from the skin of hospitalized patients. Fifty-eight of these strains were positive for the mecA gene (MRSE) and 47 were found to be negative (MSSE). Genetic characterizations were performed for the detection of the mecA, icaADBC, atlE, aap, bhp, IS256 and agr groups by PCR. Biofilm production was examined by culturing the strains in TBS medium and TBS with 0.5 and 1% respectively of glucose, and a semiquantitative assay on tissue culture plates was used. Although a molecular analysis estimate of detailed biofilm formation is costly in terms of time and complexity, a semiquantitative assay can be proposed as a rapid and cheap diagnostic method for initial screening to discover virulent strains. We confirmed a close correlation between genetic and phenotypic characteristics, highlighting the fact that, when S. epidermidis isolates were cultured in TSB with 1% of glucose, an increase in biofilm production was observed, as confirmed by positivity for the ica locus by molecular analysis

Diagnosis of Influenza: Only a Problem of Coding?

Objective: To evaluate the characteristics of hospital discharge diagnoses of influenza measured by using specific International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) codes. Subjects and Methods: The study was conducted for the 3 years 2007, 2008 and 2011. The database included (1) administrative and clinical data on Sicilian patients admitted to acute care hospitals and (2) data from the influenza virological surveillance of 10 European countries (FluNet database). All Sicilian patients diagnosed with at least 1 ICD-9 CM code for influenza (487.0, 487.1 and 487.9) were considered influenza cases. Results: Overall, 2,880 patients with an ICD-9 CM code attributable to influenza were hospitalized in Sicily: 2,119 (73.6%) were admitted from November to April, whereas 761 (26.4%) were admitted from May to October. In the 3 years studied, the analyzed European influenza surveillance systems recorded a peak of laboratory-confirmed influenza activity from November to April with 36,753 (99.7%) influenza cases, whereas only 124 cases (0.3%) were observed from May to October. Conclusions: In Sicily, more than one quarter of all hospital admissions with an ICD-9 CM code for influenza were observed in the months with a negligible circulation of influenza viruses. Our findings show that several hospital discharge records included ICD-9 CM codes for influenza with low levels of sensitivity, specificity and/or appropriateness for clinical information and support the need for improving medical education on the epidemiology and hospital management of influenza cases

The use of haemostatic agents in thyroid surgery: efficacy and further advantages: Collagen-Fibrinogen-Thrombin Patch (CFTP) versus Cellulose Gauze.

Abstract Aim: To assess the efficacy of two widely used topical haemostatic agents: oxidised regenerated cellulose gauze and Collagen-Fibrinogen-Thrombin Patch in patients undergoing total thyroidectomy. Material of study: This was a prospective, comparative, non-randomised study in which consecutive patients undergoing total thyroidectomy for benign disease received standard treatment with no haemostatic agent, cellulose gauze, or CFTP. Main outcome measures were drainage volume 24 hours after surgical procedure and the occurrence of post-operative complications (haematoma, seroma, surgical-site infection). Results: Two hundred seventy-one (271) patients undergoing total thyroidectomy for benign disease: 65 received standard treatment, 60 received cellulose gauze and 146 received CFTP. Seroma was significantly reduced in the CFTP group compared with both the cellulose gauze group (p=0.006) and the standard treatment group (p=0.017). A significant reduction in drainage volume was also observed with CFTP compared with the other two groups (both p<0.001). Drainage volume was also significantly reduced with cellulose gauze versus standard treatment (p<0.001). No septic events were observed after application of CFTP. One hematoma was observed in the non haemostatic group. Conclusions: Both haemostatic agents reduced the amount of sero-hematic fluid during the first 24 hours post-surgery, with CFTP more effective than oxidized cellulose gauze. The use of haemostatic agents may increase the quality of thyroid surgery, improve patient comfort after surgery, and reduce hospital stay