Occupational risk from measles in healthcare personnel: a case report

In 2006 and 2008 two different outbreaks of measles, both occurring during winter seasons, were reported in the region of Apulia in south-eastern Italy. The second of these epidemics involved both young adults and children younger than 13 mo, the latter being the age range established by the Regional Vaccination Schedule for the first dose of the measles, mumps, rubella (MMR) vaccine 1, 2) . The present epidemiological pattern of measles in Apulia reflects the vaccination efforts conducted in Italy from 2003, when the implementation of the National Elimination Plan for Measles and Congenital Rubella started up. The Plan engaged all Italian Regions in an extra-ordinary effort to reach target coverage of 95% in children at 24 mo of age, to introduce a second MMR dose at 5‐6 yr of age (target: 90% coverage by 2007), and to carry out a catch-up vaccination program making use of all the occasions of contact children had with the vaccination services, including a campaign aimed at inviting all children of school age in primary and lower secondary schools (up to 8th grade) who had not yet received the two recommended MMR vaccine doses 3) . Measles is usually a mild non-life-threatening disease in otherwise healthy children, but it may be severe with complications in infants, adults and people with impaired immune systems. Since the target MMR coverage for the WHO European Region (>95% for both doses) has not yet been reached, there is still the risk of outbreaks in susceptible adult subjects, and this includes health care workers. In Italy the current trends for measles in fact show an increase in the average age of infection. The vaccination of susceptible healthcare personnel against measles is recommended because it protects both the employee from complications and the patient from infection. In March, in an Apulian hospital, a case of measles was reported in a nurse, who worked in the Paediatric Unit where a child infected by measles had been hospitalized. Case Repor

Italy and Austria before and after study: second-hand smoke exposure in hospitality premises before and after 2 years from the introduction of the Italian smoking ban.

UNLABELLED: The aim of this paper was to compare nicotine concentration in 28 hospitality premises (HPs) in Florence and Belluno, Italy, where a smoking ban was introduced in 2005, and in 19 HPs in Vienna, Austria, where no anti-smoking law entered into force up to now. Airborne nicotine concentrations were measured in the same HPs in winter 2002 or 2004 (pre-ban measurements) and winter 2007 (post-ban measurements). In Florence and Belluno, medians decreased significantly (P < 0.001) from 8.86 [interquartile range (IQR): 2.41-45.07)] before the ban to 0.01 microg/m3 (IQR: 0.01-0.41) afterwards. In Austria (no smoking ban) the medians collected in winters 2004 and 2007 were, respectively, 11.00 (IQR: 2.53-30.38) and 15.76 microg/m3 (IQR: 2.22-31.93), with no significant differences. Measurements collected in winter 2007 in 28 HPs located in Naples, Turin, Milan (0.01 microg/m3; IQR: 0.01-0.16) confirmed post-ban results in Florence and Belluno. The medians of nicotine concentrations in Italy and Austria before the Italian ban translates, using the risk model of Repace and Lowery, into a lifetime excess lung cancer mortality risk for hospitality workers of 11.81 and 14.67 per 10,000, respectively. Lifetime excess lung cancer mortality risks for bar and disco-pub workers were 10-20 times higher than that calculated for restaurant workers, both in Italy and Austria. In winter 2007, it dropped to 0.01 per 10,000 in Italy, whereas in Austria it remained at the same levels. The drop of second-hand smoke exposure indicates a substantial improvement in air quality in Italian HPs even after 2 years from the ban. PRACTICAL IMPLICATIONS: The nation-wide smoking ban introduced in Italy on January 10, 2005, resulted in a drop in second-hand smoke exposure in hospitality premises, whereas in Austria, where there is no similar nation-wide smoking ban, the exposure to second-hand smoke in hospitality premises remains high. Given that second-hand smoke is considered a group 1 carcinogen according to the International Agency for Research on Cancer classification, the World Health Organization Framework Convention on Tobacco Control strongly recommends the implementation of nation-wide smoke-free policies in order to improve the indoor air quality of hospitality premises and workplaces. Results from our study strongly supports this recommendation