Reorganization of Active Surveillance of Acute Flaccid Paralysis (AFP) in Emilia-Romagna, Italy: a two-step Public Health intervention

Background and aim of the work: The International Health Regulations Emergency Committee declared in 2014 that poliovirus circulation is a public health emergency of international concern. In 2017 and 2018 Italy was classified at intermediate risk of poliovirus reintroduction based on suboptimal poliovirus surveillance. Acute flaccid paralysis active surveillance is the gold standard in the polio eradication process. The aims of this study were to investigate the causes of reduced acute flaccid paralysis case reporting in Emilia-Romagna in the last few years (step 1) and to study a public health intervention to restore an adequate level of acute flaccid paralysis surveillance in that region (step 2). Methods: In the first step a context analysis was performed by analysing the 2015-2017 Hospital Discharge Registers in Emilia-Romagna with the ICD-9-CM differential diagnosis codes for acute flaccid paralysis. Data from context analysis was then used to plan a new regional collaborative network of acute flaccid paralysis active surveillance. Results: The active surveillance network was, at the end of the study, composed by 49 doctors from both hospital administrations and clinical wards from 4 University Hospitals and 7 Local Health Authorities throughout the Region. In 15 months, 7 acute flaccid paralysis cases have been reported; 85,7% received a full clinical and virological investigation and 83,3% completed the 60 day's follow-up. The mean response to each e-mail was 48,5% (SD 7,5%). Conclusions: In 2019, the Emilia-Romagna's active surveillance system reached the sensitivity, completeness of case investigation and follow-up required to achieve the minimum levels for certification standard surveillance

Fatty acid based ionic liquids from methyl carbonates: synthesis and characterization.

In the last fifteen years, ionic liquids (ILs) have attracted considerable attention. Through continuous efforts of numerous researchers, ILs have achieved not only a consolidated popularity as “green” solvents for synthesis and extraction processes, but also as powerful catalysts, electrolytes, precursors or additives to employ in several of areas. The most attractive feature of these salts, liquid at or near room temperature, is the possibility to modify the principal physico-chemical and biological properties varying cation and/or anion structure. Herein, we report a halogen free procedure to prepare fluorine-free hydrophobic ILs. ILs composed by an imidazolium or ammonium cation and a fatty acid anion, with different chain length and saturation degree, have been synthesized by simple addition of a fatty acid to methylcarbonate based ILs in methanol. The acidity of the fatty acid is indeed sufficient to decompose the methylcarbonate anion to methanol and carbon dioxide. With respect to the classical procedure to prepare carboxylic ILs, this synthetic pathway starts from methycarbonates, prepared by alkylation of the proper base with the “green” dimethylcarbonate, and avoids metathesis reactions through silver salts. Critical points characterizing this apparently simple synthetic procedure will be evidenced. The principal physico-chemical properties of this class of highly hydrophobic ILs [1], characterized by good thermal and chemical stability, as well as the possible applications as diathermic fluids or organized media will be discussed

Poliovirus and non-polio-enterovirus environmental surveillance in Parma within the "Global Polio Eradication Program" (GPEI)

Introduzione: La sorveglianza ambientale per poliovirus svolge un ruolo essenziale nell’ambito del GPEI sia per il rilevamento della circolazione WTP e VDPV in aree endemiche sia per il monitoraggio della loro assenza nei paesi “polio-free”. Metodi: Dal 2005 al 2018, 642 campioni di acque reflue sono stati raccolti dai due impianti di trattamento di Parma, ed analizzati secondo le Linee Guida dell’OMS. Tutti i “sospetti poliovirus” isolati nel periodo sono stati caratterizzati presso il laboratorio di riferimento dell’ISS; invece la tipizzazione dei NPEV si riferisce solo al 2005-2016. Risultati: Il 68% dei campioni è risultato positivo senza differenze significative tra i due impianti. Sono stati rilevati 6 poliovirus (1,4%), tutti caratterizzati come Sabin-like: 4 polio 3 (66,7%) e 2 polio 1 (33,3%). L’85% dei NPEV sono risultati Coxsackievirus B di cui B4 il sierotipo più frequente (31%); tra gli Echovirus (15%) prevalgono Echo7 ed Echo11 (entrambi 23%). Conclusione: Poiché l’OPV non è utilizzato in Italia dal 2002, l’isolamento di poliovirus Sabin-like indica la possibilità di reintroduzione del poliovirus, considerando anche l’importante esposizione ai flussi migratori. Infine il monitoraggio della circolazione ambientale di NPEV potrebbe supplire alla mancanza di un sistema di sorveglianza delle infezioni da essi sostenute.Background: Environmental surveillance of poliovirus plays an essential role in GPEI both for the detection of WTP and VDPV circulation in endemic areas and for monitoring their absence in polio free countries. Methods: Since 2005 to 2018, in Parma, 642 wastewater samples were collected from the two wastewater treatment plants and analyzed according to the WHO Guidelines. All isolates supposed being poliovirus were sent to ISS reference laboratory for molecular characterization while NPEV only refer to samples up to 2016. Results: Positivity was obtained in 68% of samples without significant difference between the two treatment plants. Six polioviruses (1.4%) were detected, all characterized as Sabin-like: 4 of them (66.7%) were type 3 and 2 (33.3%) type 1. Coxsackieviruses B mainly recurred among NPEV (85%) while residual 15% was Echoviruses. B4 was the most frequent Coxsackie serotype isolated (31%) while, among Echovirus, Echo 7 and Echo 11 prevail (both 23%). Conclusion: As OPV isn’t used in Italy since 2002, recovery of Sabin-like polioviruses indicates the possibility of poliovirus reintroduction, considering also the important exposure to migratory flows. Finally, monitoring the environmental circulation of NPEV, could compensate for the lack of a surveillance system of the infections they cause

SINTOMATOLOGIA E PROGNOSI ASSOCIATE ALLE PARALISI FLACCIDE ACUTE (PFA) NELL’AMBITO DELLA SORVEGLIANZA ATTIVA CONDOTTA IN EMILIA ROMAGNA DAL 1996 AL 2014.

Introduzione La sorveglianza attiva delle PFA coordinata in Italia dall’Istituto Superiore di Sanità (ISS) e dal Ministero della Salute è lo strumento principale attraverso cui si certifica il raggiungimento e il mantenimento dello stato di paese libero da polio. Seppur con tassi di incidenza variabili negli anni da 0,1/100.000 a 1,4/100.000, l’UO di Sanità Pubblica dell’Università degli Studi di Parma (laboratorio OMS di referenza sub-nazionale per la polio) partecipa, dal 1996 in modo continuativo, al progetto di sorveglianza coordinando l’attività nella Regione Emilia Romagna (ER). Metodi Sono state analizzate le caratteristiche cliniche dei bambini con PFA identificati in ER, esplorando la presenza di febbre all’esordio, la progressione della paralisi, la localizzazione, l’eventuale asimmetria, l’esito a 60 giorni e la diagnosi finale in relazione a sesso, età e provenienza (WHO–recommended standards for surveillance of selected vaccine-preventable diseases, 2003). Risultati Dal 1996 al 2014, sono stati identificati 52 soggetti di età < 15 anni affetti da PFA con un’età mediana di 6 anni. La diagnosi finale è stata in più del 50% dei casi Sindrome di Guillain Barré. Il 53,8% dei bambini erano maschi, 42 italiani e 10 stranieri (19,2%). All’esordio era presente febbre nel 37,5% dei casi, paralisi asimmetrica nel 36,6% e progressiva nel 70% dei casi. A 60 giorni la paralisi era presente nel 29,3% dei casi. In tale gruppo l’età mediana era maggiore (11 vs 6) seppur in modo non statisticamente significativo. Il sesso femminile (OR 11,2 IC95% 2,0 – 61,4), l’assenza di febbre all’esordio, l’assenza di progressione e l’asimmetria (OR 6,1 IC95% 1,23 – 30,1) sono risultati associati alla persistenza dei sintomi a 60 giorni. Conclusioni La sorveglianza attiva delle PFA, rappresenta uno strumento fondamentale di conoscenza del territorio che integra evidenze epidemiologiche, virologiche e cliniche rilevanti nell’ambito del programma di eradicazione della poliomielite