The Italian Response to the 2009 H1N1 Pandemic.

In 2009, the global spread of pH1N1 prompted countries worldwide to intensify their efforts to protect the population's health to minimize the impact of the pandemic on society and the economy. Despite this common goal, considerable variability in health policies were observed around the world. This chapter analyzes the Italian public health system's infrastructure and organizational characteristics, and the policies implemented during the response to the 2009 H1N1 pandemic by using data obtained through semistructured interviews and a facilitated look-back activity. Italy and the United States faced similar challanges in the response to the pandemic, including difficulties in interpreting surveillance data, the late availability of the vaccine, and barriers in communication with the public in the midst of uncertainty regarding the evolution of the outbreak and media hype. However, the two countries differed in the way they addressed specific issues, mainly as a result of substantial differences in their organizational structure. This chapter analyzed the differences between Italy and the United States in the policies and procedures implemented to allocate vaccines, in the role and responsabilities of national and local public health agencies, and in the coordiantion of efforts between private and public providers. This chapter also aims to provide contextual informations to enable readers to understand the reasons behind specific public health decisions and, eventually, compare them with decisions undertaken in the United States. This chapter begins with a brief description of the context and characteristics of the Italian public health system, including a brief introduction to its organization, a history of major healthcare reforms, and a description of the steps undertaken during the past 10 years by national and regional governments in the development of pandemic preparedness plans. This description is followed by an analysis of the challanges, strategies, and decisions made in the response to the pandemic

The Chikungunya epidemic in Italy and its repercussion on the blood system

BACKGROUND: The Chikungunya virus (CHIKV) is transmitted by Aedes mosquitoes and recently caused a massive epidemic on La R\ue9union Island, in the Indian Ocean. Between July and September 2007 it caused the first autochthonous epidemic outbreak in Europe, in the Region of Emilia-Romagna in the north-east of Italy. MATERIALS AND METHODS: After the first reports of an unusually high number of patients with a febrile illness of unknown origin in two contiguous villages, an outbreak investigation was carried out to identify the primary source of infection, the modes of transmission and the dynamics of the epidemic. An active surveillance system was also implemented. Laboratory diagnosis was performed through serology and polymerase chain reaction (PCR) analysis. Blood donation was discontinued in the areas involved from September to October 2007 and specific precautionary blood safety and self-sufficiency measures were adopted by the regional health and blood authorities and the National Blood Centre. An estimate method to early assess the risk of viraemic blood donations by asymptomatic donors was developed, as a tool for "pragmatic" risk assessment and management, aiming at providing a reliable order of magnitude of the mean risk of CHIKV transmission through blood transfusion. RESULTS: Two hundred and seventeen cases of CHIKV infection were identified between 4th July and 28th September. The disease was fairly mild in most of the cases. The precautionary measures adopted in the blood system caused a considerable reduction of the collection of blood components and of the delivery of plasma to the pharmaceutical industry for contract manufacturing. The estimated risk of CHIKV transmission through blood transfusion peaked in the third week of August. CONCLUSION: ACHIKV epidemic poses considerable problems for public health authorities, who not only need good routine programmes of vector control and epidemiological surveillance but also local and national emergency plans to sustain the blood supply, so as to promptly deal with the potentially severe effects of an epidemic outbreak, especially when affected areas locally require a significant blood inventory and at the same time represent a critical resource for other areas depending on external supplies of blood components