Initial impact of SARS-Cov-2 vaccination on healthcare workers in Italy. Update on the 28th of march 2021

In Italy, the COVID-19 vaccination campaign started in December 2020 with the vaccination of healthcare workers (HCW). To analyse the real-life impact that vaccination is having on this population group, we measured the association between week of diagnosis and HCW status using log-binomial regression. By the week 22–28 March, we observed a 74% reduction (PPR 0.26; 95% CI 0.22–0.29) in the proportion of cases reported as HCW and 81% reduction in the proportion of symptomatic cases reported as HCW, compared with the week with the lowest proportion of cases among HCWs prior to the vaccination campaign (31 August-7 September). The reduction, both in relative and absolute terms, of COVID-19 cases in HCWs that started around 30 days after the start of the vaccination campaign suggest that COVID-19 vaccines are being effective in preventing infection in this group

Effectiveness of mRNA vaccines and waning of protection against SARS-CoV-2 infection and severe covid-19 during predominant circulation of the delta variant in Italy: Retrospective cohort study

Objectives To estimate the effectiveness of mRNA vaccines against SARS-CoV-2 infection and severe covid-19 at different time after vaccination. Design Retrospective cohort study. Setting Italy, 27 December 2020 to 7 November 2021. Participants 33 250 344 people aged ≥16 years who received a first dose of BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine and did not have a previous diagnosis of SARS-CoV-2 infection. Main outcome measures SARS-CoV-2 infection and severe covid-19 (admission to hospital or death). Data were divided by weekly time intervals after vaccination. Incidence rate ratios at different time intervals were estimated by multilevel negative binomial models with robust variance estimator. Sex, age group, brand of vaccine, priority risk category, and regional weekly incidence in the general population were included as covariates. Geographic region was included as a random effect. Adjusted vaccine effectiveness was calculated as (1-IRR)×100, where IRR=incidence rate ratio, with the time interval 0-14 days after the first dose of vaccine as the reference. Results During the epidemic phase when the delta variant was the predominant strain of the SARS-CoV-2 virus, vaccine effectiveness against SARS-CoV-2 infection significantly decreased (P<0.001) from 82% (95% confidence interval 80% to 84%) at 3-4 weeks after the second dose of vaccine to 33% (27% to 39%) at 27-30 weeks after the second dose. In the same time intervals, vaccine effectiveness against severe covid-19 also decreased (P<0.001), although to a lesser extent, from 96% (95% to 97%) to 80% (76% to 83%). High risk people (vaccine effectiveness -6%, -28% to 12%), those aged ≥80 years (11%, -15% to 31%), and those aged 60-79 years (2%, -11% to 14%) did not seem to be protected against infection at 27-30 weeks after the second dose of vaccine. Conclusions The results support the vaccination campaigns targeting high risk people, those aged ≥60 years, and healthcare workers to receive a booster dose of vaccine six months after the primary vaccination cycle. The results also suggest that timing the booster dose earlier than six months after the primary vaccination cycle and extending the offer of the booster dose to the wider eligible population might be warranted

Impact of tiered restrictions on human activities and the epidemiology of the second wave of COVID-19 in Italy

To counter the second COVID-19 wave in autumn 2020, the Italian government introduced a system of physical distancing measures organized in progressively restrictive tiers (coded as yellow, orange, and red) imposed on a regional basis according to real-time epidemiological risk assessments. We leverage the data from the Italian COVID-19 integrated surveillance system and publicly available mobility data to evaluate the impact of the three-tiered regional restriction system on human activities, SARS-CoV-2 transmissibility and hospitalization burden in Italy. The individuals’ attendance to locations outside the residential settings was progressively reduced with tiers, but less than during the national lockdown against the first COVID-19 wave in the spring. The reproduction number R(t) decreased below the epidemic threshold in 85 out of 107 provinces after the introduction of the tier system, reaching average values of about 0.95-1.02 in the yellow tier, 0.80-0.93 in the orange tier and 0.74-0.83 in the red tier. We estimate that the reduced transmissibility resulted in averting about 36% of the hospitalizations between November 6 and November 25, 2020. These results are instrumental to inform public health efforts aimed at preventing future resurgence of cases

Epidemiological characteristics of COVID-19 cases in non-Italian nationals notified to the Italian surveillance system

BACKGROUND: International literature suggests that disadvantaged groups are at higher risk of morbidity and mortality from SARS-CoV-2 infection due to poorer living/working conditions and barriers to healthcare access. Yet, to date, there is no evidence of this disproportionate impact on non-national individuals, including economic migrants, short-term travellers and refugees. METHODS: We analyzed data from the Italian surveillance system of all COVID-19 laboratory-confirmed cases tested positive from the beginning of the outbreak (20th of February) to the 19th of July 2020. We used multilevel negative-binomial regression models to compare the case fatality and the rate of admission to hospital and intensive care unit (ICU) between Italian and non-Italian nationals. The analysis was adjusted for differences in demographic characteristics, pre-existing comorbidities, and period of diagnosis. RESULTS: We analyzed 213 180 COVID-19 cases, including 15 974 (7.5%) non-Italian nationals. We found that, compared to Italian cases, non-Italian cases were diagnosed at a later date and were more likely to be hospitalized {[adjusted rate ratio (ARR)=1.39, 95% confidence interval (CI): 1.33-1.44]} and admitted to ICU (ARR=1.19, 95% CI: 1.07-1.32), with differences being more pronounced in those coming from countries with lower human development index (HDI). We also observed an increased risk of death in non-Italian cases from low-HDI countries (ARR=1.32, 95% CI: 1.01-1.75). CONCLUSIONS: A delayed diagnosis in non-Italian cases could explain their worse outcomes compared to Italian cases. Ensuring early access to diagnosis and treatment to non-Italians could facilitate the control of SARS-CoV-2 transmission and improve health outcomes in all people living in Italy, regardless of nationality

Meningiti, meningo-encefaliti ed encefaliti da virus Toscana in Italia, 2016-2021. Punta dell’iceberg di una arbovirosi endemica poco conosciuta

Toscana virus meningitis, meningo-encephalitis and encephalitis in Italy, 2016-2021: the tip of the iceberg of a poorly known endemic arbovirus Introduction Toscana virus (TOSV) is an emerging pathogen, however it is seldom considered by physicians among the differential diagnoses of summer meningitis, leading to under-ascertainment. The aim of this study is to describe cases of laboratory confirmed TOSV central nervous system (CNS) infections, notified in Italy in the period 2016-2021. Materials and methods We described all cases of meningitis/meningo-encephalitis/encephalitis notified to the Italian national TOSV surveillance system from 2016 to 2021. All cases were laboratory-confirmed. We calculated incidence (overall, stratified by year, sex, age group and by municipal urbanization level) and the frequency of hospitalizations and deaths. Results Between June 2016 and October 2021, 331 confirmed cases of TOSV meningitis/meningo-encephalitis/ encephalitis were reported in Italy (median 56 cases/year) of whom 292 were hospitalized. The cases were reported in 9/21 Italian Regions with the highest incidence in rural municipalities. Average age was 46 (range 0-89 years), most cases were male (233, 70%). An increased notification rate was observed in 2018 when incidence (1.47 cases/1,000,000) was almost twice the mean incidence in the remaining study period (0.81 cases/1,000,000). Overall, incidence was higher in age groups between 20 and 59 years. In 2020-2021 no deaths were reported. Discussion and conclusions The number of human infections caused by TOSV in Italy is under-estimated and diverse testing policies may bias the observed case distribution. Higher incidences in working age males and in rural municipalities might point to specific risk factors, also occupational. While no deaths were recently reported, TOSV impacts on hospital services

Nonrespiratory Complications and Obesity in Patients Dying with COVID-19 in Italy

Objective: This study aimed to assess the impact of obesity on nonrespiratory complications in patients dying with coronavirus disease (COVID-19). Methods: Medical charts of 3,694 of patients dying with COVID-19 in Italy were reviewed to extract information on demographics, preexisting comorbidities, and in-hospital complications leading to death. Multivariate logistic regressions were performed to assess the association of obesity with nonrespiratory complications. These analyses were adjusted for age, gender, and number of preexisting comorbidities. Results: Obesity was present in 411/3,694 (11.1%) patients dying with COVID-19. Obesity was significantly associated with increased probability of experiencing acute renal failure (adjusted odds ratio [OR], 1.33; 95% CI: 1.04-1.71) and shock (adjusted OR, 1.54; 95% CI: 1.19-1.99). The associations of obesity with acute renal failure and shock were stronger in patients aged < 60 years (adjusted OR, 2.00; 95% CI: 1.09-3.67 and OR, 2.37; 95% CI 1.29-4.36) than in those aged 60 years or older (adjusted OR, 1.20; 95% CI: 0.90-1.60 and OR, 1.22; 95% CI: 0.91-1.65). Conclusions: In patients dying with COVID-19 in Italy, obesity is associated with an increased probability of nonrespiratory complications, particularly shock and acute renal failure. These associations seem stronger in younger than in older adults. Strategies should be put in place in patients with COVID-19 with obesity to prevent these complications