Hospitalization rates for intussusception in children aged 0–59 months from 2009 to 2014 in Italy

The real cause of intussusception is not fully understood and a variety of conditions have been associated with it (Meckel diverticulum, polyps, duplication cysts, parasites, Henoch-Schönlein purpura, cystic fibrosis, hemolytic-uremic syndrome and infectious gastroenteritis). Furthermore few European countries, following WHO recommendation to monitor baseline incidence of intussusception before implementation of immunization program for rotavirus, used intussusception rate as a baseline value to compare the same figures in the period before and after introduction of vaccination. In this study, data of intussusception hospitalizations occurred among Italian children aged 0 through 59 months from 2009 to 2014 were analyzed. A total amount of 3,088 children were included, accounting for a hospitalization rate of 20.2 per 100,000. Overall, the hospitalization rate for intussusception had a slight increase in trend from 2009 to 2014 (18%). In particular children 0–11 months had a hospitalization rate higher than 12–59 months with an aggregate value of 36 Vs. 16 per 100,000 respectively. Among all children hospitalized for intussusception a total of 239 (7.7%) had also a previous or concomitant hospitalization for gastroenteritis. This study demonstrates that Italian hospitalizations for intussusception are increasing by time and the role played by different risk factors, including acute gastroenteritis, have to be investigated in the future. These data could be useful to monitor intussusception hospitalization in the perspective of anti-rotavirus vaccination introduction in Italy

Cost analysis of the first two year of universal mass vaccination against rotavirus in Sicily

Background Rotavirus vaccination (RV) is recognized by international health authority as the best strategy to prevent rotavirus gastroenteritis (RVGE) in children. Costs of RVGE were estimated in several studies and were classified into direct and indirect costs, that should be further divided into Health care and social perspective. This study aims to evaluate RVGE hospitalization costs in Sicily, before and after universal mass RV (UMRV) introduction. Methods Cases of RVGE were defined as all hospitalizations with an ICD-9-CM diagnosis code of 008.61 on any diagnosis position among children aged 0 to 59 months. Data were obtained from Hospital discharge records (HDR) of the Health Regional Office from 2009 to 2014. Direct and indirect costs of RVGE hospitalization for health care and social perspective were calculated on data reported in the REVEAL study. RV costs was extrapolated from a budget impact analysis published in 2013 by Vitale et al. Results In Sicily, during the pre-vaccination era (2009-2012) were reported 963 RVGE hospitalizations per year with a mean HDR cost of 1,521E (1,465,000E per year) , against 511 RVGE cases per year (mean HDR cost of 1,321E; 675,000E per year) after UMRV introduction (direct hospitalization Health care costs). Moreover, direct and indirect hospitalization costs for social perspective was estimated 1.5 times bigger than direct hospitalization health care cost (pre-vaccination era 2,255,000E per year, post-vaccination era 1,020,000E per year). Finally, cost of RV vaccine in Sicily in 2013 and 2014 was 1,300,000E per year (mean vaccination coverage 37%). In Sicily after RV introduction, every year was estimated a 46% reduction of RVGE hospitalizations and a 700,000E benefit for Regional fund. Conclusions Despite low vaccination rate and even though the inability to evaluate the impact of RV vaccination on primary care and emergency access for RVGE, our study demonstrated the high cost-effectiveness of UMRV on hospitalization rate and costs in Sicily

Post-vaccine measles in a child with concomitant influenza, Sicily, Italy, March 2015

We describe the occurrence of measles in an 18 monthold patient in Sicily, Italy, in March 2015, who received the first dose of a measles-containing vaccine seven days before onset of prodromal symptoms. Measles virus infection was confirmed by PCR and detection of specific immunoglobulin; viral genotyping permitted the confirmation of a vaccine-associated illness. The patient had a concurrent influenza virus infection, during a seasonal epidemic outbreak of influenza

Occurrence of a case of influenza A(H1N1)pdm09 and B co-infection during the epidemic season 2012–2013

We report the detection of one case of co-infection with influenza A(H1N1)pdm09 and B, occurred during the 2012–2013 influenza season in Sicily. The dual infection was identified in a 18-year-old boy, who was not covered by specific vaccination and who had no other pre-existing risk factors. He presented classical symptoms of influenza-like illness developing no respiratory complications. A(H1N1)pdm09 viral concen- tration was initially about 10-fold higher than B virus, whereas its clearance was more rapidly achieved than in the case of B virus infection. Although influenza co-infection appears to be a rare event, a contin- ued influenza surveillance activity is recommended, in order to evaluate diversity and evolution, but also to support public health prevention measures

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

Prevalence of Occult Hepatitis B Virus Infection in a Cohort of HIV-Positive Patients Resident in Sicily, Italy

Occult hepatitis B virus (OBI) in HIV-infected groups is still debated, as well as the associated risk-factors and clinical significance. In this paper, we examined a total of 405 HBsAg-negative/HIV-infected patients enrolled from January 2007 to December 2009. Overall, the prevalence of OBI was 5.9% (95% confidence interval (CI95%): 3.8–8.7%); it was more frequently associated with “anti- HBc alone” serological marker (11.3%; adjusted odds ratio = 3.7, CI95%: 1.4–9.8), although it was also detected in the absence of any HBV serological marker (4.9%; CI95%: 2.3–9.1%). A low prevalence of anti-HCV-positive patients with OBI was found (3.1%; CI95%: 0.6–8.7%). HIV RNA plasma levels or other immunological/clinical characteristics were not significantly associated with OBI. All but one occult HBV infections were sustained by genotype D viral strains. OBI is relatively frequent in HIV-infected patients, although it does not seem to exert a relevant clinical impact. Viral genotypes in occult HBV infections reflect those circulating in the Mediterranean area

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

Cardiovascular effects of occupational exposure to urban airborne pollution on a group of newsagents in the city of Palermo

Aims: To verify the possible correlation between exposure to airborne particulate matter the average size less than 10 μm (PM 10) of a group of newsagents working in kiosks in Palermo and evidence of carotid intimal thickening. Materials and methods: data were collected relating to environmental monitoring of airborne pollutants. We have selected a sample of newsagents, who were submitted to some clinical investigations, including the carotid echo-color doppler examination. Results: The results show no correlation between the location of the kiosks, and the presence of intimal thickening. Conclusion: Exposition to urban pollutants in Palermo is likely homogenous in the different areas and can be considered an ubiquitous atherogenic risk factor

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

Impatto della vaccinazione antirotavirus sulle ospedalizzazioni per gastroenterite rotavirale in regione Sicilia

La gastroenterite rotavirale (GERV) è una delle principali cause di ricovero nei bambini di età inferiore ai 5 anni in Italia. L'unica strategia di Sanità Pubblica in grado di prevenirla è la vaccinazione. La Sicilia è stata la prima regione italiana ad introdurre la vaccinazione universale anti-Rotavirus (anti-RV) nel Gennaio 2013. Sono stati raccolti i dati relativi ai ricoveri con codice ICD-IX CM 008.61 in qualsiasi posizione di diagnosi nei bambini di età compresa tra 0 e 59 mesi residenti in regione Sicilia nel periodo pre (2009-2012) e post (2013-2015) INTRODUZIONE vaccinale. Tra il 2009 ed il 2015 sono stati osservati 5.718 ricoveri per GERV. Sono stati registrati una media di 961 casi annui in periodo pre vaccinale, con un tasso ospedalizzazione (TO) medio di 394/100.000, e di 624 casi annui (TO 270/100.000) in periodo post vaccinale. La riduzione di ospedalizzazioni per GERV è stata più consistente nella classe di età 0-35 mesi (-41%) in cui era disponibile il vaccino nel periodo in studio. Si è osservato anche uno shift del picco stagionale dei ricoveri per GERV confrontando periodo pre e post vaccinale da Aprile a Maggio (Figura 1). Le Provincie con le migliori coperture vaccinali hanno evidenziato riduzioni più marcate dei tassi di ospedalizzazione. In Sicilia, dopo i primi tre anni di attività e con coperture vaccinali medie del 37%, i tassi di ospedalizzazione per GERV sono complessivamente in diminuzione. In particolare, i maggiori benefici si sono osservati nelle classi di età in cui era disponibile il vaccino (0-35 mesi) e nelle Provincie con coperture vaccinali superiori al 45%. La spostamento in avanti del picco di ricoveri per GERV, se confermato in futuro, potrebbe configurare un minore sovraccarico dei reparti pediatrici e una minore possibilità di trasmissione di patologie nosocomiali, venendo a mancare la sovrapposizione con patologie respiratorie tipiche del periodo tardo invernale (virus respiratorio sinciziale, influenza)