Coverage, efficacy or dosing interval: which factor predominantly influences the impact of routine childhood vaccination for the prevention of varicella? A model-based study for Italy

Background: Varicella is a highly infectious disease with a significant public health and economic burden, which can be prevented with childhood routine varicella vaccination. Vaccination strategies differ by country. Some factors are known to play an important role (number of doses, coverage, dosing interval, efficacy and catch-up programmes), however, their relative impact on the reduction of varicella in the population remains unclear. This paper aims to help policy makers prioritise the critical factors to achieve the most successful vaccination programme with the available budget. Methods: Scenarios assessed the impact of different vaccination strategies on reduction of varicella disease in the population. A dynamic transmission model was used and adapted to fit Italian demographics and population mixing patterns. Inputs included coverage, number of doses, dosing intervals, first-dose efficacy and availability of catch-up programmes, based on strategies currently used or likely to be used in different countries. The time horizon was 30 years. Results: Both one- and two-dose routine varicella vaccination strategies prevented a comparable number of varicella cases with complications, but two-doses provided broader protection due to prevention of a higher number of milder varicella cases. A catch-up programme in susceptible adolescents aged 10-14 years old reduced varicella cases by 27-43 % in older children, which are often more severe than in younger children. Coverage, for all strategies, sustained at high levels achieved the largest reduction in varicella. In general, a 20 % increase in coverage resulted in a further 27-31 % reduction in varicella cases. When high coverage is reached, the impact of dosing interval and first-dose vaccine efficacy had a relatively lower impact on disease prevention in the population. Compared to the long (11 years) dosing interval, the short (5 months) and medium (5 years) interval schedules reduced varicella cases by a further 5-13 % and 2-5 %, respectively. Similarly, a 10 % increase in first-dose efficacy (from 65 to 75 % efficacy) prevented 2-5 % more varicella cases, suggesting it is the least influential factor when considering routine varicella vaccination. Conclusions: Vaccination strategies can be implemented differently in each country depending on their needs, infrastructure and healthcare budget. However, ensuring high coverage remains the critical success factor for significant prevention of varicella when introducing varicella vaccination in the national immunisation programme

Effect of stripe clearing on 4 grasses species and 2 broadleaves of caldenal

En la Región del Espinal, Distrito del Caldén, en la provincia de San Luis existe un fuerte proceso de agriculturización con la consecuente pérdida de remanentes de bosque nativo, peligro de conservación de especies nativas e invasión de especies exóticas. El objetivo del presente trabajo fue evaluar el efecto del desmonte en franjas sobre 6 especies del caldenal (4 gramíneas y 2 latifoliadas). El estudio se realizó en un campo a 15 km. al norte de la ciudad de Villa Mercedes (San Luis), sometido a un desmonte en franjas para uso agrícola en el año 2003. En 5 sitios ubicados en franjas remanentes de bosque nativo y 5 en bosque nativo sin desmonte, se trazaron transectas de 39 m de longitud, dirección NS y a lo largo de la misma se registraron las especies presentes en 14 unidades de muestreo de 1 m2. Los datos se analizaron utilizando IBM SPSS Statistics 19, mediante Métodos No Paramétricos, U de Mann-Whitney. El análisis estadístico mostró diferencias significativas (p<0.05) en Digitaria californica, Pappophorum pappiferum, Salsola kali y Cestrum parqui. El estudio demostró que el cultivo entre franjas de bosque nativo produjo un cambio en la frecuencia de poáceas nativas y de latifoliadas.In the region of “Espinal”, Calden Distrct in the province of San Luis there is a strong agriculturization process with the consequent loss of native forest remnants, conserving endangered native species and invasion of exotic species. The aim of this study was to evaluate the effect of the stripe clearing on 6 species of caldenal (4 grasses and 2 broa- dleaves). The study was conducted in a field 15 km to the north of the city of Villa Mercedes (San Luis), subjected to a strip-clearing for agricultural use, in the year 2003. On 5 sites into native forest remnants stripes and 5 into without clearing native forest, 39 m long tran- sects were laid, N-S direction, and along the same were recorded the presente species in 14 sampling units of 1 m2. Data were analyzed by IBM SPSS Statistics 19, through non- parametric methods, Mann-Whitney U. Statistical analysis showed significant differences (p <0.05) in Digitaria californica, Pappophorum pappiferum, Salsola kali and Cestrum par- qui. The study showed that the cultivation of native forest between stripes was a change in the frequency of native grasses and broadleaves.Fil: Ruiz, O. M.. Universidad Nacional de San Luis; Argentina;Fil: Luna, H. R.. Universidad Nacional de San Luis; Argentina;Fil: Bacha, Emmanuel Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico - CONICET - San Luis; Argentina; Universidad Nacional de San Luis; Argentina;Fil: Pedranzani, H.. Universidad Nacional de San Luis; Argentina;Fil: Gabutti, E.G.. Universidad Nacional de San Luis; Argentina

Burden of herpes zoster-associated chronic pain in Italian patients aged 50 years and over (2009¿2010): a GP-based prospective cohort study.

BackgroundPost-herpetic neuralgia (PHN) is the most common complication in herpes zoster (HZ) patients.MethodsWe performed a longitudinal, prospective study in 108 general practices throughout Italy to assess how many immunocompetent patients aged ¿50 years with newly diagnosed HZ develop HZ-associated pain, its duration and management over 6-months. HZ-associated pain was assessed by a direct question to the patient and by self-assessment of the worst pain felt in the previous two weeks on a visual analogue scale (VAS), a score ¿3 was taken as pain. PHN was defined as pain reported during the study period persisting for ¿3 months. Quality of life (QoL) was measured using the SF-12 questionnaire.ResultsAt enrolment, 370 of the 413 patients (89.6%) reported HZ-associated pain which was still present in 20.6% and 9.2% of patients after three and six months, respectively, despite many patients receiving recommended anti-viral therapy. The overall QoL scores were lower than those in healthy Italians of similar age; scores for patients with HZ-associated pain were lower. The presence of >50 vesicles and VAS score ¿3 at enrolment, and being male were significantly associated with PHN at three months.ConclusionsThese results suggest that HZ and PHN represent an important burden of disease in the elderly. There is a need for interventions that can prevent and reduce the burden of HZ to help improve the quality of life of the elderly. These data may be useful as baseline epidemiology data for the assessment of the impact of the VZV vaccine in Italy, after its implementation

Fourteen years’ clinical experience and the first million babies protected with human live-attenuated vaccine against rotavirus disease in Italy

Rotavirus (RV) causes up to half of hospital and community acute gastroenteritis (AGE) cases in young children in Italy. Two RV vaccines, available since 2006, are human RV (HRV) and human bovine RV (HBRV). This report looks back at the implementation of RV vaccination with HRV in Italy, and at HRV current and future perspectives. Initial regional policies led to national implementation by 2018, after scientific societies’ disease awareness efforts. Following vaccination, RV hospitalizations declined significantly, and cost savings were observed. The two-dose HRV vaccine is easily administered during compulsory vaccine visits, helping increase coverage. Intussusception, a serious event in children &lt;1 year, was reported in Italy with a rate of 33–40 per 100,000 infants. RV vaccination presents a low increased risk of intussusception after the first dose, estimated at 0.6 cases per 100,000 doses in Italy in 2019. Parents should be aware of the intussusception risk and symptoms to ensure prompt treatment. It is widely recognized that the vaccination benefits (large numbers of RV hospitalizations prevented) outweigh the risk. HRV introduction in Italy was supported by epidemiologic burden studies, healthcare provider opinions, and congress debates, which significantly contributed to implementation of RV universal routine infant vaccination in Italy

A 2-year point-prevalence surveillance of healthcare-associated infections and antimicrobial use in Ferrara University Hospital, Italy

Background: Healthcare-Associated Infections (HAIs) represent one of the leading issues to patient safety as well as a significant economic burden. Similarly, Antimicrobial Use (AMU) and Resistance (AMR) represent a growing threat to global public health and the sustainability of healthcare services. Methods: A Point Prevalence Survey (PPS) following the 2016 ECDC protocol for HAI prevalence and AMU was conducted at Ferrara University Hospital (FUH). Data were collected by a team of trained independent surveyors in 2016 and 2018. Risk factors independently associated with HAI were assessed by a multivariate logistic regression model. Results: Of the 1102 patients surveyed, 115 (10.4%) had an active HAI and 487 (44.2%) were on at least 1 systemic antimicrobial agent. Factors independently associated with increased HAI risk were a "Rapidly Fatal" McCabe score (expected fatal outcome within 1 year), presence of medical devices (PVC, CVC, indwelling urinary catheter or mechanically assisted ventilation) and a length of hospital stay of at least 1 week. The most frequent types of HAI were pneumonia, bloodstream infections, and urinary tract infections. Antimicrobial resistance to third-generation cephalosporins was observed in about 60% of Enterobacteriaceae. Conclusions: The survey reports a high prevalence of HAI and AMU in FUH. Repeated PPSs are useful to control HAIs and AMU in large acute-care hospitals, highlighting the main problematic factors and allowing planning for improvement actions

Post-graduate medical education in public health: The case of Italy and a call for action

Public health technical expertise is of crucial importance to inform decision makers\u2019 action in the field of health and its broader determinants. Improving education and training of public health professionals for both practice and research is the starting point to strengthen the role of public health so that current health challenges can be efficiently tackled. At the Association of Schools of Public Health in the European Region (ASPHER) Deans\u2019 & Directors\u2019 2017 Annual Retreat, we presented the structure and management of public health training system in Italy, and we reported recent data on Italian public health specialists\u2019 educational experience, employment opportunities and job satisfaction. Public health training in Italy is implemented in the context of the post-graduate medical education residency programme in Hygiene and Preventive Medicine, delivered by 34 University-based Schools of Public Health. We report relatively high employment rates across the county and wide spectrum of career opportunities for young public health specialists. However, job security is low and training expectations only partially met. We call upon other Schools of Public Health to scale up the survey within the broad ASPHER community in a shared and coordinated action of systematically collecting useful data that can inform the development of public health education and training models, their implementation and fruitful interaction with population health, health systems and services

Gradiente de pastoreo bovino desde la aguada según la permanencia animal en Digitaria eriantha diferida

3 sectors were defined with different intensity of disturbance in a paddock of Digitaria eriantha, by georeferenced positions of a cow. Fecal abundance into 9 squares sampling sites of 144 m2 and coverage of Digitaria and native winter species before and after grazing period, in 3 permanent transects 10 m long by sector, were registered. To summarize the information of vegetation, INTECO was applied and forage availability was estimated in 9 samples of 0.5 m2 by sector. Fecal concentration gradually decreased getting away from the watering point. Digitaria coverage and forage availability after grazing period decreased in the 3 sectors, while in winter species just did it in nearby "C" and medium "M". The forage condition established by INTECO decreased one category after grazing period for sectors "C" and "M", in "L" (far) show a greater impact due to the entry of external animals. The geoposition of grazing animals lets to define a grazing gradient, and the studied variables support this effect. The position of grazing animals allows to define a grazing gradient, and the studied variables support this effect. The identification of grazing gradient regard to the watering point is paramount to improve the design of paddocks and water distribution, to enhance the efficiency of forage harvest.Se delimitaron 3 sectores con distinta intensidad de disturbio en un potrero de Digitaria eriantha, mediante la localización georeferenciada de una vaca de cría. Se registraron las heces presentes en 9 cuadros de muestreo de 144 m2 y cobertura de digitaria e invernales forrajeras antes y después del periodo de pastoreo en 3 transectas fijas de 10 m de largo, por sector. Para sintetizar la información de la vegetación, se aplicó el INTECO y se estimó la disponibilidad forrajera de 9 muestras de 0,5 m2 por sector. La concentración de heces decreció gradualmente al alejarse de la aguada. Las coberturas de Digitaria y forrajimasa luego del periodo de pastoreo disminuyeron en los 3 sectores, mientras la de invernales sólo lo hizo en cercano “C” y medio “M”. La condición forrajera establecida por INTECO, disminuyó una categoría luego del pastoreo en los sectores “C” y “M”, en “L” (lejos) hubo un mayor impacto debido al ingreso de animales externos. La geoposición de animales en pastoreo permite definir un gradiente de pastoreo, y las variables estudiadas corroboran dicho efecto. La identificación del gradiente de pastoreo respecto a la aguada es de suma importancia para mejorar el diseño de potreros y aguadas, y optimizar la eficiencia de cosecha forrajera

Has VZV epidemiology changed in Italy? Results of a seroprevalence study

The aim of the study was to evaluate if and how varicella prevalence has changed in Italy. In particular a seroprevalence study was performed, comparing it to similar surveys conducted in pre-immunization era. During 2013–2014, sera obtained from blood samples taken for diagnostic purposes or routine investigations were collected in collaboration with at least one laboratory/center for each region, following the approval of the Ethics Committee. Data were stratified by sex and age. All samples were processed in a national reference laboratory by an immunoassay with high sensitivity and specificity. Statutory notifications, national hospital discharge database and mortality data related to VZV infection were analyzed as well. A total of 3707 sera were collected and tested. In the studied period both incidence and hospitalization rates decreased and about 5 deaths per year have been registered. The seroprevalence decreased in the first year of life in subjects passively protected by their mother, followed by an increase in the following age classes. The overall antibody prevalence was 84%. The comparison with surveys conducted with the same methodology in 1996–1997 and 2003–2004 showed significant differences in age groups 1–19&nbsp;y. The study confirms that in Italy VZV infection typically occurs in children. The impact of varicella on Italian population is changing. The comparison between studies performed in different periods shows a significant increase of seropositivity in age class 1–4&nbsp;years, expression of vaccine interventions already adopted in some regions

Attributes influencing parental decision-making to receive the Tdap vaccine to reduce the risk of pertussis transmission to their newborn – outcome of a crosssectional conjoint experiment in Spain and Italy

Pertussis vaccination of parents and household contacts (‘cocooning’) to protect newborn infants is an established strategy in many countries, although uptake may be low. Many aspects may influence such decision-making. We conducted a cross-sectional survey (NCT01890447) of households and other close contacts of newborns aged ≤6 months (or of expectant mothers in their last trimester) in Spain and Italy, using an adaptive discrete-choice experiment questionnaire. Aims were to assess the relative importance of attributes influencing vaccine adoption, and to estimate variation in vaccine adoption rates and the impact of cost on vaccination rates. Six hundred and fifteen participants (Spain, n = 313; Italy, n = 302) completed the survey. Of 144 available questionnaire scenarios, the most frequently selected (14% of respondents in both countries) were infant protection by household vaccination at vaccination center, recommendation by family physician and health authorities, with information available on leaflets and websites. The attribute with highest median relative importance was ‘reduction in source of infection’ in Spain (23.1%) and ‘vaccination location’ in Italy (18.8%). Differences between other attributes were low in both countries, with media attributes showing low importance. Over 80% of respondents indicated a definite or probable response to vaccine adoption (at no-cost) with estimated probability of adoption of 89–98%; applying vaccine costs (25€ per person) would reduce the probability of uptake by 7–20% in definite/probable respondents. Awareness of these determinants is helpful in informing Health Authorities and healthcare practitioners implementing a cocooning strategy for those populations where maternal immunization is not a preferred option

Hospitalizations associated with rotavirus gastroenteritis in Spain, 2001–2005

<p>Abstract</p> <p>Background</p> <p>This study aims to describe and analyze hospital admissions in Spain due to rotavirus infections among children aged 5 years or under during the period 2001–2005, along with the associated health cost.</p> <p>Methods</p> <p>To update estimates of rotavirus hospitalizations rates in Spain, we conducted a retrospective study of 5 years of national hospitalization data associated with acute gastroenteritis using the Minimum Basic Data Set.</p> <p>Results</p> <p>During the study period, a total of 17.1% of all admissions due to acute gastroenteritis of any etiology in children aged ≤ 5 years were attributable to rotavirus infection as determined by the rotavirus-specific International Classification of Diseases, ninth revision, Clinical Modification code. A mean incidence of 135 hospital admissions attributable to rotavirus per 100,000 children aged ≤ 5 years was found. Hospitalizations associated with rotavirus had a marked winter-time seasonality. The estimated cost of hospital admission attributable to rotavirus has risen from 3 million euros estimated for 2001 to almost 7 million euros estimated in 2005.</p> <p>Conclusion</p> <p>Rotavirus gastroenteritis remains an important cause of hospitalizations in Spanish children, mostly during the winter season.</p