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Hepatitis A in Puglia (South Italy) after 10 years of universal vaccination: need for strict monitoring and catch-up vaccination
Chironna Maria,Prato Rosa,Sallustio Anna,Martinelli Domenico
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-271
Abstract: Background Raw seafood consumption was identified as the major risk factor for hepatitis A during the large epidemic of 1996 and 1997 in Puglia (South Italy). In Puglia, vaccination for toddlers and preadolescents has been recommended since 1998. The aim of the study was to evaluate the incidence, seroprevalence, molecular epidemiology, and environmental circulation of hepatitis A virus (HAV) in Puglia more than ten years after the introduction of anti-HAV vaccination in the regional immunization program. Methods Data on the incidence of acute hepatitis A in Puglia were analyzed. Characteristics and risk factors of 97 acute hepatitis A cases occurring in 2008–2009 were analyzed. Serum samples from 868 individuals aged 0 to 40 years were tested for anti-HAV antibodies. Fecal samples from 49 hepatitis A cases were analyzed by sequence analysis in the VP1/P2A region. In 2008, 203 mussel samples and 202 water samples from artesian wells were tested for HAV-RNA. Results Between 1998 and 2009, the incidence of acute hepatitis A declined from 14.8 to 0.8 per 100,000. The most frequent risk factors reported by cases in 2008–2009 were shellfish consumption (85%) and travel outside of Puglia or Italy (26%). Seroepidemiologic survey revealed high susceptibility to HAV in children and adults up to age 30 (65%-70%). None of the mussel or water samples were HAV-positive. Phylogenetic analysis revealed co-circulation of subtypes IA (74%) and IB (26%) and clustering of strains with strains from Germany and France, and those previously circulating in Puglia. Conclusion Vaccination and improved sanitation reduced the incidence of hepatitis A. Strict monitoring and improved vaccination coverage are needed to prevent disease resurgence.
Reproductive life disorders in Italian celiac women. A case-control study
Domenico Martinelli, Francesca Fortunato, Silvio Tafuri, Cinzia A Germinario, Rosa Prato
BMC Gastroenterology , 2010, DOI: 10.1186/1471-230x-10-89
Abstract: The association between celiac disease and menstrual cycle, gestation and puerperal disorders in a sample of 62 childbearing age women (15-49 age) was assessed within an age and town of residence matched case-control study conducted in 2008. Main outcome measures were the presence of one or more disorders in menstrual cycle and the presence of one or more complication during pregnancy.62 celiac women (median age: 31.5, range: 17-49) and 186 healthy control (median age: 32.5, range: 15-49) were interviewed. A higher percentage of menstrual cycle disorders has been observed in celiac women. 19.4% frequency of amenorrhea was reported among celiac women versus 2.2% among healthy controls (OR = 33, 95% CI = 7.17-151.8;, p = 0.000). An association has been observed between celiac disease and oligomenorrhea, hypomenorrhea, dysmenorrhea and metrorrhagia (p < 0.05). The likelihood of having at least one complication during pregnancy has been estimated to be at least four times higher in celiac women than in healthy women (OR = 4.1, 95% CI = 2-8.6, p = 0.000). A significant correlation has emerged for celiac disease and threatened abortion, gestational hypertension, placenta abruption, severe anaemia, uterine hyperkinesia, intrauterine growth restriction (p < 0.001). A shorter gestation has on average been observed in celiac women together with a lower birth weight of celiac women babies (p < 0.001).The occurrence of a significant correlation between celiac disease and reproductive disorders could suggest to consider celiac disease diagnostic procedures (serological screening) in women affected by these disorders.Celiac Disease (CD), also known as celiac sprue or gluten enteropathy, is a permanent intolerance to gluten, a protein complex contained in wheat, barley and rye, characterized by a wide clinical variability. In genetically predisposed subjects, exposure to gluten results in a mucosal damage which, progressing through different stages of severity, causes small-intest
The perception of healthcare quality of elderly in the city of Bari, South Italy
Rosa Prato, Domenico Martinelli, Annarita Fusco, Annarita Panebianco, Pietro Lopalco, Cinzia Germinario, Michele Quarto
BMC Health Services Research , 2007, DOI: 10.1186/1472-6963-7-174
Abstract: In this context, it is essential to analyze elderly real health needs and the responses to these needs, especially in terms of healthcare, that the territorial services are perceived to offer.In the period from June to September 2006 we selected randomly one General Practitioner (GP) for each district of the Bari Municipal Area and, form each GP, we randomly chose 25 patients over 65 years old (YO). We conducted phone interviews using a standard data collection questionnaire and, for each of the recruited subjects, the GP filled a data collection sheet.Although the mean age (73.6 years) of the population under study was quite high, the general state of health was judged good both by the G P- and by their elderly patients (>75%).Notably, the great majority of elderly patients considered the healthcare they receive to be satisfactory (>60%): in particular, the GP was the true point of reference for this slice of the population for strictly medical problems as well as for advice. On the contrary, the patients attributed little value to social services, which were poorly known and scarcely used (8.5%). Public hospital facilities played a central role in second level healthcare in more than 30% of cases; private facilities covered by public health insurance were also very important. As possible solutions to the problem of loneliness, 36.6% of the patients declared that they approved of nursing homes.Decision makers need to create services supporting the key role played by General Practitioners, who are well aware that their assistance is not sufficient to satisfy the health needs of the elderly.In recent decades in Italy, as in all the industrialized nations, the proportion of elderly subjects in the total population is constantly increasing. The progressive aging of the population is the result of profound demographic changes that include both a falling birth rate and a consistent decline in the mortality rates for all causes [1-4].Life expectancy at 60 years of age has
Norovirus gastroenteritis general outbreak associated with raw shellfish consumption in South Italy
Rosa Prato, Pier Lopalco, Maria Chironna, Giovanna Barbuti, Cinzia Germinario, Michele Quarto
BMC Infectious Diseases , 2004, DOI: 10.1186/1471-2334-4-37
Abstract: A retrospective cohort study was performed in order to assess risk factors associated with illness. All households where a case occurred were included in the study. Faecal specimens were collected from ill individuals. NV-specific RT-PCR was performed. Eleven samples of mussels were collected from fish-markets involved in the outbreak. A nested PCR was used for mussel samples.One hundred and three cases, detected by means of active surveillance, met the case definition. Raw shellfish eating was the principal risk factor for the disease, as indicated by the analytic issues (Risk Ratio: 1.50; IC 95%: 1.18 – 1.89; p < 0.001). NVs were found by means of RT-PCR of all the stool specimens from the 24 patients tested. Eleven samples of shellfish from local markets were tested for the presence or NVs; six were positive by nested PCR and genotypes were related to that found in patients' stools.This is the first community outbreak caused by NVs related to sea-food consumption described in Italy. The study confirms that the present standards for human faecal contamination do not seem to be a reliable indicator of viral contaminants in mussels.Norovirus (NV, previously "Norwalk-like viruses"), one of four genera in the Caliciviridae family, includes a group of morphologically similar but genetically different single-stranded RNA viruses. NVs represent the most important cause of non-bacterial gastroenteritis worldwide. In industrialised countries NVs may be responsible for up to 80% of all outbreaks of gastroenteritis [1]. Outbreaks may affect all age groups and generally occur in crowded communities such as restaurants, tourist resorts, hospitals, schools and nursing homes.Contaminated food or water commonly represents the main source of infection. Epidemics spread by the faecal-oral route, even if transmission may also occur through direct person-to-person contact or aerosolised viral particles.The incubation period of NV gastroenteritis is 24–48 hours and symptoms include vo
Prevalence of Hepatitis B, C, HIV and syphilis markers among refugees in Bari, Italy
Silvio Tafuri, Rosa Prato, Domenico Martinelli, Livio Melpignano, Maria De Palma, Michele Quarto, Cinzia Germinario
BMC Infectious Diseases , 2010, DOI: 10.1186/1471-2334-10-213
Abstract: The study was carried out in the period May-July 2008 and recruited only voluntarily enrolled healthy refugees. HBsAg, anti-HBc, anti-HCV and anti-HIV virus antibodies were detected. VDRL syphilis screening was also carried out on the serum samples.A total of 529 refugees, 442 males and 87 females, aged between 7 and 52 years, were studied. Of these, 510 were from Africa and 19 from Asia.Forty-four individuals (8.3%) were HBsAg positive and 241 (45.6%) were anti-HBc positive. A total of 24 (4.5%) individuals were anti-HCV positive. Eight asylum seekers (1.5%) were HIV positive. VDRL tests were performed on 269 subjects and 4 (1.5%) were positive. 12.3% of the study population had serological markers of chronic and transmissible infections with potential blood-borne or sexual transmission.In Italy, a suitable protocol is necessary for the early diagnosis of infectious diseases on entering Asylum Centres, so allowing the adoption of prevention measures to safeguard the health of the individuals, the residents and workers in the Centres and the general population.There are estimated to be about 3.8 million immigrants in Italy, around 6% of the resident population. In 2008 alone the non-Italian population increased by about 500.000. Reliable estimates of immigration movements can be ascertained from the figures for hirings of non-Italians by companies and families in recent years. These are 251,000 in 2005, 520,000 in 2006 and 741,000 in 2007. The immigration movements reported in the last ten years are among the highest in Italian history [1].Puglia is a region in southeastern Italy bordering the Adriatic Sea in the east, the Ionian Sea to the southeast, and the Strait of Otranto and Gulf of Taranto in the south. Because of its geographic position, Puglia has since 1991 been subject to immigration influx, at times on a large scale, and is recognized to be a "Border Region" [2].In recent years there has also been an increase in the number of people asking for asylum and
Genetic characterization of measles virus strains isolated during an epidemic cluster in Puglia, Italy 2006–2007
Maria Chironna, Rosa Prato, Anna Sallustio, Domenico Martinelli, Cinzia Germinario, Pierluigi Lopalco, Michele Quarto
Virology Journal , 2007, DOI: 10.1186/1743-422x-4-90
Abstract: Measles, a highly contagious exanthematic disease, is still a threat for children both in developing and developed countries despite the introduction of routine vaccination. World Health Organization (WHO) has strengthened the strategies for the control of measles and its related complications and mortality worldwide [1].Active epidemiologic surveillance, laboratory confirmation of suspected cases and monitoring of measles virus genotypes are also primary goals for countries of the WHO European region involved in the process of eliminating measles [2]. Therefore, molecular epidemiology of measles virus has proven a useful tool for epidemiologic investigation and enables the identification of source of infection and transmission pathways [3].Measles virus (MV), a RNA virus belonging to Morbillivirus genus of the family of Paramixoviridae, is considered monotypic although genetic heterogeneity has been evidenced among wild strains [4]. Actually, 23 genotypes (A, B1–B3, C1–C2, D1–D10, E, F, G1–G3 and H1–H2) have been recognized circulating in different parts of the world, five of them (B1, D1, E, F, and G1) considered inactive since they have not been detected in the past 15 years [5].In Italy, a National Elimination Plan for Measles and Congenital Rubella was implemented in 2003 with the aim of elimination of indigenous transmission of measles and of reduction of congenital rubella cases to <1-case/100,000 live births according to WHO program for European Region [6].In order to reach the objective, laboratory surveillance of cases and identification of contacts during outbreaks and their prompt immunization was set up to limit the spread of infection. In fact, based on the current coverage levels for MMR (measles, mumps and rubella) in Italy (a national average of 88% with the first dose within 24 months of age and 46% with the second dose in 2005) and considering the scenario prospected by mathematical models, periodical outbreaks of the diseases could occur due to t
Sur une généralisation de la notion de V-variété
Elisa Prato
Mathematics , 1999, DOI: 10.1016/S0764-4442(99)80291-2
Abstract: Nous consid\'erons un espace topologique qui est localement isomorphe au quotient de R^k par l'action d'un groupe discret et nous l'appelons quasi-vari\'et\'e de dimension k. Les quasi-vari\'et\'es g\'en\'eralisent les vari\'et\'es et les V-vari\'et\'es et repr\'esentent le cadre naturel pour la r\'eduction symplectique par rapport \`a l'action induite d'un sous-groupe de Lie, compact ou non, d'un tore. Nous d\'efinissons les quasi-tores, les actions hamiltoniennes de quasi-tores et l'application moment sur une quasi-vari\'et\'e symplectique, et nous montrons que tout polytope convexe simple, rationnel ou non, est l'image de l'application moment pour l'action d'un quasi-tore sur une quasi-vari\'et\'e.
Simple Non-Rational Convex Polytopes via Symplectic Geometry
Elisa Prato
Mathematics , 1999,
Abstract: In this article we consider a generalization of manifolds and orbifolds which we call quasifolds; quasifolds of dimension k are locally isomorphic to the quotient of R^k by the action of a discrete group - tipically they are not Hausdorff topological spaces. The analogue of a torus in this geometry is a quasitorus. We define Hamiltonian actions of quasitori on symplectic quasifolds and we show that any simple convex polytope, rational or not, is the image of the moment mapping for a family of effective Hamiltonian actions on symplectic quasifolds having twice the dimension of the corresponding quasitorus.
Italian healthcare workers' views on mandatory vaccination
Silvio ST Tafuri, Domenico DM Martinelli, Giovanni GC Caputi, Annamaria AA Arbore, Cinzia CG Germinario, Rosa RP Prato
BMC Health Services Research , 2009, DOI: 10.1186/1472-6963-9-100
Abstract: The survey was carried out using a self-administered standardised anonymous questionnaire given to all of the Vaccination Service employees in the Apulia Region.Of 302 completed questionnaire replies, 4.4% stated that mandatory vaccination should be abandoned now, 21.2% that it should be phased out, and 74.4% that it should be retained.An educational program should be set up to explain to Vaccination staff the value and worth of voluntary compared to mandatory vaccination and why high vaccination rates do not have to depend on compulsion.Mandatory vaccination was introduced for the first time in the nineteenth century in some European countries following the then sweeping smallpox epidemics [1]. Compulsory vaccination for some diseases is still extant in some countries like France, Greece, Portugal and Belgium; in other countries, like the United Kingdom and Finland, vaccinations are voluntary but the state pursues a policy of active promotion and information-giving, with vaccination being free to the user. In the USA and in Canada vaccinations are not compulsory, but some are a requirement for school enrolment [2].In Italy, the Jenner anti-smallpox vaccination was made compulsory by law on the 22nd December 1888 [3]. A further health law in 1934 allowed revaccination by the health authorities in the case of a high risk of the spreading of smallpox [4]. With the eradication of the disease, mandatory vaccination was suspended in 1977 and abolished in 1981 [5].As of today, vaccination, as pre-exposure prophylaxis, is mandatory for infants against diphtheria, tetanus, polio and hepatitis B [6-9].Currently, within the scientific community, both nationally and internationally, there is an ongoing debate on compulsory vaccination and though it has contributed to the success of immunisation programmes, its benefits are not universally recognised [10]. Rossi L. et al declare that: being duty-bound to vaccination doesn't allow people to develop a "vaccination conscience" and
Serological survey on immunity status against polioviruses in children and adolescents living in a border region, Apulia (Southern Italy)
Silvio Tafuri, Rosa Prato, Domenico Martinelli, Agata Calvario, Anna Bozzi, Michele Labianca, Annamaria Patti, Pietro Lopalco, Cinzia Germinario
BMC Infectious Diseases , 2008, DOI: 10.1186/1471-2334-8-150
Abstract: 704 blood specimens from a convenience sample were collected in six laboratories. The age of subjects enrolled was 0–15 years. The immunity against poliomyelitis was evaluated by neutralizing antibody titration in tissue culture microplates.Seropositivity (neutralising antibodies titre ≥ 8) for polioviruses 1, 2 and 3 was detected in 100%, 99.8% and 99.4% of collected sera. Antibody titres were not lower in subjects who received either four doses of inactivated polio vaccine (IPV) or a sequential schedule consisting of two doses of IPV and two of oral polio vaccine than in subjects who received four doses of OPV.These results confirmed current data of vaccine coverage for poliomyelitis: during the last ten years in Apulia, the coverage in 24 months old children was more than 90%. The high level of immunization found confirms the effectiveness both of the sequential schedule IPV-OPV and of the schedule all-IPV. Apulia region has to face daily arrivals of refugees and remains subject to the risk of the importation of poliovirus from endemic areas. Surveys aimed at determining anti-polio immunity in subpopulations as well as in the general population should be carried out.In 1988 the World Health Assembly adopted the goal to eradicate poliomyelitis by routine immunization using Oral Polio Vaccine (OPV) at birth followed by three doses at 6, 10 and 14 weeks supplemented by surveillance for acute flaccid paralysis (AFP), national immunization days (NIDs) and mopping-up immunization campaigns [1].In developing countries, during the National Immunization Days, as recommended by the World Health Organization (WHO), two doses of OPV were given to all children under the age of five irrespective of their vaccination status [2]. The final stages of this program require a mopping-up activity, that is a door-to-door search for subjects to be immunized. This operation turns out to be particularly effective in those areas characterized by poor health infrastructure and immunization
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