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The creation of guidelines is a methodologically complex activity that requires technical expertise, resources and time. Methods of guideline production must meet at least these three criteria: multidisciplinarity, systematic review, and ranked recommendations. In May 2015, the new "Guidelines for the prevention and control of Legionnaire's disease" were published on the website of the Italian Ministry of Health in order to "gather, update and integrate in a single document all the previous national recommendations published". The critical review of the document has led us to conclude that this document does not comply with these three criteria, and we emphasize that guidelines should make decision-making easier, considering the various scientific approaches to a health problem and choosing the one considered most effective. Therefore, the persons responsible for the development of guidelines should strive to widely adopt and use current standards for the development of guidelines as a means to improve patient care and health outcomes.

Ming-Chyi Pai,1,2 Hany Aref,3 Nazem Bassil,4 Nagaendran Kandiah,5 Jae-Hong Lee,6 AV Srinivasan,7 Shelley diTommaso,8 Ozgur Yuksel81Division of Behavioral Neurology, Department of Neurology, 2Alzheimer’s Disease Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; 3Department ofNeurology, Ain Shams University, Cairo, Egypt; 4Saint Georges Hospital Medical Center, Balamand University, Beirut, Lebanon; 5Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore; 6Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, South Korea; 7The Tamil Nadu Dr MGR Medical University, Chennai, Tamil Nadu, India; 8Novartis Pharma AG, Postfach, Basel, SwitzerlandPurpose: Rivastigmine transdermal patch has shown higher caregiver satisfaction and greater preference than oral formulation in patients with Alzheimer’s disease. However, there is limited literature available related to caregiver preference or treatment compliance in real-world clinical settings. To date, no such data are available from Asia and the Middle East, which account for a sizeable proportion of patients with Alzheimer’s disease. The objective of this study was to evaluate treatment preference and compliance with oral and transdermal medications in daily clinical practice in an ethnically diverse patient population from Asia and the Middle East with mild-to-moderate Alzheimer’s disease.Patients and methods: RECAP (Real-world Evaluation of Compliance And Preference in the treatment of Alzheimer’s disease) was a 24-week, multicenter, prospective, noninterventional study. Two treatment cohorts were observed during the study: oral (cholinesterase inhibitors or memantine) and transdermal (rivastigmine patch). Caregiver preference, physician preference, and patient compliance were evaluated at week 24.Results: A total of 978 of 1,931 enrolled patients (mean age: 72.8 years; 50.5% female) were in the transdermal cohort. For patients with exposure to both oral and transdermal monotherapy (n=330), a significant caregivers’ preference for the transdermal monotherapy was observed (82.7%; P

SUMMARYHumoral and cell-mediated immunity (CMI) againstB. pertussiswas assessed in a sample of adolescent, adult and senior subjects distributed in five different geographical areas in Italy. Most (99·1%) subjects had IgG anti-pertussis toxin (PT) antibodies exceeding the minimum detection level [⩾2 ELISA units (EU)/ml]. There were no significant differences between the genders; 6·2% samples recorded titres ⩾100 EU/ml. CMI was positive [stimulation index (SI) ⩾5] against PT in 39·0% of all samples. This study suggests thatB. pertussiscontinues to circulate in age groups that have been previously considered to be uninvolved in the circulation of this pathogen and that adolescent and adult pertussis boosters may be of value in these populations. Nevertheless, over the last 10 years, large increases in vaccination coverage rates have contributed to reduce the spread of the aetiological agent, especially in the immunized population.

The aim of this study was to analyze the seroprevalence of varicella in Italy and to evaluate the impact of varicella vaccination, which has been mandatory for newborns since 2017. The levels of VZV-specific IgG antibodies were determined by the ELISA method in residual serum samples obtained from subjects aged between 6 and 64 years and residing in 13 Italian regions. Overall, 3746 serum samples were collected in the years 2019 and 2020. The overall seroprevalence was 91.6% (89.9% in males and 93.3% in females; p = 0.0002). Seroprevalence showed an increasing trend (p < 0.0001) starting in the younger age groups: 6–9 years: 84.1%; 10–14 years: 88.7%; 15–19 years: 89.3%; 20–39 years: 93.1% and >40 years: 97.0%. The seroprevalence data obtained in the present study were compared with those relating to previous sero-epidemiological surveys conducted, respectively, in the years 1996–1997, 2003–2004 and 2013–2014, taking into consideration only data from regions monitored in all surveillance campaigns. The comparison highlighted for the period 2019–2020 showed significantly higher values in the age groups 6–9 (p < 0.001), 10–14 (p = 0.018) and 15–19 years (p = 0.035), while in adults, the trend did not change over time (ns). These results highlight the positive impact of varicella vaccination in Italy.

This study evaluated the prevalence of anti-legionella antibodies in workers at hospitals with a long-term history of legionella contamination. The hospitals are located in Milan and Turin, northern Italy, and in Naples and Bari, southern Italy. Antibody prevalence and titres of healthcare workers, medical and dental students and blood donors were assessed. In total 28.5% of subjects were antibody positive, most frequently to L. pneumophila serogroups 7-14. Major differences were observed in seroprevalence and type of legionella antibody in persons from different geographic areas. Healthcare workers had a significantly higher frequency of antibodies compared with blood donors in Milan (35.4 vs 15.9%, P