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Previous evolutionary models of duplicate gene evolution have overlooked the pivotal role of genome architecture. Here, we show that proximity-based regulatory recruitment by distally duplicated genes is an efficient mechanism for modulating tissue-specific production of preexisting proteins. By leveraging genomic asymmetries, we performed a coexpression analysis on Drosophila melanogaster tissue data to show the generality of enhancer capture-divergence (ECD) as a significant evolutionary driver of asymmetric, distally duplicated genes. We use the recently evolved gene HP6/Umbrea as an example of the ECD process. By assaying genome-wide chromosomal conformations in multiple Drosophila species, we show that HP6/Umbrea was inserted near a preexisting, long-distance three-dimensional genomic interaction. We then use this data to identify a newly found enhancer (FLEE1), buried within the coding region of the highly conserved, essential gene MFS18, that likely neofunctionalized HP6/Umbrea. Last, we demonstrate ancestral transcriptional coregulation of HP6/Umbreas future insertion site, illustrating how enhancer capture provides a highly evolvable, one-step solution to Ohnos dilemma.

A large outbreak of monkeypox virus (MPXV) clade I (previously known as the Congo-Basin clade) infections has been ongoing in the Democratic Republic of the Congo (DRC) since the autumn [...]

Aims: This study aimed to (1) evaluate associations between Early and Term structural MRI (sMRI) brain abnormality scores and adverse motor outcomes at 6-years corrected age (CA), (2) determine their diagnostic accuracy in predicting adverse motor outcomes and cerebral palsy (CP) at 6-years CA. Methods: Infants born

IntroductionStreptococcus pneumoniae is a prevalent and virulent global pathogen, with colonization being considered a precondition for pneumococcal disease. Understanding colonization is critical for gaining insights into transmission dynamics and developing effective interventions. This study aimed to determine the prevalence of nasopharyngeal colonization and serotype distribution in the Sicilian population.MethodsObservational study randomly selecting samples belonging to Sicilian individuals whose nasopharyngeal swabs were collected between February 1, 2020, and December 31, 2022. Pneumococcal colonization was determined using PCR for the pneumococcal autolysin (LytA) gene, and positive samples were serotyped.ResultsThe study sample consisted of 1,196 individuals, with 17.4% testing positive for the LytA gene. Pneumococcal colonization rates fell from birth to 24 years, with a peak in 0-4-year-olds (aOR=6.9; p

Tolstoj quadrangle (H08) is located in the equatorial area of Mercury, between 22.5°N and 22.5°S and 144° and 216°E. Using the NASA/MESSENGER data, we compiled a geological map of the quadrangle at a scale of 1:3.000.000. The main basemap we used was the MDIS 166 m/pixel BDR mosaic. In addition, mosaics with high-incidence illumination from west and east, MDIS global color mosaics, and the MDIS global DEM have been taken into account. In the map, we considered three feature classes: geological units, lineaments, and surface features. Geological units consist of crater material and plains. Lineaments include crater and pit rims, and structures. Finally, surface features are subdivided into crater chains or clusters, hollows, faculae, bright and dark material. The geological map will be integrated into the global 1:3M geological map of Mercury, which is being prepared in support to the ESA/JAXA BepiColombo mission.

BackgroundThe time-varying reproduction number R is a critical variable for situational awareness during infectious disease outbreaks; however, delays between infection and reporting of cases hinder its accurate estimation in real-time. A number of nowcasting methods, leveraging available information on data consolidation delays, have been proposed to mitigate this problem.MethodsIn this work, we retrospectively validate the use of a nowcasting algorithm during 18 months of the COVID-19 pandemic in Italy by quantitatively assessing its performance against standard methods for the estimation of R.ResultsNowcasting significantly reduced the median lag in the estimation of R from 13 to 8 days, while concurrently enhancing accuracy. Furthermore, it allowed the detection of periods of epidemic growth with a lead of between 6 and 23 days.ConclusionsNowcasting augments epidemic awareness, empowering better informed public health responses.

IntroductionSeasonal influenza generally represents an underestimated public health problem with significant socioeconomic implications. Monitoring and detecting influenza epidemics are important tasks that require integrated strategies. Wastewater-based epidemiology (WBE) is an emerging field that uses wastewater data to monitor the spread of disease and assess the health of a community. It can represent an integrative surveillance tool for better understanding the epidemiology of influenza and prevention strategies in public health.MethodsWe conducted a study that detected the presence of Influenza virus RNA using a wastewater-based approach. Samples were collected from five wastewater treatment plants in five different municipalities, serving a cumulative population of 555,673 Sicilian inhabitants in Italy. We used the RT-qPCR test to compare the combined weekly average of Influenza A and B viral RNA in wastewater samples with the average weekly incidence of Influenza-like illness (ILI) obtained from the Italian national Influenza surveillance system. We also compared the number of positive Influenza swabs with the viral RNA loads detected from wastewater. Our study investigated 189 wastewater samples.ResultsCumulative ILI cases substantially overlapped with the Influenza RNA load from wastewater samples. Influenza viral RNA trends in wastewater samples were similar to the rise of ILI cases in the population. Therefore, wastewater surveillance confirmed the co-circulation of Influenza A and B viruses during the season 2022/2023, with a similar trend to that reported for the weekly clinically confirmed cases.ConclusionWastewater-based epidemiology does not replace traditional epidemiological surveillance methods, such as laboratory testing of samples from infected individuals. However, it can be a valuable complement to obtaining additional information on the incidence of influenza in the population and preventing its spread.

Background/Objectives: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition characterized by social communication impairments and repetitive behaviors. Recent reports show that one in thirty-six 8-year-old children are autistic, signifying a considerable public health concern. According to previous studies, emotional dysregulation (ED) affects 50–60% of individuals with ASD and includes symptoms such as poor emotional control, heightened reactivity, and a low frustration tolerance. The main aims of the current study are to investigate the prevalence of ED among autistic preschoolers (below 6 years of age) and to assess the impacts of gender and intellectual disability on their emotional dysregulation profile. Methods: Data have been collected from three children’s research hospitals in Italy (IRCCS Stella Maris Foundation, Stella Maris Mediterraneo Foundation, and IRCCS Bambino Gesù). Parents of 825 autistic pre-schooled children (mean age: 39.68 months, SD: 10.51 months) completed a general questionnaire and the Child Behaviour Checklist (CBCL), a reliable caregiver-reported assessment tool which provides a dysregulation profile. Results: A total of 30% of the children displayed a severe-to-moderate ED (emotional dysregulation) profile, with these children exhibiting significantly higher emotional–behavioral problems compared to those without ED. Males with ED exhibited greater emotional reactivity than females with ED. However, no significant relationships were found between ED and age, autism severity (ADOS-2), or intellectual disability. Conclusions: The results underline the importance of early, tailored interventions to face emotional challenges in young children with ASD, potentially improving long-term outcomes for this population.

On September 20, 2022, Uganda's Ministry of Health declared an Ebola disease outbreak after a case caused by Sudan virus (SUDV) was confirmed in a village in Mubende District (1). [...]

ImportanceCerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years.ObjectiveTo systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support.Evidence reviewThe literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument.FindingsSixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5).Conclusions and relevanceWhen a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.

Early key visual skills, such as tracking objects, sustaining gaze, and shifting attention, rapidly develop within the first 6 months of infant life. These abilities play a significant role in the development of cognitive functions but are frequently compromised in infants at risk of developing neurodevelopmental disorders. This systematic review evaluates the potential of early vision function in the prediction of cognition at or above 12 months. Five databases were searched for relevant articles, and their quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool. Eight studies were suitable, including 521 preterm-born infants at varying risk of developing Cerebral Palsy (CP). Each study showed a significant correlation between vision and cognitive outcome. Predictive analysis including sensitivity and specificity was possible for three studies. Methodological quality was variable. Sensitivity ranged between 57 and 100% in the vision function assessments items, while specificity ranged from 59 to 100%. In conclusion, early vision showed strong correlation with cognition ≥ 12 months. While no single vision assessment was found to be superior, evaluation of specific functions, namely fixation and following, both at term age and between 3 and 6 months, demonstrated strong predictive validity.

Natural disasters and epidemics are unfortunate recurring events that lead to huge societal and economic loss. Recent advances in supercomputing can facilitate simulations of such scenarios in (or even ahead of) real-time, therefore supporting the design of adequate responses by public authorities. By incorporating high-velocity data from sensors and modern high-performance computing systems, ensembles of simulations and advanced analysis enable urgent decision-makers to better monitor the disaster and to employ necessary actions (e.g., to evacuate populated areas) for mitigating these events. Unfortunately, frameworks to support such versatile and complex workflows for urgent decision-making are only rarely available and often lack in functionalities. This paper gives an overview of the VESTEC project and framework, which unifies orchestration, simulation, in-situ data analysis, and visualization of natural disasters that can be driven by external sensor data or interactive intervention by the user. We show how different components interact and work together in VESTEC and describe implementation details. To disseminate our experience three different types of disasters are evaluated: a Wildfire in La Jonquera (Spain), a Mosquito-Borne disease in two regions of Italy, and the magnetic reconnection in the Earth magnetosphere.

After the first reports of autochthonous cases of monkeypox (MPX) in Europe at the beginning of May, the World Health Organization (WHO) and the European Centre for Disease Prevention and [...]

Monitoring the genetic variability of human respiratory syncytial virus (hRSV) is of paramount importance, especially for the potential implication of key antigenic mutations on the emergence of immune escape variants. Thus, to describe the genetic diversity and evolutionary dynamics of hRSV circulating in Sicily (Italy), a total of 153 hRSV whole-genome sequences collected from 770 hRSV-positive subjects between 2017 and 2023, before the introduction of expanded immunization programs into the population, were investigated. The phylogenetic analyses indicated that the genotypes GA.2.3.5 (ON1) for hRSV-A and GB.5.0.5a (BA9) for hRSV-B co-circulated in our region. Amino acid (AA) substitutions in the surface and internal proteins were evaluated, including the F protein antigenic sites, as the major targets of immunoprophylactic monoclonal antibodies and vaccines. Overall, the proportion of AA changes ranged between 1.5% and 22.6% among hRSV-A, whereas hRSV-B varied in the range 0.8–16.9%; the latter was more polymorphic than hRSV-A within the key antigenic sites. No AA substitutions were found at site III of both subgroups. Although several non-synonymous mutations were found, none of the polymorphisms known to potentially affect the efficacy of current preventive measures were documented. These findings provide new insights into the global hRSV molecular epidemiology and highlight the importance of defining a baseline genomic picture to monitor for future changes that might be induced by the selective pressures of immunological preventive measures, which will soon become widely available.

BackgroundOutbreaks of Aedes-borne diseases in temperate areas are not frequent, and limited in number of cases. We investigate the associations between habitat factors and temperature on individuals' risk of chikungunya (CHIKV) in a non-endemic area by spatially analyzing the data from the 2017 Italian outbreak.Methodology/principal findingsWe adopted a case-control study design to analyze the association between land-cover variables, temperature, and human population density with CHIKV cases. The observational unit was the area, at different scales, surrounding the residence of each CHIKV notified case. The statistical analysis was conducted considering the whole dataset and separately for the resort town of Anzio and the metropolitan city of Rome, which were the two main foci of the outbreak. In Rome, a higher probability for the occurrence of CHIKV cases is associated with lower temperature (OR = 0.72; 95% CI: 0.61-0.85) and with cells with higher vegetation coverage and human population density (OR = 1.03; 95% CI: 1.00-1.05). In Anzio, CHIKV case occurrence was positively associated with human population density (OR = 1.03; 95% CI: 1.00-1.06) but not with habitat factors or temperature.Conclusion/significanceUsing temperature, human population density and vegetation coverage data as drives for CHIKV transmission, our estimates could be instrumental in assessing spatial heterogeneity in the risk of experiencing arboviral diseases in non-endemic temperate areas.

Abstract Background Children with cerebral palsy (CP) often have communication impairments, including speech altered intelligibility. Multiple levels of disrupted speech have been reported in CP, which negatively impact on participation and quality of life, with increase of care needs. Augmentative Alternative Communication (AAC) is an option, with debated benefits and limitations, in particular for its functional use. This is supported by a substantial lack of defined evidences in favor of direct speech articulation intervention in CP. Motor learning-based interventions are effective in CP and are the basis of speech motor interventions such as PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets). The PROMPT speech motor treatment provides tactile-kinesthetic inputs to facilitate articulatory movements by dynamic modelling, resulting in more efficient motor patterns that can be integrated into speech and communication. In CP, exploratory evidences support the feasibility and preliminarily advantages on intelligibility of motor speech treatments, such as PROMPT, with increased speech motor control, also documented by kinematic analyses. Methods A randomized waitlist-control trial will be conducted in children aged between 3- and 10-years having CP and dysarthria (estimated sample size = 60 children). Children will be allocated in the immediate intervention or in the waitlist control group. The intervention consists of an intensive 3 weeks period of twice-a-day administration of PROMPT. Standard care will be administered in the control (waitlist) group. After repeated baseline assessments (T0), the PROMPT treated group will undergo the experimental 3-week intervention period, with T1 assessment at the end. A further T2 assessment will be provided at medium term (3 months after the end of the intervention) for evaluating the stability of intervention. Primary and secondary speech clinical and kinematics outcome measures will be collected at T0, T1 and T2. Discussion This paper describes the study protocol consisting of a RCT with two main objectives: (1) to evaluate the or short-term benefits of an intensive speech motor intervention on speech and intelligibility in children with CP and the stability of the intervention at medium term; (2) to describe the kinematic correlates of speech motor control modifications. Trial registration Trial registration date 06/12/2019; ClinicalTrials.gov Identifier: NCT04189159 .

Abstract Background Children with neurological impairment may have dysphagia and/or gastro-esophageal reflux disease (GERD), which predispose to complications affecting the airways, increasing risk for aspiration-induced acute and chronic lung disease, or secondarily malnutrition, further neurodevelopmental disturbances, stressful interactions with their caregivers and chronic pain. Only multidisciplinary clinical feeding evaluation and empirical trials are applied to provide support to the management of feeding difficulties related to dysphagia or GERD, but no standardized feeding or behavioral measure exists at any age to assess aspiration risk and support the indication to perform a videofluoroscopic swallowing study (VFSS) or a fibre-optic endoscopic examination of swallowing (FEES), in particular in newborns and infants with neurological impairments. Lung ultrasound (LUS) has been proposed as a non-invasive, radiation-free tool for the diagnosis of pulmonary conditions in infants, with high sensitivity and specificity. Methods A RCT will be conducted in infants aged between 0 and 6 years having, or being at risk for, cerebral palsy, or other neurodevelopmental disease that determines abnormal muscular tone or motor developmental delay assessed by a quantitative scale for infants or if there is the suspicion of GERD or dysphagia based on clinical symptoms. Infants will be allocated in one of 2 groups: 1) LUS-monitored management (LUS-m); 2) Standard care management (SC-m) and after baseline assessment (T0), both groups will undergo an experimental 6-months follow-up. In the first 3 months, infants will be evaluated a minimum of 1 time per month, in-hospital, for a total of 3 LUS-monitored meal evaluations. Primary and secondary endpoint measures will be collected at 3 and 6 months. Discussion This paper describes the study protocol consisting of a RCT with two main objectives: (1) to evaluate the benefits of the use of LUS for monitoring silent and apparent aspiration in the management of dysphagia and its impact on pulmonary illness and growth and (2) to investigate the impact of the LUS management on blood sample and bone metabolism, pain and interaction with caregivers. Trial registration Trial registration date 02/05/2020; ClinicalTrials.gov Identifier: NCT04253951 .

Introduction: Streptococcus pneumoniae is a prevalent and virulent global pathogen, with colonization being considered a precondition for pneumococcal disease. Understanding colonization is critical for gaining insights into transmission dynamics and developing effective interventions. This study aimed to determine the prevalence of nasopharyngeal colonization and serotype distribution in the Sicilian population. Methods: Observational study randomly selecting samples belonging to Sicilian individuals whose nasopharyngeal swabs were collected between February 1, 2020, and December 31, 2022. Pneumococcal colonization was determined using PCR for the pneumococcal autolysin (LytA) gene, and positive samples were serotyped. Results: The study sample consisted of 1,196 individuals, with 17.4% testing positive for the LytA gene. Pneumococcal colonization rates fell from birth to 24 years, with a peak in 0-4-year-olds (aOR=6.9; p<0.001). Colonization was higher in colder months, particularly in December (aOR=2.9, p<0.05) and February (aOR=4, p<0.05). Serotypes 22F and 24ABF exhibited strong colonization and an invasive pneumococcal disease (IPD) risk, whereas serotypes 4, 6AB, 9VA, and 13 had high colonization but a low IPD risk. Serotypes 3 and 8 exhibited considerable IPD risk but low colonization. Conclusion: Our findings provide insights into pneumococcal colonization mechanisms, influencing serotype prevalence, colonization risk variables, and serotype comparisons for colonization and pathogenicity propensity. [ABSTRACT FROM AUTHOR]

Background/Objectives: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition characterized by social communication impairments and repetitive behaviors. Recent reports show that one in thirty-six 8-year-old children are autistic, signifying a considerable public health concern. According to previous studies, emotional dysregulation (ED) affects 50–60% of individuals with ASD and includes symptoms such as poor emotional control, heightened reactivity, and a low frustration tolerance. The main aims of the current study are to investigate the prevalence of ED among autistic preschoolers (below 6 years of age) and to assess the impacts of gender and intellectual disability on their emotional dysregulation profile. Methods: Data have been collected from three children's research hospitals in Italy (IRCCS Stella Maris Foundation, Stella Maris Mediterraneo Foundation, and IRCCS Bambino Gesù). Parents of 825 autistic pre-schooled children (mean age: 39.68 months, SD: 10.51 months) completed a general questionnaire and the Child Behaviour Checklist (CBCL), a reliable caregiver-reported assessment tool which provides a dysregulation profile. Results: A total of 30% of the children displayed a severe-to-moderate ED (emotional dysregulation) profile, with these children exhibiting significantly higher emotional–behavioral problems compared to those without ED. Males with ED exhibited greater emotional reactivity than females with ED. However, no significant relationships were found between ED and age, autism severity (ADOS-2), or intellectual disability. Conclusions: The results underline the importance of early, tailored interventions to face emotional challenges in young children with ASD, potentially improving long-term outcomes for this population. [ABSTRACT FROM AUTHOR]

Introduction Cerebral palsy (CP) is the most common physical disability of childhood worldwide. Historically the diagnosis was made between 12 and 24 months, meaning data about effective early interventions to improve motor outcomes are scant. In high-income countries, two in three children will walk. This evaluator-blinded randomised controlled trial will investigate the efficacy of an early and sustained Goals–Activity–Motor Enrichment approach to improve motor and cognitive skills in infants with suspected or confirmed CP.Methods and analysis Participants will be recruited from neonatal intensive care units and the community in Australia across four states. To be eligible for inclusion infants will be aged 3–6.5 months corrected for prematurity and have a diagnosis of CP or ‘high risk of CP’ according to the International Clinical Practice Guideline criteria. Eligible participants whose caregivers consent will be randomly allocated to receive usual care or weekly sessions at home from a GAME-trained study physiotherapist or occupational therapist, paired with a daily home programme, until age 2. The study requires 150 participants per group to detect a 0.5 SD difference in motor skills at 2 years of age, measured by the Peabody Developmental Motor Scales-2. Secondary outcomes include gross motor function, cognition, functional independence, social–emotional development and quality of life. A within-trial economic evaluation is also planned.Ethics and dissemination Ethical approval was obtained from the Sydney Children’s Hospital Network Human Ethics Committee in April 2017 (ref number HREC/17/SCHN/37). Outcomes will be disseminated through peer-reviewed journal publications, presentations at international conferences and consumer websites.Trial registration number ACTRN12617000006347.

Problem After Italy's first national restriction measures in 2020, a robust approach was needed to monitor the emerging epidemic of coronavirus disease 2019 (COVID-19) at subnational level and provide data to inform the strengthening or easing of epidemic control measures. Approach We adapted the European Centre for Disease Prevention and Control rapid risk assessment tool by including quantitative and qualitative indicators from existing national surveillance systems. We defined COVID-19 risk as a combination of the probability of uncontrolled transmission of severe acute respiratory syndrome coronavirus 2 and of an unsustainable impact of COVID-19 cases on hospital services, adjusted in relation to the health system's resilience. The monitoring system was implemented with no additional cost in May 2020. Local setting The infectious diseases surveillance system in Italy uses consistent data collection methods across the country's decentralized regions and autonomous provinces. Relevant changes Weekly risk assessments using this approach were sustainable in monitoring the epidemic at regional level from 4 May 2020 to 24 September 2021. The tool provided reliable assessments of when and where a rapid increase in demand for health-care services would occur if control or mitigation measures were not increased in the following 3 weeks. Lessons learnt Although the system worked well, framing the risk assessment tool in a legal decree hampered its flexibility, as indicators could not be changed without changing the law. The relative complexity of the tool, the impossibility of real-time validation and its use for the definition of restrictions posed communication challenges. Probleme Apres avoir pris ses premieres mesures de restriction nationales en 2020, l'Italie avait besoin d'une approche solide pour surveiller l'epidemie naissante de maladie a coronavirus 2019 (COVID-19) au niveau regional, et fournir les donnees permettant de renforcer ou d'alleger les mesures destinees a l'endiguer. Approche Nous avons adapte l'outil d'evaluation rapide des risques du Centre europeen de prevention et de controle des maladies en y integrant des indicateurs quantitatifs et qualitatifs issus des systemes de surveillance nationaux existants. Pour definir le risque lie a la COVID-19, nous avons associe la probabilite d'une transmission incontrolee du coronavirus 2 du syndrome respiratoire aigu severe, a l'impact immediat des cas de COVID-19 sur les services hospitaliers, en procedant a des ajustements selon la resilience du systeme de soins de sante. Le dispositif de surveillance a ete mis en reuvre en mai 2020 sans entrainer de couts supplementaires. Environnement local En Italie, le systeme de surveillance des maladies infectieuses repose sur des methodes uniformes de collecte de donnees dans les provinces autonomes et regions decentralisees a travers le pays. Changements significatifs Les evaluations des risques realisees toutes les semaines avec cette approche ont permis de surveiller l'epidemie a l'echelle regionale du 4 mai 2020 au 24 septembre 2021. L'outil a identifie les dates et lieux susceptibles de connaitre une augmentation rapide de la demande en services de soins de sante si aucune mesure supplementaire de controle et de lutte n'etait prise dans les trois semaines. Lecons tirees Bien que le systeme ait fonctionne, inscrire l'outil d'evaluation des risques dans un decret legislatif a reduit sa flexibilite, car les indicateurs ne pouvaient etre modifies sans reformer la loi. La relative complexite de l'outil, l'impossibilite de proceder a une validation en temps reel et son usage pour imposer des restrictions ont pose des problemes de communication. Situacion Tras las primeras medidas nacionales de restriccion en Italia en 2020, se necesitaba un enfoque solido para supervisar la epidemia emergente de la coronavirosis de 2019 (COVID-19) a nivel subnacional y proporcionar datos que informaran sobre el refuerzo o la flexibilizacion de las medidas de contencion de la epidemia. Enfoque Se adapto la herramienta de valoracion rapida de riesgos del Centro Europeo para la Prevencion y el Control de las Enfermedades, al incluir indicadores cuantitativos y cualitativos de los sistemas nacionales de vigilancia existentes. Se definio el riesgo de la COVID-19 como una combinacion de la probabilidad de transmision descontrolada del coronavirus del sindrome respiratorio agudo grave de tipo 2 y de un efecto no sostenible de los casos de la COVID-19 en los servicios hospitalarios, y se ajusto en relacion con la capacidad de recuperacion del sistema sanitario. El sistema de supervision se aplico sin costes adicionales en mayo de 2020. Marco regional El sistema de vigilancia de las enfermedades infecciosas en Italia aplica metodos de recopilacion de datos coherentes en todas las regiones y provincias autonomas descentralizadas del pais. Cambios importantes Las valoraciones semanales de los riesgos mediante este enfoque fueron sostenibles en la supervision de la epidemia a nivel regional entre el 4 de mayo de 2020 y el 24 de septiembre de 2021. La herramienta proporciono valoraciones fiables de cuando y donde se produciria un rapido aumento de la demanda de servicios sanitarios si no se incrementaban las medidas de contencion o mitigacion en las tres semanas siguientes. Lecciones aprendidas Aunque el sistema funciono bien, el hecho de enmarcar la herramienta de valoracion de los riesgos en un decreto legal dificulto su flexibilidad, ya que los indicadores no se podian modificar sin cambiar la ley. La relativa complejidad de la herramienta, la imposibilidad de validacion en tiempo real y su uso para la definicion de las restricciones plantearon problemas de comunicacion., Introduction In its first response to the emerging epidemic of coronavirus disease 2019 (COVID-19), the Italian government implemented national restriction measures with strict physical distancing and restrictions on public movements [...]