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Hepatitis A disease is endemic in Albania even though records from the Medical Authority show outbreaks involving only limited numbers of people. In the city of Lac, 200 people became ill following an outbreak of hepatitis A started on November 2002. The age distribution of the cases shows a peak in the age group 5-9 (43.5%) followed by the age group 10-14 (28%) and the age group 1-4 (18%). No cases were recorded in the age group 0-1. Drinking water and sewage samples were collected, using electropositive cartridges, during the outbreak. Rotavirus was identified by RT-PCR in two out of five drinking water samples; however, all the samples tested negative for HAV and astrovirus. Rotavirus was also identified in three out of five sewage samples from which four were HAV positive. HAV-RNA was identified in 28 (62.2%) out of 45 IgM anti-HAV positive sera collected during the outbreak. Genotype IA was expressed from all the amplified samples. Sequence analysis of the overlapping VP1-2A region shows 97-99% homology with three Italian strains IT-SCH-00, IT-ZAM-01, and IT-CAP-00 and one Spanish strain (Sa 30/06/95), whereas the phylogenetic tree built from the 168 bp sequence of the VP1-2A shows four clusters, one including 24 out of 28 RT-PCR positive sera. Considering the deduced amino acid sequence, only one substitution was identified and reported previously for genotype IB.

Aim of the study: The present study was designed to evaluate the possible co-infection, with other enteric viruses, during an outbreak of hepatitis A (HA). Material and Methods: Forty-two stool samples and sera were collected during an outbreak of hepatitis A. Sera were analysed by the Abbott test for IgG-IgM anti-HAV antibodies. Stool samples were used to identify the presence of enteric viruses. HAV genome was identified by a RT-PCR test, other enteric viruses were identified, after cell passage and seroneutralization test on BGM cells, by RT-PCR and RFLP assay. Results: The samples were obtained from 27 employees of an industrial plant, nine household contacts and six non-employee controls. The attack rate was 12.5%, whereas the overall prevalence was 63%. In the employee group, 12 out of 27 stool samples were positive for the presence of HAV by reverse transcriptase polymerase chair reaction (RT-PCR). All the other samples (30) were negative. Five samples from employees, three from household contacts and one from non-employees were also found positive for enteroviruses. These viruses were classified by seroneutralization as poliovirus and RFLP assay as Sabin poliovirus type l. Four samples were positive both for HAV and poliiovirus. Conclusions: This study confirms co-infection with different enteric viruses may occur and also emphasizes the wide circulation of HAV and the existence of silent infection with poliovirus.

Random sera, in a total of 192, were collected in the Fever Hospital of Alexandria, Egypt, and analysed for the presence of antibodies against polioviruses. The results show good antibody levels, only three sera (1.5%) were negative for poliovirus type 1, 5 (2.6%) for poliovirus type 2 and 10 (5.2%) for poliovirus type 3; one subject was completely negative.

A total of 202 serum and stool samples from acute hepatitis patients attending the Fever Hospital of Alexandria, Egypt, have been studied to reveal markers of hepatitis virus infection. Anti-HAV IgM were detected in 21 out of 202 sera (10.4%), whereas 201 sera (99.5%) had anti-HAV IgG. The first age attack was in the class-age 0-9 years with 64.7% of anti-HAV IgM positive sera. Among 202 patients, anti-hepatitis E IgG (sample/over cut off > 1.0) was identified in 90 patients (44.5%). The anti-HEV seropositivity ranged from 17.6% to 60.0% in the different age groups, with the highest level in the class-age 20 29 years. Anti-hepatitis E IgM were identified in 49 patients with the first age attack in the class-age 10-19 years (39.4%). HAV RNA was identified by nested PCR in 7 samples out of 15, whereas HEV RNA was present in 4 out of 75 stool samples. Direct DNA sequence of the latter PCR products confirmed the presence of the HEV genome; comparison of the sequences of the isolates from Egypt with those in data banks revealed the highest homology to the Burma strain. Our data confirm that HAV and HEV are common causes of acute sporadic hepatitis in Alexandria but with different peak age positivity. Occasionally, but not infrequently, dual infections (HAV-HEV and HEV-enteric viruses) were also found. The risk analysis indicates that patients living in rural areas are exposed to a higher risk of hepatitis E infection compared to the urban population, whereas the presence of anti-HEV IgG was significantly associated with consumption of common village water and use of indoor dry pit and oral therapy for schistosomiasis.

During the years 1992-1994, we tested 948 individuals from different population groups for HIV-1 and HIV-2 infections by ELISA and WB and for HCV infection by ELISA. Repeated ELISA reactivity for HIV was found in 2.12% of blood donors, 2.95% of fire brigade personnel and 1.61% of prisoners. Western blotting studies, however, showed that these samples were non-reactive or indeterminate to either HIV-1 or HIV-2. In contrast, anti-HCV antibodies were detected in 39% of fire brigade personnel, 31.4% of prisoners and 20.8% of blood donors. The analysis of risk factors for acquiring HCV infection showed a strong association between a past history of parenteral therapy for schistosomiasis and anti-HCV seropositivity (p < 0.0001). The implementation of preventive strategies is at the moment the mandatory choice to stop a further spread of the HCV infection. Meanwhile the same preventive measures could avoid spreading of the HIV disease.

In Italy, care for people with AIDS (PWA) is centred on hospital services. However, other services are beginning to develop, both in the form of residential facilities and of home care. It seems, therefore, important to define the type of non-hospital services that should be supplied on the basis of AIDS patients' real needs. The aim of this paper is to contribute to the definition of care requirements by administration to 92 persons with ARC/AIDS of a questionnaire on Functional Multidimensional Evaluation to assess the demand for services in relation to the state of health and socio-economic situation of those interviewed. The pattern that emerged was one of severe socio-economic difficulties (most of the patients were drug addicts) and of major functional impairment (about 60% of those interviewed were not self-sufficient as far as Instrumental Activities of Daily Living were concerned). Among the main problems: difficulties of finding accommodation (almost 9% of those interviewed have no fixed abode) and economic difficulties; the demand for services was characterized by a lack of self-sufficiency. The most frequently required social services were help with preparation of meals, household chores and assistance with transport; the most frequently required health service was physiotherapy, which is also the least available. The study supplies useful information for the planning of non-hospital services in Italy and in other western countries with similar epidemiological situations.

Two strains of hepatitis A virus (HAV) were isolated in cell culture and found to induce a cytopathic effect at early passages. The nucleotide sequences of the 5' non-translated region (5'NTR) and of genes 2B, 2C, 3A and 3B were determined for these strains and found to contain mutations similar to those detected in cell-culture adapted variants of HAV strain HM175. In addition, gene 3A shows a deletion of three aspartic acid residues near the N-terminus of the polypeptide. In combination with variations in the 5'NTR and in genes 2B and 2C, the absence of an aspartic acid residue in position 4 of gene 3A of three cytopathic clones of HM175 suggests a possible role of the 3A protein in determining the cytopathic phenotype.

From April 28th to May 22nd, 1987, the Medical Authority identified 13 cases (6 symptomatic cases) of hepatitis A (HA) in a school and in a college of Rome. The principal risk factor was determined to be "full-time presence at the State school and boarders at the college". The distribution of HA cases suggested a person to person contact; anti-hepatitis A virus IgM were identified in 12 out of 13 cases with high levels of transaminases. During the disease epidemic, water samples were taken from the well of the college for bacteriological and virological analyses. The water was classified as undrinkable due to the presence of 16 total coliforms/100 ml and 35 total bacteria count at 36 degrees C. Fecal coliforms, fecal streptococci and sulfite reducing clostridia were absent. Two water samples of 100 liters were collected and concentrated by adsorption-elution method on electropositive membranes or by ultrafiltration using a Millipore apparatus. Infectious Hepatitis A virus was only isolated from samples concentrated by adsorption-elution method on electropositive membranes using tissue culture methods and subsequently HA virus was identified by other traditional methods (Elisa and immunofluorescence). In contrast, PCR test performed on the concentrated samples, was positive only for the ultraconcentrated sample. The positivity of the PCR test confirmed the presence of the Hepatitis A virus in the well water.

An outbreak of hepatitis A in a school and in a college in Rome, involving 13 cases, is described. Anti-HAV IgM were identified in 13 out of 14 cases and the epidemic curve suggested a person to person transmission of the virus. Hepatitis A virus was identified in a well-water sample of the college using traditional methods and the PCR test. This water, depending on bacteriological analysis, was classified as undrinkable. The epidemiological investigation showed that the principal risk factors were to be full-time at the State school and boarders at the college. These differences were statistically significatives.

Waterborne disease outbreaks associated with groundwater consumption have been reported in different countries. Noroviruses are considered emerging pathogens, which cause gastroenteritis in all age groups worldwide and numerous outbreaks of noroviral gastroenteritis have been ascribed to contaminated drinking water. In Italy, few data on viral contamination of water environment and groundwater in particular are available. In this study, the presence of Norovirus GG I and GG II was investigated, using reverse transcription-polymerase chain reaction (RT-PCR) test, applied to groundwater samples collected in the Latium region in central Italy. Four out of 26 samples were positive (15.38%). Our results show both the presence of Norovirus in groundwater and the possibility to apply the RT-PCR tests for virus analysis.

The influence of electric charged molecules on the early phases of enterovirus infection was studied in order to select antiviral compounds able to prevent viral attachment. The effect of different polyelectrolytes on the multiplication of coxsackie virus B3, echovirus 6 and hepatitis A virus was investigated in susceptible cells by adding the drug before, during or after the viral adsorption period. Among polyanions, the polysaccharides heparin and dextran sulfate inhibited viral infectivity, dextran sulfate being the most effective mainly towards hepatitis A virus infection. DEAE-dextran and protamine sulfate, generally recognized as enhancers of infectivity of naked and enveloped viruses, exhibited an inhibitory effect towards the three picornaviruses tested. Only in the case of hepatitis A did DEAE-dextran slightly improve viral antigen synthesis. The inhibitory effect shown by compounds belonging to positive and negative polyions suggests that the electric charge is not sufficient by itself to explain the antiviral activity of these drugs.

Background A large measles outbreak occurred in Italy in 2002–2003. This study evaluates the health burden and economic impact of measles-related hospitalizations in Italy during the specified period. Methods Hospital discharge abstract data for measles hospitalizations in Italy during 2002–2003 were analysed to obtain information regarding number and rates of measles hospitalizations by geographical area and age group, length of hospital stay, and complications. Hospitalization costs were estimated on the basis of Diagnosis-Related Groups. Results A total of 5,154 hospitalizations were identified, 3,478 (67%) of which occurred in children Conclusion The nationwide health burden associated with measles during the 2002–2003 outbreak was substantial and a high cost was incurred by the Italian National Health Service for the thousands of measles-related hospitalizations which occurred. By assuming that hospital costs represent 40–50% of the direct costs of measles cases, direct costs of measles for the two years combined were estimated to be between €17.6 – 22.0 million, which equates to the vaccination of 1.5–1.9 million children (3–4 birth cohorts) with one dose of MMR. The high cost of measles and the severity of its complications fully justify the commitment required to reach measles elimination.

Prevalence of anti-Chlamydia trachomatis specific IgG antibodies was evaluated in a sexually transmitted disease outpatient population composed of 741 heterosexuals, 470 males and 271 females, and of 147 homosexual-bisexual men. The prevalence rates were 60.0% in heterosexual males, 50.6% in females and 73.5% in homosexuals-bisexuals. A positive association between age and antibody prevalence was found in males. Among heterosexuals there is an increasing trend of seropositivity with number of partners during the previous year. A significant association between anti-chlamydial and anti-herpes simplex, type 2, antibodies has been demonstrated.

The wastewater plant of Rome airport, which receives all the sewage from the airport as well as the cess from aeroplanes, was analysed for microbiological parameters. From the bacteriological point of view, in the water and sludge samples the densities of the faecal indicator of pollution and the presence of Salmonella spp and Vibrio cholerae as bacteriological pathogens were determined. At the same time, samples were analysed for the presence of enteric viruses and phages. Overall, the mean reduction of the faecal coliforms was 96%, E. coli 92% and faecal streptococci 99%. Salmonella spp was identified in all but one of the final effluents and V. cholerae in 2/10. Enteric viruses were identified in all but one of the raw waters and in three samples of final effluent. Bacteriophages (somatic coliphage, F-plus phage and B40-8), were found in all the samples but irregularly. Phages and enteric viruses were also found in the prefilter membranes used for prefiltering the raw water samples.

Mussels (Mytilus galloprovincialis) were contaminated with known amounts of laboratory strains of hepatitis A virus and Poliovirus 1 and the effectiveness of a self-cleansing mechanism was studied using a pilot depuration system. Both viruses were rapidly bioaccumulated by mussels and the maximal concentration of about 10(4) TCID50/ml was reached within 1.5 hours. Depuration was carried out up to 24 h; infectivity titer decreased to 10(2) TCID50/ml and 10(3.2) TCID50/ml within 6 h in hepatitis A virus and Poliovirus 1 contaminated mussels, respectively, but only a very slight further decrease was obtained after 24 h. E. coli was used as a control; within 24 h the concentration decreased from 40 to 2 bacteria/ml of mussel (MPN). The elimination of bacteria is not a reliable parameter to control the effectiveness of viral depuration.

Three human hepatitis A virus strains, all of them isolated in Italy but one acquired abroad, were analyzed by T1-RNAase oligonucleotide mapping and by monoclonal antibody neutralization. The variation among their genomes according to T1-maps was calculated to be about 9%, thus confirming the poor genomic variation assessed by nucleotide sequencing (1-10%). However T1-maps of these Italian isolates were different from those reported in the literature (Weitz and Siegl, 1985). Neutralization by monoclonal antibody caused a reduction in titres of 2-25 log10. This genomic stability, if confirmed, is important with a view to a valuable vaccine.

Systematic mandatory immunization of children against tetanus begun in Italy in 1968. Preceding birth cohorts, accounting for almost 80% of present Italian population, were poorly immune or totally non-immune; around 90% of cases of tetanus occurring in Italy in recent years are observed among them. In a national sample of 4770 young males born between 1956 and 1963, about one third was not protected. Prevalence of non-immune subjects was greater in the Southern Regions and the Islands, in rural areas, among the unemployed, among the older birth cohorts.

Prevalence of Herpes Simplex, type 2, specific antibodies was estimated in sexually transmitted disease outpatients: 783 heterosexuals and 158 homosexual-bisexuals. The anti-HSV-2 prevalence rates were 69% in the homosexual-bisexuals and 35% in the heterosexuals. In both groups positive association with age of anti-HSV-2 prevalence was found: only in the homosexual-bisexuals negative as sociation with education level was detected. No difference exists between the two groups regarding the symptomatic/asymptomatic ratio of HSV-2 infection.

Multiple logistic function and Mantel-Haenszel procedure are compared in their ability to control confounding in a large set of data. In this specific application substantial equivalence is found between the two techniques. When both techniques are applicable and data are not sparse, the authors prefer stratification, which is simpler and free of assumptions.

The hepatitis B virus (HBV) and hepatitis Delta virus (HDV) infection rates were estimated in patients attending a venereal disease outpatient clinic: 759 heterosexuals and 154 homosexual-bisexual men. The anti-HBC prevalence was higher in homo-bisexual men (68.8 per 100) than in heterosexuals (41.8 per 100), whereas HBsAg was roughly the same in the two groups (about 6 per 100). The anti-HBc prevalence rate among heterosexuals was higher than that estimated in hospital personnel from the same geographical area. A positive association between anti-HBc prevalence and present or past sexually transmitted diseases (STD) was found among homo-bisexual men. Anti-HBc was also positively associated with herpes simplex type 2 antibodies in both heterosexuals and homo-bisexual men. These data are consistent with the hypothesis that sexual behavior also plays a role in the spread of infection among heterosexuals. Ten of the 46 HBsAg-positive subjects were anti-HDV positive: 6 of the 36 heterosexuals and 4 of the 10 homosexuals. All HDV-positive subjects had present or past STDs. These findings suggest sexual transmission of HDV infection.

One-hundred-ninety-two stool samples were tested for the presence of human Hepatitis A antigen. Sixteen of these were also evaluated for the presence of infectious virus. All samples were obtained from young and apparently healthy people from endemic areas for Hepatitis A disease. The isolation of the infectious virus from these stools demonstrates clearly the wide diffusion of the virus in these areas, and its transmission by the oral-fecal route.

Among 5005 Navy recruits aged 18-26 years from all sections of Italy, whose blood was tested in 1981, regional prevalence of serologic markers for hepatitis B was higher in southern Italy and in the Italian islands as compared with northern Italy and central Italy (4.3% vs. 2.3% for hepatitis B surface antigen (HBsAg) and 23.5% vs. 10.5% for any B marker). Social-demographic variables such as region, family size, and education were associated with hepatitis B as were the more traditionally associated variables related to blood or medical care such as history of intravenous injection, history of blood transfusion, or exposure to hospital. Number of siblings was positively related and educational attainment inversely related to prevalence of hepatitis B markers. The prevalence of HBsAg among Italian males aged 18-26 years with residence in southern Italy or in the Italian islands, whose education was limited to lower middle school, and who were from a family of eight siblings or more, is 14.6%. These are among the highest prevalence rates for hepatitis B antigen ever reported for a general population group in Europe. Good correlation exists between incidence of reported cases of hepatitis and prevalence of markers in the different regions of Italy.

Research has been carried out in order to clarify the chemical nature of cell receptors interacting with a fast growing strain of hepatitis A virus (HAV) producing a cytopathic effect on Frp/3 cells. Cell surface susceptibility to HAV attachment has been studied after treatment with enzymes acting on different chemical groupings. Results obtained showed a lowering of cell susceptibility to HAV infection following the action of phospholipase A2, phospholipase C, trypsin and beta-galactosidase. These data suggested that phospholipids, proteins and galactose participate to the cellular receptorial area for HAV.

The effect of lipophilic amines on hepatitis A virus infection in a monkey cell line (Frp/3 cells) was studied. Ammonium chloride, amantadine, methylamine and dansylcadaverine inhibited viral antigen synthesis when added to the cells at least one hour after the attachment step. Results obtained suggest that the HAV entry pathway in Frp/3 cells follows an endocytic route and that viral uncoating takes probably place in endosomes and/or lysosomes.

The prevalence of antibody to hepatitis A virus (anti-HAV) in a sample of 1662 Sardinian children aged 3 to 11 years was estimated by ELISA. The overall anti-HAV prevalence was 3.8 per cent; it increased from zero among children of 3 to 7.2 per cent in children of 11 years. A slight male predominance was observed (4 versus 3.6 per cent). Anti-HAV prevalence was inversely related to the number of years of education received by the father and positively related to the number of households in the sample. Children whose fathers had received less than six years of schooling, had a 6.2-fold risk (Cl 95 per cent = 2.6-15.3) and children with five or more households under one roof had a 2.6-fold risk (Cl 95 per cent = 1.4-5.0) of previous exposure to hepatitis A virus (HAV) infection. These findings suggest that exposure of Sardinian children to hepatitis A virus is relatively low, probably because of improvements in socioeconomic conditions in recent years in the island. However, overcrowding and poor education in the father of schooling appear to be important determinants of infection.

Possible hepatitis B immunization of all newborns, regardless of the mother's HBsAg status, is a strategy under consideration for selected hyperendemic areas in Italy. Sardinia is one such area. However, in 1987 in Sardinia, the prevalence of hepatitis B markers in children under 11 years was estimated at 1.7% and the prevalence of hepatitis B surface antigen (HBsAg) at 0.2%. A much higher prevalence of HBsAg was recently observed among adults in this area: 8.7% among men and 5.2% among pregnant women. This contrasting pattern is unlikely to be due to bias: the sampling procedures adopted were appropriate and the percentage of refusals was very low (2.2%). The observed low hepatitis B marker prevalence in young age groups might be the result of a cohort effect due to the improved socio-economic conditions and changes in behaviour that have occurred in Sardinia over the last few years. The finding of only 3 HBsAg+ individuals out of 1,826 children tested, in spite of the 5.2% HBsAg prevalence among pregnant women in that region, is probably attributable to the low proportion of HBeAg positive individuals among the HBsAg+ carrier mothers in this area. At present, immunization of all newborns in Sardinia cannot be recommended.

Prevalence of tetanus hyperimmunization was estimated among 3217 immune subjects to be approximately equal to 11%. Hyperimmunization was associated with age, area of residence and health care availability. Indiscriminate administration of booster doses of tetanus vaccine could result in some areas in unnecessary revaccinations and possibly hypersensitivity reactions. The immunization policy regarding booster doses should be based on factual evidence and not on rigid recommendations.

Prevalence of hepatitis A antibodies among 5005 naval recruits aged 18-26 from all parts of Italy was almost double in the south and islands (83.3%) as compared to the north and central regions (45.2%). Social-demographic variables such as education and number of siblings are associated with prevalence of anti-HAV. Hepatitis A infection is still an early acquired infection in Italy, particularly in the south where among the 18-26-year-old recruits with education limited to lower middle school or less and eight siblings or more, prevalence of anti-HAV was 95%. Good correlation exists in Italy between prevalence of anti-HAV and incidence of reported cases of hepatitis.

From nine day care centers in Rome, Italy, 253 children of middle to low socioeconomic classes were examined for cytomegalovirus (CMV) excretion in saliva. The overall excretion rate was 13%, with no marked differences between centers. Socioeconomic level, age of enrollment, chronological age, length of attendance, and number of siblings did not have any discernible influence on viral shedding. The most notable result is that during the second year of age, 100% of the excretors had been breast fed, but only 60% in the third year, indicating that maternal transmission is the most likely source of children's infection early in life. Serologic survey of 82 female workers in day care centers, 82 matched housewives, and 229 female students aged 14 to 18 years who were in training to care for children showed that at 14 years of age the CMV seropositivity rate is 85, which suggests that primary infection during childbearing age is an uncommon event in Rome.

A total of 213 subjects from a community in Italy of immigrants from Somalia and other NE African countries were enrolled in this study to evaluate the prevalence of HAV, HBV, HCV and HDV infections and to assess their possible risk factors. Of the subjects, 45 per cent (96) were female and 24 per cent (52) were under 12 years old. The age range was from 1 to 67 years and the mean age was 24 years. Eighty-three per cent (177 subjects) were born in Somalia, 10 per cent (21 subjects) in Ethiopia, and the rest in Djibouti, Egypt or Saudi Arabia. The 213 subjects were administered a questionnaire which covered socio-demographic characteristics and risk factors resulting from Western medical practice, traditional medicine, personal behaviour and living conditions. Blood was drawn from 209 subjects to ascertain the presence of HbsAg, HBeAg, anti-HAV, anti-HBc, anti-HBs, anti-HCV and anti-HDV. The results of this study show an HAV prevalence of 96 per cent (an 87.5 per cent prevalence in children under 12), and an HBV prevalence of 32 per cent (a 3.3 per cent prevalence of HBsAg carriers). No subject under 11 was HBV positive and no woman tested positive for HBeAg, confirming the extreme unlikelihood of vertical transmission of HBV. The prevalence of HBV is closely correlated with age (ranging from 2 per cent in those under 12 to 59 per cent in subjects over 39).(ABSTRACT TRUNCATED AT 250 WORDS)

Between April and December 1996, a serious outbreak of poliomyelitis occurred in Albania; almost 140 subjects were involved, and the episode presented an unusually high mortality rate (12%). During the outbreak, water samples from the Lana River in Tirana, Albania, and stool samples from two cases of paralytic poliomyelitis were collected and analyzed for the presence of polioviruses. Six polioviruses were isolated from the environmental and human samples, according to standard methods. All the samples were characterized by partial genomic sequencing of 330 bases across the 5′ untranslated region (5′-UTR) (nucleotide positions 200 to 530) and of 300 bases across the VP1 region (nucleotide positions 2474 to 2774). Comparison of these sequences with those present in data banks permitted the identification of environmental isolates Lana A and Lana B as, respectively, a Sabin-like type 2 poliovirus and an intertypic recombinant poliovirus (Sabin-like type 2/wild type 1), both bearing a G instead of an A at nucleotide position 481. The two other environmental polioviruses were similar to the isolates from the paralytic cases. They were characterized by a peculiar 5′-UTR and by a VP1 region showing 98% homology with the Albanian epidemic type 1 isolates reported by other authors. This study confirms the environmental circulation in Albania of recombinant poliovirus strains, likely sustained by a massive vaccination effort and by the presence in the environment of a type 1 poliovirus, as isolated from the Lana River in Tirana about 2 months before the first case of symptomatic acute flaccid paralysis was reported in this town.

Background. Healthcare professionals have an important role to play both as advisers—influencing smoking cessation—and as role models. However, many of them continue to smoke. The aims of this study were to examine smoking prevalence, knowledge, attitudes, and behaviours among four cohorts physicians specializing in public health, according to the Global Health Profession Students Survey (GHPSS) approach.Materials and Methods. A multicentre cross-sectional study was carried out in 24 Italian schools of public health. The survey was conducted between January and April 2012 and it was carried out a census of students in the selected schools for each years of course (from first to fourth year of attendance), therefore among four cohorts of physicians specializing in Public Health (for a total of n. 459 medical doctors). The GHPSS questionnaires were self-administered via a special website which is created ad hoc for the survey. Logistic regression model was used to identify possible associations with tobacco smoking status. Hosmer-Lemeshow test was performed. The level of significance wasP≤0.05.Results. A total of 388 answered the questionnaire on the website (85%), of which 81 (20.9%) declared to be smokers, 309 (79.6%) considered health professionals as behavioural models for patients, and 375 (96.6%) affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 388 (89.7%) heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization.Conclusions. The present study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in public health, their key role both as advisers and behavioural models, and the limited tobacco training offered in public health schools.