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INTRODUZIONE Circa il 20% degli Operatori Sanitari (OS) contrae annualmente una patologia da virus influenzale e la vaccinazione stagionale è fortemente raccomandata quale migliore strategia di prevenzione tra gli OS. Diverse iniziative sono state messe in atto a livello nazionale per incrementare le scarse coperture vaccinali antinfluenzali evidenziate tra gli OS. In questo studio viene analizzato il trend di adesione vaccinale degli OS operanti presso l’Azienda Ospedaliera Universitaria (AOU) Policlinico di Palermo nelle ultime otto stagioni vaccinali, valutando l’impatto di differenti strategie comunicative ed informative messe in atto nel corso delle ultime tre stagioni vaccinali (2015/2016 - 2016/2017 - 2017/2018) MATERIALI E METODI Gli OS aderenti alla vaccinazione antinfluenzale hanno compilato un questionario validato ed autosomministrato al termine della seduta vaccinale. Contestualmente, è stato predisposto un modulo di dissenso informato per tutti gli OS che non hanno aderito alla vaccinazione antinfluenzale, compilabile sulla pagina personale (intranet) del portale Web Aziendale. Nelle ultime tre stagioni vaccinali sono state messe in atto diverse iniziative atte a promuovere l’adesione alla vaccinazione antinfluenzale degli OS tra cui: creazione di pagine web (internet e social media) dedicate alla campagna vaccinale, creazione di locandine, slogan e hashtag anche in formato cartaceo da utilizzare per promuovere la vaccinazione, settimana di vaccinazione “on site” nei reparti, formazione preliminare degli OS operanti nei reparti a maggiore rischio (UTI, UTIN, Oncologia, Ginecologia, etc...) RISULTATI La copertura vaccinale è salita progressivamente da un valore medio del 5 (dalla stagione 2010/2011 alla 2014/2015) al 27% nell’ultima stagione 2017/2018 (chi-square for trend: 857, p

La pratica vaccinale in Italia è organizzativamente incardinata all’interno del Servizio Sanitario Nazionale (SSN) e nei Servizi Sanitari Regionali (SSR). I luoghi “classici” in cui viene effettuata la procedura/prestazione vaccinale sono i servizi di vaccinazione della Aziende Sanitarie Locali (ASL) o Provinciali (ASP) delle varie Regioni.

INTRODUZIONE: La vaccinazione antin uenzale rappresenta la misura preventiva più ef cace nel limitare la diffusione del virus in uenzale ed il Ministero della Salute raccomanda fortemente tale misura precauzionale a tutti gli operatori sanitari (OS). Gli OS sono ripetutamente esposti al virus, rappresentando una delle principali fonti di contagio per i pazienti e anticipando la malattia in uenzale rispetto alla popolazione generale. In numerosi studi, gli OS hanno riportato che la strategia preferita per implementare le coperture antin uenzali tra gli stessi, era l’organizzazione di corsi di formazione multidisciplinare sulla tematica. In questa ottica è stato svolto un intervento formativo sulla vaccinazione antin uenzale tra gli OS di alcuni reparti della AOU Policlinico di Palermo, veri candone l’ef cacia nel modi care le coperture e le scelte vaccinali degli OS MATERIALI E METODI: Gli interventi formativi sono stati condotti presso le U.O. con pazienti a maggiore rischio di contrarre la patologia in uenzale (oncologia, UTIN, etc..). E’ stato somministrato preliminarmente all’intervento un questionario ai partecipanti e per ciascuno di essi sono stati selezionati due controlli, tra gli OS afferenti allo stesso reparto che non avevano aderito all’incontro formativo. RISULTATI: Hanno partecipato 38 OS (30,4%) su 125 soggetti arruolati. La copertura vaccinale nella seguente stagione vaccinale antin uenzale è stata del 37,2% tra i casi e del 26,2% tra i controlli. Tra coloro che hanno partecipato all’intervento formativo è risultato signi cativamente superiore (p

Being a serious threat to physical and emotional health of children and adolescents all over the world, bullying in school represents an important public health issue. Since 2007, in Italy, the Ministry of Education (MIUR) has promoted activities to face and prevent bullying in schools of all levels while at the same time national and local Health Authorities have implemented effective social-health strategies. To date, the lack of consistent data needed to properly describe the concerning increase of this Public Health phenomenon prevents both the ability to systematically survey and measure the effectiveness of the public health strategies against bullying. The Bullying In Sicilian Schools (BIAS) pilot study’s aims: i) to estimate the prevalence of bullying in a sample of secondary first-grade schools of Palermo, the largest city in Sicily, investigating its characteristics, and ii) to assess the feasibility of alternative methods for the detection of the prevalence of bullying in schools. Here we present the research protocol and the questionnaires that will be used.

Objectives To apply Wolff’s Criteria to hospital discharge records (HDR) in order to detect adverse events worthy of further study. Methods Gynecology and Obstetrics Units of three Sicilian hospitals were considered and HDR regarding ordinary and day hospital admissions in 2008 were collected. A matched case-control study was designed, by random selection of 10 controls at maximum for each case. Matching was performed on the variables age and speciality of admission (gynecology or obstetrics). Results Out of a total of 7011 HDR examined, 114 cases were identified with Wolff’s Criteria. Multivariate analysis confirmed a statistically significant association with the origin of admission, diagnosis at the acceptance and length of stay: there was a decreased risk of Wolff’s event in patients having urgent admission compared to elective (OR = 0.47, 95% CI = [0.28-0.78]), an increased risk in patients reporting tumor (OR = 5:41, 95 % CI [1.89-15.47]) and other causes (OR = 2.16, 95% CI [1.10-4.24]) compared to delivery diagnosis at acceptance and in patients whose length of stay was more than 6 days (OR = 23.17, 95% CI = [12.56-42.7]) compared to less or equal than 3 days Conclusion Wolff’s Criteria can be applied for the analysis of clinical risk in hospitals with different structural characteristics, on condition that the HDR database is complete and good quality.

Summary Introduction. Vaccination coverages threaten to decrease because of false beliefs in their unsafety and inefficacy. Therefore formation of future health-care workers on this topic is fundamental to deal with any doubt and to promote active immunization among general population. Methods. In order to assess health-care students' knowledge about vaccination before an integrated seminar on this topic, and to evaluate their improvement after the educational intervention, an integrated educational intervention was held by a multidisciplinary team. Before and after the seminar, 118 students of medicine and biology schools at Palermo University were asked to answer 10 multiple-choice questions regarding vaccine history, mechanism of action, side effects, composition, use and nowadays issues (hesitancy). Two more questions investigating possible changes on students' attitudes towards vaccination and the usefulness of the formative intervention, were added at the post-test phase of the survey. Results. Eighty-one out of 118 students (68.6%) answered to both pre- and post-test questions. 97.6% and 81.5% of the participating group also completed the two additional questions about their improvement in knowledge (question 11) and attitudes (question 12) towards vaccinations. The post-test results showed a significant improvement for all questions administered, except for number 3 (about a specific immunological content), with an overall percentage of correct answers increasing from 38.8% to 77.6% (p©< 0.001). Conclusions. The present explorative study put the basis for future studies, stronger in the methodology, and highlights the importance of educating health-care professions students by integrated extra-curricular intervention to be held early in their degree curricula and in order to improve knowledge and attitudes towards vaccinations and to prepare them to promote vaccines among the general population.

Pneumococcal community-acquired pneumonia (CAP) is a leading cause of mortality. Following the introduction of pneumococcal conjugate vaccines (PCVs) in children, a decrease in the burden of the disease was reported. In parallel, an increase in non-vaccine serotypes was also noted. The objective of this study was to assess the current serotype-specific epidemiology of pneumococci among Italian older adults hospitalized for CAP. A prospective study was conducted between 2017 and 2020 in four Italian regions. Subjects aged ≥65 years hospitalized with confirmed CAP were tested for pneumococci using both pneumococcal urinary antigen and serotype-specific urine antigen tests able to identify all 24 serotypes included in the available vaccines. Of the 1155 CAP cases, 13.1% were positive for pneumococci. The most prevalent serotypes were 3 (2.0%), 8 (1.7%), 22F (0.8 %) and 11A (0.7%). These serotypes are all included in the newly licensed PCV20. The serotypes included in PCV13, PCV15 and PCV20 contributed to 3.3%, 4.4% and 7.5% of the CAP cases, respectively. In the context of a low PCV13 coverage among older adults and a high PCV coverage in children, a substantial proportion of CAP is caused by PCV13 serotypes. Higher valency PCV15 and PCV20 may provide additional benefits for the prevention of CAP in vaccinated older adults.

Influenza A and B outbreaks occur each year with different activity and molecular patterns. To date, knowledge of seasonal epidemiology remains a prerequisite not only to put in place the most effective immunization strategy against influenza but also to identify population groups at higher risk of developing serious complications. A retrospective analysis of influenza surveillance data from 2010 to 2018 aimed to explore the epidemiology of influenza in Sicily, at the primary care and hospital level. Overall, 6,740 patients with acute respiratory infection were tested, of which 3,032 (45.0%) were positive for influenza. The relative proportion of type A and B viruses markedly varied across seasons. Type A similarly spreads among children and adults, whereas type B was more commonly identified among pediatric population aged 5–9 years. The median age of confirmed influenza cases differed by health-care setting, increasing according to disease severity (range: 8–54 years). Among influenza-confirmed cases, more than 80% of hospitalized patients had an underlying medical condition. Cardiovascular disease, lung disease, diabetes, and obesity were some of the most frequent. Overall, patients admitted to an intensive care unit were more likely to have multiple comorbidities and being infected with influenza infection strongly increased the risk of severe clinical outcomes. Understanding of the epidemiology of influenza and the molecular features of circulating viruses is of paramount importance to optimize prevention and control strategies. Knowledge of predictors for the occurrence of severe forms of the disease may help to address adequate preventive measures to high-risk population groups.

Populations documenting to date low incidence rates of SARS-CoV-2 infection are immunologically susceptible and at high exposure risk of new COVID-19 outbreaks during phase 3 of the pandemic. Following the experience documented by other countries with regard to the use of Information Communication Technology (ICT) to counteract the current pandemic, Italy has implemented a contact tracing system based on a mobile application. In this work, we describe the proposal of a complementary ICT-based prototypal model of COVID-19 prevention and surveillance system, involving the university students as sentinels acting both in the academic community and the general population.

In addition to diseases shared by both sexes, there are a number of illnesses and injuries that are primarily associated with women [...]

Objective: To assess healthcare workers&rsquo, knowledge and attitudes about human papillomavirus (HPV) infection, related diseases, and prevention. Methods: A cross-sectional multicenter survey about HPV and its prevention, targeted to healthcare workers involved in HPV vaccine counseling, was performed from May 2017 to December 2018. Results: The overall median knowledge and attitude scores were 69.2% (25&ndash, 75, p = 61.5&ndash, 84.6) and 5 (25&ndash, 75, p = 4&ndash, 5), respectively. Both knowledge and attitudes statistically significantly differ between physicians and healthcare professions. The median propensity score before and after the educational intervention was stable and high, at 10 (25&ndash, 75, p = 9&ndash, 10). The predictors of statistically significantly high knowledge scores are to be a physician, general practitioner, or pediatrician, attending courses/congresses, and consulting technical product characteristics and scientific literature to obtain information about the HPV vaccine. Being a physician and consulting scientific literature to obtain information about the HPV vaccine were found also as predictors of statistically significantly different attitude scores among study participants. Conclusions: Although healthcare workers showed overall positive attitudes towards the relevance of HPV burden and prevention tools, demonstrated knowledge was largely suboptimal, particularly that shown by healthcare professions. Obtained results allow highlighting knowledge gaps, and thus improving counselling to HPV vaccine targets.

The last 2019/20 northern hemisphere influenza season overlapped with the first wave of coronavirus disease 2019 (COVID-19) pandemic. Italy was the first western country where severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread to a significant extent. In this representative cross-sectional survey, we aimed to describe some opinions and attitudes of the Italian general population towards both influenza vaccination and the COVID-19 pandemic, and to identify potential modifiers of the decision-making process regarding the uptake of the 2020/21 influenza vaccine. A total of 2543 responses were analyzed. Although most (74.8%) participants valued influenza vaccination positively and declared that it should be mandatory, some misconceptions around influenza persist. The general practitioner was the main source of trusted information on influenza vaccines, while social networks were judged to be the least reliable. Younger and less affluent individuals, subjects not vaccinated in the previous season, and those living in smaller communities showed lower odds of receiving the 2020/21 season influenza vaccination. However, the COVID-19 pandemic may have positively influenced the propensity of being vaccinated against 2020/21 seasonal influenza. In order to increase influenza vaccination coverage rates multidisciplinary targeted interventions are needed. The role of general practitioners remains crucial in increasing influenza vaccine awareness and acceptance by effective counselling.

Several studies have reported that influenza infections in healthcare workers (HCWs) can lead to nosocomial outbreaks. HCWs can potentially be infected with influenza every year, and may continue to work, encouraging the spread of the virus. Different strategies, such as informative interventions on influenza and influenza vaccination, ‘onsite’ vaccination weeks, communicative strategies through dedicated web and social media pages, and mandatory informed dissent form, were organized for HCWs working at the University Hospital of Palermo, during previous influenza seasons. However, the increased vaccination rates observed among HCWs still remain far from the 75% recommended by Public Health Authorities. The level of coverage observed in countries with mandatory vaccination policies for HCWs, could suggest the adoption of this strategy for increase influenza vaccination adherence in Italy.

Italy is the main recipient of asylum seekers in the European region, and Sicily is their first point of arrival. This geographical position creates a large job for Health Authorities to identify and deal with the health of immigrants. This study evaluates the prevalence of disease among asylum seekers, assessing which are associated factors.A cross-sectional study was conducted to analyse demographic and clinical data in an Acceptance Centres for Asylum Seekers from February 2012 to May 2013. All variables that were found to be significant on unvariable analysis for the most frequent pathologies were included in a multivariable logistic regression model.Post-traumatic stress disorders with 17.4% and major depression with 7.3% were the most frequent diseases. The factors associated with post-traumatic stress disorders among asylum seekers were: major depression diagnosis (OR=2.91, p=0.004), Pakistan as a country of origin (OR=3.88, p0.001), the largest number of medical visits (OR=1.02, p=0.033) and refugee status (OR=1.97, p=0.036). The variables linked with the diagnosis of major depression from the multivariable analysis were: suffering from post-traumatic stress disorders (OR=3.83, p0.001), Pakistan as a country of origin (OR=3.45, p=0.004) and the highest number of visits to psychologist (OR=1.15, p0.001).The mental wellbeing of asylum seekers needs special attention, and interventions should be done to prevent the consolidation of psychiatric morbidity. A short psychological screening after the arrival might prove helpful here. Moreover, carefully designed longitudinal studies should be carried out when political recommendations try to change the organization of psychological and healthcare services.Italija je na prvem mestu med državami, ki sprejemajo prosilce za azil v evropski regiji, Sicilija pa je vstopna točka za priseljence. Ta geografski položaj prinaša veliko dela zdravstvenim organizacijam, ki morajo obravnavati zdravje priseljencev. Pričujoča študija prikazuje prevalenco bolezni in z njimi povezanih dejavnikov med prosilci za azil.Izvedena je bila pregledna študija in analiza demografskih in kliničnih podatkov v sprejemnih centrih za prosilce za azil od februarja 2012 do maja 2013. Vse spremenljivke, ki so se izkazale za bistvene za univariantno analizo najpogostejših bolezni, so bile vključene v multivariantni logistično-regresijski model.Posttravmatska stresna motnja s 17,4 % in velika depresivna motnja s 7,3 % sta najbolj pogosti bolezni. Dejavniki, povezani s posttravmatsko stresno motnjo pri prosilcih za azil, so bili: diagnoza velike depresivne motnje (OR=2,91; p=0,004), Pakistan kot država izvora (OR=3,88; p0,001), največje število zdravstvenih pregledov (OR=1,02; p=0,033) in status begunca (OR=1,97; p=0,036). Spremenljivke, povezane z diagnozo velike depresivne motnje iz multivariantne analize, so bile: posttravmatska stresna motnja (OR=3,83; p0,001), Pakistan kot država izvora (OR=3,45; p=0,004) in največje število obiskov psihologa (OR=1,15;p0,001).Duševno zdravje prosilcev za azil zahteva posebno pozornost, potrebne pa so intervencije za preprečevanje krepitve psihiatrične obolevnosti. Tu bi bilo lahko v pomoč kratko psihološko presejanje po prihodu. Potrebno bi bilo izvesti tudi natančno zasnovane longitudinalne študije, ko politična priporočila poskušajo spremeniti organizacijo psiholoških in zdravstvenih služb.

Landfilling should be the last option in an integrated Municipal Solid Waste (MSW) management approach. In the European Union (EU), the policy framework to protect the environment and the public health against the impact of health hazards related to urban solid waste management has been consistently implemented in recent decades. A growing interest in the negative impact of fires in waste landfills on the environment and people’s health was reported in some European countries. In Italy, an increasing occurrence of arsons in MSW and landfills has been reported in recent years. During the summer of 2012, a multi-site arson occurred in the Palermo Municipal solid waste landfill of Bellolampo (western Sicily), giving rise to an environmental emergency of public health concern. Local health authorities reacted by creating an inter-institutional multidisciplinary task force with the aim to implement measures to prevent and control the risk of exposure by delimiting a protection area to be taken under strict monitoring. Environmental and epidemiological investigations were put in place by air, soil, and farm product sampling. A syndromic surveillance of the exposed population was conducted as well. The air monitoring stations system in place detected an increase in the concentrations of dioxins and dioxin-like substances with the PM10 highest emission pick documented within the first 24 h and estimated at about 60 μg/m3. Levels of heavy metals above the limits permitted by law were detected in the top- and sub-soil samples collected within the two landfill sampling sites and also in other nearby sites. Non-conforming concentration values of dioxins and dioxin-like substances were detected in samples taken from farms, milk, and water. The health syndromic surveillance did not document any daily increase in the notification of emergency admissions related to acute respiratory diseases or any other health effect potentially related to the waste arson, but these findings were limited by the non-systematic collection of data. The experience reported in the present case report, as declined within the European Union policy framework and in the view of environmental justice, documented the need to structure a permanent collaboration between the different institutional actors involved in environmental and public health protection activities in order to develop specific protocols to manage events related to the occurrence of waste-related environmental emergencies or disasters.

Introduction Inequality levels are associated with vaccination coverage among the older and at risk population hypothesizing socio-economic status (SES) as a determinant of health status. The aim of the study was to evaluate the trend of health outcome and socio-health-economic-status deprivation index (IDPA) among elderly people in Palermo city, Italy . Methods The Palermo Unit of 2015 CCM project deal with collection of data useful to validate IDPA using the Italian census data from 2009 to 2015 on overall mortality and cause of death. The preventive outcome used to validate the IDPA index was vaccination coverage from 2009-2010 to 2014-2015 influenza season among Palermo elderly population. Results Among the elderly IDPA had a significantly decreasing trend in overall mortality (p, Journal of Preventive Medicine and Hygiene, Vol 59, No 4s2 (2018): Influenza vaccination coverage in the elderly and socio-economic inequalities in Italy. How local deprivation indices can help to improve the prevention of influenza in specific population sub-groups. - Suppl.2

Objective: To evaluate the characteristics of hospital discharge diagnoses of influenza measured by using specific International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) codes. Subjects and Methods: The study was conducted for the 3 years 2007, 2008 and 2011. The database included (1) administrative and clinical data on Sicilian patients admitted to acute care hospitals and (2) data from the influenza virological surveillance of 10 European countries (FluNet database). All Sicilian patients diagnosed with at least 1 ICD-9 CM code for influenza (487.0, 487.1 and 487.9) were considered influenza cases. Results: Overall, 2,880 patients with an ICD-9 CM code attributable to influenza were hospitalized in Sicily: 2,119 (73.6%) were admitted from November to April, whereas 761 (26.4%) were admitted from May to October. In the 3 years studied, the analyzed European influenza surveillance systems recorded a peak of laboratory-confirmed influenza activity from November to April with 36,753 (99.7%) influenza cases, whereas only 124 cases (0.3%) were observed from May to October. Conclusions: In Sicily, more than one quarter of all hospital admissions with an ICD-9 CM code for influenza were observed in the months with a negligible circulation of influenza viruses. Our findings show that several hospital discharge records included ICD-9 CM codes for influenza with low levels of sensitivity, specificity and/or appropriateness for clinical information and support the need for improving medical education on the epidemiology and hospital management of influenza cases.

Vaccine knowledge of the general population is shaped by different information sources and strongly influences vaccination attitudes and uptake. The CCM-Italian Ministry of Health ESCULAPIO project attempted to identify the role of such information sources, in order to address adequate strategies to improve information on vaccines and vaccine preventable diseases. In the present study, data on 632 adults from Southern Italy regarding information sources were collected, and their perceived and actual knowledge on vaccinations were compared and analyzed in relation to socio-demographic characteristics and information sources. The main reported reference sources were general practitioners (GPs) (42.5%) and pediatricians (33.1%), followed by mass media (24.1%) and the Internet (17.6%). A total of 45.4% reported they believed to be informed (45.4%), while those estimated to be truly informed were 43.8%. However, as showed in the multivariate logistic regression, people having the perception to be correctly informed ascribed their good knowledge to their profession in the health sector (Adj OR 2.28, CI 1.09–4.77, p < 0.05) and to friends/relatives/colleagues (AdjOR 6.25, CI 2.38–16.44, p < 0.001), while the non-informed population thought the responsibility had to be attributed to mass media (AdjOR 0.45, CI 0.22–0.92, p < 0.05). Those showing the real correct information, instead, were younger (AdjOR 1.64, CI 1.04–2.59, p < 0.05), and their main reference sources were pediatricians (AdjOR 1.63, CI 1.11–2.39, p < 0.05) and scientific magazines (Adj OR 3.39, CI 1.51–7.59, p < 0.01). Only 6% knew the “VaccinarSì” portal, developed to counter the widespred antivaccine websites in Italy. The post-survey significant increase of connections to “VaccinarSi” could be ascribed to the counselling performed during questionnaire administration. Strategies to improve information about vaccination should be addressed to fortifying healthcare workers knowledge in order to make them public health opinion leaders. General population should be provided with correct indications on trustworthy websites on vaccines to contrast false information supplied by anti-vaccinists on their own websites or social networks pages and on the mass media.

The real cause of intussusception is not fully understood and a variety of conditions have been associated with it (Meckel diverticulum, polyps, duplication cysts, parasites, Henoch-Schönlein purpura, cystic fibrosis, hemolytic-uremic syndrome and infectious gastroenteritis). Furthermore few European countries, following WHO recommendation to monitor baseline incidence of intussusception before implementation of immunization program for rotavirus, used intussusception rate as a baseline value to compare the same figures in the period before and after introduction of vaccination. In this study, data of intussusception hospitalizations occurred among Italian children aged 0 through 59 months from 2009 to 2014 were analyzed. A total amount of 3,088 children were included, accounting for a hospitalization rate of 20.2 per 100,000. Overall, the hospitalization rate for intussusception had a slight increase in trend from 2009 to 2014 (18%). In particular children 0–11 months had a hospitalization rate higher than 12–59 months with an aggregate value of 36 Vs. 16 per 100,000 respectively. Among all children hospitalized for intussusception a total of 239 (7.7%) had also a previous or concomitant hospitalization for gastroenteritis. This study demonstrates that Italian hospitalizations for intussusception are increasing by time and the role played by different risk factors, including acute gastroenteritis, have to be investigated in the future. These data could be useful to monitor intussusception hospitalization in the perspective of anti-rotavirus vaccination introduction in Italy.

The spread of Streptococcus pneumoniae within families has been scarcely investigated so far. This feasibility study aimed to estimate the prevalence of pneumococcal carriage in school-aged children and co-habiting relatives and to explore the potential link between the family environment and the sharing of pneumococcal serotypes covered by the vaccine. Oropharyngeal samples of 146 subjects belonging to 36 different family groups were molecularly tested for pneumococcal detection and serotyping. The overall prevalence of pneumococcal carriage was 65.8% (n = 96/146), whereas it was higher among schoolchildren (77.8%, n = 28/36); subjects of seven years of age had the highest odds of being colonized (odds ratio, OR = 5.176; p = 0.145). Pneumococcal serotypes included in the 13-valent conjugate vaccine formulation were largely detected in the study population and multiple serotypes colonization was considerable. Factors relating to a close proximity among people at the family level were statistically associated with pneumococcal carriage (OR = 2.121; p = 0.049), as well as active smoking habit with a clear dose-response effect (ORs = 1.017-3.326). About half of family clusters evidenced similar patterns of carried pneumococcal serotypes and the odds of sustaining a high level of intrafamilial sharing increased with household size (ORs = 1.083-5.000). This study highlighted the potential role played by the family environment in sustaining both the circulation and horizontal transmission of pneumococcus.

Vaccination represents the most effective intervention to prevent infection, hospitalization and mortality due to influenza. This meta-analysis quantifies data reporting influenza vaccine effectiveness (VE) on influenza visits and hospitalizations of case-control and cohort studies among high-risk groups. A systematic literature review including original articles published between 2007 and 2016, using a protocol registered on Prospero with No. 42017054854, and a meta-analysis were conducted. For three high-risk groups (subjects with underlying health conditions, pregnant women and health care workers) only a qualitative evaluation was carried out. The VE quantitative analysis demonstrated a clear significant overall effect of 39% (95%CI: 32%-46%) for visits and 57% (95%CI: 30%-74%) for hospitalization among children. Considering the elderly influenza VE had a clear effect of 25% (95%CI: 6%-40%) for visits and 14% (95%CI: 7%-21%; p

In Sicilia, a fronte di un incremento dell’estensione dello screening organizzato del cervicocarcinoma, non corrisponde un aumento dell’adesione. Nei mesi di gennaio-giugno 2016 è stata condotta un’indagine trasversale somministrando un questionario standardizzato a un campione di 365 donne, per descrivere le ragioni del fenomeno e promuovere interventi mirati. Per le variabili di atteggiamento e conoscenza è stato utilizzato l’Health Belief Model, che ha esplorato la percezione della donna della suscettibilità (rischio di sviluppare il cancro), della gravità della patologia e dei benefici derivanti dal pap-test. Dai risultati emerge che il 66,6% delle intervistate ha effettuato un pap- test nell’ultimo triennio (valore nazionale 79,2%); il consiglio da parte di un operatore sanitario e la suscettibilità percepita sono associati a una maggiore adesione allo screening. Il potenziamento dei programmi organizzati di screening e l’intervento attivo del medico di medicina generale rappresentano strategie efficaci di promozione dello screening.

Among solid organ transplant recipients, influenza infection is commonly associated with higher morbidity and mortality than immunocompetent hosts. Therefore, in these subjects influenza vaccination is of paramount importance. The main objective of the study was to assess compliance to vaccination and analyze factors associated with influenza vaccination of solid organ transplant recipients admitted to the Sicilian solid organ transplant Reference Center IRCCS-ISMETT in Palermo during 2014–2015 influenza season. Thirty one (37.8%) out of 82 solid organ transplant recipients were vaccinated against influenza. The main reason for vaccination refusal was fear of adverse reaction (n = 16, 31.4%), impaired health status (n = 14, 27.4%) and low vaccine efficacy (n = 10, 19.6%). Vaccinated solid organ transplant recipients compare with unvaccinated had smaller hospital admissions for infectious respiratory diseases (9.7% Vs 23.5%) during surveillance period. On multivariate analysis the factors positively associated with influenza vaccination were the advice of Reference Center physicians (OR 53.4, p < 0.001) and to perform vaccine against pneumococcus (OR 7.0, p = 0.016). This study showed that Reference Center physicians play a key role on vaccine communication and recommendation for patients at risk and it underlines the effectiveness of influenza vaccination in solid organ transplant recipients. However, it remains that, although physician advice resulted a strong determinant for vaccination, influenza vaccination coverage in this subset of population remains still unsatisfactory.

INTRODUZIONE L’Herpes Zoster (HZ) e la Nevralgia Post-Erpetica (NPE) sono patologie frequenti nell’adulto, specialmente in chi è affetto da comorbosità, e possono essere causa di ospedalizzazione. Oltre il 95% degli adulti italiani, avendo contratto la varicella, ne sono a rischio e l’unica METODIca di prevenzione è la vaccinazione. MATERIALI É stato condotto uno studio retrospettivo osservazionale delle Schede di Dimissione Ospedaliera dei soggetti residenti in Sicilia dal 2007 al 2015 per analizzare le variabili socio- demografiche e sanitarie tra cui la presenza di comorbosità dei ricoverati per HZ e PHN. I codici ICD9-CM utilizzati per identificare i casi HZ e NPE sono stati 053-053.9 presenti in almeno una delle 6 diagnosi. RISULTATI In totale 3.939 ricoveri per HZ/PHN sono stati registrati in Sicilia dal 2007 al 2015 in tutte le età (3.199 nei soggetti >50 anni). L’andamento delle ospedalizzazioni per età dei ricoveri con un codice di HZ/NPE in una delle 6 diagnosi è stato di 8,7 per 100.000 (range 10,9-6,3). In tutto il periodo analizzato si è avuto un sostanziale incremento dei ricoveri a partire dai 55 anni, il sesso femminile è stato maggiormente ospedalizzato (M/F ratio=0,9) e la durata media del ricovero è stata di 7 giorni. I soggetti ricoverati con diagnosi di HZ/PHN, senza comorbosità, sono stati 689 (17,4%). Tra i soggetti con HZ e comorbosità i maggiori tassi di ospedalizzazione si sono osservati in quelli affetti da HIV (725 per 100.000), LLC (530 per 100.000), MM (246 per 100.000) e BPCO (103 per 100.000). CONCLUSIONI La maggiore età risulta essere uno dei principali fattori di rischio per HZ e NPH, presumibilmente per la riduzione dell’immunità cellulo-mediata virus specifica. Poichè le categorie a maggior rischio di contrarre una forma grave di HZ sono costituite dai soggetti ai quali è parzialmente controindicata la vaccinazione anti-zoster (HIV, MM e LLC) sarebbe opportuno valutare caso per caso l'eventuale vaccinazione di tali soggetti.

La gastroenterite rotavirale (GERV) è una delle principali cause di ricovero nei bambini di età inferiore ai 5 anni in Italia. L'unica strategia di Sanità Pubblica in grado di prevenirla è la vaccinazione. La Sicilia è stata la prima regione italiana ad introdurre la vaccinazione universale anti-Rotavirus (anti-RV) nel Gennaio 2013. Sono stati raccolti i dati relativi ai ricoveri con codice ICD-IX CM 008.61 in qualsiasi posizione di diagnosi nei bambini di età compresa tra 0 e 59 mesi residenti in regione Sicilia nel periodo pre (2009-2012) e post (2013-2015) INTRODUZIONE vaccinale. Tra il 2009 ed il 2015 sono stati osservati 5.718 ricoveri per GERV. Sono stati registrati una media di 961 casi annui in periodo pre vaccinale, con un tasso ospedalizzazione (TO) medio di 394/100.000, e di 624 casi annui (TO 270/100.000) in periodo post vaccinale. La riduzione di ospedalizzazioni per GERV è stata più consistente nella classe di età 0-35 mesi (-41%) in cui era disponibile il vaccino nel periodo in studio. Si è osservato anche uno shift del picco stagionale dei ricoveri per GERV confrontando periodo pre e post vaccinale da Aprile a Maggio (Figura 1). Le Provincie con le migliori coperture vaccinali hanno evidenziato riduzioni più marcate dei tassi di ospedalizzazione. In Sicilia, dopo i primi tre anni di attività e con coperture vaccinali medie del 37%, i tassi di ospedalizzazione per GERV sono complessivamente in diminuzione. In particolare, i maggiori benefici si sono osservati nelle classi di età in cui era disponibile il vaccino (0-35 mesi) e nelle Provincie con coperture vaccinali superiori al 45%. La spostamento in avanti del picco di ricoveri per GERV, se confermato in futuro, potrebbe configurare un minore sovraccarico dei reparti pediatrici e una minore possibilità di trasmissione di patologie nosocomiali, venendo a mancare la sovrapposizione con patologie respiratorie tipiche del periodo tardo invernale (virus respiratorio sinciziale, influenza).

INTRODUZIONE La colonizzazione orofaringea da pneumococco interessa il 90% dei bambini nel primo anno di vita ed i contatti familiari possono giocare un ruolo cruciale nella stessa. Per analizzare i fattori associati alla colonizzazione da pneumococco e alla possibile trasmissione intra-familiare, è stato realizzato il progetto BINOCOLO: "Bambini Insieme ai NOnni COntro LO Pneumococco" su una popolazione studentesca e relativi familiari co- residenti. METODI Per l'arruolamento dei partecipanti allo studio, sono state identificate due scuole primarie del Comune di Palermo. Per ogni soggetto reclutato, un questionario e un tampone orofaringeo sono stati raccolti attraverso un team opportunamente formato di operatori sanitari. La ricerca e la sierotipizzazione di Streptococcus pneumoniae sono state condotte mediante analisi molecolari in real-time PCR. RISULTATI Nello studio sono stati arruolati 36 nuclei familiari di studenti, per un totale di 110 individui co-residenti. L'86% degli studenti aveva ricevuto almeno una dose di vaccino anti- pneumococcico (contro il 2% dei familiari >12 anni di età). Tra i principali fattori associati alla colonizzazione da pneumococco sono stati individuati: la presenza di un meno di 4 stanze per abitazione (p=0.05), il fumare più di 15 sigarette/die (p=0.078), l'aver effettuato o meno la vaccinazione antipneumococcica (p=0.77). La distribuzione dei sierotipi identificati è riportata in Figura 1. CONCLUSIONI Il presente lavoro identifica alcuni potenziali determinanti socio-demografici e comportamentali correlabili alla diffusione della colonizzazione da pneumococco in ambito familiare. I RISULTATI ottenuti, per quanto statisticamente non significativi per la limitata dimensione campionaria, confermano quanto emerso in altre esperienze condotte in contesti differenti. Lo studio ha permesso di standardizzare i METODI da applicare in futuro su una casistica più ampia in grado di consolidare i RISULTATI preliminari fin qui ottenuti.

Background: Intussusception is the most common cause of bowel obstruction in infants with an incidence ranging from 9-328 cases per 100,000 infants aged 0-11 months. Causes underlining this clinical manifestation are still unknown. Possible relationship with a withdrawn tetravalent rotavirus vaccine was not confirmed by post-licensure studies and actually no increased risk of intussusception was found between infants vaccinated with both the recently licensed rotavirus vaccines. Aim of this study is to analyze the intussusception hospitalizations in Sicily from 2003 to 2012 before the introduction of rotavirus universal vaccination and its possible relation with rotavirus gastroenteritis trend. Methods: Were collected data from hospital discharge records occurred from 1st January 2003 to 31st December 2012 in Sicily. Intussusception cases were defined as all hospitalizations with an ICD-9-CM code of 560.0 on any discharge diagnoses. As a proxy for the severity of cases were considered ICD-9-CM procedure codes accounting for surgical or radiologic reduction. Results: A total of 340 intussusception cases were hospitalized in Sicily from 2003 to 2012 in children aged 0-59 months. 46.8 % occurred in the age class 0-11 months. Hospitalization rate for intussusception was 11.4 cases per 100,000 per year (32.6 cases per 100,000 among 0-11 months children; 7.3 cases per 100,000 among 12-59 months children), with a M:F sex ratio of 1.8. During hospitalization only 25 % of intussusceptions had a spontaneous resolution, 56.5 % of cases required a surgical intervention. From 2003 to 2012 intussusception cases were equally distributed during the year without any seasonality, while gastroenteritis hospitalizations due to rotavirus infection have a typically late winter and spring distribution. Conclusions: In Sicily from 2003 to 2012 hospitalizations due to intestinal invagination were higher among children aged 0-11 months with observed rates similar to other European countries. Regional baseline data analysis of intussusception among 0-59 children is recognized as an evidence-based public health strategy by international health authorities. Indeed, this strategy is necessary to compare any post-licensure age or sex-related change in intussusception trend after universal rotavirus vaccination introduction.

Background Previous studies have identified a possible relationship between anti-rotavirus vaccines and intussusception risk although not confirmed by post licensure studies. In Italy some administrative regions started to introduce rotavirus vaccination in 2013. Monitoring intussusception in pre and post vaccination era will be crucial to ensure safety of the vaccine program. Methods An observational study was carried out to analyze age-specific (0-59 months) Italian trends in intussusception hospitalization rates before (2009–2012) and after (2013) anti-rotavirus vaccine introduction. Results A total of 2,728 hospitalizations for intussusceptions were observed in Italy from 2009 to 2013, with a M:F sex ratio of 1.73. Furthermore, 1,001 cases were reported in the age class 0 to 11 months (36.7%). Compared with 2009 (16.4 per 100,000), the hospitalization rate was greater in 2010 (18.8 per 100,000; rate ratio [RR], 1.15), decreased in 2010 (17.6 per 100,000; RR, 0.93), rise up in 2012 (22.0 per 100,000; RR 1.25) and went down in 2013 (21.6 per 100,000; RR, 0.98). In particular, intussusception hospitalization rate decreased where rotavirus vaccine was offered as universal mass vaccination (UMV) or for at risk groups in 2013 (15.3 per 100,000) respect to 2009–2012 (15.7 per 100,000). On the other hand intussusception rates increased in 2013 (24.9 per 100,000) compared to 2009–2012 (20.3 per 100,000) in the Italian area where anti-rotavirus vaccine was not offered or was offered in co-payment. Conclusions Intussusception is a rare condition with an undefined etiology that mainly happens in the first moths of life and in male sex. Potential association with rotavirus vaccination was still debated in literature. In Italy, in the first year after vaccination introduction was not observed an increase in hospitalization rates for intussusception. In detail, districts with UMV and for at risk group vaccination showed a small decrease in intussusceptions rates.

Background Rotavirus vaccination (RV) is recognized by international health authority as the best strategy to prevent rotavirus gastroenteritis (RVGE) in children. Costs of RVGE were estimated in several studies and were classified into direct and indirect costs, that should be further divided into Health care and social perspective. This study aims to evaluate RVGE hospitalization costs in Sicily, before and after universal mass RV (UMRV) introduction. Methods Cases of RVGE were defined as all hospitalizations with an ICD-9-CM diagnosis code of 008.61 on any diagnosis position among children aged 0 to 59 months. Data were obtained from Hospital discharge records (HDR) of the Health Regional Office from 2009 to 2014. Direct and indirect costs of RVGE hospitalization for health care and social perspective were calculated on data reported in the REVEAL study. RV costs was extrapolated from a budget impact analysis published in 2013 by Vitale et al. Results In Sicily, during the pre-vaccination era (2009-2012) were reported 963 RVGE hospitalizations per year with a mean HDR cost of 1,521E (1,465,000E per year) , against 511 RVGE cases per year (mean HDR cost of 1,321E; 675,000E per year) after UMRV introduction (direct hospitalization Health care costs). Moreover, direct and indirect hospitalization costs for social perspective was estimated 1.5 times bigger than direct hospitalization health care cost (pre-vaccination era 2,255,000E per year, post-vaccination era 1,020,000E per year). Finally, cost of RV vaccine in Sicily in 2013 and 2014 was 1,300,000E per year (mean vaccination coverage 37%). In Sicily after RV introduction, every year was estimated a 46% reduction of RVGE hospitalizations and a 700,000E benefit for Regional fund. Conclusions Despite low vaccination rate and even though the inability to evaluate the impact of RV vaccination on primary care and emergency access for RVGE, our study demonstrated the high cost-effectiveness of UMRV on hospitalization rate and costs in Sicily.

Background. The migration of people has always accompanied the history of man and produced a gradual but constant reorganization of the coordinates of the ethnic and cultural world. Today, all of this continues to undergo a profound acceleration, taking aback often unprepared governments and the same population and generating fears, mostly unfounded concerns and prejudices that make complex a peaceful and necessary integration. The purpose of this study is understand the actual perception of immigrants from a sample of students who live in Western Sicily. Methods. A cross-sectional survey was carried out, throughout an anonymous questionnaire, to all students attending a high school in Castellammare del Golfo, in Sicily close to an Acceptance Centers for Asylum Seekers (CARA). This questionnaire contains a series of questions that take into account different aspects of Immigration (socio-demographic and health aspects). Results. The sample consists of 253 students attending a high school in Sicily, of which 176 (69.6%) are females. 187 of these (73.9%) think that there are too much immigrants in Italy. The reasons that push migrants to come to Italy, for their opinion, are considered the economic ones (204, 80.6%) and logistic ones (ease of entry) (71, 28.1%). Half of this sample (136, 53.8%) knows the CARA in their town. 106 (41.9%) of respondents tend to be agree on the possibility that immigration promotes the spread of terrorism and crime. Considering health aspects, 61 (24.1%) of the students believe that the most frequent pathology into a CARA is tuberculosis (tb), instead 66 (26.1%) think about respiratory illness. 106 (41.9%) of respondents believe that immigrants can transmit specific diseases, such as tb (36, 33.9%) and all the pathologies examined (gastroenteritis, tuberculosis, respiratory illness with fever, meningitis) (34, 32.1%). Furthermore it was performed a multivariate logistic analysis between the variable of who think that immigrants can transmit infectious diseases and the other ones. The results show that this variable is directly associated with the idea that the main cause of hospitalization among male immigrants is the same infectious diseases (OR= 3.15 p=0.007). On the other side this variable is inversely associated with being little (OR=0.04 p=0.009) and not at all (OR=0.27 p=0.02) agree with the idea that immigrants can promote the spread of terrorism. Conclusion. These data suggest that the knowledge about migrants is not still sufficient, and that the perception of the foreign is still marked by prejudices. The research aimed to investigate the perception of these adolescents compared to immigrants, an indispensable prerequisite to give tools able to inform people properly on immigration with particular reference to health topics and to fight prejudices and stereotypes in healthcare.

Background Approximately 20% of healthcare workers are infected with influenza each year, causing nosocomial outbreaks and staff shortages. Despite influenza vaccination of healthcare workers representing the most effective preventive strategy, coverage remains low. Aim To analyse the risk of nosocomial influenza-like illness (NILI) among patients admitted to an acute care hospital in relation to influenza vaccination coverage among healthcare workers. Methods Data collected over seven consecutive influenza seasons (2005–2012) in an Italian acute care hospital were analysed retrospectively. Three different sources of data were used: hospital discharge records; influenza vaccination coverage among healthcare workers; and incidence of ILI in the general population. Clinical modification codes from the International Classification of Diseases, 9th Revision were used to define NILI. Findings Overall, 62,343 hospitalized patients were included in the study, 185 (0.03%) of whom were identified as NILI cases. Over the study period, influenza vaccination coverage among healthcare workers decreased from 13.2% to 3.1% (P < 0.001), whereas the frequency of NILI in hospitalized patients increased from 1.1‰ to 5.7‰ (P < 0.001). A significant inverse association was observed between influenza vaccination coverage among healthcare workers and rate of NILI among patients (adjusted odds ratio 0.97, 95% confidence interval 0.94–0.99). Conclusion Increasing influenza vaccination coverage among healthcare workers could reduce the risk of NILI in patients hospitalized in acute hospitals. This study offers a reliable and cost-saving methodology that could help hospital management to assess and make known the benefits of influenza vaccination among healthcare workers.

Introduzione Secondo l’Organizzazione Mondiale della Sanità l’incidenza annuale delle malattie sessualmente trasmesse (MST) è di circa 448 milioni di nuovi casi nel mondo nei soggetti di età compresa tra i 15 ed i 49 anni. A tal proposito la Scuola di Specializzazione in Igiene e Medicina Preventiva dell'Università degli Studi di Palermo ha condotto un'indagine per valutare le conoscenze degli studenti dei 6 anni del Corso di Laurea in Medicina e Chirurgia dell'Università degli Studi di Palermo in quanto, proprio per la loro specifica formazione, saranno coinvolti in prima persona nel counselling delle popolazioni a rischio di contrarre le MST. Materiali e Metodi Lo studio si è basato sulla somministrazione di un questionario anonimo svolto durante l’orario delle lezioni. La somministrazione è stata preceduta da una breve descrizione dello studio e delle sue finalità. Il questionario è costituito da 5 sezioni principali: dati demografici, abitudini sessuali, metodi contraccettivi, conoscenze sulle MST, informazione ed educazione sessuale. I dati sono stati caricati su un file Excel 5.0.Le analisi statistiche sono state condotte con il software Epi Info v3.5.1. Sono stati considerati significativi valori di p-value