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Measles is a highly contagious airborne disease. Unvaccinated pregnant women are not only at risk of infection but also at risk of severe pregnancy complications. As measles causes a dysregulation of the entire immune system, we describe immunological variations and how immune response mechanisms can lead to adverse pregnancy outcomes. We evaluated data during the measles outbreak reported in the province of Catania, Italy, from May 2017 to June 2018. We controlled hospital discharge records for patients admitted to hospital obstetric wards searching the measles diagnostic code. We have indicated the case as "confirmed" when the IgM was found to be positive with the ELISA method. We registered 843 cases of measles and 51% were females (430 cases). 24 patients between the ages of 17 and 40 had measles while they were pregnant. Adverse pregnancy outcomes included 2 spontaneous abortions, 1 therapeutic abortion, 1 foetal death, and 6 preterm deliveries. Respiratory complications were more prevalent in pregnant women (21%) than in nonpregnant women with measles (9%). 14 health care workers (1.7%) were infected with measles, and none of these had been previously vaccinated. Immune response mechanisms were associated with adverse pregnancy outcomes in women with measles. To reduce the rate of measles complications, gynaecologists should investigate vaccination history and antibody test results in all women of childbearing age. During a measles outbreak, gynaecologists and midwives should be active proponents of vaccination administration and counteract any vaccine hesitancy not only in patients but also among health care workers., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2020 Rosalia Ragusa et al.)

Healthcare workers (HCWs) are exposed to biological hazards on a daily basis. The aim of the present study was to evaluate the risks of infection after occupational exposure to blood or body fluids among HCWs operating in the period 2013-2014, in a university hospital of Southern Italy. The frequency of accidents during the 2-year period was always lower than 5%. In 2013, 103 cases occurred; in 2014, the number of injuries had significantly decreased (n = 60). In 2013, an anti-hepatitis B surface antigen protective titer was only found in 70% of cases; in 2014, the subjects with a positive titer rose to 82%. No HCWs showed seroconversion to the main blood-borne pathogens. The implementation of strict prevention measures after the accidents reported in 2013 allowed the significant reduction of the number of injuries in 2014.

Introduction: In recent years, a phenomenon known as "vaccine hesitancy" has spread throughout the world, even among health workers, determining a reduction in vaccination coverage (VC).A study aimed at evaluating VC among healthcare workers (HCWs) in 10 Italian cities (L'Aquila, Genoa, Milan, Palermo, Sassari, Catanzaro, Ferrara, Catania, Naples, Messina) was performed., Materials and Methods: Annex 3 of the Presidential Decree n. 445 of 28 December 2000 was used to collect information on the vaccination status of HCWs. The mean and standard deviation (SD) were calculated with regard to the quantitative variable (age), while absolute and relative frequencies were obtained for categorical data (sex, professional profile, working sector, vaccination status). The connection between VC and the categorical variables was evaluated by chi-square method (statistical significance at p < 0.05). The statistical analyses were performed by SPSS and Stata software., Results: A total of 3,454 HCWs participated in the project: 1,236 males and 2,218 females.The sample comprised: physicians (26.9%), trainee physicians (16.1%), nurses (17.2%) and other professional categories (9.8%). Low VC was generally recorded. Higher VC was found with regard to polio, hepatitis B, tetanus and diphtheria, while coverage was very low for measles, mumps, rubella, pertussis, chickenpox and influenza (20-30%)., Conclusions: This study revealed low VC rates among HCWs for all the vaccinations. Measures to increase VC are therefore necessary in order to prevent HCWs from becoming a source of transmission of infections with high morbidity and/or mortality both within hospitals and outside.

Introduction: Clostridium difficile (CD) is the most common cause of health-care-associated infectious diarrhea with increasing incidence and severity in recent years. The main cause of hospital's acquired cross infections can be attributed to incorrect hand hygiene. We described the epidemiology of CD infection (CDI) in a teaching hospital in Southern Italy during a two years surveillance period and evaluated the health-care workers compliance to hand hygiene., Methods: CDI Incidence rates were calculated as the number of patients with positive C. difficile toxin assay per 10,000 patient-days. Compliance with hand hygiene was the ratio of the number of performed actions to the number of opportunities observed. Approximately 400 Hand Hygiene (HH) opportunities/year /ward were observed. We finally checked out if any correlation could be found., Results: From January 2015 to December 2016 a total number of 854 CD determinations were performed in patients with clinical symptoms of diarrhea. The search for toxins A and B was positive in 175 cases (21,2%), confirming the diagnosis of CDI. Compliance to hand hygiene was significantly inversely associated with the number of CDIs: the lower the compliance of health-care workers with hand hygiene the higher was the number of cases of CDIs (p = 0.003)., Conclusions: According to our results proper handwashing of health-care workers appears to be a key intervention in interrupting CD cross infections regardless of age and type of department in which the patient is admitted., Competing Interests: All authors report no potential conflicts of interest relevant to this article.

A study was performed to evaluate safety and hygienic quality levels in dental clinics in Catania (Sicily, Italy). Microbiological checks of air samples, surfaces and water were performed in seven modern dental clinics with a high perceived quality of care. In total, 16 active dental units were present in the clinics included in the study. Water samples were obtained from dental air-water syringes and directly from the water supply and analyzed to determine aerobic mesophilic bacteria counts, coliform counts and number of legionella unit-forming-colonies. The BART™ system was used to identify Pseudomonas spp. and other biological indicators. Critical levels of one or more indicators were found in the water circuits. In particular, Legionella pneumophila was found in five dental units, associated with Pseudomonas spp., high mesophilic aerobic bacterial counts and the presence of slime-producing bacteria. The results indicate the need for hygienic quality control checks through the use of appriopriate biological indicators, even in dental clinics with a high perceived quality.

This study was performed to evaluate the prevalence of anti-tuberculosis (TB) drug resistance in Sicily (Italy). A total of 92 Mycobacterium tuberculosis strains were tested, 43 of which were isolated from outpatients between 2004 and 2007 and 49 isolated from patients hospitalized in various eastern Sicilian hospitals. The 92 strains were all isolated from adult patients (mean age 56 years), 71 of which were Italian and the remaining 21non-Italian. Drug sensitivity testing was performed by using the Canetti proportion method and revealed a large proportion of strains (48.9%) found to be resistant to one or more drugs. The most frequent type of resistance was found to be towards rifampicin (38%). Simultaneous resistance to rifampicin and isoniazid, which characterizes multi-drug resistant TB (MDR-TB), was observed in 19.5% of strains; this was always associated with resistance to at least one other anti-tuberculosis drug. No significant differences were found in the distribution of drug resistance, including multi-drug resistance, between strains isolated from Italian and non-Italian patients. A higher percentage of resistance was found amongst strains isolated from hospitalized patients with respect to those from outpatients: rifampicin 53% vs 21%; isoniazid 41% vs 9%; Mdr-TB 47% vs 12%.

Cases of cutaneous leishmaniasis diagnosed at the laboratory of Department of Hygiene of the University of Catania (Italy), from 1998-2007 were evaluated. Specifically, demographic and personal data, area of origin and temporal trend of the 97 cases confirmed by microscopy in this 10-year period were examined. The data collected shows that the disease is still widely present in this area ; on the other hand official data regarding this disease appears incomplete and shows various inconsistencies. This is due to underreporting but also to scarce knowledge of the disease by physicians. Elimination of cutaneous leishmaniasis can be achieved by controlling leishmaniasis in dogs and improving environmental conditions; this requires greater efforts not only by institutions but also by individuals.

Objectives: For several years, children in Sicily with acute lymphoblastic leukaemia have been treated locally at the University of Catania. We compared the results of locally treated children with the results obtained at other centres., Methods: The diagnosis of acute lymphoblastic leukaemia (ALL) was made in 78 children in the haematology and oncology division of the University of Catania, Sicily, From January 1987 to December 1992. Patients diagnosed before December 1990 were treated with the protocol ALL 87 including prednisone, vincristine, daunorubicine, L-asparaginase and intrathecal methotrexate. Total duration of treatment was 25-26 months. For patients diagnosed after December 1990, the protocol 90-91 used the same drugs for induction and three intrathecal drugs (methotrexate, cytarabine and prednisone) as well as cyclophosphamide to prolong induction in intermediary risk patients. Only high risk patients received cerebral irradiation. Total duration of treatment was 2 years. Full follow-up data were available for 76 patients., Results: Survival rate without relapse was 66% and the 5-year survival rate was 82.7%. These results were comparable with those published by other international groups. In addition, particular attention was given to psychological support to decrease the deleterious effects of both the disease and the treatment protocols., Conclusion: These results demonstrate that ALL children can be cared for locally in Sicily without risking poorer outcome. It would be preferable to treat these children as near as possible to their area of residence in order to diminish the psychological trauma resulting from long-term hospitalization far from their family.

The prevalence of cutis verticis gyrata was studied in a psychiatric institutional population of 494 patients, the majority of whom were mentally retarded or had chronic schizophrenia. Twenty-two subjects (21 males and 1 female) were found to have primary cutis verticis gyrata, yielding a prevalence of about 4.5%. The frequency of the scalp disorder was 11.4% among mentally retarded patients and 1.7% in schizophrenic subjects. A cytogenetic study was performed on patients with primary cutis verticis gyrata. In 9 out of 21 subjects there was evidence of chromosomal fragile sites: 5 patients had fragile sites on the X-chromosome, in 2 there was fragility of chromosome 12 and in 2, fragility of chromosome 9. The fragile X-site is the genetic marker of the 'fragile X-syndrome', a sex-linked inherited disorder often associated with mental retardation and other neuropathological findings.

We have studied the prevalence of the fra (X) and of the autosomal fragile sites fra (10) (q25) and fra (16) (q22) in patients from an institute for the mentally retarded in Italy. We found six cases (1.9%) of fra (10) (q25) and 9 (2.9%) of fra (16) (q22). The study of the fra (X) was restricted to a subgroup of 91 males who did not have other chromosome anomalies or variants, and led to the discovery of 4 fra (X) cases. These 4 had the Martin-Bell syndrome; 3 of them were epileptic and had a characteristic EEG pattern originating during sleep from the temporal lobe not previously described in fra (X) mental retardation.