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We aimed to assess the characteristics and integration of immunization services into the prenatal care provided by maternity care units (MCUs) in Italy.A cross-sectional nationwide study using a web-based survey was conducted from June to August 2021. The study population consisted of 342 ob-gyns, members of the Italian Society of Obstetrics and Gynecologists and heads of MCUs. The main outcome was to assess the performance of several vaccine-related services among the surveyed MCUs.Overall, 112 out of 342 MCUs completed the survey, for an overall response rate of 32.7%. Almost all MCUs (96.4%) provided vaccine information, but only 22% had an onsite vaccination clinic. Less than half (43.8%) offered vaccines during prenatal visits and 75% of those sites required women to set up an extra appointment for vaccination. Although 68% MCUs recorded vaccines administered, only 20% of them managed to record vaccines in their own medical records. The institutional-logistic issues were the most voted vaccination barrier (40.2%).Institutional barriers and lack of certain vaccine-related services offered during prenatal care in Italian MCUs might be responsible for many missed vaccination opportunities. Embedding maternal immunization programs within the current prenatal care services might optimize vaccine coverage.

The Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), represents the pandemic of the century, with approximately 3.5 million cases and 250,000 deaths worldwide as of May 2020. Although respiratory symptoms usually dominate the clinical presentation, COVID-19 is now known to also have potentially serious cardiovascular consequences, including myocardial injury, myocarditis, acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure, and cardiogenic shock. The cardiac manifestations of COVID-19 might be related to the adrenergic drive, systemic inflammatory milieu and cytokine-release syndrome caused by SARS-CoV-2, direct viral infection of myocardial and endothelial cells, hypoxia due to respiratory failure, electrolytic imbalances, fluid overload, and side effects of certain COVID-19 medications. COVID-19 has profoundly reshaped usual care of both ambulatory and acute cardiac patients, by leading to the cancellation of elective procedures and by reducing the efficiency of existing pathways of urgent care, respectively. Decreased utilization of healthcare services for acute conditions by non-COVID-19 patients has also been reported and attributed to concerns about acquiring in-hospital infection. Innovative approaches that leverage modern technologies to tackle the COVID-19 pandemic have been introduced, which include telemedicine, dissemination of educational material over social media, smartphone apps for case tracking, and artificial intelligence for pandemic modelling, among others. This article provides a comprehensive overview of the pathophysiology and cardiovascular implications of COVID-19, its impact on existing pathways of care, the role of modern technologies to tackle the pandemic, and a proposal of novel management algorithms for the most common acute cardiac conditions., Although respiratory symptoms usually dominate the clinical presentation of COVID-19, cardiovascular manifestations have also been reported, including myocardial injury, myocarditis, acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure, and cardiogenic shock. The pandemic might have an indirect impact on the delivery of cardiovascular care both among COVID-19 and non-COVID-19 patients. Innovative approaches that leverage modern technologies to tackle the pandemic have been used. This article provides an overview of the cardiovascular implications of COVID-19.

Background A suboptimal maternal vaccination coverage in 2017–18 has been reported in Italy. The study aims were to (i) assess changes in maternal influenza and tetanus, diphtheria and acellular pertussis vaccination coverage during 2018–19 influenza season compared to the previous season (ii) estimate influenza vaccine coverage among maternal care providers (MCPs) and (iii) explore the characteristics of vaccine delivery to pregnant women. Methods We conducted a cross-sectional survey among pregnant women and MCPs about influenza and pertussis immunization during pregnancy. We also collected information regarding prenatal care characteristics and vaccine delivery among four centers in Italy. Results We recruited 483 pregnant women and 452 MCPs. The influenza and pertussis vaccine uptake among pregnant women for the season 2018–19 was 14.9% and 60.9%, respectively. MCPs’ influenza vaccine uptake was 33.6%. Knowing that the flu vaccine was safe for mothers and their infants and being vaccinated in the previous influenza season were associated with higher vaccine uptake. Regarding pertussis, being a housewife was associated to lower vaccine uptake, while knowing the vaccine is effective and safe for mothers and newborns were associated with higher pertussis vaccine uptake. The single most important factor associated to higher coverage of both influenza and pertussis vaccines was receiving a health-care provider’s vaccine advice. Most pregnant women (69.4%) stated that they preferred to be vaccinated in their same prenatal care setting. Conclusions Receiving a health-care provider’s vaccine advice and the availability of vaccines during prenatal care visits might improve vaccination coverage among pregnant women.

Pertussis is a widespread vaccine-preventable disease, associated with an increasing trend to hospitalization among newborns. Pertussis in newborns can be fatal, and the most effective way to prevent it is maternal immunization (MI) with a reduced antigen content tetanus, diphtheria, and acellular pertussis vaccine (Tdap). In Italy, the National Immunization Plan (NIP) 2017-2019 introducedA cross-sectional survey was conducted. Pregnant women up to 28th gestational weeks were interviewed by Telephone using a questionnaire with 16 questions. Statistics were descriptive.The final sample recruited 600 respondents evenly distributed across Italy. The average duration of pregnancy at the time of the interview was 20.8 weeks (standard deviation [SD] 6.0). Most women (60.7%) were between 30 and 40 years of age. About half were aware of the risks of pertussis for newborns (54.5%) and the increased risk of hospitalization (59.8%); 47.2% were aware that Tdap MI was offered free of charge under the NIP. Safety information regarding the mother and newborn was considered the most important information in deciding whether to be vaccinated (47.4%), followed by safety information related only to the newborn (29.5%). About half (52.2%) stated that they would "certainly" accept MI, and 25.3% would like to receive more information. Gynecologists were the preferred healthcare providers (HCPs) for the provision of MI information (34.3%), followed by pediatricians (25.5%). Two-thirds of the respondents would prefer to be informed about MI before getting pregnant (66.0%). Vaccines investigated specifically for use in pregnancy were preferred by respondents. Overall, no relevant differences were observed between women pregnant for the first time and those with more than one pregnancy, nor between geographical regions.The results show room for improving the awareness and understanding of the risks of pertussis for infants and the protective role of MI. The pregnant women preferred to receive advice on MI from an HCP, primarily their gynecologist. They were most interested in information on the safety profile of Tdap during pregnancy, on the mother, fetus, and newborn. The potential impact of this study to support clinical practice of Healthcare Providers is highlighted in the Focus on the Patient section. [Formula: see text].

Background There is controversy as to whether iso-osmolar contrast media (IOCM) are associated with lower risk of contrast-induced acute kidney injury (CI-AKI), compared with low-osmolar contrast media (LOCM). We aimed to evaluate if a differential risk of CI-AKI exists after percutaneous coronary intervention (PCI) according to different contrast media (CM) types. Methods We performed a single-center retrospective study in a cohort of all-comers undergoing PCI between January 2012 and December 2016. CI-AKI was defined as an increase in serum creatinine ≥0.3 mg/dl or ≥50% within 72 h from PCI. IOCM were represented by iodixanol, whereas four different LOCM were utilized (ioversol, iopromide, iomeprol, iobitridol). Multiple-treatment inverse probability of treatment weighting (IPTW)-adjusted logistic regression analysis was performed to identify whether CM type was an independent predictor of CI-AKI. Results We included 2648 subjects (ioversol, n = 272; iopromide, n = 818; iomeprol, n = 611; iobitridol, n = 460; iodixanol, n = 487). CI-AKI occurred in 300 patients (11.7%) overall, with no differences across CM groups (ioversol 13.0%, iopromide 11.5%, iomeprol 10.2%, iobitridol 13.9%, iodixanol 11.3%; p = 0.42). CI-AKI requiring dialysis was observed in 8 patients (0.3%) overall (p = 0.50). On IPTW-adjusted analysis, none of the LOCM was associated with a significantly different risk of CI-AKI compared with iodixanol: ioversol OR 0.986 (95% confidence interval [CI] 0.611–1.591), iopromide OR 0.870 (95% CI 0.606–1.250), iomeprol OR 0.904 (95% CI 0.619–1.319), iobitridol OR 1.258 (95% CI 0.850–1.861). Conclusions In a large cohort of all-comers undergoing PCI, there were no differences in the adjusted risk of CI-AKI across 4 LOCM, compared with iodixanol.

Vaccination during pregnancy is increasingly being recognised internationally a useful means of preventing illness in pregnant women and their newborns. It has been used since the 1960s, when it was found that tetanus vaccine was highly effective in preventing neonatal tetanus, but interest has greatly increased over the last few years. As new data become available showing the numerous benefits of maternal immunisation and its potential for improving maternal and neonatal health in relation to a number of infectious conditions, it is being increasingly incorporated into the national vaccination programmes around the world. However, the development of new vaccines, the existence of clinical trials testing the efficacy of vaccinating pregnant women in order to protect newborns against respiratory syncytial virus and group B Streptococcus infections, and the fact that the uptake of influenza and pertussis vaccines during pregnancy is lower than expected in developed countries is making it increasingly clear that existing maternal vaccination programmes need to be strengthened. This reviews addresses the importance of integrating maternal immunisation and standard obstetrical care in order to promote vaccination administration by maternal care providers (MCPs) because the vaccination goals for pregnant women cannot be achieved without appropriate training and extending the role of MCPs as vaccinators. In order to make meaningful progress, it is necessary to develop and refine targeted messages for pregnant women concerning the benefits of maternal immunisation for themselves and their infants.

Objective In 2017, the Italian Ministry of Health issued the new 2017-19 National Plan of Vaccine Prevention and pregnant women were targeted to be vaccinated against influenza and pertussis. Our study aim was to assess the barriers and facilitators regarding maternal immunization acceptance among pregnant women after the launch of this program. Study design We conducted a multi-center survey in three Italian cities between March and June 2018. Collected data were analyzed anonymously, and included information about current recommendations of maternal immunization, antenatal care characteristics and reasons for accepting or rejecting vaccination. Results A total of 743 pregnant women completed the survey. Half of the study population were aged 25–35 years and 88 % were Italian. Only 18 % pregnant women received advice to be vaccinated. In this group, the vaccine was recommended in most cases by an obstetrician-gynecologist (68 %) and during a routine antenatal visit (74 %). Self-reported influenza and pertussis vaccination coverage was 6.5 % (95 % confidence interval, 4.9 %–8.5 %) and 4.8 % (95 % confidence interval, 3.5 %–6.6 %), respectively. The main vaccination barriers identified were lack of vaccine recommendation by any health-care provider (81 %) and safety concerns (18 %). Respondents mentioned the willingness to protect their offspring (82 %) and themselves (66 %) and having received immunization advice by a maternal care provider (62 %), as the main vaccination facilitators. Conclusions Lack of immunization advice by health-care providers and safety concerns were the main vaccination barriers against influenza and pertussis, among surveyed pregnant women. Vaccine delivery in the antenatal care setting could lead to increase of vaccine acceptance among pregnant women.

Objective Maternal care providers (MCPs), obstetrician-gynaecologists and midwives are uniquely placed to increase maternal vaccination acceptance. We aimed to assess their knowledge, attitudes and practices regarding influenza and pertussis vaccination during pregnancy. Methods We conducted an online survey among MCPs working at "Attention to Sexual and Reproductive Health" (ASSIR) Units in Catalonia region. The survey included questions about current recommendations of influenza and pertussis immunization during pregnancy, reasons for not routinely recommending vaccination and several strategies to increase vaccination uptake. Results A total of 194 MCPs completed the survey, 178 (91.8%) were female and 145 (70%) were midwives. Only 61 (31.4%) stated they vaccinated themselves annually against influenza with a significant lower uptake among midwives (26.9%) than obstetrician-gynaecologists (44.9%) (p = 0.03). Overall, 53.6% of MCPs knew influenza vaccine was indicated during first trimester but only 43.3% stated they prescribed it. Almost all MCPs (98.5%) knew pertussis vaccine was recommended and 97.4% stated they prescribed it. The most important vaccination barrier found was the concern related to vaccine adverse events (25.9%) and more midwives than obstetrician-gynaecologists expressed this concern (30.8 vs. 10%) (p = 0.02). The most popular strategies were: including vaccine recommendations in the pregnancy booklet (93.8%) and receiving vaccination training (92.3%). In the adjusted analysis, the only factor significantly associated with MCPs' prescription of influenza vaccine during second/third trimester was having been vaccinated themselves (odds ratio 3.70, 95% confidence interval 1.3-13.2). Conclusions for Practice Implementation of practical tools, continuous training and clear definition of responsibilities regarding vaccination among MCPs may have a significant impact on maternal vaccination coverage.

Background Human respiratory syncytial virus (HRSV) is the main cause of lower respiratory tract infections among infants and young children. Objectives The molecular epidemiology and characterization of HRSV strains detected at a Spanish tertiary hospital during the 2013–2014 season is reported. Study design Phylogenetic analysis and molecular characterization of HRSV laboratory-confirmed respiratory samples were performed, based on coding sequences of G and F proteins. Results HRSV infection was laboratory-confirmed in respiratory samples from 320 patients of which 223 (70%) were less than 2 years of age and none undergoing Palivizumab treatment. HRSV was detected at varying levels throughout the season with a maximum rate in the week 52/2013, right before the beginning of the influenza epidemic. Whilst both HRSV groups were found co-circulating, HRSV-B group clearly predominated. The phylogenetic analyses from 139 HVR-2 sequences revealed that most characterized strains belonged to ON1 and BA9 genotypes. Three different phylogenetic subgroups could be distinguished within these genotypes. In addition, three strains (out of the 52 randomly selected) were carrying amino acid substitutions in the epitope A of the F protein, one of them previously related to Palivizumab resistance. Conclusions The results of the present study highlight the importance of a continuous HRSV surveillance to monitor not only the introduction of new genotypes on circulation but also the emergence of viral variants with new genetic characteristics that can affect the antigenicity features and the susceptibility to the only current prophylaxis treatment and also for the future development of HRSV vaccines.

Resumen Introduccion La vacunacion antigripal se recomienda en Cataluna a ninos mayores de 6 meses que presentan condiciones de riesgo para desarrollar complicaciones por la gripe. El objetivo de este estudio es determinar la cobertura vacunal antigripal en ninos con condiciones de riesgo y su asociacion con factores sociodemograficos y variables medicas. Material y metodo Estudio descriptivo transversal de los ninos con condiciones de riesgo para desarrollar complicaciones por la gripe (edad entre 6 meses y 15 anos) al inicio de la campana vacunal antigripal 2011-2012 asignados a los Centros de Atencion Primaria de Cataluna. La informacion sobre el estado vacunal y las variables en estudio se recogio a partir de los datos registrados en la historia clinica electronica de los equipos de atencion primaria. Se analizo la asociacion de la vacunacion antigripal con variables demograficas y medicas mediante un analisis bivariado y un modelo de regresion logistica multiple. Resultados La cobertura vacunal antigripal fue del 23,9%. Las variables predictoras de vacunacion antigripal fueron: edad superior a 2 anos (ORa: 1,6 [1,4-1,7] en ninos de 3-5 anos; 1,8 [1,7-2,0] en ninos de 6-10 anos; 2,1 [2,0-2,4] en ninos ≥ 11 anos); sexo masculino (ORa: 1,1 [1,0-1,1]); nacionalidad extranjera (ORa: 1,2 [1,2-1,3]); inmunizacion correcta segun calendario de vacunacion sistematica (ORa: 3,3 [2,8-3,8]); haber realizado mas de una visita al medico de atencion primaria (5 o mas visitas) (ORa: 4,1 [3,8-4,4]), y tener mas de una condicion de riesgo (3 o mas condiciones) (ORa: 2,5 [1,6-3,9]). Discusion La cobertura vacunal antigripal en ninos con condiciones de riesgo es baja en nuestro medio, en comparacion con la descrita en otros paises. Es necesario implementar estrategias para aumentar la cobertura.

Summary Objective To estimate outpatient visits and hospitalization rates due to cardiopulmonary illness attributable to influenza from 2008-09 to 2012-13 in a large cohort of pregnant women from Catalonia, Spain. Methods We estimated the event rates occurring during influenza epidemic, influenza non-epidemic and non-influenza seasons, and by pregnancy status (one year before pregnancy, first, second and third trimester). We fitted quasi-Poisson models in order to identify the variables associated to higher event rates. Results During influenza epidemic seasons, pregnant women in their second trimester had the highest rates of outpatient visits (153 per 10,000 women-months). An increased risk of outpatient visits was associated to first or second trimester (adjusted rate ratio (aRR) = 1.17; 95% CI, 1.10–1.23 and aRR, 1.36; 95% CI, 1.28–1.43, respectively) and having any comorbidity (aRR = 1.28; 95% CI, 1.21–1.36). Women during third trimester had the highest rates of hospitalizations (1.60 per 10,000 women-months), and an increased risk of hospitalization was significantly associated to third trimester (aRR, 1.85; 95% CI, 1.01–3.39), having any comorbidity (aRR, 1.93; 95% CI, 1.10–3.41) and the pandemic influenza season (aRR, 2.90 (1.81; 95% CI, 1.81–4.64). Conclusion Our findings provide significant information regarding influenza burden of disease among pregnant women.

Pregnant women are vaccinated against influenza less frequently than other high-risk groups. To design effective vaccination strategies, we must understand how decisions regarding vaccination may vary by trimester and over vaccination campaigns. We used a Cox model indexed by calendar time to estimate the effect of gestational trimester and other factors on vaccination uptake in a large cohort of pregnant women in Catalonia (Spain) during 2008-09 to 2012-13 influenza vaccination campaigns. We analyzed 247,316 pregnancies. Vaccination coverage was 3.7%, 5.2%, 4.8%, 5.6% and 4.6% from 2008-09 to 2012-13 seasonal vaccination campaigns and 8.3% for the 2009 pandemic vaccination campaign. Pregnant women previously vaccinated had higher uptake than women not previously vaccinated and the hazard ratios (HRs) comparing these 2 groups decreased from 10, the first day of seasonal campaigns, to 1.3 the last day. During the pandemic campaign, HRs decreased over the course of the campaign from 8.6 to 1.9. Women in second and third trimester had higher uptake than women in first trimester, with HR=2.8 and 2.3, respectively, at the start of seasonal campaigns. Influenza vaccination coverage among this cohort of pregnant women was alarmingly low. Our analysis reveals that gestational and calendar time have distinct and interacting effects on vaccination uptake; women in their second trimester and third trimester and previously vaccinated were more prone to be vaccinated, but this effect wanes as the influenza season progresses.

Resumen: Introducción: Una de las medidas de control para prevenir la transmisión de infecciones en el hospital es la aplicación de precauciones de aislamiento. En las áreas pediátricas, debido al tipo de pacientes e infecciones, así como a las características arquitectónicas de las unidades de hospitalización, es difícil una aplicación y seguimiento estrictos de las mismas. Material y métodos: Estudio observacional descriptivo de las precauciones de aislamiento aplicadas en el área pediátrica del Hospital Universitario Vall d’Hebron de Barcelona, de enero a diciembre de 2007. Las precauciones de aislamiento utilizadas son las de los Centers for Disease Control and Prevention de los EE. UU. y las del Departament de Salut de la Generalitat de Catalunya. Resultados: Un 5,4% de los pacientes ingresados precisaron medidas de aislamiento. La unidad de pediatría general es la que generó un mayor número de aislamientos (10,7%). Los microorganismos aislados con mayor frecuencia fueron el virus respiratorio sincitial y el rotavirus, y la precaución de aislamiento más aplicada, la de contacto (90% de los aislamientos). La unidad de cuidados intensivos neonatal y el servicio de oncología y hematología son las áreas donde se requirieron un mayor número de aislamientos en pacientes con infección o colonización por bacterias multirresistentes (el 48 y el 67% del total de aislamientos, respectivamente). Conclusiones: El establecimiento de un programa de vigilancia y control de la transmisión de las infecciones es necesario para reducir la tasa de infecciones nosocomiales. Conocer la frecuencia de aislamientos en cada centro y la disponibilidad de recursos para su correcta aplicación, es fundamental para conseguir este objetivo. Abstract: Introduction: Isolation is one of the measures to prevent the spread of nosocomial infections. However, in children's hospitals, given the type of patients and infections, and the architectural features of hospital wards, isolation precautions are sometimes difficult to implement and enforce. Material and methods: An observational, descriptive study was conducted on the isolation precautions taken at the Children's Hospital Vall d’Hebron in Barcelona, from January to December, 2007. The isolation precautions applied were those of the Centers for Disease Control and Prevention from the USA, and those of the Department of Health of the Generalitat de Cataluña. Results: Of the patients admitted during the study period, 5.4% needed isolation. The General Paediatrics ward generated the highest number of isolations (10.7%). The most frequently microorganisms needing isolation precautions were respiratory syncytial virus and rotavirus. Contact precautions was the type of isolation most applied (90% of isolations). The Neonatal Intensive Care Unit and the Paediatric Oncology and Haematology Service were the areas with a greater number of patients isolated due to infection or colonization by multiresistant bacteria (48% and 67% of the isolations, respectively). Conclusions: The implementation of a surveillance and infection control program is essential to reduce the rate of hospital-acquired infections. Knowledge of the frequency of isolated patients at each centre and the availability of resources for the correct application of isolation precautions are fundamental for these goals to be achieved.

There is controversy as to whether iso-osmolar contrast media (IOCM) are associated with lower risk of contrast-induced acute kidney injury (CI-AKI), compared with low-osmolar contrast media (LOCM). We aimed to evaluate if a differential risk of CI-AKI exists after percutaneous coronary intervention

Introduction In neonatal units, Salmonella infections have been attributed to food-borne sources and person to person transmission. Methods The outbreak described is the first reported by Salmonella enterica serotype Newport in a neonatal facility in Spain. Results The index case was an 8-day premature newborn that developed clinical sepsis with positive blood cultures. The outbreak source was the mother of the index case. Conclusions It is essential to improve infection control measures taking into account the parents, as they can be an important source of infection.

BackgroundThe aim of the present study is to evaluate the impact of glucose-lowering agents in the risk of cancer in a large type 2 diabetic population.MethodsA nested case-control study was conducted within a defined cohort (275,164 type 2 diabetic patients attending 16 Primary Health Care Centers of Barcelona). Cases (n = 1,040) comprised those subjects with any cancer diagnosed between 2008 and 2010, registered at the Cancer Registry of Hospital Vall d'Hebron (Barcelona). Three control subjects for each case (n = 3,120) were matched by age, sex, diabetes duration, and geographical area. The treatments analyzed (within 3 years prior to cancer diagnosis) were: insulin glargine, insulin detemir, human insulin, fast-acting insulin and analogues, metformin, sulfonylureas, repaglinide, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, and alpha glucosidase inhibitors. Conditional logistic regressions were used to calculate the risk of cancer associated with the use of each drug adjusted by age, BMI, dose and duration of treatment, alcohol use, smoking habit, and diabetes duration.ResultsNo differences were observed between case and control subjects for the proportion, dose or duration of exposure to each treatment. None of the types of insulin and oral agents analyzed showed a significant increase in the risk of cancer. Moreover, no cancer risk was observed when glargine was used alone or in combination with metformin.ConclusionsOur results suggest that diabetes treatment does not influence the risk of cancer associated with type 2 diabetes. Therefore, an eventual increase of cancer should not be a reason for biasing the selection of any glucose-lowering treatment in type 2 diabetic population.

Human respiratory syncytial virus (HRSV) is one of the most common viral aetiological agents in the youngest population. In the present study a novel HRSV-B BA genotype is first described based on the phylogenetic analysis of the coding hypervariable region 2 sequences of G protein from strains detected during the 2014-2015 season. Among all strains detected in the last season, 44% belonged to this new genotype. Therefore, it highlights the importance of a continuous HRSV surveillance to monitor the emergence and spread of new genotypes or variants with genetic changes that may affect antigenic and tropism features.