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Background: Tdap (Tetanus-Diphtheria-acellular Pertussis) vaccination is nowadays a worldwide-recommended practice to immunize pregnant women. The vaccine administration at the third trimester of pregnancy (as recommended by the WHO) would ensure antibody protection to both the mother and the newborn and has contributed to the significant drop of pertussis cases in infants. The aim of this observational study was to describe for the first time the socio-demographic characteristics and determinants of Tdap vaccination adhesion of pregnant women in the Florentine area. Methods: Information about parents’ vaccination status, their citizenship, employment type and mothers’ previous pregnancies and/or abortions were collected at the time of birth through the assistance birth certificates (CedAP) both for the years 2019 and 2020. This archive and the regional SISPC (Collective Prevention Healthcare Information System) linked using an anonymous unique personal identifier to retrieve the mother’s vaccination status. Results: We found an overall Tdap vaccination adhesion of 43% in 2019 and 47.3% in 2020. Several socio-demographic parameters would determine an increased vaccination adhesion, including parents’ geographical origin, mothers’ age and educational background, as well as the number of previous deliveries, abortions or voluntary termination of pregnancy. Conclusions: Since not much data are available on this topic in Italy, this study may constitute the baseline information for Tdap vaccination adhesion in pregnant women in the Florentine area (Italy). Thus, future successful vaccination strategies may be designed accordingly.

Asplenic or hyposplenic (AH) individuals are particularly vulnerable to invasive infections caused by encapsulated bacteria. Such infections have often a sudden onset and a fulminant course. Infectious diseases (IDs) incidence in AH subjects can be reduced by preventive measures such as vaccination. The aim of our work is to provide updated recommendations on prevention of infectious diseases in AH adult patients, and to supply a useful and practical tool to healthcare workers for the management of these subjects, in hospital setting and in outpatients consultation. A systematic literature review on evidence based measures for the prevention of IDs in adult AH patients was performed in 2015. Updated recommendations on available vaccines were consequently provided. Vaccinations against S. pneumoniae, N. meningitidis, H. influenzae type b and influenza virus are strongly recommended and should be administered at least 2 weeks before surgery in elective cases or at least 2 weeks after the surgical intervention in emergency cases. In subjects without evidence of immunity, 2 doses of live attenuated vaccines against measles-mumps-rubella and varicella should be administered 4–8 weeks apart from each other; a booster dose of tetanus, diphtheria and pertussis vaccine should be administered also to subjects fully vaccinated, and a 3-dose primary vaccination series is recommended in AH subjects with unknown or incomplete vaccination series (as in healthy people). Evidence based prevention data support the above recommendations to reduce the risk of infection in AH individuals.

IntroductionAbout 1.25 million people worldwide die every year because of road accidents. Risk is higher when drivers use mobile phones, whereas seat belts help to prevent crash-related injury. We aimed to evaluate the prevalence, associated factors, and temporal trend of the use of seat belts and mobile phones among drivers and passengers in Florence, Italy (2005-2015).MethodsUse of seat belts and mobile phones use was monitored via direct observation in four areas in the province of Florence. We fitted Poisson regression models with robust variance to investigate the factors associated with the use of seat belts and mobile phones use by the drivers and to explore long-term trends and seasonal patterns in the two time-series.ResultsWe observed a total of an overall 134,775 vehicles: seat belts were worn by 71.8% of drivers and front-seat passengers and 27.6% of back-seat passengers, while mobile phones were being used by 4.8% of drivers. Drivers were more likely to wear seat belt when transporting passengers (≥2 vs none: prevalence ratio [PR] 1.21, 95% confidence intervals [CI] 1.14-1.29) and while driving in the afternoon (PR 1.04, 95% CI 1.03-1.05), and less likely when the front-seat passenger was not wearing seat belts (PR 0.33, 95% CI 0.32-0.34). After an initial increase, seat belts use by the driver decreased over time (-0.5% each year during 2010-2015), with significant peaks and troughs in July and January, respectively. Mobile phone use by the driver was inversely associated with wearing seat belts (PR 0.67, 95% CI 0.64-0.70) and carrying passengers (≥2 vs. none PR 0.20, 95% CI 0.07-0.52). The proportion of drivers using mobile phones did not vary over time nor showed any clear seasonality.ConclusionsDrivers' risky behaviours (not wearing a seat belt and using a mobile phone) are associated, showing a global misperception of risk among a subset of drivers. The number of passengers and their behaviour is also associated with the driver's attitude. The effectiveness of primary enforcement laws has declined in Italy in recent years; therefore, other strategies should be devised and implemented.

Borrelia recurrentis, transmitted by Pediculus humanus humanus, is the etiological agent of louse-borne relapsing fever (LBRF). Currently the main focus of endemicity of LBRF is localized in East African countries. From July 2015 to October 2015, 36 cases of LBRF have been diagnosed in Europe in immigrants from the Horn of Africa. Here we report a case of LBRF with meningitis diagnosed in Florence, Italy, in an immigrant arrived from Somalia.In October 2015, a 19-year-old Somali male presented to the emergency department of the Azienda Ospedaliero Universitaria Careggi, Florence, Italy, with a 3-day history of high fever. The patient had disembarked in Sicily 10 days before admission after a long migration trip from his country of origin. On clinical examination, neck stiffness was found. Main laboratory findings were thrombocytopenia, increased procalcitonin, and increased polymorphonucleates in the cerebrospinal fluid. Suspecting a possible meningitis, the patient was treated with ceftriaxone, pending results of laboratory testing for malaria, and developed severe hypotension that was treated with fluid resuscitation and hydrocortisone. Hemoscopic testing revealed the presence of spirochetes and no malaria parasites. The patient rapidly improved with doxycycline for 7 days and ceftriaxone for 11 days, then was lost to follow-up. Total DNA from blood was extracted, and amplification and sequencing with universal 16S rDNA primers D88 and E94 revealed a 100% identity with B. recurrentis A1.LBRF is a rare but emerging infectious disease among vulnerable displaced immigrants from the Horn of Africa. Since immigrants from endemic areas can carry the vector with them, the infection should be suspected even in subjects with compatible clinical features living in the same place where new arrival immigrants are hosted. Healthcare providers should be aware of this condition to implement adequate diagnostic, therapeutic, and public health measures.

Invasive pneumococcal diseases (IPD) and community acquired pneumonia (CAP) represent two of the major causes of out-patient visits, hospital admissions and deaths in the elderly. In Tuscany (Italy), in the Local Health Unit of Florence, a project aimed at implementing an active surveillance of pneumococcal diseases in the hospitalized elderly population started in 2013. The aim of this study is to show the results of the retrospective analysis (2010–2012) on hospital discharge records (HDRs) related to diseases potentially due to S. pneumoniae, using a selection of ICD9-CM codes. All ordinary hospitalizations (primary and secondary diagnoses) of the elderly population were included (11 245 HDRs). Among a population of about 200 000 inhabitants ≥65 y, the hospitalization rate (HR) increased with increasing age and was higher in males in all age groups. Almost all hospitalizations (95%) were due to CAP, only 5% were invasive diseases. Only few cases of CAP were specified as related to S. pneumoniae, the percentage was higher in case of meningitis (100%) or septicemia (22%). In-hospital deaths over the three-year period were 1703 (case fatality rate: 15%). The risk of dying, being hospitalized for a disease potentially attributable to pneumococcus (as primary diagnosis) increased significantly with age (P < 0.001), the odds ratio (OR) per increasing age year was 1.06 (95% CI 1.05–1.07) and was higher in patients with co-existing medical conditions with respect to patients without comorbidities. Currently, an active surveillance system on S. pneumoniae diseases with the inclusion of bio-molecular tests (RT-PCR), is a key step to assess the effectiveness of the PCV13 vaccine (13-valent pneumococcal conjugate vaccine) in the elderly population after implementation of vaccination policies. The results of this study will provide the comparator baseline data for the evaluation of a possible immunization programme involving one or more cohorts of the elderly in Tuscany.

Tuberculosis is a leading cause of morbidity for Peruvian migrants in Florence, Italy, where they account for about 20% of yearly diagnosed cases. A retrospective study on cases notified in Peruvian residents in Florence in the period 2001-2010 was carried out and available Mycobacterium tuberculosis strains were genotyped (MIRU-VNTR-24 and Spoligotyping). One hundred thirty eight cases were retrieved. Genotyping performed in 87 strains revealed that 39 (44.8%) belonged to 12 clusters. Assuming that in each cluster the transmission of tuberculosis from the index case took place in Florence, a large proportion of cases could be preventable by improving early diagnosis of contagious cases and contact tracing.

On 31 May 2013, the first case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in Italy was laboratory confirmed in a previously healthy adult man, who developed pneumonia with moderate respiratory distress after returning from a holiday in Jordan. Two secondary cases were identified through contact tracing, among family members and colleagues who had not previously travelled abroad. Both secondary cases developed mild illness. All three patients recovered fully.

To estimate the use, during transport by car, of restraint/booster seats by children of 6-12 years old in Florence.To examine children's use, knowledge and behaviors regarding safety devices in cars, a questionnaire has been administered to 537 students attending 17 primary schools in Florence, during their visit to an area equipped for street education. Sociodemographic data (nationality, level of education and parents' work) have been collected as well to assess the socioeconomic membership. Collected data have been analyzed using SPSS 17.0. Chi squared test has been used to evaluate differences in the frequency of distribution of the use of safety devices by available variables. Univariate and multivariate logistic regressions have been used to calculate the degree of association among the modes of transport and the available variables.Prevalence of use of restraint/booster seats, risk of having been incorrectly transported.39.1% children, during the last travel, has been correctly transported, i.e. on the booster seat with fastened seat belt, 38.0% only with fastened seat belt and 22.9% free.The risky behaviors were not so much related to socioeconomic indices, but rather to some geographical variables and parents' nationality (especially of the mother).Children whose parents were both Italian were more frequently transported correctly compared to foreigners. We also observed peculiar and different modes of transport within specific ethnic minorities.It is necessary to design and implement interventions aimed at promoting interventions for improving safety for the whole population, but with specific safeguarding social and territorial specificities as regards to territory and ethnicity.

to evaluate the trend over time of the use of seat belts by drivers and passengers of cars and vans and the use of hand held mobile phone while driving in Florence from 2005 to 2009. DESIGN, SETTING AND PARTICIPANTS AND MAIN OUTCOME MEASURES: direct observations (58,773 vehicles) have been conducted to detect the use of seat belts by occupants of cars and vans, and the use of mobile phone while driving. It has been carried out correlation analysis between the use of the seat belt by occupants of vehicles and between the simultaneous use of this device and mobile phone while driving.Moreover, it has been carried out time series analysis (ARIMA Box Jenkins) of in the prevalence of the use of seat belts by occupants of vehicles observed, of mobile phone by drivers and the trend of the risk to drive using the mobile phone with unfastened seat belt rather than to drive using the mobile phone with fastened seat belt.seat belts were used on average by 75.7% of drivers, 75.5% of front passengers and 25.1% of rear passengers. The average mobile phone use while driving was 4.5%. Drivers most frequently fasten seat belt if front passengers use it and while they do not use mobile phone. The use of seat belts by drivers and front passengers has not changed over time, whereas the use of mobile phone while driving has significantly increased. The prevalence of using mobile phone with unfastened seat belt rather than to use it with fastened seat belt while driving has significantly decreased over the years, indicating an increase in the use of mobile phone, especially among those who fasten the seat belt.it is necessary to plan and realize stronger interventions in the whole area.

Background Many sources of health advice are consulted by travelers, but in Europe, only 35% go to a travel clinic. Travel to countries outside Europe increases daily, and from 2001 to 2004, there was a marked increase in the number of travelers from the Florentine area crossing the borders (+18.0%), taking a plane (+81.4% of international travelers in Pisa airport), and applying to the Centre of Travel and Migration Medicine (CTMM) (+96%). Methods An anonymous survey was carried out at CTMM among those travelers returning to complete vaccinations for which the first dose had been given before going abroad. The survey included questions on vaccination status, adherence to recommended antimalaria prophylaxis, occurrence of other health problems, and food and drink consumption. Results The study population (which represents a “best case scenario”) was composed of 1,237 subjects and had a very high compliance to the proposed questionnaire (95%). Approximately 55% of travelers took malaria chemoprophylactic measures, and 88% of them followed the indications given. Approximately 28% reported one or more secondary effects following antimalarial medication, and approximately 69% reported constant attention regarding safe consumption of food and drinks. Notwithstanding these measures, 236 cases of travelers’ diarrhea were reported. Conclusions Our results are conditioned by the self-selection of the study population (those who seek advice are likely to follow it through). However, since no certainty exists about other sources of health advice for the remainder of the traveler population in our region, both the importance of counseling offered by travel clinics as well as the recommendation to the ever-increasing number of travelers to consult these clinics are stressed.

A case of Hepatitis A occurred in a traveller in spite of a complete course of immunization with a combined HAV and HBV vaccine [Taliani G, Sbaragli S, Bartoloni A, Santini MG, Tozzi A, Paradisi F. Hepatitis A vaccine failure: how to treat the threat. Vaccine 2003;21(31):4505–6]. A retrospective study was performed to evaluate whether the failure was primary or could be attributed to a specific lot of vaccine or to its inadequate handling and/or storage. Two distinct populations of vaccinees were selected in a 1:2 proportion. The case group (N = 31) included subjects who were vaccinated in the same period and with the same lot and batch of vaccine as the case. The control group (N = 62) included subjects who received different lot and batch of the same vaccine as the case group. A persisting antibody response to HAV vaccine was found among all subjects (anti-HAV >20 mIU/ml). The overall anti-HBs seropositivity rate (anti-HBs >10 mIU/ml) was 74%, without significant difference between the case (77%) and the control group (73%; P > 0.05). The reported Hepatitis A case can be attributed to a rare primary vaccine failure rather than to inefficacy of a specific lot of vaccine or to inappropriate vaccine handling or storage. Our study supports the indications for use of combined Hepatitis A + B immunization in travellers at risk for both infections, but stresses the need for information on correct hygienic behaviours while abroad.

Two outbreaks of hepatitis A started almost simultaneously in a maternal school and in a day care centre located at opposite sides of Florence, Italy, at the end of 2002. Both of them originated from immigrant children, and in both cases, hepatitis A was initially not recognised due to aspecific symptoms. While vaccination of contacts started with delay in the first outbreak, the same intervention was organised and performed in 3 days in the other. The outbreak starting in the maternal school caused 30 notified cases, plus 7 cases diagnosed retrospectively. Nine of them were in a secondary school, where vaccination (in accordance with the Italian national guidelines on hepatitis A (HA) vaccination) had been started only after a secondary case occurred. Only three cases occurred overall in the other outbreak starting in the day care centre, where >80% of infants, children and personnel were immunised. Although few asymptomatic infections probably occurred, no source of contagion existed any longer 2 months after immunisation. A rapid vaccination of school and family contacts of hepatitis A cases after the first case (irrespective of school grade) seems to play an important role to shorten outbreak duration.