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Background: Nursing students can be exposed to patients with hepatitis A virus (HAV) and can represent a vehicle of transmission both for health personnel, patients and relatives., Objectives: The aim of this study was to assess the risk of HAV infection in nursing students during their internship., Patients and Methods: A seroprevalence survey on HAV infection was performed on nursing students at the Cagliari university-hospital, together with the assessment of the compliance to preventive measures to decrease the risk of infection during their internship. Blood specimens were obtained from 253 students. All serum samples were tested for anti-HAV antibodies (IgG) by the enzyme-linked immunosorbent assay (ELISA). Compliance to preventive measures was recorded by trained personnel., Results: Overall HAV seropositivity in nursing students (mean age 24, range 17 - 45 years) was 3%. Compliance to preventive measures was not uniform (6% - 76%) and extremely low in some specific measures targeted to decrease the oral-fecal transmission., Conclusions: The high proportion of susceptible nursing students can contribute to an increase in the risk of nosocomial transmission, especially when specific preventive measures are not completely applied. Nursing education packages, before starting medical internship, should be implemented in order to increase their compliance to preventive measures, especially in wards at higher risk. Vaccination should be considered in wards at higher risk.

Background: Human papillomavirus (HPV) infection is the most common sexually transmitted infection and high-risk HPV types are a necessary cause for the development of cervical cancer. The present study investigated the HPV-type specific prevalence in 650 women, aged 15-76 years, with cytological abnormalities and the association between HPV infection and cervical disease in a subset of 160 women for whom cytological results for Pap-Test were available, during the period 2008-2011 in Cagliari (Southern Italy)., Design and Methods: HPV-DNA extraction was performed by lysis and digestion with proteinase K and it was typed by using the INNOLiPA HPV Genotyping Assay., Results: Overall the HPV prevalence was 52.6%; high-risk genotypes were found in 68.9% of women and multiple-type infection in 36.1% of HPV-positive women. The commonest types were HPV-52 (23.4%), HPV-53 (15.7%), HPV-16 (15.4%) and HPV-6 (12.4%). Among the women with cytological diagnosis, any-type of HPV DNA was found in 49.4% of the samples and out of these 93.7% were high-risk genotypes. Genotype HPV 53 was the commonest type among women affected by ASCUS lesions (21.4%), genotype 52 in positive L-SIL cases (22.5%), genotype 16 H-SIL (27.3%)., Conclusions: This study confirmed the high prevalence of HPV infection and high-risk genotypes among women with cervical abnormalities while, unlike previously published data, genotype HPV-52 was the most common type in our series. These data may contribute to increase the knowledge of HPV epidemiology and designing adequate vaccination strategies. Significance for public healthHuman papillomavirus (HPV) is the most common sexually-transmitted agent, which can cause cervical lesions and cancer in females. Efforts to reduce the burden of cervical cancer with cytology screening in the last years have had limited success. HPV infection and disease imposes a substantial burden of direct costs on the Italian National Health Service that have never been fully quantified. Monitoring HPV prevalence could represent a tool to follow the evolution of the infection in the vaccination and post-vaccination era, to understand the impact of HPV types in cervical diseases in Italy. Our survey shows an high frequency of infections sustained by HPV 52. Given the recent implementation of a widespread immunization program with vaccines not containing HPV 52, it has been relevant to prove the high prevalence of this HPV genotype from the beginning of the vaccination campaign, to avoid ascribing to the vaccination program a possible selection effect and the importance of non-vaccine HPV types in the burden of cervical disease, in order to assess the opportunity to realize new vaccine including other types.

The introduction of vaccination against Human Papillomavirus (HPV) in adolescent girls in 2006 has focused virological surveillance on this age group. As few studies have evaluated HPV infections in young populations, further data are needed in order to improve and extend prophylactic policy and to monitor epidemiological changes. The present study aimed at evaluating overall and type-specific HPV prevalence in both female and male adolescents in Italy. HPV DNA detection and genotyping was performed on urine samples collected from 870 unvaccinated adolescents (369 females, 501 males, 11-18 years of age) in five cities in Italy. Following DNA extraction by means of a commercial kit (NucliSENS(®)-miniMAG(®), bioMérieux), the L1 gene fragment was PCR amplified and genotyped by restriction fragment length polymorphism analysis. HPV DNA was detected in 1.5% of all samples, and in 3% and 0.4% of samples from females and males, respectively. In approximately 70% of HPV DNA positive adolescents, the infection was due to a single genotype, with 88.9% of genotypes belonging to the HR-clade. The only two HPV-positive boys (14 and 18 years old) had HPV-70 genotype. Only one of the 11 HPV-infected girls was in the 11-14 age-group. HPV prevalence was 4.2% in girls aged 15-18 years and 60% of infections were due to vaccine types HPV-16 or HPV-6/-11. This is one of the few studies, the first conducted in Italy, on HPV infection in adolescents. Urine testing is the easier way of detecting HPV infection in younger populations. Our data revealed a very low HPV prevalence, and no infections were observed in the 12-year-old vaccine target population. The majority of infections were seen in females aged 15-18 years. Overall, more than 50% and 30% of the potentially persistent HPV infections detected in this group could have been prevented by the quadrivalent and the bivalent vaccines, respectively.

Background: Human Papillomavirus (HPV) is the most common sexually transmitted infection. The main risk factors correlated with HPV infection are: early sexual debut, the number of partners, frequency and type of sexual contact and partner's sexual histories.We surveyed sexual habits among young people in order to provide information that might orient decision-makers in adopting HPV multi-cohort vaccination policies., Methods: We administered a questionnaire to students (14-24 years old) in five Italian cities., Results: 7298 questionnaires were analyzed (4962 females and 2336 males); 55.3% of females (95% CI 53.9-56.7) and 52.5% of males (95% CI 50.5-54.5) reported regular sexual activity. The mean age at sexual debut was 15.7 ± 1.6 and 15.6 ± 1.6 for females and males, respectively, and the median age was 16 for both sexes.With regard to contraceptive use during the last year, 63.6% of males and 62.8% of females responded affirmatively; 42.6% of males and 42.8% of females used condoms., Conclusion: The results reveal precocious sexual activity among respondents, with the mean age at first intercourse declining as age decreases. Condom use proved to be scant. Considering lifestyle-related risk factors, males appear to have a higher probability of acquiring HPV infection than females.These data support the importance of promoting multi-cohort HPV vaccination strategies for females up to 25 years of age. It is essential to improve vaccination coverage through different broad-spectrum strategies, including campaigns to increase awareness of sexually transmitted diseases and their prevention.

Background: Continuous assessment of hepatitis A virus (HAV) seroepidemiology is a useful tool to control the risk of infection., Objectives: This study aimed to evaluate the changing patterns of anti-HAV seroprevalence in a population,which isgenerally considered to be anarea ofhigh endemicity., Patients and Methods: Overall, the results of 3349 sera collected during the period 2005-2008 from patients attending the University Hospital of Cagliari, Italy were studied; their mean age was 52.7 years, (s + 16.22). Patients with liver disease were excluded from the study. Age specific seroprevalence results were compared with those observed in similar previous studies carried out in the same area., Results: The overall prevalence of anti-HAV was 74.6% with consistently lower values in subjects younger than 40 years (17.5%; P < 0.0001) particularly in those under 30 years of age (8.9%, CI 5.8-11.9). A significant declining trend in age specific seroprevalence has been foundin people under 30 years;61% in 1988, 33% in 1995 and 8.9% in 2005-2008., Conclusions: Our findings show that a significant decline inherd immunity has occurred in the last 20 years as a consequence of lower HAV circulation due to improvementsin socio-economical and hygienic conditions. Adolescents and young adults are becoming increasingly susceptible to HAV infections, as recent outbreaks of acute HAV hepatitis have occurred. Persistent environmental monitoring and the implementation of prevention measures must be considered in order to contain the risk related to this epidemiological shift.

Rotaviruses (RVs) were found to cause human disease in 1973. They are the leading cause of severe gastroenteritis in infants and young children of <5 years of age worldwide and they are the cause of approximately half a million deaths each year. The impact of the disease on families and society (increased health care costs, lost productivity) is extremely significant and the incidence of gastroenteritis (RVGE) is similar both in industrialized and in developing countries. Virtually, all the children will be Infected by RVs before the ages of 3-5 years with the highest incidence rate registered between 6-24 months of age while the greatest risk for developing severe disease by RV occurs under 12 months of age. Clinically, the infection can vary from asymptomatic and sub clinic forms, which are more common in older children and adults, to acute gastroenteritis with fever, vomiting and self-limiting watery diarrhea which persist for 3 to 8 days. Severe forms with profuse diarrhea accompanied by vomiting and fever with risk of dehydration not adequately and rapidly correct can be fatal, mainly in developing countries. Hygienic-sanitary measures are unable to limit the diffusion of this infection and vaccination at present seems the only effective system to reduce the burden of the disease, human and economic costs related to RVGE. Since the 1980s research has focused on the development of RV vaccines. Vaccines against RV are efficacious, and underwent extensive safety trials (involving more than 130,000); no association with intussusception was detected and in four years since they were licensed a substantial reduction in the rates of RVs hospitalization and deaths for RVs infection have been observed both in developed and less-developed countries. It has been also described in different studies that herd immunity can be induced by RV vaccines (as an indirect effect) by reducing the risk of unvaccinated persons to be infected. Thus, introduction of the vaccine into countries immunization programs is likely to have a greater effect than that predicted on the basis of the efficacy trials. The worldwide epidemiological impact of RV infection pointed the development of safe and effective vaccines against RVs as a public health priority. The great economical burden on health care systems and families suggests the importance of monitoring circulating strains, establishment of systems for surveillance and implementation of universal newborns vaccination.

Background: Viral hepatitis caused by hepatitis B virus (HBV) is a leading cause of acute and chronic liver diseases worldwide., Objectives: In Italy, a mandatory vaccination policy was introduced in 1991 and was established for all newborns and 12-year-old individuals. In 2004, vaccination of 12-year old adolescents was discontinued, and that of infants was maintained., Patients and Methods: We evaluated the seroprevalence of HBV markers in 806 individuals, who were vaccinated at birth or at 12 years of age, to assess the effectiveness of the national policy against HBV., Results: The overall prevalence of anti-HBs antibodies was 90.32% (95% confidence interval [CI]: 88.28-92.36%); 2.23% (95% CI: 1.21-3.25%) of the subjects were positive for both antibodies to HBsAg (anti-HBs) and antibodies to hepatitis B core antigen (anti-HBc), whereas 5.83% (95% CI 4.21-7.45) of the subjects were negative for all markers tested. Further, 1.61% (95% CI: 0.74-2.48%) of the subjects were positive for hepatitis B surface antigen (HBsAg)., Conclusions: Our data provide additional evidence that HBV vaccination can confer long-term immunity when performed at birth and when performed for healthy adolescents; moreover, the results show the effectiveness of the application of a national vaccination strategy.

Introduction: The aim of this study was to determine the seroprevalence of anti-HEV antibodies in humans sera and to study HEV prevalence in swine from different Sardinian farms, testing viral HEV-RNA in bile samples., Methods: In the first six months of 2008, 532 subjects of whom 402 blood donors and 130 workers at zoonotic risk, were enrolled. Anti-HEV were determined with an enzyme linked immunosorbent assay (ELISA). In positive subjects, RNA was extracted and tested by RT-Nested-PCR. From July 2006 to March 2007, 95 bile samples were collected from randomly selected pigs. RNA was extracted from 250 microl of bile and tested by RT-Nested-PCR., Results: The overall prevalence of anti-HEV antibodies was 4.3%; 5.0% among blood donors and 2.3% among workers at zoonotic risk, with no statistically significant differences between sex, age classes and occupation. The search for HEV-RNA in the subjects positive for antibodies, gave negative results. HEV genome was detected in 6 of the 95 swine bile samples tested. Sequences were clustered within the genotype 3 and are edited on GenBank under accession number: from FJ850960 to FJ850962 and from FJ883000 to FJ883002., Discussion: The overall prevalence of anti-HEV shows that the virus circulates without giving origin to cases of acute hepatitis. The low prevalence value found in workers at zoonotic risk do not apparently support the hypothesis of professional risk. In this study, HEV-RNA was isolated from pigs in Sardinia for the first time confirming the role of swine as HEV reservoir and the possibility of virus transmission to humans.

The human papillomavirus (HPV) infection is necessary for the development of cervical cancer. Our study aims to evaluate the rate of HPV circulation in our population, to identify the prevalent genotypes and to establish correlation with cervical abnormalities. Furthermore, the awareness of women about HPV issues was investigated. This study included 864 women attending the Oncologic Prevention Service for their routine Pap test screening or the Health Promotion Mother-Child Service for counselling about sexual activity, from July 2006 to September 2007. All the participants gave their informed consent to be enrolled in the study and were invited to fill in a questionnaire about the socio-cultural state, sexual activity and awareness about HPV. The women samples were tested for HPV-DNA and HPV genotypes: any type of HPV-DNA was detected in 31.0% of the women; single or multiple infections sustained by HPV-16 or HPV-18 represented 43.5% of all HPV infections, accounting for infections in 11.8% of the recruited women. The HPV and high-risk HPV (HR-HPV) prevalence significantly declined in women older than 46 years. The Pap test result was available in 490 women; 48.1% of the Pap test positive women had also an HPV infection and among these 22.7% were infected by HPV-16 and/or HPV-18 genotype, while 51.9% (94/181) were HPV negative. The analysis by binary logistic regression showed that genotype 16 and/or 18 is a risk factor for the Pap positive test with a odds ratio (OR) of 2.9 (95% C.I. 1.4-5.9) and 3.6 (95% C.I. 1.58-8.42) respectively, while age is a protective factor (OR 0.97, C.I. 95% 0.96-0.99); furthermore, the mean age at the first sexual intercourse and the mean number of partners since the beginning of sexual activity, were statistically associated with the risk of HPV infection. More than half of women were aware about HPV, its sexual transmission and of its correlation with cervix cancer. Our findings evidenced that HPV infection is frequent in women aged 18-46 years in Sardinia and particularly that 16 and 18 HPV genotypes are detectable in more than 40% of the infected women. The proportion of women informed about HPV issues is sufficient to guarantee an aware approach to HPV vaccination.

Hepatitis E Virus (HEV) is the causative agent of an acute and self-limited form of hepatitis. The virus is transmitted by the faecal-oral route and is a major cause of viral hepatitis in much of the developing world where it causes sporadic infections and large-scale epidemics. A simple and rapid protocol for the measurement of HEV faecal shedding by a real-time polymerase chain reaction (PCR) with the SYBR Green method on a LightCycler instrument, is described. After only 3h the real-time quantitative PCR method detected 10 molecules of HEV cDNA fragment per reaction tube and showed a high linear dynamic range of quantitation (10-10(6) molecules of cDNA/reaction) with a good correlation (r = -1.00). Its specificity was confirmed by assay in human faecal samples.

The aim of the study was to evaluate the frequency of the screening for HBV infection in pregnant women and the application of immunoprophylaxis in newborns to HBV carrier women. The study, carried out in 2001 for 2 months, involved 1596 pregnant women consecutively recruited in public and private hospitals of the Sardinia. Information has been collected by a questionnaire: 90.5% of the women underwent HBV screening during pregnancy and 2.6% of them were found positive to HBsAg test. Among the newborns to HBsAg carrier mothers, 89.2% received the immunoprophylaxis protocol (specific immunoglobulin and the first dose of vaccine within 24 hours from birth). Two variables resulted statistically associated with the lack of adherence to HBV screening: the original family size of women (more than 4 members in the household) and the delivery in a private hospital. These findings point out a satisfactory adherence to HBV screening during pregnancy and the application of immunisation protocol in most of the newborns to HBsAg carrier mothers. However, the increase of information programs turned to the population is required to reach the total application of the prevention tools available in Italian public health.

We have studied the prevalence and the serological profile of HBV, HCV, HDV and HIV infections in 137 Italian subjects addicted to the intravenous use of heroine and correlated the virological findings with sexual behaviour. HBV and HCV viremia were also measured in 114 patients. Anti-HCV was detected in 81% of the addicts, and one or more markers of HBV infection were detected in 62.8% (4.4% were carriers of HBsAg, 58.4% had evidence of past HBV infection and 13.1% of the latter also had HDV markers). Anti-HIV was positive in 23.4%; 26% of those positive for anti-HCV and 4.6% of those positive for HBV markers had no other viral marker: none had only anti-HIV. HBV-DNA was negative in the carriers of HBsAg, and HCV-RNA was not detected in any of the HBsAg carriers who also had circulating anti-HCV. Overall, 34% of the anti-HCV positive addicts had HCV-RNA in their blood. The prevalence of the virus infection correlated with the duration of drug addiction but not with sexual behaviour, and sexual behaviour did not influence the acquisition of any virus. HCV infection was most frequent and probably the first infection to occur, but exposure to HBV was also common despite a low rate of HBsAg carriage. The prevalence of HDV infection was high (50%) in the HBsAg carriers, while the overall prevalence of HIV was lower (23%) than expected. Lack of HBV-DNA and HCV-RNA in carriers of HBV with anti-HCV in serum may indicate that HBV and HCV mutually inhibit their own replication.

Alpha-naphthyl acetate esterase (ANAE) reaction of mouse and rat thymus cells was studied. The majority of cells demonstrated ANAE in the form of multiple scattered granules. A reaction of this type appeared particularly labile, was found only when smears were fixed in formalin vapours and was inhibited by NaF. ANAE staining of thymus cells from mice of different ages was studied: the percentage of cells with single-spotted ANAE reaction was found to increase with age, while cells with granular scattered activity showed a progressive slight decrease. The percentage of ANAE positive cells in spleen appeared to be lower than in thymus, and showed only minor variations in different ages. In mouse and rat thymus and bowel lamina propria clusters of lymphocytes were found showing a sickle-shaped ANAE reaction, surrounding diffusely stained large cells which, on the basis of cytochemistry and phagocytosis ability, could be identified as macrophages. Analogous cell clusters were found in human tonsils and adenoids. These cell clusters were found to be similar to those formed by Ia-positive interdigitating cells which have been previously observed in human thymus, tonsils and bowel. The role of these clusters in the education process of lymphocytes is discussed.

The prevalence of Hepatitis A in South-Sardinia was determined in two samples of students in 1987 and 1988. In this paper we present the results of a seroepidemiologic survey covering a population of workers who were residents of the city of Cagliari or its suburbs. A sample of 299 workers was randomly drawn from a population of workers who went to the public health office to ask for a certificate of good health. A radioimmunoassay test (ABBOTT) was used for detection of anti-HAV. The analysis has been carried out in accordance with the manufacturer's instructions. We also study a sample of 323 students 14-19 years old. The age-specific prevalence was analyzed using an exponential model. The age is denoted by the variable x. The parameter h is the force of infection, the per capita rate at which susceptibles individuals acquire infection. If we take the force of infection as a constant, the fraction y of susceptibles in a population is y = exp (-h x) The anti-HAV prevalente increase with age: in workers 14-19 years of age 44 percent of the tested individuals were antibody positive. The prevalence was 82.7 percent in the population 25-29 years old. Finally we found a nearly total exposure to HAV in persons over 30 years of age. The workers 14-19 years of age showed a higher prevalence than the students did; the difference was statistically significant. The prevalence that we have observed in our study population is lower the one observed in the city of Sassari (North-Sardinia) in 1981. The siero-epidemiological pattern is similar to that prevailing in Greece and France (1979), in Umbria (1978), in the city of Milan (1973). The prevalence was, on the contrary, higher than that observed in North European Countries (1979) and in Venetia (1987). The data from the study population can be fitted satisfactorily with the exponential model (R2 = 0.994). So we can take the force of infection (h = -0.118, se = 0.005 as a constant.(ABSTRACT TRUNCATED AT 250 WORDS)

In the developing countries, where socioeconomic and hygienic conditions are inadequate, hepatitis A is mainly a childhood infection. Improvements in environmental conditions cause a decline in the exposure to hepatitis A virus and a change in the age-distribution of the incidence. In the Sardinian population 3-11 years old a study conducted in 1987 showed that 3.8 percent of children were anti-HAV positive. In this research work we studied the anti-HAV prevalence in the population 13-20 years old. The study population consisted of all the children who attended the third year of the junior high school (13-16 years old) and the fifth year of the senior high school (17-20 years old) in 7 health districts of South-Sardinia. All schools were identified in each district. Our list consisted of 455 classes of the last year of secondary schools and of 242 classes of the last year of high schools. Our sample consisted of 20 classes of the last year of junior high schools and of 29 classes of the last year of senior high schools. We used a precoded questionnaire recording age, sex, number of households and father's years of schooling. Sera from 794 students were collected between May and June 1988 and stored at--20 degrees C. A ELISA test (ABBOTT) was used for detection of anti-HAV. The analysis has been carried out in accordance with the manufacturer's instructions. We determined the prevalence of anti-HAV according to age, sex and socioeconomic conditions. We calculated odds' ratios and their 95% confidence limits. We considered as not exposed the group in the most favourable level of exposure (father's highest educational level, lowest number of households). There is a sharp increase from an anti-HAV prevalence of 16.5 percent in students 13-16 years of age to 24.8 percent in students 17-20 years of age. As far as the persons 13-16 years of age are concerned we can recognize a significant difference between females (21.8 percent) and males (10.3 percent). In the other group of age, on the contrary, the difference is not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

The prevalence of antibodies to hepatitis A in South-Sardinia was determined in samples of students and workers. In 1987 sera were collected from the children who attended kindergarten and elementary schools, in 1988 from students 13-20 years old (high schools) and from a group of workers who went to the public health office to ask for a certificate of good health. As far as the workers are concerned, the force of infection can be taken as a constant. In childhood, on the contrary, our findings are suggestive for a different immunization model. In this research work the prevalence observed in the population is analyzed using a mathematical model. Our model is based on the assumption that the force of infection increases linearly with age. The estimated fraction of susceptibles to hepatitis A is denoted by Y (X). The parameter h (X) represents the force of infection, the per capita rate at which susceptible population acquires infection. We assume that susceptibility may be lost only by natural infection and that permanent immunity results from first infection. So the fraction of susceptible population is gamma = exp (- x o integral of h (chi) d chi) if the force of infection increases linearly with age h (X) = ax + b then Y = exp (aX2 + bX + c) We can write In Y = y We obtain y = aX2 + bX + c Goodness of fit has been tested using the coefficient of determination R2. The number of cases in the group of age X - X + 1 can be estimated, for 10000 inhabitants, as (Y (X) - Y(X + 1) * 10000) Our findings are suggestive for a linear increasing of the force of infection with the group of age (R2 = 0.974). This could result from an age-dependent force of infection presumably as a consequence of age-related changes in behavioural patterns. Another explication could be a time-dependent force of infection according to improvements in socioeconomic and hygienic conditions. There is clear need for further research to separate the variations attributable to age from those attributable to time. Case notifications records could be very useful, but these data are notoriously unreliable.