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Clinical records from 4820 outpatients who required assistance after animal bites during 1986 at the "Antirabid Center" of Rome were collected and analysed. The study was carried out to investigate epidemiology of animal bites among our population and the proportion of people who received post-exposure antirabid prophylaxis. We noted a high proportion of people submitted to rabies immunization after animal bites (44% received at least one dose of HDCV vaccine), in spite of the fact that rabies is absent from Central Italy since many years in both wild and domestic animals (being present, on the contrary, in Northern Italy). These considerations suggest the opportunity of a substantial revision of the official Recommendations, and we feel that a differential policy should be adopted in rabies enzootic areas (Northern Italy) compared to those where risk is only potential.

Pneumococcal serotyping by quellung reaction has been performed in five Italian areas on 267 strains, isolated from throat swab, sputum, blood, liquor, etc. 37 serotypes have been identified. The most frequent types resulted 19, 6, 3, 20, 9, 4 (in 50% of total samples), with no difference from those detected in other European countries. The proportion of type 19 was the highest among all age group, in four out of five different areas and in bacteremic pneumonia and meningitis. 36 strains were isolated from infection sites among which type 19 resulted more frequent than in isolates from throat swab and sputum (27.7% versus 16.1%). Pneumococcal serotyping should be routinely done in the light of forthcoming use of polysaccharide vaccine.

The adequacy of antitetanus prophylaxis given in five hospital emergency rooms to 729 individuals up to 15 years, suffering from different types of injuries, was evaluated retrospectively using vaccinal data retrieved from a terminal of the computerized files of the City of Milan Health Authority operated in our Department. Comparing the recommended treatment (according to the guidelines issued by the Italian Ministry of Health, 1982) with that actually obtained, we have classified the subjects into three ("correctly treated", "undertreated" and "overtreated") groups. Correct treatment ranged from 70 to 90 percent, undertreatment from 4 to 6 percent, and overtreatment from 8 to 26 percent at the different hospitals. Undertreatment was most likely in incompletely immunized patients (having previously received one or two doses of tetanus toxoid), while overtreatment was much more common in patients fully immunized. By comparison, 545 patients sixteen and older, whose immunization history was unknown, were evaluated to obtain information about the behaviour adopted by the physicians in the same circumstances. Grouping the subjects by age we found that in two hospitals the highest proportion of untreated (18 and 25 percent) belonged to the group of individuals more prone to the disease (over 60 years of age). Compliance with the Ministerial Instructions would have led to an increase in the use of tetanus toxoid and to a decrease in the use of human immunoglobulin, improving the quality of prevention without adding to its cost.

A study of the duration of the immunity to tetanus, by means of the passive haemagglutination test, was undertaken in three groups of subjects immunized with two (primary immunization), three (basic immunization) and four (basic immunization with booster) does of DT. All the subjects of the first group, who had gone 9 months since their last dose, possessed antitoxin titers greater than or equal to 0.01 I.U./ml. Among the subjects of the second group within 12 months of the basic immunization course none had less than 0.01 I.U./ml, within 13-48 months 3% had less than 0.01 I.U./ml, within 49-72 months 9.7% had less than 0.01 I.U./ml and after 73 months 26.5% had less than 0.01 I.U./ml. No dependence on age at time of vaccination could be demonstrated. In the third group of subjects within 48 months of the immunization course with four doses none had less than 0.01 I.U./ml, after 48 months 11.1% had less than 0.01 I.U./ml. Interpolation of the data with the use of linear regression (y = a + bx), which better-fits in comparison with polynomial model (y = a + b1x + b2x2...+ bnxn) until the quartic term, pointed out the possibility that titer falls below the "alert level" (0.1 I.U./ml) and the protective threshold (0.01 I.U./ml): after 22 and 34 months for subjects of the first group; after 110 and 180 months for subjects of the second group and after 164 and 269 months for subjects of the third group. However, the presence of "poor" or "not responders" in the second group is not negligible and justifies the necessity that the first booster dose be given at five-year intervals.

From June 1978 throughout February 1979, 66 children with a mean age of 13 months were admitted to a pediatric intensive care unit in Naples (Santobono Hospital) after a rapid onset of coma or deep stupor of unknown ethiology. The "mystery disease" ("il male oscuro") as somebody in Naples has defined this syndrome, was suspected to be associated with tetanus and diphtheria immunization. Epidemiological investigations and an international symposium of experts agreed not to consider the cases due to immunization. Some of these deaths were related with with Respiratory Syncitial Virus (RSV), evidence which is favored by the poor sanitary situation, evident in many sections of Naples. Although an ad hoc Committee appointed by the Italian Ministry of Health excluded any correlation with immunization, the Ministry of Health invited some Italian groups to carry epidemiological retrospective studies in some Regions of the Country. To obtain comparable results a special protocol was prepared. Two retrospective case-control studies, performed in Genoa and Florence, did not show any association between immunization with anti-diphtheria-tetanus and even anti-poliomyelitis vaccine and severe neurological illness. A retrospective study, performed by us at the Institute of Hygiene of the University of Milan for the years 1983, 1984 and 1985, has included not only the 208 admittances to the only pediatric intensive care unit of Milan (S. Carlo Hospital) but also the other intensive care units of Milan where, sometimes, children are accepted, especially if they were previously admitted to the pediatric wards of the same hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

To evaluate exposure to hepatitis B virus (HBV) in dental operators, we surveyed 297 students of the Dental School, University of Milano, and 526 dentists registered at the Italian Dental Association (A.M.D.I.) of Lombardia. Out of 297 students, 10.8% had one or more serologic markers of HBV infection; none was hepatitis B surface antigen (HBsAg) positive. No significant difference in seropositivity was detected among students in relation to sex, age, or possible risk factors investigated. Out of 526 practitioners, 2.3% were positive for HBsAg, and 37.3% were antibody positive. The seropositivity increased progressively with age and years of professional experience, reaching the highest proportion in dentists with 30 years or more of practice (79.3%). Of those who had suffered from clinical hepatitis during their curriculum, 81.1% were seropositive compared with 34.5% observed in dentists without a prior clinical history of viral hepatitis. The proportion of seropositive dentists did not vary significantly with a history of blood transfusion, size of their practice, presence or absence (or unawareness) of subjects at high risk for HBV infection among their patients. The seropositivity was significantly lower in dentists who routinely adopted mask and gloves (21.1%) compared with those who never and/or occasionally used such barriers (46.3%). The result of the study confirmed that hepatitis B does remain a significant hazard for dental professionals, hence immunization with hepatitis B vaccine should be delivered early in their employment.

A questionnaire concerning the acceptance of hepatitis B vaccination was mailed in April 1985 to 626 private dentists practicing in Milano and its county. Two hundred and twenty eight dentists (36.4%) filled out the questionnaire, 166 of them indicating their willingness to receive the vaccine. Between October 1985 and February 1986 we tested 241 practitioners for HBs antigen, anti-HBs and anti-HBc antibody, and SGPT (ALT) enzyme level. A 14.9% prevalence of HBV markers was found in the prevaccination testing. All persons with positivity for anti-HBs or HBsAg or with elevations of SGPT were excluded from the study (the latter temporarily). A few (42 or 20.9%) left spontaneously before the first dose of vaccine was administered. On the whole, 159 participants began the vaccination course. The proportion of vaccine recipients in dentists who indicated in the questionnaire their willingness to accept the vaccine and/or participated in a seroepidemiological survey performed in 1983 by some of us (85.1%) was significantly greater than that in the group of dentists who did neither (65.0%) (p less than 0.01). Educational effort appeared to be important to enroll and to counsel practitioners in implementing vaccination programme.

The vaccinal preventive measures which were made compulsory since 1963 for the new working levies of some professional high risk categories, and since 1968 for the newborns, contributed to a large extent to the tetanus control in our country. In the last twenty years a progressive drop in the notified tetanus cases was observed. The epidemiology of this disease is conditioned, on the one hand by the correct application of the legal directions in force; on the other hand, by the level of health education, acquired by those who have not yet been involved, so far, by the compulsory antitetanus vaccination.

The results of a seroepidemiological prevalence survey on the immune status against tetanus of steelmill workers (who, limited to the new work call ups, had to be vaccinated since 1968) are reported. We did not observe remarkable differences in protection against tetanus among those who had begun work before 1968 (46.4% protected) and after 1968 (53.5% protected). In both cases, the protective values were the result of immunization procedures that were performed exclusively in consequence of the military service and/or on the occasion of industrial accident and/or road accident or of accidents of other kinds. It appears, moreover, that the protection of workers against this disease is, nowadays, too often relying on serum prophylaxis, which was the only preventive measure adopted for over half of the workers. In the light of the reported data we need to enforce the existing legislative measures.

Fourteen antigen and 17 antigen polyvalent vaccines against Str. pneumoniae have been tested on 137 healthy volunteers. They have been shown to cause side-effects infrequently. A two-fold or higher increase of antibody concentration (detected by RIA) has been demonstrated in 80% of the vaccinees against all antigens of the 17 valent vaccine; while such increase has been demonstrated only for 12 out of 14 antigens in the other vaccine (for the other two antigens the percentages have been 66.7% (antigen 1) and 73.7% (antigen 12F). It is stressed that the use of these vaccines is particularly recommended for the prevention of pneumococcal diseases in higher risk subjects.