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The COVID-19 outbreak disproportionately affected the elderly and areas with higher population density. Among the multiple factors possibly involved, a role for air pollution has also been hypothesized. This nationwide observational study demonstrated the significant positive relationship between COVID-19 incidence rates and PM2.5 and NO 2 levels in Italy, both considering the period 2016-2020 and the months of the epidemic, through univariate regression models, after logarithmic transformation of the variables, as the data were not normally distributed. That relationship was confirmed by a multivariate analysis showing the combined effect of the two pollutants, adjusted for the old-age index and population density. An increase in PM2.5 and NO 2 concentrations by one unit (1 µg/m 3 ) corresponded to an increase in incidence rates of 1.56 and 1.24 × 10 4 people, respectively, taking into account the average levels of air pollutants in the period 2016-2020, and 2.79 and 1.24 × 10 4 people during March-May 2020. Considering the entire epidemic period (March-October 2020), these increases were 1.05 and 1.01 × 10 4 people, respectively, and could explain 59% of the variance in COVID-19 incidence rates (R 2 = 0.59). This evidence could support the implementation of targeted responses by focusing on areas with low air quality to mitigate the spread of the disease.

Background : Pertussis is a highly contagious infectious disease which continues to be an important public-health issue despite the high immunization coverage rates achieved. However, evidence of increased circulation of pertussis among adolescents and adults due to waning immunity and atypical clinical manifestations seem to be the main reasons for its resurgence. The aim of this study was the analysis of the epidemiological trend for pertussis-related hospitalizations in Italy, in relation with vaccination coverage and information from laboratory confirmed cases of pertussis . Methods : A retrospective observational study investigating hospitalizations for pertussis from 2002 to 2016 in Italy was conducted. Frequencies and rates of hospitalization were analyzed and hospitalization data were compared with a series of already published laboratory confirmed data. Results : This study highlighted a rising trend for pertussis hospitalizations in Italy since 2008. Infants aged <1 year showed the highest frequencies (63.39%) and average rates (74.60 × 100000 infants) of hospitalization despite an extremely high vaccination coverage (95.89%). An increasing trend of hospitalization frequency emerged for the age group with levels of IgG antibodies to pertussis toxin compatible with pertussis infection within the last year (20-29 years old age group). Conclusions : The rising trend for pertussis hospitalizations and the greater involvement of infants aged <1 year require an integrated approach, including the implementation of booster doses administration in adolescence and adulthood, the vaccination of pregnant women and the cocoon strategy., Competing Interests: FF declares that she has no competing interests. GG received grants from GlaxoSmithKline Biologicals SA, Sanofi Pasteur MSD, Novartis, Crucell/Janssen, Seqirus, Sanofi Pasteur, Merck Italy, Pfizer and Emergent Biosolutions for being consultant or taking part in advisory board, expert meetings, being a speaker or an organizer of congresses/conferences, and acting as investigator in clinical trials. AM declares that she has no competing interests.