Search

Surveillance and control of infectious diseases in the Italian military include prompt reporting of all occurring cases and prophylaxis through compulsory vaccination practices. The last mandatory immunisation programme in the Italian military was launched in 1998 (more than 10 years after the previous programme was introduced in 1986-1987) and it was planned according to the epidemiological data herein reported. The incidence rates (number of cases x 100000 subjects) of infectious diseases notified during the period 1976-1980 were compared with the corresponding figures notified 15 years later (1991-1995). An increase of three airborne-transmitted viral diseases--varicella, rubella and measles--counterbalanced by a decrease of other infectious diseases, such as mumps, typhoid fever, tuberculosis, viral hepatitis, scabies, syphilis and gonorrhea, was observed. This may be related to improvements in the general hygienic conditions and more responsible sexual behaviour among Italian military recruits. Moreover, incidence rates of cases notified in the military were compared with those notified in the general population of the same sex- and similar age-range (15-24 years) over a 12-year period (1986-1997), to monitor the epidemiological situation in relation to (a) potential risk factors specifically linked to military life and (b) protective effects induced by specific vaccinations. Airborne-transmitted viral diseases, such as varicella, rubella, measles and mumps--which are usually underreported among civilians--show higher incidence rates in the military. Meningococcal meningitis shows higher incidence rates in the military in 1986 and 1987 (before the introduction of mandatory specific vaccination) as well as in 1995-1997 (main etiologic agent N. meningitidis serogroup B); similar rates were instead observed in the other years. Incidence rates for typhoid fever are generally lower in the military, despite the community life, probably reflecting the protective efficacy of specific vaccine. Hepatitis A and B show similar rates between military and civilian population. Finally, pulmonary tuberculosis generally shows higher rates in the military. These data therefore allow the conclusion that the only infectious diseases, for which possible risk factors in the military life may be hypothesised, seem to be meningococcal meningitis and perhaps pulmonary tuberculosis. Epidemiological surveillance of infectious diseases in the military as a pre-requisite for appropriate public health intervention strategy represents a good model to be followed also in larger contexts.

In Italy systematic mandatory tetanus immunization of children started in 1968. In a national sample of 241 young males born after 1968 the prevalence of non-immune subjects was 11.2% (5.5% in the North-Centre, 15.9% in the South-Islands; p < 0.02). Comparing these data with the corresponding figure obtained in a previous study of subjects born before 1968 a significant decrease (11.2% versus 32.6%; p < 0.01) is observed. The prevalence of non-immune subjects born after 1968 is significantly (p < 0.01) lower than that observed in subjects born before 1968 by geographical area as well as by area (urban/rural) of residence. These findings indicate that the introduction of compulsory tetanus vaccination for all newborns has favourably affected the immune status of younger Italian men. However, more efforts should still be addressed to decrease regional inequalities in the delivery of health care.

Meningococcal meningitis is still a serious infectious disease with a mortality rate that can be as high as 10% even in developed countries. Military recruits are generally a high-risk group for meningococcal disease, with a reported incidence of four to ten times greater than that of the general population. In Italy the results of the National Meningitis Surveillance Programme showed a high attack rate of the disease among recruits in 1985 as well as in 1986, with 92 and 95% of the cases, respectively, caused by serogroup C and thus preventable. These findings led to the authorities' decision to make vaccination against meningococcal disease mandatory for recruits starting from January 1987. After almost 5 years from the introduction of meningococcal vaccination, we here sum up the epidemiological and immunological effects of the vaccination. From the epidemiological point of view we have observed a dramatic reduction of the prevalence of the disease. In 1987, the year in which we had 150,000 unvaccinated and 150,000 vaccinated recruits, the protective efficacy was 91.2%. From the immunological point of view, vaccination is highly effective, as seroconversion against polysaccharide (PS) A and C is 84 and 91%, respectively. The spectrotypic analysis of the sera before and after vaccination shows that the type of response is mainly oligoclonal, like the majority of the responses to PSs, and the antibodies induced by a sole PS are not qualitatively different from the antibodies induced by natural immunization. In addition, the efficacy is not modified by environmental factors like hypoxia, as demonstrated during permanence at 16,174 feet for 20 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Summary: Meningococcal polysaccharide (Men‐Ps) vaccine immunogenicity following either primary immunization or revaccination in adults was evaluated. The study population consisted of subjects who have received tetravalent Men‐Ps vaccine once (group 1) or at least twice, with a 2–6 dose range (group 2). Human leucocyte antigen (HLA)‐typing was performed by polymerase chain reaction and specific immunoglobulin (Ig)G was measured by enzyme‐linked immunosorbent assay. Nine months post‐immunization, the percentages of individuals with levels of anti‐Men‐Ps IgG ≥ 2 µg/ml were comparable in both groups, with the exception of anti‐Men‐PsW135 IgG, which were significantly higher in group 2. The percentage of subjects doubling IgG levels at 9 months was significantly higher in group 1. The high baseline anti‐Men‐Ps antibody levels negatively influenced the response to revaccination, suggesting a feedback control of specific IgG. The calculated durability of anti‐Men‐Ps IgG was 2·5–4·5 years, depending on the Men‐Ps, following a single vaccine dose. No interference by other vaccinations nor HLA alleles association with immune response were observed. This study confirms that Men‐Ps vaccine in adults is immunogenic, even when administered repeatedly, and underlines the vaccine suitability for large‐scale adult immunization programmes that the higher costs of conjugate vaccines may limit in developing countries. Meningococcal polysaccharide (Men‐Ps) vaccine immunogenicity following either primary immunization or revaccination was evaluated in adult subjects who have received tetravalent Men‐Ps vaccine once (group 1) or at least twice, with a 2–6 dose range (group 2). Nine months post‐immunization, the percentages of individuals with levels of anti‐Men‐Ps immunoglobulin (Ig)G ≥ 2 µg/ml were comparable in both groups, with the exception of anti‐Men‐PsW135 IgG, which were significantly higher in individuals receiving booster doses. This study confirms that Men‐Ps vaccine in adults is immunogenic, even when repeatedly administered, and underlines the vaccine suitability for large‐scale adult immunization programmes that the higher costs of conjugate vaccines may limit in developing countries. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis ( RA) patients under immunosuppressive therapy are particularly susceptible to infections, mainly of the respiratory tract, thus vaccination may represent a strategy to reduce their incidence in this vulnerable population. In the 2009-10 influenza season, the safety and immunogenicity of co-administered non-adjuvanted seasonal and MF59-adjuvanted pandemic influenza vaccines were evaluated in this study in 30 RA patients under therapy with anti-tumour necrosis factor ( TNF)-α agents or Abatacept and in 13 healthy controls ( HC). Patients and HC underwent clinical and laboratory evaluation before ( T0), 1 ( T1) and 6 months ( T2) after vaccinations. No severe adverse reactions, but a significant increase in total mild side effects in patients versus HC were observed. Both influenza vaccines fulfilled the three criteria of the Committee for Proprietary Medicinal Products ( CPMP). Seroconversion rate for any viral strain in patients and HC was, respectively, 68 versus 45 for H1- A/ Brisbane/59/07, 72 versus 81 for H3- A/ Brisbane/10/07, 68 versus 54 for B/ Brisbane/60/08 and 81 versus 54 for A/ California/7/2009. A slight increase in activated interferon ( IFN)-γ-, TNF-α- or interleukin ( IL)-17 A-secreting T cells at T1 compared to T0, followed by a reduction at T2 in both patients and HC, was registered. In conclusion, simultaneous administration of adjuvanted pandemic and non-adjuvanted seasonal influenza vaccines is safe and highly immunogenic. The largely overlapping results between patients and HC, in terms of antibody response and cytokine-producing T cells, may represent further evidence for vaccine safety and immunogenicity in RA patients on biologicals. [ABSTRACT FROM AUTHOR]

Patients with defects of terminal complement components are particularly exposed to the risk of developing neisserial infections and seem to respond poorly to meningococcal capsular polysaccharide (PS) C via natural immunization. The sole meningococcal PSC is, on the other hand, an excellent immunogen in normal people. Considering the great importance of vaccine prophylaxis for the prevention of meningococcal infections in patients with complement defects, it is crucial to study the antibody response to the sole meningococcal PS in these patients. We therefore analysed the levels of anti- PSA and PSC antibodies in the members of four families including patients with homozygous and heterozygous defects of C7, C8 or factor H, before and after vaccination with the sole PSA + C. Surprisingly, we found the highest levels of antibodies before vaccination In homozygous subjects, followed by heterozygous and normal controls, whereas, after vaccination, homozygous subjects showed the lowest increase of specific antibodies, indicating their relative incapability to respond to sole meningococcal PS. In conclusion, this study demonstrates (I) the capacity to respond to meningococcal PS via natural immunization by patients with total complement defects, and (2) the low responsiveness to meningococcal PS via vaccine immunization by the same patients. We propose that vaccination should be given to patients lacking specific antibodies and their serological response should be assessed. In addition this study confirms previous observations on a likely lower immunogenic power of meningococcal serogroup C via natural immunization compared with the better immunogenicity of the sole PSC. [ABSTRACT FROM AUTHOR]

A collaborative survey was carried out in Italy on a group 0159 subjects with a past history of meningococcal meningitis. The aim was to evaluate the prevalence of complement deficiencies. the serogroup of meningococci responsible for the disease and other possible immune abnormalities associated with the infection. Complement analysis allowed the detection of 10 cases (17%) with deficiencies of the terminal components, and in particular six cases of C8β, three of C7 and one of C6 defect. Half of the subjects with complement deficiencies had recurrences of meningitis and developed the infection at an older age in comparison with the control group with normal complement activity. The meningococcal C strain was the most diffuse (68%) and infected all the complement-deficient subjects. Evaluation of the antibody response to meningococcal capsular polysaccharides (PS) showed that only 42.5% of the individuals with group C had antibodies as opposed to 83% and 100% of the patients with meningitis due to group A and B. respectively. In all 59 subjects serum Ig as well as IgG subclasses were present. at normal levels for the age. Vaccination of seven out of the 24 subjects without detectable anti-meningococcal PS antibodies with the sole PS A + C induced a normal response in six of them, including a subject with complement defect. In the subject who did not respond to the antigen. the antibodies against the ubiquitous pneumococcal PS type 14 were also lacking, whereas anti-tetanus toxoid (TT) antibodies were normally present. From these data we may conclude the following: (I) the high prevalence (17%) of late complement components defect among survivors of meningococcal meningitis is also confirmed in the Italian population; (2) the serogroup C. responsible for the infections in all the cases with late complement components defect, is highly recirculating in Italy and apparently less immunogenic: (3) specific vaccination with meningococcal PS is a valid prophylaxis in subjects with lack of specific antibodies as well as in subjects with complement defect. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate immunological safety and immunogenicity of influenza vaccine administration in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Patients and methods: Twenty-four patients with low and/or stable disease activity 14 with SLE (mean age 43.42±12.18 years; 13 women) and 10 with RA (mean age 51±14.57 years; 9 women), diagnosed on the basis of the American College of Rheumatology criteria, have been immunized with trivalent split influenza vaccine without adjuvant. Further 24 non-vaccinated patients, 14 with SLE and 10 with RA, and 10 vaccinated healthy subjects, all age- and sex-matched, were used as controls. The patients underwent clinical and laboratory (specific anti-influenzavirus antibodies, auto-antibodies, peripheral blood lymphocyte subpopulations) evaluation before and 30 days after vaccination; auto-antibodies were also assessed at 90 days and disease activity at 90 and 180 days. Results: The specific antibody response towards the three used antigens (A/New Caledonia/20/99, A/Moscow/10/99, and B/Shangdong/7/97) significantly increased in both patients and healthy controls, without any significant difference between them. No significant difference could instead be observed on the clinical activity, auto-antibodies, and peripheral blood lymphocyte subpopulations before and after vaccination, and between patients and controls. Conclusions: Trivalent split influenza vaccine without adjuvant seems to be safe and immunogenic in patients with SLE and RA, provided that only patients with low and/or stable disease activity are selected. [Copyright &y& Elsevier]