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Background: in Europe homelessness is a known risk factor both for active and latent tuberculosis (TB). In Rome 409 cases of TB were notified in 2004, but the real occurrence among homeless people is unknown. Tuberculosis surveillance has been organized with the aim to develop an integrated model for the risk evaluation and management of both Latent Tuberculosis infections (LTBI) and TB in Rome homeless people. Methods: the eligible individuals have been recruited in the homeless’ refuges. The Tuberculin Mantoux test has been used to evaluate the infection prevalence; in case of a positive result, the individual’s expectorate has been collected and the chest X-ray has been performed. A collecting data form has been filled in for evaluating some risk factors. Multiple logistic regression models have been carried out to find statistically significant determinants of infection. Results: out of 120 subjects recruited, 108 came back for the evaluation of the skin test; the prevalence of LTBI was 43.5% (47/108 subjects); no active TB cases were found. According to the multivariate analysis, factors significantly associated to LTBI are gender (for males OR = 4.94; 95% CI: 1.46 – 16.67, 1st model; OR 5.84; 95% CI: 1.26 – 21.10, 2nd model), birth place (for Europe: OR 3.05; 95% CI: 1.02 – 9.13, 1st model; OR 3.12; 95% CI: 1.10 – 8.88, 2nd model; for East Mediterranean native Region OR = 4.34; 95%CI: 1.15-16.39); Body Mass Index class (for obesity OR = 3.34; 95% CI:1.31-8.51). Conclusions: these preliminary results have demonstrated a high prevalence of LTBI among homeless people. Male gender, birth place (Europe and East Mediterranean native Region) and obesity were found to be significant risk factors. The surveillance system allowed positive patients for LTBI to be rapidly directed to a specialized centre for the clinical evaluation and the appropriate therapy in order to prevent the evolution of disease.

Viene descritta l'elaborazione di un modello integrato per la valutazione e la successiva gestione del rischio di infezione tubercolare e di TBC attiva in popolazioni socialmente svantaggiate nella città di Roma e vengono presentati e discussi il "percorso" dei pazienti e la scheda di raccolta dati realizzata, strumenti utili per la sorveglianza epidemiologica e per la gestione clinica della patologia

OBJECTIVES: To perform a 3-year, prospective surveillance program for legionnaires disease (LD) in a large university hospital in Rome, and to assess the usefulness of the hospital water monitoring program in predicting the risk of nosocomial LD. METHODS: Samples from patients with new cases of nosocomial pneumonia were sent for legionella laboratory investigations. Meanwhile, water samples for bacteriological analysis were collected every 6 months from high- and medium-risk hospital wards (10 in total). Legionella pneumophila isolates collected were serotyped and analyzed by pulsed-field gel electrophoresis. RESULTS: From June 2001 through May 2004, the pneumonia surveillance identified one case of nosocomial LD among 43 cases of nosocomial pneumonia (2.3%). Environmental investigations detected L. pneumophila in 12 (18.7%) of the 64 water samples, of which 50% belonged to serogroup 1. The L. pneumophila count and the percentage of positive locations never exceeded 10(2) colony-forming units/L and 20%, respectively, except when the LD nosocomial case occurred (positive water samples, 40%; L. pneumophila count, <10(2) colony-forming units/L). Genotyping showed 3 prevalent clones of L. pneumophila in the water distribution network, of which one persisted over the 3 years. One clone contained 3 different L. pneumophila serogroups (2, 4, and 6). CONCLUSIONS: The low incidence of nosocomial cases of LD appears to be associated with a low percentage (<20%) of positive water samples per semester and with a low contamination level (<10(2) colony-forming units/L). An infection control system for nosocomial LD should, therefore, be based on both environmental and clinical surveillance, together with the appropriate maintenance of the hospital water distribution system.

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