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Chikungunya fever (CHIKF) is an emerging infectious disease caused by an alphavirus transmitted by Aedes spp. mosquitoes. Because mosquito control programs are not highly efficient for outbreak containment, vaccines are essential to reduce the burden of disease. Although no licensed vaccine against CHIKF is yet available, many highly promising candidates are undergoing preclinical studies, and a few of them have been tested in human trials of phase 1 or 2. Here, we review recent findings regarding the need for a CHIKF vaccine and provide an update on vaccines nearing or having entered clinical trials. We also address needs to tackle bottlenecks to vaccine development—including scientific and financial barriers—and to accelerate the development of vaccines; several actions should be taken: (i) design efficacy trials to be conducted during the course of outbreaks; (ii) evaluate the opportunity for adopting the “animal rule”for demonstration of efficacy for regulatory purposes; (iii) strengthen the collective commitment of nations, international organizations, potential donors and industry; (iv) stimulate public and/or private partnerships to invest in vaccine development and licensure; and (v) identify potential markets for an effective and safe CHIKF vaccine. [ABSTRACT FROM AUTHOR]

So far, only three small outdated studies have investigated hepatitis C virus (HCV) incidence and risk factors among illicit drug users (DUs) in Italy. Thus, during 2007-2010, we conducted a prospective cohort study among DUs attending 17 Italian rehabilitation centers serving urban areas. Two hundred eighty-four HCV-uninfected DUs were prospectively followed by interview and anti-HCV antibody and RNA testing every 6 months. Incidence was calculated using the person-years method. Infection predictors were assessed by time-dependent Cox analysis. Participants were mostly male (83.4%), under opioid substitution therapy (OST) (78.9%), non-injecting DUs (67.9%), and with a mean age of 30.8. Ninety-one of 224 DUs initially under OST interrupted treatment during the follow-up. Overall HCV incidence was 5.83/100 person-years at risk (PYAR) [95% confidence intervals (CI), 3.63-9.38]. The incidence did not significantly differ according the participants' sociodemographic characteristics or the degree of urbanization of the towns involved in the study. The incidence was higher for DUs under than for those not under OST (6.23 vs 4.50/100 PYAR; p = 0.681). Incidence was also higher for those with than for those without OST interruption (7.17 vs 5.04/100 PYAR; p = 0.55). However, all these differences were non-significant. At last follow-up visit, a significant decrease in frequency of sharing equipment for preparation/using drugs (by injection or not) was observed by analyzing either the whole cohort or DUs under OST only. Anti-HCV seroconversion resulted independently associated with sharing drug preparation/use equipment, backloading, having a HCV-positive sexual partner, or household and (marginally) intravenous injection. In this study, HCV incidence was non-negligible and OST seemed to lack effectiveness in reducing it. In Italy, implementation of combined harm reduction interventions and antiviral treatment of chronically infected DUs would be needed. [ABSTRACT FROM AUTHOR]

Background Sub-Saharan Africa (SSA) contributes very little to overall climate change and yet it is estimated to bear the highest burden of climate change, with 34% of the global DALYs attributable to the effects of climate change found in SSA. With the exception of vector-borne diseases, particularly malaria, there is very limited research on human health effects of climate change in SSA, in spite of growing awareness of the region's vulnerability to climate change. Objectives Our objective is to systematically review all studies investigating temperature variability and non-vector borne morbidity and mortality in SSA to establish the state and quality of available evidence, identify gaps in knowledge, and propose future research priorities. Methods PubMed, Ovid Medline and Scopus were searched from their inception to the end of December 2014. We modified the GRADE guidelines to rate the quality of the body of evidence. Results Of 6745 studies screened, 23 studies satisfied the inclusion criteria. Moderate evidence exists to associate temperature variability with cholera outbreaks, cardiovascular disease hospitalization and deaths, and all-cause deaths in the region. The quality of evidence on child undernutrition is low, and for diarrhea occurrence, meningitis, Ebola, asthma and respiratory diseases, and skin diseases, very low. Conclusions The evidence base is somehow weakened by the limited number of studies uncovered, methodological limitations of the studies, and notable inconsistencies in the study findings. Further research with robust study designs and standardized analytical methods is thus needed to produce more credible evidence base to inform climate change preparedness plans and public health policies for improved adaptive capacity in SSA. Investment in meteorological services, and strengthening of health information systems is also required to guarantee timely, up-to-date and reliable data. [ABSTRACT FROM AUTHOR]

We investigated 400 cases of dengue-like illness in persons hospitalized during an outbreak in Al Hudaydah, Yemen, in 2012. Overall, 116 dengue and 49 chikungunya cases were diagnosed. Dengue virus type 2 was the predominant serotype. The co-circulation of these viruses indicates that mosquitoborne infections represent a public health threat in Yemen. [ABSTRACT FROM AUTHOR]

The immunogenicity and the efficacy of a beta-propiolactone-inactivated caprine herpesvirus 1 (CpHV-1) vaccine adjuvanted with MF59™ were tested in goats. Following two subcutaneous immunizations, goats developed high titers of CpHV-1-specific serum and vaginal IgG and high serum virus neutralization (VN) titers. Peripheral blood mononuclear cells (PBMC) stimulated in vitro with inactivated CpHV-1 produced high levels of soluble IFN-gamma and exhibited high frequencies of IFN-gamma producing cells while soluble IL-4 was undetectable. On the other hand, control goats receiving the inactivated CpHV-1 vaccine without adjuvant produced only low serum antibody responses. A vaginal challenge with virulent CpHV-1 was performed in all vaccinated goats and in naϊve goats to assess the efficacy of the two vaccines. Vaginal disease was not detected in goats vaccinated with inactivated CpHV-1 plus MF59TM and these animals had undetectable levels of infectious challenge virus in their vaginal washes. Goats vaccinated with inactivated CpHV-1 in the absence of adjuvant exhibited a less severe disease when compared to naϊve goats but shed titers of challenge virus that were similar to those of naϊve goats. Detection and quantitation of latent CpHV-1 DNA in sacral ganglia in challenged goats revealed that the inactivated CpHV-1 plus MF59™ vaccine was able to significantly reduce the latent viral load when compared either to the naϊve goats or to the goats vaccinated with inactivated CpHV-1 in the absence of adjuvant. Thus, a vaccine composed of inactivated CpHV-1 plus MF59™ as adjuvant was strongly immunogenic and induced effective immunity against vaginal CpHV-1 infection in goats. [ABSTRACT FROM AUTHOR]

Objective. To determine whether early postseroconversion CD4 cell counts and human immunodeficiency virus (HIV) loads have changed over time. Methods. Our analysis was based on 22 cohorts of people with known dates of seroconversion from Europe, Australia, and Canada (Concerted Action on Seroconversion to AIDS and Death in Europe Collaboration). We focused on individuals seroconverting between 1985 and 2002 who had the first CD4 cell count ( n = 3687) or HIV load (n = 1584) measured within 2 years of seroconversion and before antiretroviral use. Linear regression models were used to assess time trends in postseroconversion CD4 cell count and HIV load. Trends in time to key thresholds were also assessed, using survival analysis. Results. The overall median initial CD4 cell count was 570 cells/μL (interquartile range [IQR], 413-780 cells/ μL). The median initial HIV load was 35,542 copies/mL (IQR, 7600-153,050 copies/mL; on log10 scale, 3.9-5.2 log10 copies/mL). The postseroconversion CD4 cell count changed by an average of -6.33 cells/μL/year (95% confidence interval [CI], -8.47 to -4.20 cells/μL/year; ), whereas an increase was observed in log10 HIV P < .001 load (+0.044 log10 copies/mL/year; 95% CI, +0.034 to +0.053 log10 copies/mL/year). These trends remained after adjusting for potential confounders. The probability of progressing to a CD4 cell count of <500 cells/μL by 24 months from seroconversion increased from 0.66 (95% CI, 0.63-0.69) for individuals who seroconverted before 1991 to 0.80 (95% CI, 0.75-0.84) for those who seroconverted during 1999-2002. Conclusion. These data suggest that, in Europe, there has been a trend of decrease in the early CD4 cell count and of increase in the early HIV load. Additional research will be necessary to determine whether similar trends exist in other geographical areas. [ABSTRACT FROM AUTHOR]

This Viewpoint from physicians with the Italian National Institute of Health confirms a higher case-fatality rate from coronavirus disease 2019 (COVID-19) in Italy compared with China and explains possible reasons, including age, cause of death definitions, and testing strategy. [ABSTRACT FROM AUTHOR]

The human immunodeficiency virus (HIV) type 1 Tat protein plays a key role in the life cycle of the virus and in pathogenesis and is highly conserved among HIV subtypes. On the basis of this and of safety, immunogenicity, and efficacy findings in monkeys, Tat is being tested as a vaccine in phase 1 trials. Here, we evaluated the incidence and risk of progression to advanced HIV disease by anti-Tat serostatus in a cohort of 252 HIV-1 seroconverters. The risk of progression was lower in the anti-Tat-positive subjects than in the anti- Tat-negative subjects. Progression was faster in the persistently anti-Tat-negative subjects than in the transiently anti- Tat-positive subjects, and no progression was observed in the persistently anti-Tat-positive subjects. [ABSTRACT FROM AUTHOR]

Analyzes the relationship between viral load and gender differences among individuals with known duration of HIV infection. Laboratory assays; Sex differences in the plasma HIV ribonucleic acid concentrations of HIV patients; Difference in viral load between men and women with HIV in a linear regression model.

Examines the prevalence and risk factors for human herpesvirus 8 (HHV-8) infection in northern Cameroon. Non-sexual modes of transmission; Serological testing for anti-HHV-8 antibodies; Use of enzyme-linked immunosorbent assay.

Identifies the risk factors for human t-lymphotropic viruses (HTLV) types I and II and provides a distinction of the epidemiologic patterns of the two viruses in Italy. Profiles of the individuals studied; Role of sexual behavior in the spread of HTLV-I; Detection of the virus in endemic areas; Exposure of injecting drug users to the HTLV-II infection.

This study describes a SARS-CoV-2 outbreak caused by the Delta (B.1.617.2) variant in a nursing home in Central Italy during October–November 2021. Trained interviewers collected data from residents, staff, and administration officers with an agreed informed consent procedure. Thirty-two (44.5%) out of 72 residents (median age 89 years) and six (26.1%) of 23 healthcare workers were found to be infected with SARS-CoV-2. Infections occurred more often among residents with a higher index of independence in daily living activities, suggesting an increased risk for those with more interactions. Twenty-five infected residents (78.1%) received the booster dose of mRNA anti-COVID-19 vaccine > 7 days before SARS-CoV-2 onset. Half of the infected residents had mild symptoms, and only three required hospitalisation, one of whom died from COVID-19 complications. The study underlines the effectiveness of a booster dose in providing a high protection against severe disease and hospitalisation even among vulnerable individuals infected with the Delta variant of concern. [ABSTRACT FROM AUTHOR]

Seasonal influenza vaccination coverage in most EU/EEA remains suboptimal. Providers' and users' confidence in influenza vaccines is undermined by reports of moderate to low vaccine effectiveness and by the lack of solid evidence on disease burden. A study from Preaud and co. indicates that even with current levels of vaccine effectiveness, increasing vaccination coverage would significantly reduce disease burden and health cost. The results of the study should be interpreted cautiously because some of the assumptions are not generalizable or are imprecise, especially those on vaccine coverage, disease burden and health cost. Increasing vaccination coverage in EU/EEA countries is very challenging. Multifaceted approaches and country specific strategies are needed to address vaccine hesitancy in health care workers and in the population, and to manage organisational and financial obstacles. One key element for increasing vaccination coverage is the development of better influenza vaccines, e.g. vaccines that are more effective, provide longer lasting immunity and do not require annual administration. Vaccine producers should consider this as the highest research priority in the field of influenza vaccine development. [ABSTRACT FROM AUTHOR]

Background: The incidence of Kaposi's sarcoma (KS) is increased severalfold in individuals infected with human immunodeficiency virus-1 (HIV). Human herpesvirus 8 (HHV8) has also been implicated in KS. We investigated several factors that may determine the onset of KS, particularly HHV8 infection in individuals after becoming seropositive for HIV.Methods: We studied 366 individuals belonging to different HIV-exposure categories (i.e., homosexual activity, intravenous drug use, and heterosexual contact) for whom a negative HIV serologic test and then a positive HIV serologic test were available within a 2-year period. HHV8 antibody testing was performed by use of an immunofluorescence assay on the first serum sample available after the first positive HIV test. Actuarial rates of progression of KS and of other acquired immunodeficiency syndrome (AIDS)-defining diseases were estimated by use of time-to-event statistical methods. All statistical tests were two-sided.Results: Twenty-one of the 366 study participants developed AIDS-related KS, and 83 developed AIDS without KS. One hundred forty (38.3%) participants had detectable anti-HHV8 antibodies. The actuarial progression rate to KS among persons co-infected with HIV/HHV8 was nearly 30% by 10 years after HIV seroconversion. Increasing HHV8 antibody titers increased the risk of developing KS (for seronegative versus highest titer [1:125 serum dilution], adjusted relative hazard [RH] = 51.82; 95% confidence interval [CI] = 6.08-441.33) but not of other AIDS-defining diseases (adjusted RH = 1.14; 95% CI = 0.72-1.80). HHV8-seropositive homosexual men compared with HHV8-seropositive participants from other HIV-exposure categories showed an increased risk of KS that approached statistical significance (adjusted RH = 6.93; 95% CI = 0.88-54.84).Conclusions: Approximately one third of individuals co-infected with HIV/HHV8 developed KS within 10 years after HIV seroconversion. Progression to KS increased with time after HIV seroconversion. Higher antibody titers to HHV8 appear to be related to faster progression to KS but not to other AIDS-defining diseases. [ABSTRACT FROM AUTHOR]

We used data from different sources to estimate the extent and the trend of the epidemic of drug use in Italy in the second half of the '80s. During the study, period, the number of subjects attending drug dependency units increased from 13 905 to 61 689. Mortality and morbidity indicators showed an increase in both drug related deaths (mainly from overdose) and AIDS cases reported in injecting drug users, particularly among older subjects. However, the number of young adults detected as drug users at the army recruitment remained virtually stable from 1986 on. These findings suggest that both demand and availability of treatment increased through the years 1985-89, and that clinical consequences of drug use related behaviour have become an important public health priority. [ABSTRACT FROM AUTHOR]

A series of 716 HIV-negative IDUs entering a large drug treatment centre in central Italy was studied to evaluate the pattern of T-lymphocyte subsets among IDUs and to determine the effects of individual variables such as age, gender, duration of drug use and infection with viral hepatitis B and C. To this end, white cell count, total lymphocyte count and absolute number of lymphocyte subsets (i.e. CD3+, CD4+ and CD8+), HBV markers and HCV serology, were determined. For each individual, information on age, gender and duration of drug use was collected. To evaluate the association between level of lymphocyte subsets and phases of HBV infection, participants were stratified into three groups: (A) negative for all markers; (B) HBsAg-positive, with or without HBeAg, and HBsAb-negative; and (C) HBsAg and HBeAg-negative, positive for any other serological marker. The median absolute number of CD3+, CD4+ and CD8+ was 1909, 1080 and 770 cells/mm3, respectively, and did not vary across age bands. The CD8+ count was higher in males than in females. There was a tendency for CD3+ lymphocyte counts (mainly due to CD8+ counts) to be higher in individuals with 6-8 years of drug use compared to those who started injecting 4 years before or less. There was no evidence of increasing counts for a duration of drug use of more than 8 years. With regard to HBV, there was a general tendency for individuals in group "C" to have higher CD3+ and CD8+ counts than those in group "A". Finally, there was no difference in absolute lymphocyte count subsets between HCV-positive and HCV-negative IDUs. In conclusion, demographic and behavioural factors such as long-term heroin use or infection with HCV do not seem to influence the level of lymphocyte subsets among HIV-negative IDUs, nor does the infection with HBV seem to determine dramatic changes in CD4+ counts. [ABSTRACT FROM AUTHOR]

Focuses on HIV prevalence and frequency of risk behavior in injecting drug users (IDUs) in Italy. ]Characteristics that may distinguish injecting drug users entering treatment from those out of treatment; Assessment of HIV prevalence among injecting drug users; Results emphasizing the need to implement outreach programs aimed at harm reduction.

Determines if morphine programs implemented in the city of Naples, Italy between 1980 and 1985 might contribute to the low HIV prevalence rate detected among injecting drug users. Study population characteristics; Comparison of HIV incidence among prescription morphine users versus methadone; Study limitations.

We studied residents of remote villages and the capital (Port Moresby) of Papua New Guinea to determine the distribution of human herpesvirus-8 (HHV-8) infection. Our data suggest that HHV-8 has been endemic on the island for a long time and that the epidemiologic pattern of HHV-8 is more similar to that of herpes simplex virus-2 than hepatitis C virus. [ABSTRACT FROM AUTHOR]

Introduction: A COVID-19 outbreak occurred at the end of October 2021 among pilgrims returning from Medjugorje (Bosnia and Herzegovina). Methodology: Whole genome sequencing (WGS) of SARS-CoV-2, epidemiological data, and phylogenetic analysis were used to reconstruct outbreak dynamics. Results: The results suggest that only in one case, associated with the SARS-CoV-2 sub-lineage AY.9.2, it is possible to trace back the place of contagion to Medjugorje, while the other cases were likely to be acquired in the country of origin. Conclusions: The combined use of phylogenetic data derived from WGS, and epidemiological data allowed us to study epidemic dynamics and to formulate a possible hypothesis on the place of exposure to SARS-CoV-2. The identification of different sub-lineages of the SARSCoV-2 Delta variant also suggested that different chains of transmission contributed to the outbreak. [ABSTRACT FROM AUTHOR]

Limited evidence is available on the additional protection conferred by second mRNA vaccine boosters against severe COVID-19 caused by omicron BA.5 infection, and whether the adapted bivalent boosters provide additional protection compared with the monovalent ones. In this study, we aimed to estimate the relative effectiveness of a second booster with monovalent or bivalent mRNA vaccines against severe COVID-19 in Italy. Linking data from the Italian vaccination registry and the SARS-CoV-2 surveillance system, between Sept 12, 2022, and Jan 7, 2023, we matched 1:1 each person aged 60 years or older receiving a second booster with a person who had received the first booster only at least 120 days earlier. We used hazard ratios, estimated through Cox proportional hazard models, to compare the hazard of severe COVID-19 between the first booster group and each type of second booster (monovalent mRNA vaccine targeting the original strain of SARS-CoV-2, bivalent mRNA vaccine targeting the original strain plus omicron BA.1 [bivalent original/BA.1], and bivalent mRNA vaccine targeting the original strain plus omicron BA.4 and BA.5 [bivalent original/BA.4-5]). Relative vaccine effectiveness (rVE) was calculated as (1–hazard ratio) × 100. We analysed a total of 2 129 559 matched pairs. The estimated rVE against severe COVID-19 with the bivalent original/BA.4-5 booster was 50·6% (95% CI 46·0–54·8) in the overall time interval 14–118 days post-administration. Overall, rVE was 49·3% (43·6–54·4) for the bivalent original/BA.1 booster and 26·9% (11·8–39·3) for the monovalent booster. For the bivalent original/BA.4-5 booster, we did not observe relevant differences in rVE between the 60–79-year age group (overall, 53·6%; 46·8–59·5) and those aged 80 years or older (overall, 48·3%; 41·9–54·0). These findings suggest that a second booster with mRNA vaccines provides additional protection against severe COVID-19 due to omicron BA.5 (the predominant circulating subvariant in Italy during the study period) in people aged 60 years or older. Although rVE decreased over time, a second booster with the original/BA.4-5 mRNA vaccine, currently the most used in Italy, was found to be still providing protection 4 months post-administration. NextGenerationEU-MUR-PNRR Extended Partnership initiative on Emerging Infectious Diseases (project number PE00000007, INF-ACT). For the Italian translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

Several risk factors for Coronavirus-2019 (COVID-19) disease have been highlighted in clinical evidence. Among the various risk factors are advanced age, metabolic illness such as diabetes, heart disease, and diseases of the respiratory system. Cystic Fibrosis (CF) is a rare disease with autosomal recessive transmission, characterised by a lack of synthesis of the CFTR channel protein, and multi-organ clinical symptoms mainly affecting the respiratory tract with recurrent pulmonary exacerbations. In view of the pathophysiological mechanisms, CF disease should be in theory considered a risk factor for SARS-CoV2 or severe COVID-19. However, recent clinical evidence seems to point in the opposite direction, suggesting that CF could be a protective factor against severe COVID-19. Possibly, the lack of presence or function of the CFTR channel protein could be linked to the expression of the membrane glycoprotein ACE-2, a key enzyme for the endocellular penetration of SARS-CoV-2 and related to the pathophysiology of COVID-19 disease. Furthermore, CFTR channel modulating agents could indirectly influence the expression of ACE-2, playing an important role in restoring the proper functioning of mucociliary clearance and the pulmonary microbiome in the host response to SARS-CoV-2 infection. In this review, the authors attempt to shed light on these important associations of issues that are not yet fully elucidated. [ABSTRACT FROM AUTHOR]

The article discusses reappearance of chikungunya in Italy in the summer of 2017 after a gap of ten years. It mentions that local health authorities set up an active surveillance system to identify new cases of chikungunya and to retrospectively confirm suspected cases. It mentions that epidemiological investigation and phylogenetic analysis performed by Istituto Superiore di Sanità indicated a link between outbreak and the one in Anzio.

The severe acute respiratory syndrome coronavirus (SARS-CoV)-2 responsible for the global COVID-19 pandemic has caused almost 760 million confirmed cases and 7 million deaths worldwide, as of end-February 2023. Since the beginning of the first COVID-19 case, several virus variants have emerged: Alpha (B1.1.7), Beta (B135.1), Gamma (P.1), Delta (B.1.617.2) and then Omicron (B.1.1.529) and its sublineages. All variants have diversified in transmissibility, virulence, and pathogenicity. All the newly emerging SARS-CoV-2 variants appear to contain some similar mutations associated with greater "evasiveness" of the virus to immune defences. From early 2022 onward, several Omicron subvariants named BA.1, BA.2, BA.3, BA.4, and BA.5, with comparable mutation forms, have followed. After the wave of contagions caused by Omicron BA.5, a new Indian variant named Centaurus BA.2.75 and its new subvariant BA.2.75.2, a second-generation evolution of the Omicron variant BA.2, have recently been identified. From early evidence, it appears that this new variant has higher affinity for the cell entry receptor ACE-2, making it potentially able to spread very fast. According to the latest studies, the BA.2.75.2 variant may be able to evade more antibodies in the bloodstream generated by vaccination or previous infection, and it may be more resistant to antiviral and monoclonal antibody drug treatments. In this manuscript, the authors highlight and describe the latest evidences and critical issues have emerged on the new SARS-CoV-2 variants. [ABSTRACT FROM AUTHOR]

Background: The difficulty in identifying SARS‐CoV‐2 infections has not only been the major obstacle to control the COVID‐19 pandemic but also to quantify changes in the proportion of infections resulting in hospitalization, intensive care unit (ICU) admission, or death. Methods: We developed a model of SARS‐CoV‐2 transmission and vaccination informed by official estimates of the time‐varying reproduction number to estimate infections that occurred in Italy between February 2020 and 2022. Model outcomes were compared with the Italian National surveillance data to estimate changes in the SARS‐CoV‐2 infection ascertainment ratio (IAR), infection hospitalization ratio (IHR), infection ICU ratio (IIR), and infection fatality ratio (IFR) in five different sub‐periods associated with the dominance of the ancestral lineages and Alpha, Delta, and Omicron BA.1 variants. Results: We estimate that, over the first 2 years of pandemic, the IAR ranged between 15% and 40% (range of 95%CI: 11%–61%), with a peak value in the second half of 2020. The IHR, IIR, and IFR consistently decreased throughout the pandemic with 22–44‐fold reductions between the initial phase and the Omicron period. At the end of the study period, we estimate an IHR of 0.24% (95%CI: 0.17–0.36), IIR of 0.015% (95%CI: 0.011–0.023), and IFR of 0.05% (95%CI: 0.04–0.08). Conclusions: Since 2021, changes in the dominant SARS‐CoV‐2 variant, vaccination rollout, and the shift of infection to younger ages have reduced SARS‐CoV‐2 infection ascertainment. The same factors, combined with the improvement of patient management and care, contributed to a massive reduction in the severity and fatality of COVID‐19. [ABSTRACT FROM AUTHOR]

Highlights • Good health is essential for active ageing. • Childhood diseases are becoming diseases of the adults. • A holistic approach is needed when assessing the value of vaccination. • The shift from childhood to life-long vaccination is essential to promote healthy ageing. • Key actions with a European multidisciplinary network to promote vaccination of 50+ appear mandatory. Abstract The proportion of the population ≥65 years old is about 17% today and will be about 27% in 2050 worldwide. The problem, however, is not ageing in itself, it is individual disabilities associated with ageing. This manuscript summarizes the consensus points reached during a pan-European meeting on gaps and barriers in making vaccination of adults aged 50+ a reality and on further joint actions in Europe. The shift from childhood to life-long vaccination is essential to prevent disability, morbidity and mortality in the elderly and promote healthy ageing. This vaccination shift is a major challenge in the post-truth, media-based era in countries with dwindling resources for the provision of healthcare. The challenge can be met only by adopting an innovative approach designed to shift the mindset of decision-makers from treatment to prevention. A number of key actions are required and for these actions a European multidisciplinary network including health authorities, medical doctors with different specialties, sociologists, psychologists, pharmaceutical companies and Associations of patients appears mandatory. [ABSTRACT FROM AUTHOR]

The authors presents their views on the early phase of the swine flu epidemic. Despite the lessons learned since the identification of H1N1 variant (v) in April 2009, gaps in the knowledge need to be bridged. The authors highlighted the lack of definition of the clinical spectrum of infection with H1N1v. Improvements were seen in the capacity to follow real-time virus movements and changes but the authors downplay the preparedness efforts to contain initial outbreaks. They question the effectivity of mitigation and treatment in reducing global pandemic.

In this article the author discusses the outbreak of chikungunya (CHIK) fever which resulted to 200 human cases in the Emilia-Romagna Region of Italy. He discusses the possible causes of the epidemic such as the globalization of vectors and humans. Also investigated is the West Nile virus (WNV), which was reported in Emilia-Romagna in the late summer of 2008. He also highlights the importance of research that centers on vector-borne infections as well as mosquito control activities.

This article discusses the avian influenza, which poses a threat to human being. In January 2004, the most serious outbreak of avian influenza in terms of the number of human deaths began. This outbreak was caused by the viral subtype H5NI haemoagglutinin and neuraminidase and, to date, constitutes the largest epidemic in commercial poultry,' affecting a number of Asian countries, where more than 100 million birds either died or were culled in the first two months of 2004. Although this evidence suggests that human to human transmission is inefficient, the potential for viruses to mutate must be considered. Influenza A viruses are known to undergo small or large antigenic changes, and major changes can result in worldwide pandemics, such as those of "Asian" flu in 1957 and "Hong Kong" flu in 1968.

Presents a letter to the editor on mass media coverage of the epidemics of severe acute respiratory syndrome.

Objectives: The incidence of acute cardiac events is one of the main reasons for medical consultation, disembarkation, repatriation, and death among seafarers at sea. Managing cardiovascular risk factors, particularly those that can be modified, is the key to preventing cardiovascular disease. Therefore, this review estimates the pooled prevalence of major CVD risk factors among seafarers. Methods: We conducted a comprehensive search of studies published between 1994 and December 2021 in four international databases, namely PubMed/Medline, Scopus, Google Scholar, and Web of Science (WOS). Each study was evaluated for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies. The DerSimonian–Laird random-effects model with logit transformations was used to estimate the pooled prevalence of major CVD risk factors. The results were reported in accordance with the Preferred Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Results: Out of all 1484 studies reviewed, 21 studies with 145,913 study participants met the eligibility criteria and were included in the meta-analysis. In the pooled analysis, the prevalence of smoking was found to be 40.14% (95% CI: 34.29 to 46.29%) with heterogeneity between studies (I2 = 98%, p < 0.01). The prevalence of hypertension, overweight, obesity, diabetes mellitus, and alcohol consumption was 45.32%, 41.67%, 18.60%, 12.70%, and 38.58%, respectively. However, the sensitivity analysis after excluding studies showed a pooled prevalence of hypertension, overweight, obesity, and diabetes mellitus of 44.86%, 41.87%, 15.99%, and 16.84%, respectively. The subgroup analysis demonstrated that smoking prevalence among seafarers had decreased significantly after 2013. Conclusion: This study demonstrated that CVD risk factors, particularly hypertension, overweight, smoking, alcohol consumption, and obesity, are prevalent among seafarers. These findings may serve as a guide for shipping companies and other responsible bodies in order to prevent CVD risk factors among seafarers. PROSPERO Registration: CRD42022300993. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor commenting on Kaslow and colleagues' article which concluded that psychoactive substance use did not accelerate the progression toward acquired immunodeficiency syndrome (AIDS), published in the 'Journal of the American Medical Association'.

Seasonal influenza vaccination coverage in most EU/EEA remains suboptimal. Providers' and users' confidence in influenza vaccines is undermined by reports of moderate to low vaccine effectiveness and by the lack of solid evidence on disease burden. A study from Preaud and co. indicates that even with current levels of vaccine effectiveness, increasing vaccination coverage would significantly reduce disease burden and health cost. The results of the study should be interpreted cautiously because some of the assumptions are not generalizable or are imprecise, especially those on vaccine coverage, disease burden and health cost. Increasing vaccination coverage in EU/EEA countries is very challenging. Multifaceted approaches and country specific strategies are needed to address vaccine hesitancy in health care workers and in the population, and to manage organisational and financial obstacles. One key element for increasing vaccination coverage is the development of better influenza vaccines, e.g. vaccines that are more effective, provide longer lasting immunity and do not require annual administration. Vaccine producers should consider this as the highest research priority in the field of influenza vaccine development. [ABSTRACT FROM AUTHOR]

Candida auris is an emerging fungus that represents a serious health threat globally. In Italy, the first case was detected in July 2019. Then, one case was reported to the Ministry of Health (MoH) on January 2020. Nine months later, a huge number of cases were reported in northern Italy. Overall, 361 cases were detected in 17 healthcare facilities between July 2019 and December 2022 in the Liguria, Piedmont, Emilia-Romagna, and Veneto regions, including 146 (40.4%) deaths. The majority of cases (91.8%) were considered as colonised. Only one had a history of travel abroad. Microbiological data on seven isolates showed that all but one strain (85.7%) were resistant to fluconazole. All the environmental samples tested negative. Weekly screening of contacts was performed by the healthcare facilities. Infection prevention and control (IPC) measures were applied locally. The MoH nominated a National Reference Laboratory to characterise C. auris isolates and store the strains. In 2021, Italy posted two messages through the Epidemic Intelligence Information System (EPIS) to inform on the cases. On February 2022, a rapid risk assessment indicated a high risk for further spread within Italy, but a low risk of spread to other countries. [ABSTRACT FROM AUTHOR]

• Evidence on relative effectiveness (RVE) of a 2nd booster of COVID-19 vaccine is scarce. • We estimated RVE of a 2nd booster as compared to a 1st booster given ≥ 120 days earlier in elders ≥ 80 years. • RVE against severe COVID-19 was about 30 % 2–4 months after the 2nd booster dose. • However, RVE against infection was negligible in the same time interval. • Cost-benefit of a 3rd booster four months after the 2nd booster should be evaluated. Several countries started a 2nd booster COVID-19 vaccination campaign targeting the elderly population, but evidence around its effectiveness is still scarce. This study aims to estimate the relative effectiveness of a 2nd booster dose of COVID-19 mRNA vaccine in the population aged ≥ 80 years in Italy, during predominant circulation of the Omicron BA.2 and BA.5 subvariants. We linked routine data from the national vaccination registry and the COVID-19 surveillance system. On each day between 11 April and 6 August 2022, we matched 1:1, according to several demographic and clinical characteristics, individuals who received the 2nd booster vaccine dose with individuals who received the 1st booster vaccine dose at least 120 days earlier. We used the Kaplan-Meier method to compare the risks of SARS-CoV-2 infection and severe COVID-19 (hospitalisation or death) between the two groups, calculating the relative vaccine effectiveness (RVE) as (1 – risk ratio)X100. Based on the analysis of 831,555 matched pairs, we found that a 2nd booster dose of mRNA vaccine, 14–118 days post administration, was moderately effective in preventing SARS-CoV-2 infection compared to a 1st booster dose administered at least 120 days earlier [14.3 %, 95 % confidence interval (CI): 2.2–20.2]. RVE decreased from 28.5 % (95 % CI: 24.7–32.1) in the time-interval 14–28 days to 7.6 % (95 % CI: −14.1 to 18.3) in the time-interval 56–118 days. However, RVE against severe COVID-19 was higher (34.0 %, 95 % CI: 23.4–42.7), decreasing from 43.2 % (95 % CI: 30.6–54.9) to 27.2 % (95 % CI: 8.3–42.9) over the same time span. Although RVE against SARS-CoV-2 infection was much reduced 2–4 months after a 2nd booster dose, RVE against severe COVID-19 was about 30 %, even during prevalent circulation of the Omicron BA.5 subvariant. The cost-benefit of a 3rd booster dose for the elderly people who received the 2nd booster dose at least four months earlier should be carefully evaluated. [ABSTRACT FROM AUTHOR]

An abstract of the article "Lessons Learned From Chikungunya," by Giovanni Rezza is presented.

Presents several medical evidences on HIV-1 infections. Development of Kaposi's sarcoma in human herpesvirus 8 infection; Enhancement of KS expression with HIV-induced immunosuppression; Prevalence of mucosal immune response in seronegative sex partners of HIV-infected persons.

• Lazio region mpox prevention strategies included social and public health measures. • The vaccination campaign was an opportunity to inform those at risk of mpox adequately. • Mpox slowdown could result from mitigation strategies and vaccine effectiveness. • Vaccination campaign plays a role in the decline of mpox cases. • Integrating vaccination campaigns with information and sensitization is crucial. A pre-exposure vaccination campaign to prevent the spread of the mpox virus was initiated in Italy in August 2022. We explore the possible factors affecting the trend of mpox cases in an Italian region (Lazio) with a rapid roll-out of the vaccination campaign. We estimated the impact of the communication and vaccination campaign by fitting a Poisson segmented regression model. Results By September 30, 2692, high-risk men who have sex with men had received at least one dose of vaccine, with a vaccination coverage of 37%. The analysis of surveillance data showed a significant decreasing trend in the number of mpox cases starting from the second week after vaccination (incidence rate ratio 0.452 [0.331-0.618]). The reported trend in mpox cases is likely to result from a combination of multiple social and public health factors combined with a vaccination campaign. [ABSTRACT FROM AUTHOR]

We analyzed the first 255 PCR-confirmed cases of monkeypox in Italy in 2022. Preliminary estimates indicate mean incubation period of 9.1 (95% CI 6.5-10.9) days, mean generation time of 12.5 (95% CI 7.5-17.3) days, and reproduction number among men who have sex with men of 2.43 (95% CI 1.82-3.26). [ABSTRACT FROM AUTHOR]

In accordance with the World Health Organization, one dose of yellow fever vaccine may guarantee protection lifelong in healthy adults. However, relatively little information is still available from ad hoc studies. We evaluated the persistence of neutralizing antibodies, which are considered to be an immune correlate of protection, in a large number of military personnel vaccinated up to 47 years before. Overall, 322 individuals were studied. The median time from vaccination to blood collection for neutralizing antibody evaluation was 9 years, ranging from <1 to 47 years. Of the 322 participants, 319 had neutralizing antibodies (99.1 %). The highest median PRNT 50 value was observed in those vaccinated ≤1 year before (median PRNT 50 = 320). In conclusion, our study confirms on a larger scale that, in healthy adults, neutralizing antibodies may persist as long as 47 years after a single yellow fever vaccines dose. [ABSTRACT FROM AUTHOR]

Background: By April 13, 2022, more than 4 months after the approval of BNT162b2 (Pfizer-BioNTech) for children, less than 40% of 5-11-year-olds in Italy had been vaccinated against COVID-19. Estimating how effective vaccination is in 5-11-year-olds in the current epidemiological context dominated by the omicron variant (B.1.1.529) is important to inform public health bodies in defining vaccination policies and strategies.Methods: In this retrospective population analysis, we assessed vaccine effectiveness against SARS-CoV-2 infection and severe COVID-19, defined as an infection leading to hospitalisation or death, by linking the national COVID-19 surveillance system and the national vaccination registry. All Italian children aged 5-11 years without a previous diagnosis of infection were eligible for inclusion and were followed up from Jan 17 to April 13, 2022. All children with inconsistent vaccination data, diagnosed with SARS-CoV-2 infection before the start date of the study or without information on the municipality of residence were excluded from the analysis. With unvaccinated children as the reference group, we estimated vaccine effectiveness in those who were partly vaccinated (one dose) and those who were fully vaccinated (two doses).Findings: By April 13, 2022, 1 063 035 (35·8%) of the 2 965 918 children aged 5-11 years included in the study had received two doses of the vaccine, 134 386 (4·5%) children had received one dose only, and 1 768 497 (59·6%) were unvaccinated. During the study period, 766 756 cases of SARS-CoV-2 infection and 644 cases of severe COVID-19 (627 hospitalisations, 15 admissions to intensive care units, and two deaths) were notified. Overall, vaccine effectiveness in the fully vaccinated group was 29·4% (95% CI 28·5-30·2) against SARS-CoV-2 infection and 41·1% (22·2-55·4) against severe COVID-19, whereas vaccine effectiveness in the partly vaccinated group was 27·4% (26·4-28·4) against SARS-CoV-2 infection and 38·1% (20·9-51·5) against severe COVID-19. Vaccine effectiveness against infection peaked at 38·7% (37·7-39·7) at 0-14 days after full vaccination and decreased to 21·2% (19·7-22·7) at 43-84 days after full vaccination.Interpretation: Vaccination against COVID-19 in children aged 5-11 years in Italy showed a lower effectiveness in preventing SARS-CoV-2 infection and severe COVID-19 than in individuals aged 12 years and older. Effectiveness against infection appears to decrease after completion of the current primary vaccination cycle.Funding: None.Translation: For the Italian translation of the summary see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

• We conducted a survey on vaccine shortages and stockouts in Europe in 2016–2019. • Vaccine shortages and stockouts were reported by 19 of 21 surveyed countries. • The vaccines most frequently affected were DT-containing and hepatitis B vaccines. • The most commonly reported causes were production issues and global shortage. • Vaccine shortages/stockouts had a relevant impact on vaccine services. National immunisation programmes require an adequate supply of vaccines to function properly but many countries, globally and in Europe, have reported vaccine shortages. A comprehensive view of vaccine shortages and stockouts in the EU/EEA is missing in the published literature. This study was conducted in the framework of the European Joint Action on Vaccination (EU-JAV). Twenty-eight countries, including 20 EU-JAV consortium member states and an additional 8 EU/EEA countries, were invited to participate in a survey aimed at collecting information on vaccine shortages and stock-outs experienced from 2016 to 2019, their main causes, actions taken, and other aspects of vaccine supply. Twenty-one countries completed the survey (response rate 75%), of which 19 reported at least one shortage/stock-out event. Overall, 115 events were reported, 28 of which led to a change in the national immunisation programme. The most frequently involved vaccines were DT- and dT-containing combination vaccines, hepatitis B, hepatitis A, and BCG vaccines. The median duration of shortages/stock-outs was five months (range <1 month–39 months). Interruption in supply and global shortage were the most frequently indicated causes. Only about half of countries reported having an immunization supply chain improvement plan. Similarly, only about half of countries had recommendations or procedures in place to address shortages/stockouts. The survey also identified the occurrence of shortages/stockouts of other biological products (e.g. diphtheria antitoxin in 12 countries). Public health strategies to assure a stable and adequate vaccine supply for immunization programmes require coordinated actions from all stakeholders, harmonized definitions, strengthening of reporting and monitoring systems, the presence of an immunization supply chain improvement plan in all countries, and procedures or recommendations in place regarding the use of alternative vaccines or vaccination schedules in case of shortages/stockouts. [ABSTRACT FROM AUTHOR]

Generally, seafarers face a higher risk of illnesses and accidents than land workers. In most cases, there are no medical professionals on board seagoing vessels, which makes disease diagnosis even more difficult. When this occurs, onshore doctors may be able to provide medical advice through telemedicine by receiving better symptomatic and clinical details in the health abstracts of seafarers. The adoption of text mining techniques can assist in extracting diagnostic information from clinical texts. We applied lexicon sentimental analysis to explore the automatic labeling of positive and negative healthcare terms to seafarers' text healthcare documents. This was due to the lack of experimental evaluations using computational techniques. In order to classify diseases and their associated symptoms, the LASSO regression algorithm is applied to analyze these text documents. A visualization of symptomatic data frequency for each disease can be achieved by analyzing TF-IDF values. The proposed approach allows for the classification of text documents with 93.8% accuracy by using a machine learning model called LASSO regression. It is possible to classify text documents effectively with tidy text mining libraries. In addition to delivering health assistance, this method can be used to classify diseases and establish health observatories. Knowledge developed in the present work will be applied to establish an Epidemiological Observatory of Seafarers' Pathologies and Injuries. This Observatory will be a collaborative initiative of the Italian Ministry of Health, University of Camerino, and International Radio Medical Centre (C.I.R.M.), the Italian TMAS. [ABSTRACT FROM AUTHOR]

We performed next-generation sequencing (NGS), phylogenetic analysis, gene flows, and N- and O-glycosylation prediction on SARS-CoV-2 genomes collected from lab-confirmed cases from different Italian regions. To this end, a total of 111 SARS-CoV-2 genomes collected in Italy between 29 January and 27 March 2020 were investigated. The majority of the genomes belonged to lineage B.1, with some descendant lineages. The gene flow analysis showed that the spread occurred mainly from the north to the center and to the south of Italy, as confirmed by epidemiological data. The mean evolutionary rate estimated here was 8.731 × 10−4 (95% highest posterior density, HPD intervals 5.809 × 10−4 to 1.19 × 10−3), in line with values reported by other authors. The dated phylogeny suggested that SARS-CoV-2 lineage B.1 probably entered Italy between the end of January and early February 2020. Continuous molecular surveillance is needed to trace virus circulation and evolution. [ABSTRACT FROM AUTHOR]

Problem After Italy's first national restriction measures in 2020, a robust approach was needed to monitor the emerging epidemic of coronavirus disease 2019 (COVID-19) at subnational level and provide data to inform the strengthening or easing of epidemic control measures. Approach We adapted the European Centre for Disease Prevention and Control rapid risk assessment tool by including quantitative and qualitative indicators from existing national surveillance systems. We defined COVID-19 risk as a combination of the probability of uncontrolled transmission of severe acute respiratory syndrome coronavirus 2 and of an unsustainable impact of COVID-19 cases on hospital services, adjusted in relation to the health system's resilience. The monitoring system was implemented with no additional cost in May 2020. Local setting The infectious diseases surveillance system in Italy uses consistent data collection methods across the country's decentralized regions and autonomous provinces. Relevant changes Weekly risk assessments using this approach were sustainable in monitoring the epidemic at regional level from 4 May 2020 to 24 September 2021. The tool provided reliable assessments of when and where a rapid increase in demand for health-care services would occur if control or mitigation measures were not increased in the following 3 weeks. Lessons learnt Although the system worked well, framing the risk assessment tool in a legal decree hampered its flexibility, as indicators could not be changed without changing the law. The relative complexity of the tool, the impossibility of real-time validation and its use for the definition of restrictions posed communication challenges. [ABSTRACT FROM AUTHOR]

Following the identification of Aedes (Ae.) aegypti in the Sochi area in Russia at the beginning of 2000, entomological surveys were conducted during the summers of 2007, 2011, and 2012, leading to the identification of Ae. albopictus and Ae. koreicus. These findings highlight Russia as being the only country in the World Health Organization European Region with a documented presence of both Ae. aegypti and Ae. albopictus mosquitoes. Both mosquito species are found on the coasts of the Black Sea. Control measures are needed to reduce the possible risks of importing exotic vector-borne infections, such as dengue and chikungunya. [ABSTRACT FROM AUTHOR]

Objective: To investigate the problems in seeking dental care faced by HIV-positive individuals in Italy. Methods: A multicenter observational study was performed by distributing an anonymous self-administered questionnaire to patients of six public healthcare facilities specialized in the treatment of individuals with HIV infection. The questions concerned personal data potentially correlated with discrimination, the patient–dentist relationship before and after HIV diagnosis, and the reasons for seeking dental care in public facilities. We also evaluated the patients’ discomfort in the patient–dentist relationship after HIV diagnosis, performing univariate and multivariate analyses. Results: Of the 1500 questionnaires distributed; 883 were filled-out completely. A total of 630 persons received dental care after HIV diagnosis: 209 (33.2%) did not tell the dentist that they were seropositive. Of those who did, 56 were refused care. For patients treated by a private dentist, having been treated by the same dentist before diagnosis was a risk factor for great discomfort in the patient–dentist relationship ( P < 0.002). Being treated in public facilities was associated with having received dental care after HIV diagnosis ( P < 0.001) and a primary school education ( P < 0.001). Conclusions: There exist episodes of discrimination on the part of some dentists, and a relatively high proportion of HIV-positive persons do not disclose their seropositivity to the dentist. Dentists should be provided with training for promoting both ethically acceptable practices and suitable clinical management of HIV-positive persons. [ABSTRACT FROM AUTHOR]

Background: On 11 March 2020, the World Health Organisation (WHO) declared the coronavirus disease 2019 (COVID-19) outbreak to be a pandemic. As the mosquito season progressed, the understandable concern that mosquitoes could transmit the virus began to increase among the general public and public health organisations. We have investigated the vector competence of Culex pipiens and Aedes albopictus, the two most common species of vector mosquitoes in Europe, for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Due to the very unusual feeding behaviour of Ae. albopictus, we also evaluated the role of this mosquito in a potential mechanical transmission of the virus. Methods: For the vector competence study, mosquitoes were allowed to take several infectious blood meals. The mosquitoes were then collected and analysed at 0, 3, 7 and 10 days post-feeding. For the mechanical transmission test, Ae. albopictus females were allowed to feed for a short time on a feeder containing infectious blood and then on a feeder containing virus-free blood. Both mosquitoes and blood were tested for viral presence. Results: Culex pipiens and Ae. albopictus were found not be competent vectors for SARS-CoV-2, and Ae. albopictus was unable to mechanically transmit the virus. Conclusions: This is the first study to show that the most common species of vector mosquitoes in Europe do not transmit SARS-CoV-2 and that Ae. albopictus is unable to mechanically transmit the virus from a positive host to a healthy host through host-feeding. [ABSTRACT FROM AUTHOR]