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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. Probleme Apres avoir pris ses premieres mesures de restriction nationales en 2020, l'Italie avait besoin d'une approche solide pour surveiller l'epidemie naissante de maladie a coronavirus 2019 (COVID-19) au niveau regional, et fournir les donnees permettant de renforcer ou d'alleger les mesures destinees a l'endiguer. Approche Nous avons adapte l'outil d'evaluation rapide des risques du Centre europeen de prevention et de controle des maladies en y integrant des indicateurs quantitatifs et qualitatifs issus des systemes de surveillance nationaux existants. Pour definir le risque lie a la COVID-19, nous avons associe la probabilite d'une transmission incontrolee du coronavirus 2 du syndrome respiratoire aigu severe, a l'impact immediat des cas de COVID-19 sur les services hospitaliers, en procedant a des ajustements selon la resilience du systeme de soins de sante. Le dispositif de surveillance a ete mis en reuvre en mai 2020 sans entrainer de couts supplementaires. Environnement local En Italie, le systeme de surveillance des maladies infectieuses repose sur des methodes uniformes de collecte de donnees dans les provinces autonomes et regions decentralisees a travers le pays. Changements significatifs Les evaluations des risques realisees toutes les semaines avec cette approche ont permis de surveiller l'epidemie a l'echelle regionale du 4 mai 2020 au 24 septembre 2021. L'outil a identifie les dates et lieux susceptibles de connaitre une augmentation rapide de la demande en services de soins de sante si aucune mesure supplementaire de controle et de lutte n'etait prise dans les trois semaines. Lecons tirees Bien que le systeme ait fonctionne, inscrire l'outil d'evaluation des risques dans un decret legislatif a reduit sa flexibilite, car les indicateurs ne pouvaient etre modifies sans reformer la loi. La relative complexite de l'outil, l'impossibilite de proceder a une validation en temps reel et son usage pour imposer des restrictions ont pose des problemes de communication. Situacion Tras las primeras medidas nacionales de restriccion en Italia en 2020, se necesitaba un enfoque solido para supervisar la epidemia emergente de la coronavirosis de 2019 (COVID-19) a nivel subnacional y proporcionar datos que informaran sobre el refuerzo o la flexibilizacion de las medidas de contencion de la epidemia. Enfoque Se adapto la herramienta de valoracion rapida de riesgos del Centro Europeo para la Prevencion y el Control de las Enfermedades, al incluir indicadores cuantitativos y cualitativos de los sistemas nacionales de vigilancia existentes. Se definio el riesgo de la COVID-19 como una combinacion de la probabilidad de transmision descontrolada del coronavirus del sindrome respiratorio agudo grave de tipo 2 y de un efecto no sostenible de los casos de la COVID-19 en los servicios hospitalarios, y se ajusto en relacion con la capacidad de recuperacion del sistema sanitario. El sistema de supervision se aplico sin costes adicionales en mayo de 2020. Marco regional El sistema de vigilancia de las enfermedades infecciosas en Italia aplica metodos de recopilacion de datos coherentes en todas las regiones y provincias autonomas descentralizadas del pais. Cambios importantes Las valoraciones semanales de los riesgos mediante este enfoque fueron sostenibles en la supervision de la epidemia a nivel regional entre el 4 de mayo de 2020 y el 24 de septiembre de 2021. La herramienta proporciono valoraciones fiables de cuando y donde se produciria un rapido aumento de la demanda de servicios sanitarios si no se incrementaban las medidas de contencion o mitigacion en las tres semanas siguientes. Lecciones aprendidas Aunque el sistema funciono bien, el hecho de enmarcar la herramienta de valoracion de los riesgos en un decreto legal dificulto su flexibilidad, ya que los indicadores no se podian modificar sin cambiar la ley. La relativa complejidad de la herramienta, la imposibilidad de validacion en tiempo real y su uso para la definicion de las restricciones plantearon problemas de comunicacion., Introduction In its first response to the emerging epidemic of coronavirus disease 2019 (COVID-19), the Italian government implemented national restriction measures with strict physical distancing and restrictions on public movements [...]

On February 21, 2020, the earliest known case of locally transmitted severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection was reported in Italy (1; D. Cereda et al., unpub. data, [...]

Quantifying the potential spatial spread of an infectious pathogen is key to defining effective containment and control strategies. The aim of this study is to estimate the risk of SARS-CoV-2 transmission at different distances in Italy before the first regional lockdown was imposed, identifying important sources of national spreading. To do this, we leverage on a probabilistic model applied to daily symptomatic cases retrospectively ascertained in each Italian municipality with symptom onset between January 28 and March 7, 2020. Results are validated using a multi-patch dynamic transmission model reproducing the spatiotemporal distribution of identified cases. Our results show that the contribution of short-distance ( ≤ 10 k m) transmission increased from less than 40% in the last week of January to more than 80% in the first week of March 2020. On March 7, 2020, that is the day before the first regional lockdown was imposed, more than 200 local transmission foci were contributing to the spread of SARS-CoV-2 in Italy. At the time, isolation measures imposed only on municipalities with at least ten ascertained cases would have left uncontrolled more than 75% of spillover transmission from the already affected municipalities. In early March, national-wide restrictions were required to curb short-distance transmission of SARS-CoV-2 in Italy. [ABSTRACT FROM AUTHOR]

Chikungunya is a disease carried by Aedes mosquitoes that affects >100 countries, mostly in the tropics and subtropics (1). In the European Union (EU), chikungunya is not endemic, even though [...]

In 2007 (1) and 2017 (2), local outbreaks of human chikungunya infection occurred in Italy; both outbreaks were caused by the East/Central/South African strain of chikungunya virus (CHIKV). Both outbreaks [...]

COVID-19 dramatically influenced mortality worldwide, in Italy as well, the first European country to experience the Sars-Cov2 epidemic. Many countries reported a two-wave pattern of COVID-19 deaths; however, studies comparing the two waves are limited. The objective of the study was to compare all-cause excess mortality between the two waves that occurred during the year 2020 using nationwide data. All-cause excess mortalities were estimated using negative binomial models with time modeled by quadratic splines. The models were also applied to estimate all-cause excess deaths “not directly attributable to COVD-19”, i.e., without a previous COVID-19 diagnosis. During the first wave (25th February−31st May), we estimated 52,437 excess deaths (95% CI: 49,213–55,863) and 50,979 (95% CI: 50,333–51,425) during the second phase (10th October−31st December), corresponding to percentage 34.8% (95% CI: 33.8%–35.8%) in the second wave and 31.0% (95%CI: 27.2%–35.4%) in the first. During both waves, all-cause excess deaths percentages were higher in northern regions (59.1% during the first and 42.2% in the second wave), with a significant increase in the rest of Italy (from 6.7% to 27.1%) during the second wave. Males and those aged 80 or over were the most hit groups with an increase in both during the second wave. Excess deaths not directly attributable to COVID-19 decreased during the second phase with respect to the first phase, from 10.8% (95% CI: 9.5%–12.4%) to 7.7% (95% CI: 7.5%–7.9%), respectively. The percentage increase in excess deaths from all causes suggests in Italy a different impact of the SARS-CoV-2 virus during the second wave in 2020. The decrease in excess deaths not directly attributable to COVID-19 may indicate an improvement in the preparedness of the Italian health care services during this second wave, in the detection of COVID-19 diagnoses and/or clinical practice toward the other severe diseases.

Dengue (DENV) and Zika (ZIKV) viruses are mosquito-borne human pathogens. In Italy, the presence of the competent vector Aedes albopictus increases the risk of autochthonous transmission, and a national plan for arboviruses prevention, surveillance, and response (PNA 2020–2025) is in place. The results of laboratory diagnosis of both viruses by the National Reference Laboratory for arboviruses (NRLA) from November 2015 to November 2022 are presented. Samples from 655 suspected cases were tested by both molecular and serological assays. Virus and antibody kinetics, cross-reactivity, and diagnostic performance of IgM ELISA systems were analysed. Of 524 cases tested for DENV, 146 were classified as confirmed, 7 as probable, while 371 were excluded. Of 619 cases tested for ZIKV, 44 were classified as confirmed, while 492 were excluded. All cases were imported. Overall, 75.3% (110/146) of DENV and 50% (22/44) of ZIKV cases were confirmed through direct virus detection methods. High percentages of cross reactivity were observed between the two viruses. The median lag time from symptoms onset to sample collection was 7 days for both DENV molecular (range 0–20) and NS1 ELISA (range 0–48) tests, with high percentages of positivity also after 7 days (39% and 67%, respectively). For ZIKV, the median lag time was 5 days (range 0–22), with 16% positivity after 7 days. Diagnostic performance was assessed with negative predictive values ranging from 92% to 95% for the anti-DENV systems, and of 97% for the ZIKV one. Lower positive predictive values were seen in the tested population (DENV: 55% to 91%, ZIKV: 50%). DENV and ZIKV diagnosis by molecular test is the gold standard, but sample collection time is a limitation. Serological tests, including Plaque Reduction Neutralization Test, are thus necessary. Co-circulation and cross-reactivity between the two viruses increase diagnostic difficulty. Continuous evaluation of diagnostic strategies is essential to improve laboratory testing. [ABSTRACT FROM AUTHOR]