Sistemi di sorveglianza

  • Antonia Stazi1

  1. Istituto superiore di sanità, Roma

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Ricerca bibliografica periodo 1 febbraio 2011 – 1 aprile 2011

Per leggere le caratteristiche di questa ROUTINE di ricerca clicca qui

Database: Pubmed/MEDline
Stringa: (Sentinel Surveillance [MESH] or Behavioral Risk Factor Surveillance System [MESH] or Population Surveillance [MESH]) AND ( Italy [MESH] or Italy (termine libero)). Limiti: da 1 gennaio 2010 a 15 settembre 2010

Di ogni articolo è disponibile l'abstract. Per visualizzarlo basta cliccare sul titolo.

1. Masocco M, Kodra Y, Vichi M, Conti S, Kanieff M, Pace M, Frova L, Taruscio D. Mortality associated with neurofibromatosis type 1: a study based on Italian death certificates (1995-2006). Orphanet J Rare Dis. 2011 Mar 25;6(1):11. [Epub ahead of print]
BACKGROUND: Persons affected by neurofibromatosis type 1 (NF1) have a decreased survival, yet information on NF1-associated mortality is limited.
METHODS: The National Mortality Database and individual Multiple-Causes-of-Death records were used to estimate NF1-associated mortality in Italy in the period 1995-2006, to compare the distribution of age at death (as a proxy of survival) to that of the general population and to evaluate the relation between NF1 and other medical conditions by determining whether the distribution of underlying causes of NF1-associated deaths differs from that of general population.
RESULTS: Of the nearly 6.75 million deaths in the study period, 632 had a diagnosis of NF1, yet for nearly three-fourths of them the underlying cause was not coded as neurofibromatosis. The age distribution showed that NF1-associated deaths also occurred among the elderly, though mortality in early ages was high. The mean age for NF1-associated death was approximately 20 years lower than that for the general population. The gender differential may suggest that women are affected by more severe NF1-related complications, or they may simply reflect a greater tendency for NF1 to be reported on the death certificates of young women. Regarding the relation with other medical conditions, we found an excess, as the underlying cause of death, for malignant neoplasm of connective and other soft tissue and brain, but not for other sites. We also found an excess for obstructive chronic bronchitis and musculoskeletal system diseases among elderly persons.
CONCLUSION: This is the first nationally representative population-based study on NF1-associated mortality in Italy. It stresses the importance of the Multiple-Causes-of-Death Database in providing a more complete picture of mortality for conditions that are frequently not recorded as the underlying cause of death, or to study complex chronic diseases or diseases that have no specific International Classification of Diseases code, such as NF1. It also highlights the usefulness of already available data when a surveillance system is not fully operational.

Breve commento a cura di Antonia Stazi
In questo lavoro gli autori hanno stimato la mortalità associata alla neurofibromatosi tipo I (NF1), malattia per cui non esiste un sistema di sorveglianza ad hoc e per cui l’ICD-9 e l’ICD10 non utilizzano un codice specifico, linkando due fonti di dati di mortalità ISTAT disponibili per il periodo 1995-2006: quelli riferiti alla mortalità per causa regolarmente pubblicati, e quelli contenuti nell’archivio delle cause multiple(tutte le diagnosi in chiaro rese dal medico certificatore al momento del decesso) . Oltre al risultato “per se”( viene stimato che l’attesa di vita per le persone affette da NF1 è di 20 anni inferiore al resto della popolazione, che oltre all’attesa mortalità per tumori c’è un rischio doppio di mortalità associata a bronchite cronico ostruttiva negli over 40) l’articolo è molto interessante da un punto di vista metodologico. L’insieme delle informazioni riguardanti il quadro patologico complessivo che conduce l’individuo al decesso contenute nell’archivio delle cause multiple, si rileva come un’importante fonte informativa in grado di fornire un quadro della mortalità “associata” ad una patologia, più completo ed efficace di quello ricavabile dai soli dati di mortalità specifici per causa, sui i quali si basano le statistiche ufficiali di mortalità. In particolare, l’archivio delle cause multiple risulta prezioso soprattutto nello studio della mortalità per condizioni morbose croniche gravemente invalidanti che poco frequentemente vengono riportate come causa principale di decesso, o quelle che si caratterizzino per quadri clinici complessi che si complicano in diverse forme o coinvolgono molti organi, o ancora per le patologie che non sono univocamente rappresentate da un codice specifico nella Classificazione Internazionale delle Malattie, come accade per la NF1. Naturalmente la collaborazione con l’ISTAT è d’obbligo!

2. Falconi C, López-Olvera JR, Gortázar C. BTV infection in wild ruminants, with emphasis on red deer: A review. Vet Microbiol. 2011 Feb 23. [Epub ahead of print]
Instituto de Investigación en Recursos Cinegéticos (IREC; CSIC-UCLM-JCCM), Ciudad Real, Spain; ASL 8, Dipartimento di Prevenzione, Servizio Veterinario Sanità Animale - Area A, Cagliari, Italy.
The distribution of bluetongue virus has changed, possibly related to climate change. Vaccination of domestic ruminants is taking place throughout Europe to control BT expansion. The high density of wild red deer (Cervus elaphus) in some European regions has raised concerns about the potential role that unvaccinated European wild ungulates might play in maintaining or spreading the virus. Most species of wild ruminants are susceptible to BTV infection, although frequently asymptomatically. The red deer population density in Europe is similar to that of domestic livestock in some areas, and red deer could account for a significant percentage of the BTV-infection susceptible ruminant population in certain regions. High serum antibody prevalence has been found in red deer, and BTV RNA (BTV-1, BTV-4 and BTV-8) has been repeatedly detected in naturally infected European red deer by means of RT-PCR. Moreover, red deer may carry the virus asymptomatically for long periods. Epidemiological studies suggest that there are more BT cases in domestic ungulates in those areas where red deer are present. Vector and host density and environmental factors are implicated in the spatial distribution of BT. As in domestic ruminants, BTV transmission among wild ruminants depends almost exclusively on Culicoides vectors, mainly C. imicola but also members of the C. obsoletus and C. pulicaris complex. However, BTV transmission from red deer to the vector remains to be demonstrated. Transplacental, oral, and mechanical transmissions are also suspected. Thus, wild red deer contribute to the still unclear epidemiology of BTV in Europe, and could complicate BTV control in domestic ruminants. However, further research at the wildlife host-vector-pathogen interface and regarding the epidemiology of BT and BT vectors in wildlife habitats is needed to confirm this hypothesis. Moreover, red deer could be used as BT sentinels. Serum and spleen tissue of calves sampled from late autumn onwards should be the target samples when establishing a BTV surveillance program.
3. Di Giacobbe A, Pecetta S, Virga A, Scazzocchio F, Aquilanti L, Iebba V, Passariello C. Diffusion of meticillin-resistant Staphylococcus aureus USA300 strains in central Italy. Int Arch Allergy Immunol. 2011 Feb 22;155(4):403-411. [Epub ahead of print]
Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, P.le Aldo Moro 5, 00185 Rome, Italy.
Meticillin-resistant Staphylococcus aureus (MRSA) is an outstanding, clonally evolving pathogen that in recent years, under the selective pressure of antibiotics, has acquired the crucial ability to infect people outside of hospitals. MRSA USA300 has progressively become synonymous with severe community-associated staphylococcal disease worldwide. Whilst spreading worldwide, these clones have progressively acquired resistance to several antibiotics and have gained the ability to cause infections in hospital settings. Recently, USA300-related strains showing resistance to several antibiotics have been isolated from community-acquired infections in Italy. This paper reports the high frequency of isolation of USA300-related strains both from community- and hospital-acquired infections in central Italy as well as their genotypic characteristics and antibiotic susceptibility. Analysis of these characteristics by partial least squares discriminant analysis enabled it to be demonstrated that whilst moving from the community to the hospital setting these isolates underwent an adaptive process that generated clones showing distinctive characteristics. These observations further support the hypothesis that the threatening generation of strains combining both resistance and virulence is becoming a reality, and stress the necessity of constant molecular epidemiological surveillance of MRSA.
4. Minardi V, Campostrini S, Carrozzi G, Minelli G, Salmaso S. Social determinants effects from the Italian risk factor surveillance system PASSI. Int J Public Health. 2011 Feb 22. [Epub ahead of print]
National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy,
OBJECTIVES: To offer examples on how risk factor surveillance systems can help in providing useful information on social determinants effects and health inequalities.
METHODS: The Italian risk factor surveillance system (PASSI) collects monthly information from most of the Italian Local Health Units (over 85% of the Italian population is covered) on major health-related behaviours together with information on health practices, attitudes and opinions. Multivariate analysis of associations with possible indicators of social determinants collected by the system, offers important indications on the value that the system has in providing useful information on the effects of social determinants. RESULTS:
Social determinants, although measured through very simple indicators, have major influence on health outcomes (in the example here, depression), geographical disparities in health (efficacy of smoking ban), and access to preventive services (pap test in our analysis).
CONCLUSIONS: Risk factor surveillance can offer valuable information for monitoring social determinants effects and inequalities, and, when considering data over time, for evaluating the gross impact of future interventions and policies aimed at reducing them.
5. Zehender G, Ebranati E, Bernini F, Presti AL, Rezza G, Delogu M, Galli M, Ciccozzi M. Phylogeography and epidemiological history of West Nile virus genotype 1a in Europe and the Mediterranean basin. Infect Genet Evol. 2011 Apr;11(3):646-53. Epub 2011 Feb 12.
Department of Clinical Sciences, L. Sacco, University of Milan, c/o Ospedale L. Sacco, Via G.B. Grassi 74, 20157 Milan, Italy.
Aim of this study was to reconstruct the temporal and spatial phylodynamics of WNV-1a, the genotype to which the majority of European/Mediterranean viral strains belongs, by using sequences retrieved from public databases. WNV-1a isolates segregated into two major clades: the recent West Mediterranean sequences formed a single monophyletic group within clade A. Clade B included sequences from East Mediterranean and America. Phylogeographic analysis suggested that WNV-1a probably originated in sub-Saharan Africa in the early XXth century, and then spread northwards since the late 1970s, via two routes: one crossing Eastern Mediterranean and the other the Western Mediterranean countries. Our data suggest that the circulation of the virus in a given geographical area usually precedes the onset of the outbreak by one year or more, and underline the importance of the spatial-temporal phylodynamics reconstruction in clarifying the recent epidemiology and in setting up an efficient surveillance system for emerging/reemerging zoonosis.

Breve commento a cura di Antonia Stazi
In questo studio viene ricostruita la filogenia del West Nile virus genotype 1a, con l’intento di datarne l’origine, caratterizzarne la genealogia e lo sviluppo, utilizzarla anche come strumento per studiare la storia della migrazione del virus stesso e, possibilmente, prevedere l’insorgenza di outbreacks. Gli autori datano a poco prima degli anni 20 nell’Africa del sub Sahara il “most recent common ancestor”, cioè il virus più recente da cui tutti i virus del gruppo direttamente discendono. Gli autori inoltre indicano che il virus ha circolato nelle aree geografiche interessate un anno prima dell’outbreack, suggerendo che la ricostruzione spazio temporale della filogenetica dei virus potrebbe fornire elementi importanti nei sistemi di sorveglianza delle zoonosi emergenti e riemergenti. L’argomento è estremamente interessante per sia per il merito del problema che per gli strumenti utilizzati nell’affrontarlo. Solo recentemente le “vecchie” analisi filogenetiche hanno potuto avvalersi di nuovi metodi in grado di considerare analisi di tipo Bayesiano nella simulazione dei flussi temporali e geografici dei virus, unitamente alla disponibilità di banche dati pubbliche, tipo GenBank, da cui poter scaricare le sequenze complete dei genomi virali di interesse. L’articolo è anche arricchito da una sezione on line in cui è possibile visualizzare con Google Earth alcuni pattern di diffusione del WNV-1a.

6. Bozzetta E, Nappi R, Crudeli S, Meloni D, Varello K, Loprevite D, Melis PG, Mazza M, Colussi S, Ingravalle F, Ru G, Nonno R, Ligios C. Comparative performance of three TSE rapid tests for surveillance in healthy sheep affected by scrapie. J Virol Methods. 2011 Jan 21. [Epub ahead of print]
CEA - Istituto Zooprofilattico Sperimentale del Piemonte Liguria e Valle d'Aosta, Via Bologna 148, 10154 Turin, Italy.
Rapid tests specific for sheep and goats became part of European Union-wide active scrapie surveillance in 2006. Performance of three approved TSE rapid tests for the detection of sheep infected with scrapie in field cases in the pre-clinical stage of the disease was compared. The medulla oblongata of 969 asymptomatic sheep of various genotype and breed aged over 18 months from 23 Italian flocks affected with scrapie, were tested by the Bio-Rad TeSeE Sheep/Goat (A), the IDEXX HerdChek BSE-Scrapie Antigen Test Kit, EIA (B) and the Prionics(®)-Check Western Small Ruminant (C) rapid tests. Of 136 positive samples of classical scrapie, as confirmed by Western blot assay, 132 were positive with test A (Se 97.06%, CI 95% 92.64-99.19); 135 with test B (Se 99.26%, 95% CI 95.97-99.98) and 128 with test C (Se 94.12%, 95% CI 88.74-97.43). Tests A and B showed the best performance on analytical sensitivity. All three systems demonstrated good reproducibility: being the intrarater and interrater kappa coefficients always over 0.83. The one available atypical scrapie sample was positive with tests A and B, negative with test C. Considering the discrepant results in the detection of low PrP(sc) concentrations and of the atypical case, differences can be expected in the efficacy of an active surveillance system, depending on the test adopted.
7. Dorigo W, Pulli R, Nesi M, Alessi Innocenti A, Pratesi G, Inzitari D, Pratesi C. Urgent carotid endarterectomy in patients with recent/crescendo transient ischaemic attacks or acute stroke. Eur J Vasc Endovasc Surg. 2011 Mar;41(3):351-7. Epub 2010 Dec 31.
Department of Vascular Surgery, University of Florence, Florence, Italy.
OBJECTIVES: Objective of this study was to review the results of urgent carotid endarterectomy (CEA) performed in patients with recent (< 24 h) or crescendo (at least 2 episodes in 24 h) transient ischaemic attack (TIA) or with acute stroke in a single centre experience.
MATERIALS AND METHODS: From January 2000 to December 2008, 75 patients underwent urgent CEA for severe internal carotid artery stenosis and recent/crescendo TIA (51 patients, TIA group) or acute stroke (24 patients, stroke group). In patients with acute stroke the intervention was proposed on the basis of clinical and instrumental features (patient conscious, patency of middle cerebral artery, no lesions or limited brain infarction at CT scan) according to neurologists' suggestion. Data from all the interventions were prospectively collected in a dedicated database, which included main pre-, intra- and postoperative parameters. Independent neurological assessment with National Institute of Health Stroke Scale (NIHSS) score calculation was performed before the operation and within the 30th postoperative day. Early (< 30 days) results were evaluated in terms of mortality, modifications in NIHSS values and stroke and death rates. The surveillance program consisted of clinical and ultrasonographic examinations at 1, 6 and 12 months and yearly thereafter. Follow-up results (survival, occurrence of ipsilateral stroke in TIA group, recurrence of stroke in stroke group) were analysed by Kaplan-Meier curves.
RESULTS: Among patients presenting with TIA, 28 had crescendo TIAs and 23 had a recent TIA; In stroke group, two patients had a stroke in evolution, eight patients had a recent major non-disabling stroke and 14 patients had a recent minor stroke. Preoperative mean value of NIHSS score in stroke group was 4.7 (SD 3.2). There were 2 perioperative (< 30 days) deaths, both in stroke group, in one case due to acute respiratory failure and to fatal stroke in the other one (preoperative NIHSS value 9, postoperative 17), with a cumulative 30-day mortality rate of 2.7%, significantly higher in stroke group (8.3%) than in TIA group (no death, p = 0.03). No postoperative cerebral haemorrhage occurred. In TIA group one postoperative major stroke occurred, with a 30-day stroke and death rate of 1.9%. In surviving patients of stroke group NIHSS value improved in 13 cases, with a mean improvement of 2 points (SD 0.9); in 8 cases the value remained unchanged, while in the remaining case it increased from 2 to 4. Mean postoperative NIHSS score in stroke group was 3.9 (SD 3.7), significantly reduced in comparison with preoperative value (p < 0.001). Mean duration of follow-up was 34 months (SD 28.1). No ipsilateral stroke in patients of TIA group occurred; in stroke group a recurrent fatal stroke at 1 postoperative month was recorded. Estimated 48-month stroke-free survival rate TIA group was 95% and 79% in stroke group (p = 0.02).
CONCLUSIONS: Urgent CEA in patients with recent/crescendo TIA provided in our experience excellent results, with low rates of perioperative and late stroke. In selected patients with acute stroke early surgery seems to provide acceptable results.
8. Ansaldi F, Canepa P, de Florentiis D, Bandettini R, Durando P, Icardi G. Increasing incidence of Streptococcus pneumoniae serotype 19A and emergence of two vaccine escape recombinant ST695 strains in Liguria, Italy, 7 years after implementation of the 7-valent conjugated vaccine. Clin Vaccine Immunol. 2011 Feb;18(2):343-5. Epub 2010 Dec 22.
Department of Health Sciences, University of Genoa, Genoa 16100, Italy.
Two serotype 19A (ST695) Streptococcus pneumoniae vaccine escape recombinant strains attributable to capsular switching events were detected by a laboratory surveillance system that is an integral part of a vaccination program begun in Liguria, Italy, in May 2003, an Italian administrative region with long-lasting high coverage, an unusual occurrence in Europe. To our knowledge, this is the first detection of an occurrence of capsular switching outside the United States.
9. Peragallo MS, Urbano F, Lista F, Sarnicola G, Vecchione A. Evaluation of cancer surveillance completeness among the Italian army personnel, by capture-recapture methodology. Cancer Epidemiol. 2011 Apr;35(2):132-8. Epub 2010 Jul 17.
Preventive Medicine Branch, Army Medical and Veterinary Research Center, via Santo Stefano Rotondo 4, 00184 Rome, Italy.
Objective: This study provides an assessment of completeness of cancer surveillance and incidence estimates for all malignancies, Hodgkin's lymphoma and thyroid cancer in the Italian army, for the years 2001-2007.
Methods: The two-source capture-recapture method was employed, using both Chapman's and Chao's formulae, on the basis of cancer notifications from military hospitals and unit infirmaries. The estimated incident cases were then confronted with the corresponding expected cases; the standardized incidence ratios and 95% confidence intervals (SIR [95% CI]) were then calculated.
Results: A total of 442 cancer notifications, concerning 371 cases, were reported (311 from army hospitals and 131 from unit infirmaries; of these, 71 were overlapping). The estimated total number of cases, by Chapman's and Chao's formulae, was 571 and 688, respectively. Overall, sensitivity of the surveillance system was 65% by Chapman's and 54% by Chao's estimators. Completeness of notification was significantly higher in younger patients, in those previously deployed in Bosnia or Kosovo, and for cases of Hodgkin's lymphoma. Estimated SIRs, using both formulae, were not significant for all malignancies and Hodgkin's lymphoma, but significant for thyroid cancer (SIR: 2.25 [1.61-2.89] by Chapman's formula, and 3.12 [1.81-4.43] by Chao's estimator).
Conclusion: Completeness of cancer registry of the Italian military is low, and methods to improve its sensitivity are discussed. Overall, the estimated number of incident cancer cases, including Hodgkin's lymphoma, is not significantly higher than expected, except thyroid cancer. The increased incidence of this malignancy requires further investigation; however, in the military, as well as in the general population, this may be partly due to the growing availability of diagnostic opportunities in the last decades. Moreover, detection of thyroid cancer may be further facilitated by a selection bias generated by the annual and pre-/post-deployment medical examinations and blood tests routinely performed on all military personnel.
10. Kyriakis CS, Brown IH, Foni E, Kuntz-Simon G, Maldonado J, Madec F, Essen SC, Chiapponi C, Van Reeth K. Virological surveillance and preliminary antigenic characterization of influenza viruses in pigs in five European countries from 2006 to 2008. Zoonoses Public Health. 2011 Mar;58(2):93-101. doi: 10.1111/j.1863-2378.2009.01301.x.
Laboratory of Virology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
This study presents the results of the virological surveillance for swine influenza viruses (SIVs) in Belgium, UK, Italy, France and Spain from 2006 to 2008. Our major aims were to clarify the occurrence of the three SIV subtypes - H1N1, H3N2 and H1N2 - at regional levels, to identify novel reassortant viruses and to antigenically compare SIVs with human H1N1 and H3N2 influenza viruses. Lung tissue and/or nasal swabs from outbreaks of acute respiratory disease in pigs were investigated by virus isolation. The hemagglutinin (HA) and neuraminidase (NA) subtypes were determined using standard methods. Of the total 169 viruses, 81 were classified as 'avian-like' H1N1, 36 as human-like H3N2 and 47 as human-like H1N2. Only five novel reassortant viruses were identified: two H1N1 viruses had a human-like HA and three H1N2 viruses an avian-like HA. All three SIV subtypes were detected in Belgium, Italy and Spain, while only H1N1 and H1N2 viruses were found in UK and Northwestern France. Cross-hemagglutination inhibition (HI) tests with hyperimmune sera against selected older and recent human influenza viruses showed a strong antigenic relationship between human H1N1 and H3N2 viruses from the 1980s and H1N2 and H3N2 human-like SIVs, confirming their common origin. However, antisera against human viruses isolated during the last decade did not react with currently circulating H1 or H3 SIVs, suggesting that especially young people may be, to some degree, susceptible to SIV infections.