Domenico Martinelli

Università degli studi di Foggia, Foggia, Apulia, Italy

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Publications (137)248.59 Total impact

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    ABSTRACT: The Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health conducted a multicentre survey aiming to evaluate undergraduate health care students' knowledge of tuberculosis and tuberculosis control measures in Italy.
    BMC Public Health 09/2014; 14(1):970. · 2.08 Impact Factor
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    ABSTRACT: We determined the in vitro antifungal activity of liposomal amphotericin B (L-AmB) against 604 clinical yeast isolates. Amphotericin B deoxycholate (D-AmB) was tested in parallel against all the isolates. Susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) M27-A3 method. Overall, L-AmB was highly active against the isolates (mean MIC = 0.42 μg/ml; MIC90= 1μg/ml; 97.2% of MICs were ≤ 1μg/ml) and comparable to D-AmB (mean MIC = 0.48μg/ml; MIC90= 1μg/ml; 97.3% of MICs were ≤ 1μg/ml). The in vitro activity of D-AmB and L-AmB was correlated (R2 = 0.61; exp (Coef.) = 2.3; 95% IC= 2.19-2.44, p<0.001). Candida albicans (mean MICs of D-AmB and L-AmB, 0.39 μg/ml and 0.31 μg/ml, respectively) and Candida parapsilosis (mean MICs of D-AmB and L-AmB, 0.38 μg/ml and 0.35 μg/ml, respectively) were the species most susceptible to the agents tested, while Candida krusei (currently named Issatchenkia orientalis) (mean MICs of D-AmB and L-AmB, 1.27 μg/ml and 1.13 μg/ml, respectively) was the least susceptible. The excellent in vitro activity of L-AmB may have important implications for empirical treatment approaches and support its role in treatment of a wide range of invasive infections due to yeasts.
    Journal of Medical Microbiology 09/2014; · 2.30 Impact Factor
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    ABSTRACT: In Italy, between 2003 and 2010, 8/21 Regions recommended varicella routine vaccination (URV). The National Immunization Plan (PNPV) 2012-2014 scheduled the introduction of URV nationwide in 2015, following the results achieved by the eight Regions. Puglia adopted varicella URV in 2006. This study describes epidemiology and costs of varicella in Puglia between 2003 and 2012. One-dose Vaccine Effectiveness (VE) against varicella of any severity and severe hospitalized cases in children was also evaluated. Vaccination coverage (VC) was estimated from the regional immunization registry. Incidence and hospitalization rates were calculated from computerised surveillance system for communicable diseases and hospital discharge registry (CD9-CM codes: 052.x), respectively. URV impact was assessed by Incidence Rate Ratios (IIRs) and Hospitalization Risk Ratios (HRRs). Hospitalization costs were also evaluated. VE was estimated using the screening method, where PPV was VC in children aged<72 months and PCV was the proportion of cases vaccinated among notified or hospitalized cases, respectively. One-dose VC in children aged ≤ 24 months increased from 49% in the birth cohort 2006 to 91.1% in the cohort 2010; 2-dose VC was 64.8% and 28.8% in the 2005 and 1997 cohort, respectively. Comparing pre and post-vaccination era, incidence declined from 122.5 ×100 000 in 2003-2005 to 13.7 in 2009-2012 (IRR = 0.11, 95% CI = 0.10-0.12), hospitalization rate from 3.9 ×100 000 to 1.1 (HRR = 0.29, 95% CI = 0.21-0.4), hospitalization costs from 319 000 Euros/year to 106 000. One-dose VE against varicella of any severity and severe hospitalized disease was 98.8% and 99%, respectively. Our findings strongly support varicella URV introduction into the Italian Essential Health Interventions, as scheduled by 2015.
    Human vaccines & immunotherapeutics. 08/2014; 11(1).
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    ABSTRACT: The Italian National Plan of Measles and Rubella Elimination 2010-2015 has deferred the objective to reduce congenital rubella syndrome (CRS) to<1 case per 100 000 live births to 2015 and has highlighted the need to reduce to<5% susceptibility to rubella among women in childbearing-age. In Puglia region, MMR vaccine coverage is 93% in newborns (cohort 2010; one dose), 85% in children 5-6 years old and 77% in adolescents (cohort 2005 and 1997, respectively; two doses). Combining available seroepidemiological data and results of a survey on the attitude towards rubella vaccination and rubella testing before pregnancy, we could estimate that 5.7% of Apulian women in childbearing-age are currently susceptible to rubella infection. The regional infectious disease routine notification system reported no cases of CRS and rubella in pregnancy in 2001-2010 period. The inconsistency among the mentioned data triggered the evaluation of the reliability of disease reporting. We performed a retrospective case-finding for the years 2003-2011. We scanned the regional hospital discharge registry to identify hospitalizations for rubella in pregnancy and CRS and retrieve individual records. We also searched for clinical history of CRS mothers in the delivery assistance certificate registry. We identified one CRS, two confirmed and four suspected congenital infections, and seven cases of rubella in pregnancy. Passive surveillance of CRS and rubella in pregnancy appears not to be reliable in the light of strengthening rubella elimination strategies.
    Human vaccines & immunotherapeutics. 08/2014; 11(1).
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    ABSTRACT: In Italy, vaccination against diphtheria, tetanus, polio and hepatitis B is compulsory for infants countrywide, except in Veneto region where since 2007 Health Authorities have experimented the suspension of mandatory vaccination. In light of the recent discussion on the potential abrogation in other regions, we explored the opinion of family pediatricians who play a crucial role in promoting immunization programmes in Italy. In November 2009, we interviewed by phone the family pediatricians working in Puglia region using a standardised, ad hoc and piloted questionnaire. Of the 596 contacted, 502 (84.2%) completed the questionnaire (54% female, median age = 52 y). Among the respondents, 72 (14.3%) would agree on the hypothesis of abrogation. This judgment was associated with having a good opinion on the level of awareness of the importance of vaccinations in the general public (OR = 6.6; 95% CI: 3.6-12.1) and having the perception of adequate organization of Vaccination Services in supporting the abrogation (OR = 3.6; 95% CI: 1.7-5.9). Family pediatricians appeared really sceptical about the abrogation of compulsory vaccination that could be hypothesized only increasing public awareness, communication skills and capability of Vaccination Services personnel in offering vaccinations.
    Human vaccines & immunotherapeutics. 08/2014; 11(1).
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    ABSTRACT: Vaccination of healthcare workers (HCWs) reduces the risk of occupational infections, prevents nosocomial transmission and maintains healthcare delivery during outbreaks. Despite the European directive and national legislation on workers' protection, immunization coverage among HCWs has often been very low. In light of Italian National Vaccination Plan 2012-2014 recommendations, the aim of this study was to assess levels of immunization and factors influencing adherence to vaccinations needed for HCWs in Puglia region, South Italy. The study was conducted using an interview-based standardized anonymous questionnaire administered to hospital employees in the period November 2009-March 2011. A total of 2198 health professionals responded in 51/69 Apulian hospitals (median age: 45 years; 65.2% nurses, 22.6% doctors and 12.2% other hospital personnel). Vaccination coverage was 24.8% for influenza, 70.1% for hepatitis B, 9.7% for MMR, 3.6% for varicella, and 15.5% for Td booster. Receiving counselling from occupational health physicians (OHPs) was associated with influenza (OR = 1.8; 95%CI = 1.5-2.2; P<0.001), hepatitis B (OR = 4.9; 95%CI = 3.9-6.3; P<0.001), varicella (OR = 43.7; 95%CI = 18.9-101.7; P<0.001), MMR (OR = 8.8; 95%CI = 4.1-18.6; P<0.001) and tetanus (OR = 50.5; 95%CI = 30.1-88.3; P<0.001) vaccine uptake. OHPs should be trained with standard guidelines specific for healthcare settings and HCWs' risk groups to facilitate their crucial role in improving vaccine coverage among HCWs and increase awareness on the duty to protect both employees and patients.
    Human vaccines & immunotherapeutics. 08/2014; 11(1).
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    ABSTRACT: In Italy, the introduction of Universal Varicella Vaccination (UVV) has been decided but postponed, as a national programme, until 2015, when data from Regions which have already implemented it will be available. Starting from 2003, eight Italian Regions (Basilicata, Calabria, Friuli Venezia Giulia, Apulia, Sardinia, Sicily, Tuscany and Veneto) have progressively introduced UVV, in their immunization programme, with different schedules in children aged 13-15 months and 5-6 years, currently a two-dose schedule is adopted by all Regions. In June 2013, an Interregional Group on Varicella Vaccination (IGVV) has been established in order to assess the effectiveness of varicella vaccination with standardized and shared tools. The aim of this study was to evaluate the impact of varicella vaccination on the incidence and hospitalizations due to varicella and its complications in the period 2003-2012 in order to support the Italian decision makers on the future national adoption. Preliminary data showed that a general reduction of incidence and hospitalization rates was observed in the study period, resulting in relevant savings for the National Health Service. Immunization coverage with first dose at 24 months of age was high in all Regions (84%-95%) in 2012. Adverse events due to varicella vaccines were rare and without permanent sequelae. Underreporting of varicella cases and delays in the administration of the first dose of varicella vaccines were the main critical issues. In conclusion, solid evidences in support of universal UVV arise from the experiences available today in Italy.
    Human vaccines & immunotherapeutics. 08/2014; 11(1).
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    ABSTRACT: To describe an outbreak of acute gastroenteritis in people who had eaten at a hash house in southern Italy.
    Public health. 05/2014;
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    ABSTRACT: The exhaled breath temperature (EBT) has been proven to be the expression of airways inflammation as well as of the increased vascularity. Although both these conditions characterize lung cancer pathogenesis, this is the first study where the EBT has been analysed in patients affected by non-small-cell lung cancer. The aim of this study was to verify whether and how the lung cancer being examined influences the EBT for possible future clinical implications. Eighty-two consecutive subjects with a radiological suspicion of lung cancer were enrolled and underwent standard diagnostic and staging procedures for cancer. EBT was measured in all the subjects at the enrolment with the X-Halo device. Forty patients resulted as affected by lung cancer while 42 as false-positive (controls). We found a higher EBT in NSCLC patients compared to healthy subjects. The EBT was correlated with number of packs/year and associated with the stage of lung cancer. We identified a cut-off value for the EBT that is able to screen patients with lung cancer with a high sensitivity and specificity. Our results suggest that lung cancer causes an increase in the EBT, which, whether confirmed and validated, could become a new non-invasive clinical tool in the screening and monitoring of this disease.
    Medical Oncology 05/2014; 31(5):952. · 2.14 Impact Factor
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    ABSTRACT: This study aims to evaluate the determinants of breakthrough infection after one dose of varicella vaccine. We designed a retrospective case-control study. Breakthrough cases were children, aged 1-15, who presented varicella symptoms ≥ 42 days after the first dose of varicella vaccine (breakthrough). Controls were children, aged 1-15 years, who attended the same class (in a school or in a kindergarten) than the cases in the year of the breakthrough onset; they received a dose of varicella vaccine ≥ 42 days before the case rash onset and they did not develop varicella symptoms. We enrolled 45 cases and 135 controls. 40% of cases (n = 18; 95% CI = 25.4-54. 6) presented at least one risk factor; this proportion was 39.2% (95% CI = 30.9-47.6) among the controls (chi-square = 0.0078; P = 0.93). Time between vaccination and virus exposure was longer among cases. Logistic regression showed that breakthrough disease was associated with duration of time from vaccination.
    Human vaccines & immunotherapeutics. 01/2014; 10(3).
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    ABSTRACT: Celiac disease (CD) is a chronic autoimmune illness of the small intestine triggered by gluten consumption in genetically predisposed individuals. CD presentation is not limited to the gastrointestinal tract and it is still under-diagnosed. Complete resolution of clinical manifestations follows if a gluten-free diet is adopted. In western countries, CD prevalence is approximately 1%. Age of onset is often between 6 months and 7 years.We assessed the approach to diagnosis and management of celiac patients by the paediatricians in Puglia Region, Italy. We conducted a cross-sectional survey among the 589 Apulian Family Paediatricians (FPs) during January 2011-January 2012 using a self-administered web-based standardized questionnaire including self-assessment of their knowledge, diagnostic path and type of management they would follow for CD, clinical information on their celiac patients. We assessed associations among the explored variables by defining double-entry contingency tables and calculating Odds Ratio (OR) with 95% Confidence Intervals (CIs). The 218 (37%) FPs participating in the study reported 1,020 CD patients (representing approximately 1% of the child population covered by the enrolled FPs). Of them, 55% were female; 45% were aged 5-10 years. Weight loss and stunting were the main reported symptoms at diagnosis (41%). The majority (98%) of FPs requested anti-transglutaminase antibody (tTG-Ab) titres for CD diagnosis. Approximately 78% of FPs recommended gluten introduction in the diet of infants at the age of 6 months; 12% and 8% recommended introduction of gluten before and after 6 months of age respectively.The degree of knowledge for either CD diagnosis making process or CD related diseases was medium/high in 97% and 82% of the participating FPs respectively. FPs (83%) who had a medium or high degree of knowledge of CD patients' diet were more likely to experience low or no difficulty in providing their patients with dietary advices (OR:5.5; 95%CI:1.7-17.5). Apulian FPs report a good degree of knowledge of CD, its diagnosis and its management. We will diffuse results and recommendations to all paediatricians in the Region. Actions aiming to continued education on CD in medical under and postgraduate trainings are crucial to prevent under-diagnosis.
    BMC Gastroenterology 01/2014; 14(1):38. · 2.11 Impact Factor
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    ABSTRACT: Celiac disease (CD) is a chronic autoimmune illness triggered by gluten consumption in genetically predisposed individuals. Worldwide, CD prevalence is approximately 1%. Several studies suggest a higher prevalence of undiagnosed CD in patients with infertility. We described reproductive disorders and assessed the frequency of hospital admissions for infertility among celiac women aged 15-49. We conducted two surveys enrolling a convenient sample of celiac women, residing in Apulia or in Basilicata (Italy). Moreover, we selected hospital discharge records (HDRs) of celiac women and women with an exemption for CD, and matched the lists with HDRs for reproductive disorders. In the surveys we included 91 celiac women; 61.5% of them reported menstrual cycle disorders. 47/91 reported at least one pregnancy and 70.2% of them reported problems during pregnancy. From the HDRs and the registry of exemption, we selected 4,070 women with CD; the proportion of women hospitalized for infertility was higher among celiac women than among resident women in childbearing age (1.2% versus 0.2%). Our findings highlight a higher prevalence of reproductive disorders among celiac women than in the general population suggesting that clinicians might consider testing for CD women presenting with pregnancy disorders or infertility.
    TheScientificWorldJournal. 01/2014; 2014:614269.
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    ABSTRACT: The introduction of universal pertussis immunization and the high coverage achieved in most developed countries have largely changed the epidemiology of the disease. Although vaccination rates are high in the first year of life, the rates of booster doses are unsatisfactory and lead to the onset of outbreaks. This report describes an outbreak of pertussis affecting school students already immunized in a town of Puglia (Italy), detected at the end of April 2009. Vaccine effectiveness is measured by calculating the incidence rates (attack rates- AR) of disease among vaccinated (ARV) and unvaccinated (ARU) people and determining the percentage reduction in the incidence rate of disease among vaccinated people compared to unvaccinated people. The index case was a healthy child, female, 9-years-old who attended a local elementary school and developed pertussis on 27 April 2009. The secondary cases were the aunt and the cousin of the index case who developed a cough on 10 May 2009. In the elementary class of the index case, a cluster occurred. The overall AR was 15.8%, in particular 20% in children who did not receive the booster doses at 5--6 years old (ARU) and 14.3% in children receiving the booster (ARV). The VE of booster dose in this setting was 28.5%. Moreover, only the index case developed a persistent cough; the VE against moderate to severe pertussis was 100%. A cluster was detected in the middle school class that the cousin of the index case attended; AR was 44.4% (12/27); ARU was 50% (10/20) and ARV 28.6% (2/7). VE in this setting was 42.8%. Our results confirm the need to administer booster doses; failure the booster is the principal determinant for the outbreak onset.
    BMC Infectious Diseases 11/2013; 13(1):541. · 3.03 Impact Factor
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    ABSTRACT: We compared the risk factors, the diagnostic tools and the outcome of filamentous fungal infections (FFIs) in hematological patients (HAEs) and non-hematological patients (non-HAEs). Prospective surveillance (2009-2011) of proven and probable FFIs was implemented in 23 Italian hospitals. Out of 232 FFIs, 113 occurred in HAEs and 119 in non-HAEs. The most frequent infection was invasive aspergillosis (76.1 % for HAEs, 56.3 % for non-HAEs), and the localization was principally pulmonary (83.2 % for HAEs, 74.8 % for non-HAEs). Neutropenia was a risk factor for 89.4 % HAEs; the main underlying condition was corticosteroid treatment (52.9 %) for non-HAEs. The distribution of proven and probable FFIs was different in the two groups: proven FFIs occurred more frequently in non-HAEs, whereas probable FFIs were correlated with the HAEs. The sensitivity of the galactomannan assay was higher for HAEs than for non-HAEs (95.3 vs. 48.1 %). The overall mortality rate was 44.2 % among the HAEs and 35.3 % among the non-HAEs. The etiology influenced the patient outcomes: mucormycosis was associated with a high mortality rate (57.1 % for HAEs, 77.8 % for non-HAEs). The epidemiological and clinical data for FFIs were not identical in the HAEs and non-HAEs. The differences should be considered to improve the management of FFIs according to the patients' setting.
    Infection 10/2013; · 2.44 Impact Factor
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    ABSTRACT: Pneumococcal disease epidemiology has changed after introduction of pneumococcal conjugate vaccines. Seven-valent vaccine (PCV7) has been effective in reducing invasive pneumococcal disease (IPD). In Europe, PCV13 effectiveness was estimated at 78% (95% CI: -18-96%) for 2-priming doses. In Italy, PCV7 was introduced in 2006 in the childhood immunization schedule and replaced with PCV13 in 2010. In Apulia, vaccination coverage has reached 95.1% (birth-cohort 2010). We estimated PCV program effectiveness and its impact on S.pneumoniae diseases. PCV Effectiveness We used the screening method. We calculated the Proportion of Population Vaccinated from immunization registries and detected cases through a laboratory-confirmed surveillance among hospitalized children ≤60 mo. A confirmed IPD case was a child with PCR positive for S.pneumoniae. Differences among children were assessed with the Chi-square or the Fisher exact test (P value<0.05). PCV Impact: We constructed time series using outcome-specific Poisson regression models: hospitalization rate in pre-PCV era and hospitalization Risk Ratios (RRs) with 95% CIs for both PCV7 and PCV7/PCV13 shifting era. We calculated hospitalization RR with 95% CIs comparing pre-PCV years with vaccination period. The PCV effectiveness was 84.3%(95% CI: 84.0-84.6%). In May 2010-January 2013, we enrolled 159 suspected IPD of whom four were confirmed. Two (fully vaccinated) were caused by serotype 9V, one (not vaccinated) by serotype 3, one (vaccinated with 2 PCV13 doses) by 15B/C. The most important reduction was for pneumococcal pneumonia (RR: 0.43, 95% CI: 0.21-0.90). The PCV program show promising results in terms of both PCV13 effectiveness and its impact in reducing IPD in children<5 y.
    Human vaccines & immunotherapeutics. 10/2013; 10(1).
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    ABSTRACT: SUMMARY In this study we assessed the seroprevalence of hepatitis E virus (HEV) infection in both the Italian population and immigrants from developing countries in Foggia (Apulia, Southern Italy). The seroprevalence of HEV was determined in 1217 subjects [412 (34%) immigrants and 805 Italian subjects (blood donors, general population, HIV-positive, haemodialysis patients)]. Serum samples were tested for anti-HEV and confirmed by Western blot assay; in positive patients HEV RNA and genotype were also determined. There were 8·8% of patients that were positive to anti-HEV, confirmed by Western blot. The prevalence in immigrants was 19·7%, and in Italians 3·9% (blood donors 1·3%, general population 2·7%, HIV-positive patients 2·0%, haemodialysis patients 9·6%). Anti-HEV IgM was found in 38/107 (35·5%) of the anti-HEV-positive serum samples (34 immigrants, four Italians). This study indicates a higher circulation of HEV in immigrants and Italian haemodialysis patients, whereas a low prevalence of HEV antibodies was seen in the remaining Italian population.
    Epidemiology and Infection 05/2013; · 2.87 Impact Factor
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    ABSTRACT: In recent decades in South-Italy, drastic epidemiological changes in the pattern of the enterically transmitted diseases were recorded. This work aims to support the hypothesis that universal routine vaccination against hepatitis A started in Puglia in 1998 could be also effective in reducing contamination in seafood. Three studies on different samples of Mitylus edulis lamellibranch were conducted over 20years. Microbiological analysis measured both the standard bacteriological indexes (faecal coliforms, Escherichia coli, Salmonella spp.) and the presence of hepatitis A, enterovirus, norovirus and rotavirus. Between 1989 and 2009, the highest number of hepatitis A cases was reported in 1996 and in 1997 (mean incidence rate of 130 per 100,000). Since 1999, the number of cases progressively decreased, reaching 29 cases in 2006 (incidence rate of 0.7 per 100,000). A progressive improvement in vaccination coverage of newborns was recorded ranging from 1997 (38.3%) to 2005 birth-cohorts (63.4%). Vaccination coverage of 12-year-old adolescents was 67.6% (95% CI: 58.4-76.8%). Hepatitis A was detected in 3.7% of samples in the 1987 study, in 18.3% of samples in the 1999-2000 study and it was absent in the 2007 study. The decreasing of HAV circulation in humans and in shellfish provides support for the link between vaccination efforts and the safety of molluscs.
    International journal of food microbiology 03/2013; 162(2):125-8. · 3.01 Impact Factor
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    ABSTRACT: In recent decades in South-Italy, drastic epidemiological changes in the pattern of the enterically transmitted diseases were recorded. This work aims to support the hypothesis that universal routine vaccination against hepatitis A started in Puglia in 1998 could be also effective in reducing contamination in seafood. Three studies on different samples of Mitylus edulis lamellibranch were conducted over 20years. Microbiological analysis measured both the standard bacteriological indexes (faecal coliforms, Escherichia coli, Salmonella spp.) and the presence of hepatitis A, enterovirus, norovirus and rotavirus. Between 1989 and 2009, the highest number of hepatitis A cases was reported in 1996 and in 1997 (mean incidence rate of 130 per 100,000). Since 1999, the number of cases progressively decreased, reaching 29 cases in 2006 (incidence rate of 0.7 per 100,000). A progressive improvement in vaccination coverage of newborns was recorded ranging from 1997 (38.3%) to 2005 birth-cohorts (63.4%). Vaccination coverage of 12-year-old adolescents was 67.6% (95% CI: 58.4-76.8%). Hepatitis A was detected in 3.7% of samples in the 1987 study, in 18.3% of samples in the 1999-2000 study and it was absent in the 2007 study. The decreasing of HAV circulation in humans and in shellfish provides support for the link between vaccination efforts and the safety of molluscs.
    International Journal of Food Microbiology 01/2013; 162(2):125-128. · 3.43 Impact Factor
  • Silvio Tafuri, Domenico Martinelli, Rosa Prato, Cinzia Germinario
    Human vaccines 01/2013; 9(1). · 3.14 Impact Factor
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    ABSTRACT: In recent decades in South-Italy, drastic epidemiological changes in the pattern of the enterically transmitted diseases were recorded. This work aims to support the hypothesis that universal routine vaccination against hepatitis A started in Puglia in 1998 could be also effective in reducing contamination in seafood. Three studies on different samples of Mitylus edulis lamellibranch were conducted over 20 years. Microbiological analysis measured both the standard bacteriological indexes (faecal coliforms, Escherichia coli, Salmonella spp.) and the presence of hepatitis A, enterovirus, norovirus and rotavirus. Between 1989 and 2009, the highest number of hepatitis A cases was reported in 1996 and in 1997 (mean incidence rate of 130 per 100,000). Since 1999, the number of cases progressively decreased, reaching 29 cases in 2006 (incidence rate of 0.7 per 100,000). A progressive improvement in vaccination coverage of newborns was recorded ranging from 1997 (38.3%) to 2005 birth-cohorts (63.4%). Vaccination coverage of 12-year-old adolescents was 67.6% (95% CI: 58.4–76.8%). Hepatitis A was detected in 3.7% of samples in the 1987 study, in 18.3% of samples in the 1999–2000 study and it was absent in the 2007 study. The decreasing of HAV circulation in humans and in shellfish provides support for the link between vaccination efforts and the safety of molluscs.
    International Journal of Food Microbiology 01/2013; 162:125-128. · 3.43 Impact Factor

Publication Stats

258 Citations
248.59 Total Impact Points

Institutions

  • 2007–2014
    • Università degli studi di Foggia
      • Department of Medical and Surgical Sciences
      Foggia, Apulia, Italy
  • 2006–2012
    • Università degli Studi di Bari Aldo Moro
      • Dipartimento di Scienze Biomediche ed Oncologia Umana (DIMO)
      Bari, Apulia, Italy
  • 2010
    • Ospedali Riuniti di Bergamo
      Bérgamo, Lombardy, Italy
  • 2008
    • University of Rome Tor Vergata
      Roma, Latium, Italy
    • The Catholic University of America
      Washington, Washington, D.C., United States