1
|
de Pretis N, Carlin M, Calderini E, Caldart F, Conti Bellocchi MC, Amodio A, De Marchi G, Campagnola P, Crinò SF, Bernardoni L, Gabbrielli A, Martinelli L, Frulloni L. Clinical features and long-term outcomes of patients with type 2 autoimmune pancreatitis. United European Gastroenterol J 2024; 12:319-325. [PMID: 38217278 PMCID: PMC11017755 DOI: 10.1002/ueg2.12504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/24/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVES Type 2 is a rare form of autoimmune pancreatitis (AIP). Despite being considered a benign disease, only few studies with limited sample size and short follow-up have been published on type 2 AIP. The aim of this observational study was to evaluate long-term outcomes, such as the risk of relapse, pancreatic insufficiency and cancer in a large type 2 AIP cohort with long follow-up. METHODS Patients with definitive or probable diagnosis of type 2 AIP by International Consensus Diagnostic Criteria (ICDC) present in our prospectively maintained database since 1995 at 31.12.2021 were identified. All patients were clinically evaluated during the year 2022. Clinical, radiological, serological, and pathological data were evaluated. RESULTS Eighty-eight out of 420 patients present in the database (21%) were diagnosed with type 2 AIP (mean age 33.5 ± 13.5 years). According to the ICDC, 21 patients (23.8%) had a definitive and 67 (76.2%) a probable diagnosis of type 2 AIP. The mean follow-up was 9.2 ± 7.1 years (range 1-27 years). No differences were observed when comparing patients with definitive and probable type 2 AIP diagnosis. Concomitant IBD was reported in 77 patients (87.5%). The probability of disease relapse was lower in patients treated with steroids versus surgery (at 5 years 13% vs. 33%; p = 0.038) but this difference was not statistically significant at multivariable analysis. The risk of endocrine or severe exocrine insufficiency was low (5% and 25%). Four extra-pancreatic malignancies (5%) were diagnosed, none pancreatic. One patient died in a car accident. CONCLUSIONS Type 2 AIP has benign long-term clinical outcomes. Mortality and cancer rates are low and no specific follow-up is needed after radiological remission.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Luigi Martinelli
- Department of Diagnostics and Public HealthUniversity of VeronaVeronaItaly
| | - Luca Frulloni
- Department of MedicineUniversity of VeronaVeronaItaly
| |
Collapse
|
2
|
Zorzi A, Campagnola P, Amodio A, Caldart F, De Pretis N, Frulloni L. An update on improving long-term outcomes for patients with chronic pancreatitis post-surgery. Expert Rev Gastroenterol Hepatol 2024; 18:25-36. [PMID: 38375780 DOI: 10.1080/17474124.2024.2321947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/19/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Chronic pancreatitis is a common inflammatory disease that severely impairs patients' quality of life, mainly due to abdominal pain which is the most frequent symptom. Current guidelines suggest medical therapy as the first line intervention based on a stepwise use of analgesics (i.e. NSAIDs followed by weak opioids and later by strong oppioids), which is rarely effective in improving pain and often leads to opioid addiction. Interventional procedures are therefore frequently needed. Endoscopic therapy is suggested as the second line of intervention, aiming at decompressing the main pancreatic duct via structure dilatation and ductal stone removal. Endoscopic therapy is usually effective in reducing pain in the short term, but its effects frequently decrease with time and multiple procedures are often required. Surgery is usually reserved as a last resource when medical and endoscopic therapy have failed. Pancreatic surgery is burdened with non negligible morbidity and mortality but is effective in reducing pain and improving quality of life in chronic pancratitis with long lasting effects. AREAS COVERED Surgical treatment of chronic pancreatitis is based on resection of inflammatory head mass or decompression of the ductal system, alone or in combination, which can be performed using different techniques. In this paper we reviewed the current evidence on the long-term outcomes of this type of surgery in terms of pain relief, quality of life, exocrine end endocrine function, and long-term mortality. EXPERT OPINION Quality of current evidence on this field is on average poor; a consensus to define clinically significant outcomes is needed in order to correctly design prospective studies that will enable gastroenterologists to understand which patients, and when, will benefit most from surgery and should therefore be referred to surgeons.
Collapse
Affiliation(s)
- Alberto Zorzi
- Gastroenterology B, Pancreas Institute, University of Verona, Verona, Italy
| | - Pietro Campagnola
- Gastroenterology B, Pancreas Institute, University of Verona, Verona, Italy
| | - Antonio Amodio
- Gastroenterology B, Pancreas Institute, University of Verona, Verona, Italy
| | - Federico Caldart
- Gastroenterology B, Pancreas Institute, University of Verona, Verona, Italy
| | - Nicolo De Pretis
- Gastroenterology B, Pancreas Institute, University of Verona, Verona, Italy
| | - Luca Frulloni
- Gastroenterology B, Pancreas Institute, University of Verona, Verona, Italy
| |
Collapse
|
3
|
Caldart F, de Pretis N, Luchini C, Ciccocioppo R, Frulloni L. Pancreatic steatosis and metabolic pancreatic disease: a new entity? Intern Emerg Med 2023; 18:2199-2208. [PMID: 37462859 PMCID: PMC10635967 DOI: 10.1007/s11739-023-03364-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/30/2023] [Indexed: 08/24/2023]
Abstract
Overweight and obesity are some of the most important health challenges. Many diseases are related to these metabolic disorders, and, among them, the pancreatic fat accumulation, also called "pancreatic steatosis" or "nonalcoholic fatty pancreas", seems to have an emerging role in different conditions. There are different method to evaluate the fat content in the pancreas, such as histology, different imaging techniques and endoscopic ultrasound, but there is no gold standard for the correct diagnosis and for the identification of "inter/intralobular" and "intra-acinar" pancreatic fat. However, the fat storage in the pancreas is linked to chronic inflammation and to several conditions, such as acute and chronic pancreatitis, type 2 diabetes mellitus and pancreatic cancer. In addition, pancreatic fat accumulation has also been demonstrated to play a role in surgical outcome after pancreatectomy, in particular for the development of postoperative pancreatic fistula. Different possible therapeutic approaches have been proposed, but there is still a lack of evidence. The aim of this review is to report the current evidence about the relationship between the obesity, the pancreatic fat accumulation and its potential role in pancreatic diseases.
Collapse
Affiliation(s)
- Federico Caldart
- Gastroenterology B Unit, University of Verona-Verona Hospital, Verona, Italy.
| | - Nicolò de Pretis
- Gastroenterology B Unit, University of Verona-Verona Hospital, Verona, Italy
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy
| | - Rachele Ciccocioppo
- Gastroenterology B Unit, University of Verona-Verona Hospital, Verona, Italy
| | - Luca Frulloni
- Gastroenterology B Unit, University of Verona-Verona Hospital, Verona, Italy
| |
Collapse
|
4
|
Conti Bellocchi MC, Crinò SF, De Marchi G, De Pretis N, Ofosu A, Caldart F, Ciccocioppo R, Frulloni L. A Clinical and Pathophysiological Overview of Intestinal and Systemic Diseases Associated with Pancreatic Disorders: Causality or Casualty? Biomedicines 2023; 11:biomedicines11051393. [PMID: 37239064 DOI: 10.3390/biomedicines11051393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
The relationship between chronic intestinal disease, including inflammatory bowel disease (IBD) and celiac disease (CelD), and pancreatic disorders has been little investigated. Although an increased risk of acute pancreatitis (AP), exocrine pancreatic insufficiency with or without chronic pancreatitis, and chronic asymptomatic pancreatic hyperenzymemia have been described in these patients, the pathogenetic link remains unclear. It may potentially involve drugs, altered microcirculation, gut permeability/motility with disruption of enteric-mediated hormone secretion, bacterial translocation, and activation of the gut-associated lymphoid tissue related to chronic inflammation. In addition, the risk of pancreatic cancer seems to be increased in both IBD and CelD patients with unknown pathogenesis. Finally, other systemic conditions (e.g., IgG4-related disease, sarcoidosis, vasculitides) might affect pancreatic gland and the intestinal tract with various clinical manifestations. This review includes the current understandings of this enigmatic association, reporting a clinical and pathophysiological overview about this topic.
Collapse
Affiliation(s)
| | - Stefano Francesco Crinò
- Diagnostic and Interventional Endoscopy of Pancreas, Pancreas Institute, University of Verona, 37134 Verona, Italy
| | - Giulia De Marchi
- Gastroenterology Unit, Department of Medicine, Pancreas Institute, University of Verona, 37134 Verona, Italy
| | - Nicolò De Pretis
- Gastroenterology Unit, Department of Medicine, Pancreas Institute, University of Verona, 37134 Verona, Italy
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Federico Caldart
- Gastroenterology Unit, Department of Medicine, Pancreas Institute, University of Verona, 37134 Verona, Italy
| | - Rachele Ciccocioppo
- Gastroenterology Unit, Department of Medicine, Pancreas Institute, University of Verona, 37134 Verona, Italy
| | - Luca Frulloni
- Gastroenterology Unit, Department of Medicine, Pancreas Institute, University of Verona, 37134 Verona, Italy
| |
Collapse
|
5
|
Campagnola P, de Pretis N, Zorzi A, Caldart F, Frulloni L. Chronic pancreatitis and nutritional support. Best Pract Res Clin Gastroenterol 2023; 62-63:101823. [PMID: 37094906 DOI: 10.1016/j.bpg.2023.101823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/29/2023] [Indexed: 04/26/2023]
Abstract
Malnutrition in patients with chronic pancreatitis is common, but its evaluation is often missed in clinical practice. Pancreatic exocrine insufficiency is the single most important cause of malnutrition; therefore, it needs to be screened for and treated appropriately. Specific diet regimens in patients suffering from chronic pancreatitis are rarely reported in the literature. Patients suffering from chronic pancreatitis have a higher demand for energy but a lower caloric intake secondary to pancreatic exocrine insufficiency, combined with the malabsorption of liposoluble vitamin and micronutrients, which needs be corrected by appropriate dietary counselling. Diabetes is frequently observed in chronic pancreatitis and classified as type 3c, which is characterized by low levels of both serum insulin and glucagon; therefore, there is a tendency towards hypoglycaemia in patients treated with insulin. Diabetes contributes to malnutrition in chronic pancreatitis. Strategies to treat exocrine and endocrine insufficiency are important to achieve better control of the disease.
Collapse
Affiliation(s)
| | | | - Alberto Zorzi
- Department of Medicine, University of Verona, Verona, Italy
| | | | - Luca Frulloni
- Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
6
|
Facchin S, Calgaro M, Pandolfo M, Caldart F, Ghisa M, Vitulo N, Savarino EV. Editorial: non-invasive testing for EoE-does microbiome testing hold the key? Authors' reply. Aliment Pharmacol Ther 2022; 56:729-730. [PMID: 35879893 DOI: 10.1111/apt.17144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Sonia Facchin
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, Padua, Italy
| | - Matteo Calgaro
- Department of Biotechnology, University of Verona, Verona, Italy
| | - Mattia Pandolfo
- Department of Biotechnology, University of Verona, Verona, Italy
| | - Federico Caldart
- Department of Medicine, Gastroenterology Unit, University of Verona, Verona, Italy
| | - Matteo Ghisa
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, Padua, Italy.,Department of Oncological Gastrointestinal Surgery, Gastroenterology Unit, S. Maria del Prato Hospital, Feltre, Italy
| | - Nicola Vitulo
- Department of Biotechnology, University of Verona, Verona, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, Padua, Italy
| |
Collapse
|
7
|
Facchin S, Calgaro M, Pandolfo M, Caldart F, Ghisa M, Greco E, Sattin E, Valle G, Dellon ES, Vitulo N, Savarino EV. Salivary microbiota composition may discriminate between patients with eosinophilic oesophagitis (EoE) and non-EoE subjects. Aliment Pharmacol Ther 2022; 56:450-462. [PMID: 35715947 DOI: 10.1111/apt.17091] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/16/2022] [Accepted: 06/06/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Data on the role of the microbiome in adult patients with eosinophilic oesophagitis (EoE) are limited. AIMS To prospectively collect and characterise the salivary, oesophageal and gastric microbiome in patients with EoE, further correlating the findings with disease activity. METHODS Adult patients with symptoms of oesophageal dysfunction undergoing upper endoscopy were consecutively enrolled. Patients were classified as EoE patients, in case of more than 15 eosinophils per high-power field, or non-EoE controls, in case of lack of eosinophilic infiltration. Before and during endoscopy, saliva, oesophageal and gastric fundus biopsies were collected. Microbiota assessment was performed by 16 s rRNA analysis. A Sparse Partial Least Squares Discriminant Analysis (sPLS-DA) was implemented to identify biomarkers. RESULTS Saliva samples were collected from 29 EoE patients and 20 non-EoE controls;, biopsies from 25 EoE and 5 non-EoE controls. In saliva samples, 23 Amplicon Sequence Variants (ASVs) were positively associated with EoE and 27 ASVs with controls, making it possible to discriminate between EoE and non-EoE patients with a classification error (CE) of 24%. In a validation cohort, the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of this model were 78.6%, 80%, 75%, 80% and 60%, respectively. Moreover, the analysis of oesophageal microbiota samples observed a clear microbial pattern able to discriminate between active and inactive EoE (CE = 8%). CONCLUSION Our preliminary data suggest that salivary metabarcoding analysis in combination with machine learning approaches could become a valid, cheap, non-invasive test to segregate between EoE and non-EoE patients.
Collapse
Affiliation(s)
- Sonia Facchin
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, Padua, Italy
| | - Matteo Calgaro
- Department of Biotechnology, University of Verona, Verona, Italy
| | - Mattia Pandolfo
- Department of Biotechnology, University of Verona, Verona, Italy
| | - Federico Caldart
- Department of Medicine, Gastroenterology Unit, University of Verona, Verona, Italy
| | - Matteo Ghisa
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, Padua, Italy.,Department of Oncological Gastrointestinal Surgery, Gastroenterology Unit, S. Maria del Prato Hospital, Feltre, Italy
| | - Eliana Greco
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, Padua, Italy
| | | | | | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Nicola Vitulo
- Department of Biotechnology, University of Verona, Verona, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, Padua, Italy
| |
Collapse
|
8
|
Dorigatti I, Lavezzo E, Manuto L, Ciavarella C, Pacenti M, Boldrin C, Cattai M, Saluzzo F, Franchin E, Del Vecchio C, Caldart F, Castelli G, Nicoletti M, Nieddu E, Salvadoretti E, Labella B, Fava L, Guglielmo S, Fascina M, Grazioli M, Alvisi G, Vanuzzo MC, Zupo T, Calandrin R, Lisi V, Rossi L, Castagliuolo I, Merigliano S, Unwin HJT, Plebani M, Padoan A, Brazzale AR, Toppo S, Ferguson NM, Donnelly CA, Crisanti A. SARS-CoV-2 antibody dynamics and transmission from community-wide serological testing in the Italian municipality of Vo'. Nat Commun 2021; 12:4383. [PMID: 34282139 PMCID: PMC8289856 DOI: 10.1038/s41467-021-24622-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/21/2021] [Indexed: 01/04/2023] Open
Abstract
In February and March 2020, two mass swab testing campaigns were conducted in Vo', Italy. In May 2020, we tested 86% of the Vo' population with three immuno-assays detecting antibodies against the spike and nucleocapsid antigens, a neutralisation assay and Polymerase Chain Reaction (PCR). Subjects testing positive to PCR in February/March or a serological assay in May were tested again in November. Here we report on the results of the analysis of the May and November surveys. We estimate a seroprevalence of 3.5% (95% Credible Interval (CrI): 2.8-4.3%) in May. In November, 98.8% (95% Confidence Interval (CI): 93.7-100.0%) of sera which tested positive in May still reacted against at least one antigen; 18.6% (95% CI: 11.0-28.5%) showed an increase of antibody or neutralisation reactivity from May. Analysis of the serostatus of the members of 1,118 households indicates a 26.0% (95% CrI: 17.2-36.9%) Susceptible-Infectious Transmission Probability. Contact tracing had limited impact on epidemic suppression.
Collapse
Affiliation(s)
- Ilaria Dorigatti
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK.
| | - Enrico Lavezzo
- Department of Molecular Medicine, University of Padova, Padova, Italy.
| | - Laura Manuto
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Constanze Ciavarella
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | | | | | | | - Francesca Saluzzo
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Elisa Franchin
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | | | - Federico Caldart
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Gioele Castelli
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Michele Nicoletti
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Eleonora Nieddu
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | | | - Beatrice Labella
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Ludovico Fava
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Simone Guglielmo
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | | | - Marco Grazioli
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Gualtiero Alvisi
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | | | | | | | | | | | | | - Stefano Merigliano
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - H Juliette T Unwin
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Mario Plebani
- Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Padoan
- Department of Medicine, University of Padova, Padova, Italy
| | | | - Stefano Toppo
- Department of Molecular Medicine, University of Padova, Padova, Italy
- CRIBI Biotech Centre, University of Padova, Padova, Italy
| | - Neil M Ferguson
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Christl A Donnelly
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
| | - Andrea Crisanti
- Department of Molecular Medicine, University of Padova, Padova, Italy.
- Azienda Ospedale Padova, Padova, Italy.
- Department of Life Science Imperial College London, Exhibition Road, London, UK.
| |
Collapse
|
9
|
Lavezzo E, Franchin E, Ciavarella C, Cuomo-Dannenburg G, Barzon L, Del Vecchio C, Rossi L, Manganelli R, Loregian A, Navarin N, Abate D, Sciro M, Merigliano S, De Canale E, Vanuzzo MC, Besutti V, Saluzzo F, Onelia F, Pacenti M, Parisi SG, Carretta G, Donato D, Flor L, Cocchio S, Masi G, Sperduti A, Cattarino L, Salvador R, Nicoletti M, Caldart F, Castelli G, Nieddu E, Labella B, Fava L, Drigo M, Gaythorpe KAM, Brazzale AR, Toppo S, Trevisan M, Baldo V, Donnelly CA, Ferguson NM, Dorigatti I, Crisanti A. Author Correction: Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo'. Nature 2021; 590:E11. [PMID: 33452443 PMCID: PMC7810098 DOI: 10.1038/s41586-020-2956-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Enrico Lavezzo
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Elisa Franchin
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Constanze Ciavarella
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Gina Cuomo-Dannenburg
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | | | | | - Arianna Loregian
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Nicolò Navarin
- Department of Mathematics "Tullio Levi-Civita", University of Padova, Padua, Italy
- CRIBI Biotech Center, University of Padova, Padua, Italy
| | - Davide Abate
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | - Stefano Merigliano
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | | | | | | | - Francesca Saluzzo
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Francesco Onelia
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | - Saverio G Parisi
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | | | | | - Silvia Cocchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Giulia Masi
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Alessandro Sperduti
- Department of Mathematics "Tullio Levi-Civita", University of Padova, Padua, Italy
- CRIBI Biotech Center, University of Padova, Padua, Italy
| | - Lorenzo Cattarino
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Renato Salvador
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | | | | | | | | | | | - Ludovico Fava
- School of Medicine, University of Padova, Padua, Italy
| | - Matteo Drigo
- School of Medicine, University of Padova, Padua, Italy
| | - Katy A M Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | | | - Stefano Toppo
- Department of Molecular Medicine, University of Padova, Padua, Italy
- CRIBI Biotech Center, University of Padova, Padua, Italy
| | - Marta Trevisan
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Christl A Donnelly
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
| | - Neil M Ferguson
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Ilaria Dorigatti
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK.
| | - Andrea Crisanti
- Department of Molecular Medicine, University of Padova, Padua, Italy.
- Department of Life Sciences, Imperial College London, London, UK.
| |
Collapse
|
10
|
Lavezzo E, Franchin E, Ciavarella C, Cuomo-Dannenburg G, Barzon L, Del Vecchio C, Rossi L, Manganelli R, Loregian A, Navarin N, Abate D, Sciro M, Merigliano S, De Canale E, Vanuzzo MC, Besutti V, Saluzzo F, Onelia F, Pacenti M, Parisi SG, Carretta G, Donato D, Flor L, Cocchio S, Masi G, Sperduti A, Cattarino L, Salvador R, Nicoletti M, Caldart F, Castelli G, Nieddu E, Labella B, Fava L, Drigo M, Gaythorpe KAM, Brazzale AR, Toppo S, Trevisan M, Baldo V, Donnelly CA, Ferguson NM, Dorigatti I, Crisanti A. Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo'. Nature 2020; 584:425-429. [PMID: 32604404 DOI: 10.1038/s41586-020-2488-1] [Citation(s) in RCA: 623] [Impact Index Per Article: 155.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/23/2020] [Indexed: 01/12/2023]
Abstract
On 21 February 2020, a resident of the municipality of Vo', a small town near Padua (Italy), died of pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection1. This was the first coronavirus disease 19 (COVID-19)-related death detected in Italy since the detection of SARS-CoV-2 in the Chinese city of Wuhan, Hubei province2. In response, the regional authorities imposed the lockdown of the whole municipality for 14 days3. Here we collected information on the demography, clinical presentation, hospitalization, contact network and the presence of SARS-CoV-2 infection in nasopharyngeal swabs for 85.9% and 71.5% of the population of Vo' at two consecutive time points. From the first survey, which was conducted around the time the town lockdown started, we found a prevalence of infection of 2.6% (95% confidence interval (CI): 2.1-3.3%). From the second survey, which was conducted at the end of the lockdown, we found a prevalence of 1.2% (95% CI: 0.8-1.8%). Notably, 42.5% (95% CI: 31.5-54.6%) of the confirmed SARS-CoV-2 infections detected across the two surveys were asymptomatic (that is, did not have symptoms at the time of swab testing and did not develop symptoms afterwards). The mean serial interval was 7.2 days (95% CI: 5.9-9.6). We found no statistically significant difference in the viral load of symptomatic versus asymptomatic infections (P = 0.62 and 0.74 for E and RdRp genes, respectively, exact Wilcoxon-Mann-Whitney test). This study sheds light on the frequency of asymptomatic SARS-CoV-2 infection, their infectivity (as measured by the viral load) and provides insights into its transmission dynamics and the efficacy of the implemented control measures.
Collapse
Affiliation(s)
- Enrico Lavezzo
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Elisa Franchin
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Constanze Ciavarella
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Gina Cuomo-Dannenburg
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | | | | | - Arianna Loregian
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Nicolò Navarin
- Department of Mathematics "Tullio Levi-Civita", University of Padova, Padua, Italy
- CRIBI Biotech Center, University of Padova, Padua, Italy
| | - Davide Abate
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | - Stefano Merigliano
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | | | | | | | - Francesca Saluzzo
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Francesco Onelia
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | - Saverio G Parisi
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | | | | | - Silvia Cocchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Giulia Masi
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Alessandro Sperduti
- Department of Mathematics "Tullio Levi-Civita", University of Padova, Padua, Italy
- CRIBI Biotech Center, University of Padova, Padua, Italy
| | - Lorenzo Cattarino
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Renato Salvador
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | | | | | | | | | | | - Ludovico Fava
- School of Medicine, University of Padova, Padua, Italy
| | - Matteo Drigo
- School of Medicine, University of Padova, Padua, Italy
| | - Katy A M Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | | | | | - Stefano Toppo
- Department of Molecular Medicine, University of Padova, Padua, Italy
- CRIBI Biotech Center, University of Padova, Padua, Italy
| | - Marta Trevisan
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Christl A Donnelly
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
| | - Neil M Ferguson
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Ilaria Dorigatti
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK.
| | - Andrea Crisanti
- Department of Molecular Medicine, University of Padova, Padua, Italy.
- Department of Life Sciences, Imperial College London, London, UK.
| | | |
Collapse
|
11
|
Lavezzo E, Franchin E, Ciavarella C, Cuomo-Dannenburg G, Barzon L, Del Vecchio C, Rossi L, Manganelli R, Loregian A, Navarin N, Abate D, Sciro M, Merigliano S, De Canale E, Vanuzzo MC, Besutti V, Saluzzo F, Onelia F, Pacenti M, Parisi SG, Carretta G, Donato D, Flor L, Cocchio S, Masi G, Sperduti A, Cattarino L, Salvador R, Nicoletti M, Caldart F, Castelli G, Nieddu E, Labella B, Fava L, Drigo M, Gaythorpe KAM, Brazzale AR, Toppo S, Trevisan M, Baldo V, Donnelly CA, Ferguson NM, Dorigatti I, Crisanti A. Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo'. Nature 2020. [PMID: 32604404 DOI: 10.1101/2020.04.17.20053157] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
On 21 February 2020, a resident of the municipality of Vo', a small town near Padua (Italy), died of pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection1. This was the first coronavirus disease 19 (COVID-19)-related death detected in Italy since the detection of SARS-CoV-2 in the Chinese city of Wuhan, Hubei province2. In response, the regional authorities imposed the lockdown of the whole municipality for 14 days3. Here we collected information on the demography, clinical presentation, hospitalization, contact network and the presence of SARS-CoV-2 infection in nasopharyngeal swabs for 85.9% and 71.5% of the population of Vo' at two consecutive time points. From the first survey, which was conducted around the time the town lockdown started, we found a prevalence of infection of 2.6% (95% confidence interval (CI): 2.1-3.3%). From the second survey, which was conducted at the end of the lockdown, we found a prevalence of 1.2% (95% CI: 0.8-1.8%). Notably, 42.5% (95% CI: 31.5-54.6%) of the confirmed SARS-CoV-2 infections detected across the two surveys were asymptomatic (that is, did not have symptoms at the time of swab testing and did not develop symptoms afterwards). The mean serial interval was 7.2 days (95% CI: 5.9-9.6). We found no statistically significant difference in the viral load of symptomatic versus asymptomatic infections (P = 0.62 and 0.74 for E and RdRp genes, respectively, exact Wilcoxon-Mann-Whitney test). This study sheds light on the frequency of asymptomatic SARS-CoV-2 infection, their infectivity (as measured by the viral load) and provides insights into its transmission dynamics and the efficacy of the implemented control measures.
Collapse
Affiliation(s)
- Enrico Lavezzo
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Elisa Franchin
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Constanze Ciavarella
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Gina Cuomo-Dannenburg
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | | | | | - Arianna Loregian
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Nicolò Navarin
- Department of Mathematics "Tullio Levi-Civita", University of Padova, Padua, Italy
- CRIBI Biotech Center, University of Padova, Padua, Italy
| | - Davide Abate
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | - Stefano Merigliano
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | | | | | | | - Francesca Saluzzo
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Francesco Onelia
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | - Saverio G Parisi
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | | | | | - Silvia Cocchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Giulia Masi
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Alessandro Sperduti
- Department of Mathematics "Tullio Levi-Civita", University of Padova, Padua, Italy
- CRIBI Biotech Center, University of Padova, Padua, Italy
| | - Lorenzo Cattarino
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Renato Salvador
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | | | | | | | | | | | - Ludovico Fava
- School of Medicine, University of Padova, Padua, Italy
| | - Matteo Drigo
- School of Medicine, University of Padova, Padua, Italy
| | - Katy A M Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | | | - Stefano Toppo
- Department of Molecular Medicine, University of Padova, Padua, Italy
- CRIBI Biotech Center, University of Padova, Padua, Italy
| | - Marta Trevisan
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Christl A Donnelly
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
| | - Neil M Ferguson
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Ilaria Dorigatti
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK.
| | - Andrea Crisanti
- Department of Molecular Medicine, University of Padova, Padua, Italy.
- Department of Life Sciences, Imperial College London, London, UK.
| |
Collapse
|