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Acuti Martellucci C, Flacco ME, Soldato G, Di Martino G, Carota R, Rosso A, De Benedictis M, Di Marco G, Di Luzio R, Lisbona F, Caponetti A, Manzoli L. Risk of SARS-CoV-2 Reinfection 3 Years after the Start of the Pandemic: A Population-Level Observational Study. Life (Basel) 2023; 13:2111. [PMID: 38004251 PMCID: PMC10672528 DOI: 10.3390/life13112111] [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: 09/13/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
The risk of SARS-CoV-2 reinfections changes as new variants emerge, but the follow-up time for most of the available evidence is shorter than two years. This study evaluated SARS-CoV-2 reinfection rates in the total population of an Italian province up to three years since the pandemic's start. This retrospective cohort study used official National Healthcare System data on SARS-CoV-2 testing and vaccinations, demographics, and hospitalizations in the Province of Pescara, Italy, from 2 March 2020 to 31 December 2022. A total of 6541 (5.4%) reinfections and 33 severe and 18 lethal COVID-19 cases were recorded among the 121,412 subjects who recovered from a primary infection. There were no severe events following reinfection in the young population, whereas 1.1% of reinfected elderly died. A significantly higher reinfection risk was observed among females; unvaccinated individuals; adults (30-59 y); and subjects with hypertension, COPD, and kidney disease. Up to three years after a primary SARS-CoV-2 infection, the majority of the population did not experience a reinfection. The risk of severe COVID-19 following a reinfection was very low for young and adult individuals but still high for the elderly. The subjects with hybrid immunity showed a lower reinfection risk than the unvaccinated.
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Affiliation(s)
- Cecilia Acuti Martellucci
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (C.A.M.); (M.E.F.); (A.R.)
| | - Maria Elena Flacco
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (C.A.M.); (M.E.F.); (A.R.)
| | - Graziella Soldato
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Giuseppe Di Martino
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Roberto Carota
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Annalisa Rosso
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (C.A.M.); (M.E.F.); (A.R.)
| | - Marco De Benedictis
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Graziano Di Marco
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Rossano Di Luzio
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Francesco Lisbona
- Department of Medical and Surgical Sciences, University of Bologna, 40100 Bologna, Italy;
| | - Antonio Caponetti
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Lamberto Manzoli
- Department of Medical and Surgical Sciences, University of Bologna, 40100 Bologna, Italy;
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Flacco ME, Acuti Martellucci C, Soldato G, Di Martino G, Rosso A, Carota R, De Benedictis M, Di Marco G, Di Luzio R, Ricci M, Caponetti A, Gori D, Manzoli L. Predictors of SARS-CoV-2 Infection and Severe and Lethal COVID-19 after Three Years of Follow-Up: A Population-Wide Study. Viruses 2023; 15:1794. [PMID: 37766201 PMCID: PMC10534678 DOI: 10.3390/v15091794] [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: 07/29/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
In this cohort study, the general population of an Italian Province was followed for three years after the start of the pandemic, in order to identify the predictors of SARS-CoV-2 infection and severe or lethal COVID-19. All the National Healthcare System information on biographical records, vaccinations, SARS-CoV-2 swabs, COVID-19 cases, hospitalizations and co-pay exemptions were extracted from 25 February 2020 to 15 February 2023. Cox proportional hazard analysis was used to compute the relative hazards of infection and severe or lethal COVID-19, adjusting for age, gender, vaccine status, hypertension, diabetes, major cardiovascular diseases (CVD), chronic obstructive pulmonary disease (COPD), kidney disease or cancer. Among the 300,079 residents or domiciled citizens, 41.5% had ≥1 positive swabs during the follow-up (which lasted a mean of 932 days). A total of 3.67% of the infected individuals experienced severe COVID-19 (n = 4574) and 1.76% died (n = 2190). Females, the elderly and subjects with diabetes, CVD, COPD, kidney disease and cancer showed a significantly higher risk of SARS-CoV-2 infection. The likelihood of severe or lethal COVID-19 was >90% lower among the youngest, and all comorbidities were independently associated with a higher risk (ranging from +28% to +214%) of both outcomes. Two years after the start of the immunization campaign, the individuals who received ≥2 doses of COVID-19 vaccines still showed a significantly lower likelihood of severe or lethal disease, with the lowest risk observed among subjects who received at least one booster dose.
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Affiliation(s)
- Maria Elena Flacco
- Department of Environmental and Preventive Sciences, University of Ferrara, 44121 Ferrara, Italy
| | | | | | | | - Annalisa Rosso
- Department of Environmental and Preventive Sciences, University of Ferrara, 44121 Ferrara, Italy
| | | | | | | | | | - Matteo Ricci
- Department of Medical and Surgical Sciences, University of Bologna, 40100 Bologna, Italy
| | | | - Davide Gori
- Department of Medical and Surgical Sciences, University of Bologna, 40100 Bologna, Italy
| | - Lamberto Manzoli
- Department of Medical and Surgical Sciences, University of Bologna, 40100 Bologna, Italy
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Rosso A, Flacco ME, Soldato G, Di Martino G, Acuti Martellucci C, Carota R, De Benedictis M, Di Marco G, Di Luzio R, Fiore M, Caponetti A, Manzoli L. COVID-19 Vaccination Effectiveness in the General Population of an Italian Province: Two Years of Follow-Up. Vaccines (Basel) 2023; 11:1325. [PMID: 37631893 PMCID: PMC10459219 DOI: 10.3390/vaccines11081325] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/29/2023] Open
Abstract
We carried out a cohort study on the overall population of the province of Pescara, Italy, to assess the real-world effectiveness of SARS-CoV-2 vaccination against infection, severe, or lethal COVID-19, two years after the start of the vaccination campaign. We included all the resident or domiciled subjects, and extracted the official demographic, vaccination, COVID-19, hospital and co-pay exemption datasets from 1 January 2021, up to 15 February 2023. Cox proportional hazards analyses were adjusted for gender, age, diabetes, hypertension, COPD, major cardio- and cerebrovascular events, cancer, and kidney diseases. Throughout the follow-up (466 days on average), 186,676 subjects received greater than or equal to three vaccine doses (of ChAdOx1 nCoV-19, BNT162b2, mRNA-1273, NVX-CoV2373, or JNJ-78436735), 47,610 two doses, 11,452 one dose, and 44,989 none. Overall, 40.4% of subjects were infected with SARS-CoV-2. Of them, 2.74% had severe or lethal (1.30%) COVID-19. As compared to the unvaccinated, the individuals who received greater than or equal to one booster dose showed a ≥85% lower risk of severe or lethal COVID-19. A massive impact of vaccination was found among the elderly: 22.0% of the unvaccinated, infected individuals died, as opposed to less than 3% of those who received greater than or equal to three vaccine doses. No protection against infection was observed, although this finding was certainly influenced by the Italian restriction policies to control the pandemic. Importantly, during the Omicron predominance period, only the group who received at least a booster dose showed a reduced risk of COVID-19-related death.
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Affiliation(s)
- Annalisa Rosso
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (C.A.M.)
| | - Maria Elena Flacco
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (C.A.M.)
| | - Graziella Soldato
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Giuseppe Di Martino
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Cecilia Acuti Martellucci
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (C.A.M.)
| | - Roberto Carota
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Marco De Benedictis
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Graziano Di Marco
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Rossano Di Luzio
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Matteo Fiore
- Department of Medical and Surgical Sciences, University of Bologna, 40100 Bologna, Italy;
| | - Antonio Caponetti
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (G.D.M.); (R.C.); (M.D.B.); (G.D.M.); (R.D.L.); (A.C.)
| | - Lamberto Manzoli
- Department of Medical and Surgical Sciences, University of Bologna, 40100 Bologna, Italy;
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Liani R, La Torre S, Liani V, Melchiorre A, D’Ettorre D, Tripaldi R, Lattanzio S, Di Luzio R, Coli M, Velussi C. Study of pulsed electrostatic field (PESF) in the perfusion of peripheral tissues: Microangiopathy, nutrition and quality of perceiver life. PLoS One 2022; 17:e0268497. [PMID: 36107868 PMCID: PMC9477350 DOI: 10.1371/journal.pone.0268497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/02/2022] [Indexed: 11/18/2022] Open
Abstract
Microangiopathy compromises the structural and functional integrity of organs and tissues in patients with type II diabetes mellitus (T2DM) negatively affecting the perceived quality of life. Nitric oxide (NO) is a multifunctional signalling molecule, acting as a vasodilator, neurotransmitter, and modulator of inflammatory processes. Patients with type II diabetes mellitus and chronic kidney disease, controlled from glycaemic status, were treated or not with pulsed electrostatic field (PESF) cycles to evaluate effect on the perfusion of peripheral tissues. Everyone was monitored for the metabolic profile, and we tested circulating NO with a commercial enzyme immunoassay kit. In addition, we tested the perceived quality of life of patients before/after a PESF cycle using a questionnaire. Patients treated with PESF were improved circulating NO levels, significant changes in systolic and diastolic blood pressure, heart rate and were more homogeneous for their metabolic profile. The questionnaire showed also a marked improvement in the perceived quality of life. The use of pulsed electrostatic fields has allowed us to observe an improvement in the metabolic, psychological, and clinical profile in patients with T2DM and chronic kidney disease whose pathological profile is strongly compromised.
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Affiliation(s)
- Rossella Liani
- Department of Medicine and Aging, CAST_Center for Advanced Studies and Technology, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
- * E-mail:
| | - Sara La Torre
- Department of Medicine and Aging, CAST_Center for Advanced Studies and Technology, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Valentina Liani
- Nephrology and Dialysis Unit, "S. Massimo" Hospital, Penne, Italy
| | | | - Danilo D’Ettorre
- Nephrology and Dialysis Unit, "S. Massimo" Hospital, Penne, Italy
| | - Romina Tripaldi
- Department of Medicine and Aging, CAST_Center for Advanced Studies and Technology, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Stefano Lattanzio
- Department of Medicine and Aging, CAST_Center for Advanced Studies and Technology, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Rossano Di Luzio
- Nephrology and Dialysis Unit, "S. Massimo" Hospital, Penne, Italy
| | - Mauro Coli
- Department of Economics, Institute of Statistics, University of Chieti, Chieti, Italy
| | - Carlo Velussi
- Retired Associate Professor of Physiology, University of Padova, Padova, Italy
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Flacco ME, Soldato G, Acuti Martellucci C, Carota R, Di Luzio R, Caponetti A, Manzoli L. Interim Estimates of COVID-19 Vaccine Effectiveness in a Mass Vaccination Setting: Data from an Italian Province. Vaccines (Basel) 2021; 9:628. [PMID: 34200538 PMCID: PMC8227269 DOI: 10.3390/vaccines9060628] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/14/2022] Open
Abstract
This retrospective cohort study compared the rates of virologically-confirmed SARS-CoV-2 infections, symptomatic or lethal COVID-19 among the residents of the Italian province of Pescara who received one or two doses of COVID-19 vaccines, versus the unvaccinated. The official data of the National Health System were used, and a total of 69,539 vaccinated adults were compared with 175,687 unvaccinated. Among the subjects who received at least one vaccine dose, 85 infections (0.12%), 18 severe and 3 lethal COVID-19 cases were recorded after an average follow-up of 38 days. Among the unvaccinated, the numbers were 6948 (4.00%), 933 (0.53%) and 241 (0.14%), respectively. The serious adverse event reports-yet unconfirmed-were 24 out of 102,394 administered doses. In a Cox model, adjusting for age, gender, and selected comorbidities, the effectiveness of either BNT162b2, ChAdOx1 nCoV-19 or mRNA-1273 vaccines was higher than 95% in preventing infections (mostly due to B.1.1.7 variant), symptomatic or lethal COVID-19. No differences were observed across genders, and among the 691 subjects who received the second dose of vaccine later than the recommended date. Although preliminary, these findings support current immunization policies and may help reducing vaccine hesitancy.
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Affiliation(s)
- Maria Elena Flacco
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.E.F.); (C.A.M.)
| | - Graziella Soldato
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (R.C.); (R.D.L.); (A.C.)
| | | | - Roberto Carota
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (R.C.); (R.D.L.); (A.C.)
| | - Rossano Di Luzio
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (R.C.); (R.D.L.); (A.C.)
| | - Antonio Caponetti
- Local Health Unit of Pescara, 65124 Pescara, Italy; (G.S.); (R.C.); (R.D.L.); (A.C.)
| | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.E.F.); (C.A.M.)
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Montagna MT, De Giglio O, Napoli C, Diella G, Rutigliano S, Agodi A, Auxilia F, Baldovin T, Bisetto F, Arnoldo L, Brusaferro S, Busetti M, Calagreti G, Casini B, Cristina ML, Di Luzio R, Fiorio M, Formoso M, Liguori G, Martini E, Molino A, Mondello P, Mura I, Novati R, Orsi GB, Patroni A, Poli A, Privitera G, Ripabelli G, Rocchetti A, Rose F, Sarti M, Savini S, Silvestri A, Sodano L, Spagnolo AM, Tardivo S, Teti V, Torregrossa MV, Torri E, Veronesi L, Zarrilli R, Pacifico C, Goglio A, Moro M, Pasquarella C. Control and prevention measures for legionellosis in hospitals: A cross-sectional survey in Italy. Environ Res 2018; 166:55-60. [PMID: 29864633 DOI: 10.1016/j.envres.2018.05.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/09/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
Risk assessment, environmental monitoring, and the disinfection of water systems are the key elements in preventing legionellosis risk. The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine, and Public Health and the Italian Multidisciplinary Society for the Prevention of Health Care-Associated Infections carried out a national cross-sectional survey to investigate the measures taken to prevent and control legionellosis in Italian hospitals. A multiple-choice questionnaire was developed, comprising 71 questions regarding hospital location, general characteristics, clinical and environmental surveillance, and control and preventive measures for legionellosis in 2015. Overall, 739 hospitals were enrolled from February to June 2017, and 178 anonymous questionnaires were correctly completed and evaluated (response rate: 24.1%). The survey was conducted using the SurveyMonkey® platform, and the data were analyzed using Stata 12 software. Of the participating hospitals, 63.2% reported at least one case of legionellosis, of which 28.2% were of proven nosocomial origin. The highest case numbers were reported in the Northern Italy, in hospitals with a pavilion structure or cooling towers, and in hospitals with higher numbers of beds, wards and operating theaters. Laboratory diagnosis was performed using urinary antigen testing alone (31.9%), both urinary antigen testing and single antibody titer (17.8%), or with seroconversion also added (21.5%). Culture-based or molecular investigations were performed in 28.8% and 22.1% of the clinical specimens, respectively. The water systems were routinely tested for Legionella in 97.4% of the hospitals, 62% of which detected a positive result (> 1000 cfu/L). Legionella pneumophila serogroup 2-15 was the most frequently isolated species (58.4%). The most common control measures were the disinfection of the water system (73.7%), mostly through thermal shock (37.4%) and chlorine dioxide (34.4%), and the replacement (69.7%) or cleaning (70.4%) of faucets and showerheads. A dedicated multidisciplinary team was present in 52.8% of the hospitals, and 73% of the hospitals performed risk assessment. Targeted training courses were organized in 36.5% of the hospitals, involving nurses (30.7%), physicians (28.8%), biologists (21.5%), technicians (26.4%), and cleaners (11%). Control and prevention measures for legionellosis are present in Italian hospitals, but some critical aspects should be improved. More appropriate risk assessment is necessary, especially in large facilities with a high number of hospitalizations. Moreover, more sensitive diagnostic tests should be used, and dedicated training courses should be implemented.
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Affiliation(s)
- Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy.
| | - Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy
| | - Christian Napoli
- Department of Medical and S urgical Sciences and Translational Medicine, Sapienza University of Roma, Square A. Moro 5, 00185 Roma, Italy
| | - Giusy Diella
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy
| | - Serafina Rutigliano
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Str. S. Sofia, 87, Comparto 10 Edificio C, 95123 Catania, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milano, Str. Pascal 36, 20133 Milano, Italy
| | - Tatjana Baldovin
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Hygiene and Public Health Unit, Str. Loredan, 18.35131 Padova, Italy
| | - Francesco Bisetto
- Presidio Ospedaliero di Camposampiero, AULss6 Euganea Str. P. Cosma 1, 35012 Camposampiero, PD, Italy
| | - Luca Arnoldo
- Department of Medicine, University of Udine, Str. Colugna 50, 33100 Udine, Italy
| | - Silvio Brusaferro
- Department of Medicine, University of Udine, Str. Colugna 50, 33100 Udine, Italy
| | - Marina Busetti
- University Hospital ASUITS, Microbiology Unit, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Gioia Calagreti
- Hospital "Alto Tevere", AUSL Umbria 1, Città di Castello, PG, Italy
| | - Beatrice Casini
- Department of Translational Research, N.T.M.S. - Hygiene and Epidemiology Unit, University of Pisa, Str. S. Zeno 35-39, 56127 Pisa, Italy
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genova, Str. A. Pastore 1, 16132 Genova, Italy
| | | | | | - Maurizio Formoso
- Hospital "Miulli", Str. 127 km 4.1, Santeramo-Acquaviva delle Fonti, BA, Italy
| | - Giorgio Liguori
- Department of Movement Sciences and Wellbeing, University "Parthenope", Napoli, Italy
| | - Enrica Martini
- AOU "Ospedali Riuniti", Str. Conca, 71, 60126 Ancona, Italy
| | - Andrea Molino
- Hospital "Madonna delle Grazie", Contrada Cattedra Ambulante s.nc. 75100 Matera, Italy
| | | | - Ida Mura
- Department of Biomedical Science, University of Sassari, Sassari, Italy
| | | | - Giovanni Battista Orsi
- Department of Public Health and Infectious Disease, Sapienza University of Roma, Roma, Italy
| | - Andrea Patroni
- ASST Valcamonica, Str. Manzoni 142, 25040 Esine, BS, Italy
| | - Anna Poli
- Hospital "San Giovanni di Dio", Str. Torre Galli 3, 50143 Firenze, Italy
| | - Gaetano Privitera
- Department of Translational Research, N.T.M.S. - Hygiene and Epidemiology Unit, University of Pisa, Str. S. Zeno 35-39, 56127 Pisa, Italy
| | - Giancarlo Ripabelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Andrea Rocchetti
- ASO "SS. Antonio, Biagio and C. Arrigo", Str. Venezia 17, 15121 Alessandria, Italy
| | | | - Mario Sarti
- Hospital "OCSAE", Str. Giardini 1355, Baggiovara, MO, Italy
| | - Sandra Savini
- AOU "Ospedali Riuniti", Str. Conca, 71, 60126 Ancona, Italy
| | - Antonio Silvestri
- Hospital "San Camillo Forlanini", Circonvallazione Gianicolense 87, 00152 Roma, Italy
| | - Luisa Sodano
- Hospital "San Camillo Forlanini", Circonvallazione Gianicolense 87, 00152 Roma, Italy
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genova, Str. A. Pastore 1, 16132 Genova, Italy
| | - Stefano Tardivo
- Department of Diagnostic and Public Health, University of Verona, Str. Le Grazie 8, 37134 Verona, Italy
| | | | - Maria Valeria Torregrossa
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Str. Vespro, 133, 90127 Palermo, Italy
| | - Emanuele Torri
- Department of Health ans Social Policy, Str. Gilli 4, 38123 Trento, Italy
| | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma, Str. Volturno 39, Parma, Italy
| | - Raffaele Zarrilli
- Department of Public Health, University of Napoli "Federico II", Str. S. Pansini, 5, Napoli, Italy
| | - Claudia Pacifico
- Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Matteo Moro
- Hospital "San Raffaele", Str. Olgettina 60, 20132 Milano, Italy
| | - Cesira Pasquarella
- Department of Medicine and Surgery, University of Parma, Str. Volturno 39, Parma, Italy
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