Flu vaccination coverage in healthcare workers during a 3-year period in the context of the pandemic

Background

Vaccination of healthcare workers (HCWs) against seasonal influenza is considered the most effective way to protect HCWs and maintain essential healthcare services during influenza epidemics. With the present study we aimed to evaluate the efficacy of measures implemented during the three flu campaigns of 2018/19, 2019/20 and 2020/21 in a university hospital in Pisa, Italy, through the assessment of vaccination coverage (VC) in HCWs and to assess attitudes toward flu vaccination.

Methods

Flu VC was stratified according to sex, age, job and vaccination status for each season and the association between each variable and vaccination status was explored. In 2020, a survey collecting data on knowledge and attitudes on flu vaccination was distributed.

Results

Starting from the 2018/19 campaign, an increasing flu VC rate was registered: contained in 2019/20 (from 11.6% to 14.3%, Δ%=23.1) and significant (VC = 39.6%, Δ%=177.6) in 2020/21 as compared with the previous year. Physicians were the professionals most willing to get vaccinated during all seasons. Considering age the situation changed greatly over the study period, with VC rising in 2020/21 in those age groups marked by low VC in previous years (<30 and 41-50 years old, Δ%=293). Having been vaccinated in the previous year represented the most important variable to predict likelihood of accepting flu jab. However, while previously vaccinated HCWs were 13 times more likely to get the flu jab in 2019/20 compared with the others; in 2020/21 they were only 3 times. Only half of HCWS considered themselves at higher risk of contracting influenza compared to the general population, while 71% totally agreed that receiving the flu jab in 2020/21 was more important than the previous years due to COVID.

Conclusions

A significant increase in VC was observed in 2020/21, especially among those sub-groups with consistently lower uptake in previous years, due to the COVID pandemic that positively influenced vaccination uptake.

Key messages

• This study evaluates the impact of subsequent flu vaccination campaigns implemented in a large university hospital in Italy through the assessment of flu VC among HCWs.

• A significant increase in flu VC among HCWs was observed in 2020/21, especially in those categories characterized by lower VC rates in the previous years, more likely due to the COVID-19 pandemic.

COVID-19 vaccination in prison settings: a model to design tailored vaccine delivery strategies

Introduction

Vaccinations are one of the most powerful preventive tools discovered by modern medicine. Although expanded programmes of immunization are well established in EU/EEA, significant immunity gaps and suboptimal coverage are registered among specific populations, including people living in prisons (PLP). PLP are also at increased risk to vaccine-preventable diseases (VPD) with potential outbreak in prison, e.g. flu, COVID-19, as well as other VPDs such as HBV. The EU-funded project RISE-Vac, aimed at collecting models of care developed during the pandemic to design tailored vaccine delivery strategies that could be extended beyond the sole COVID-19 vaccine.

Methods

Through a survey to healthcare staff working in prisons in six countries of the EU/EEA (Cyprus, France, Germany, Italy, Moldova, UK) we collected information on the implementation of COVID-19 vaccination program. The following areas were investigated: challenges & barriers encountered, workload distribution, education & training activities for prison staff and PLP, referral strategies after release, immunization information system.

Results

The respondents reported that in prisons COVID-19 programs have been implemented efficiently. Strategies for optimal management of the vaccination campaign included: week-day dedicated to vaccination services when vaccines were delivered and immediately administered to overcome cold chain challenges; new staff recruitment & task shifting; administration of booster doses within prison premises for released individuals; distribution of informational material both to PLP & prison staff.

Conclusions

Our results show that universal immunisation campaigns are feasible, acceptable and effective in places of detention when there is commitment to implementing them. Evidence from the pandemic situation may inform future provision of expanded immunization programmes.

Viral hepatitis micro-elimination: models of care and barriers to implementation in 5 EU/EEA prisons

Introduction

Coverage of essential prevention and control services and adequate monitoring schemes for viral hepatitis are often suboptimal in prison settings. Yet, evidence shows that targeted interventions are feasible and effective in reducing viral hepatitis burden and decreasing virus circulation among people living in prison and the community at large. To promote transferability and improvement of prison health quality in EU/EEA the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) will identify and disseminate models of care for viral hepatitis elimination in prisons.

Methods

The models of care were gathered using a data collection tool that has been designed for this purpose based on the literature review and agreed with an expert advisory group. Based on the results of the data collection, a survey for healthcare staff working in 5 selected prison institutions in the EU/EEA has been developed.

Results

The following models of care were collected: HCV micro-elimination in prison; transitional care for HCV treatment or HBV prevention/treatment; HCV or HBV care services tailored to women living in prison; HBV or HAV/HBV vaccination in prison settings. Harm reduction and drug treatment services in the prison are essential at all steps of the prevention and continuum of care. Among barriers identified were: engagement of people living in prison and prison governance structure, availability of infrastructural and human resources, daily prison organisation, inter-sectorial collaboration within prison and between prison and community services, training for prison staff and lack of systematic monitoring.

Conclusions

Evidence of effective and acceptable interventions in prison to prevent and control viral hepatitis is essential to foster inclusion of prison setting within national elimination programmes. Intra-EU benchmarking may help promote awareness, to allocate adequate resources, monitor of impact and ultimately the achievement of the elimination goal.

Overview of availability of harm reduction interventions in European prisons

Introduction

Prisons are high-risk environments for the transmission of drug related infections, due to over-incarceration of people who inject drugs; often inadequate healthcare, substandard prison conditions; and others. An overview of the availability and coverage of prison-based harm reduction interventions in Europe is presented.

Methods

National Focal Points of the EMCDDA (30) collected 2019 data, which were integrated with findings from the European funded project HA-REACT (Joint Action on HIV and Co-infection Prevention and Harm Reduction).

Results

Prison based harm reduction interventions are available in European countries, but only few of them are available in most countries and often with a low coverage (e.g. less than 10% of prison population in Opioid Substitution Treatment (OST) in most countries). Interventions available in most countries (20 or more) include: HIV, HBV, HCV testing (29), OST continued from community (29), Referral to HIV treatment upon release (28), HIV treatment (27), Referral to HCV treatment upon release (25), HCV antiviral treatment (25), Testing for TB (23), HBV antiviral therapy (25), OST initiated in prison (22), Treatment for TB (21), Vaccination for HBV (20). Interventions available in 10 to 19 countries are: condom distribution (19), OST (re)initiated before release (17), prison/community guidelines for implementation of OST (13). Interventions provided in < 10 countries include: distribution of disinfectant (9), condom with lubricant (9), take-home naloxone (5), needles and syringes programs (3).

Conclusions

Compared to the community, the availability and coverage of harm reduction interventions in European prisons are limited and large information gaps exist. Scaling up harm reduction in prison can achieve important individual and public-health benefits.

An integrated hospital-district evaluation for communicable diseases in low/middle-income countries

Background

The last two decades saw an extensive effort to design and implement integrated and multidimensional healthcare evaluation systems in high-income countries. However, in low/middle-income countries, few experiences of such systems implementation have been reported in the scientific literature. We developed and piloted an innovative tool to assess the performance of health services provision for communicable diseases in three African countries.

Methods

A total of 42 indicators, 14 per each communicable disease care pathway (Tuberculosis, Gastroenteritis, and HIV/AIDS), were developed. A sub-set of 23 indicators was included in the evaluation process. The indicators assessed four care phases: prevention, diagnosis, treatment, and outcome. All indicators were calculated for the period 2017-2019, while performance evaluation was performed for 2019. The analysis involved four health districts and their relative hospitals in Ethiopia, Tanzania, and Uganda.

Results

Substantial variability was observed over time and across the four different districts. In the TB pathway, the majority of indicators scored below the standards and below-average performance was mainly reported for prevention and diagnosis phases. Along the Gastroenteritis pathway, excellent performance was instead evaluated for most indicators and the highest scores were reported in prevention and treatment phases. The HIV/AIDS pathway indicators related to screening and outcome phases were below the average score, while good or excellent performance was registered within the treatment phase.

Conclusions

The bottom-up approach and stakeholders’ engagement increased local ownership of the process and the likelihood that findings will inform health services performance and quality of care. Despite the intrinsic limitations of data sources, this framework may contribute to promoting good governance, performance evaluation and accountability in settings characterised by multiple healthcare service providers.

Key messages

• A successful experience in developing and implementing a communicable diseases performance evaluation systems in three sub-Saharan African countries using a bottom-up approach.

• The communicable diseases performance evaluation tool helped the data sharing between local healthcare providers and the development of competencies in data collection, analysis and interpretation.

Prevalence of injected drug use and access to OAT in prison: survey in 7 EU countries, 2014-2018

Background

People in prison report high rates of drug use and drug-related problems and people who use or inject drugs (PWUD) have higher rates of offending and an increased likelihood of spending part of their lives in prison. They represent a vulnerable population with high burden of diseases, socio-economic disadvantages and limited access to healthcare. In this study, we aimed to describe the lifetime prevalence (LTP) of heroin use, injected drug use and opioid agonist therapy (OAT) among people living in prison.

Methods

Individual data collection was carried out in seven European countries (Czech Republic, Latvia, Lithuania, Poland, Portugal, Slovenia, Spain) between 2014 and 2018 with a model European Questionnaire on Drug use among people in Prison. Risk factors analysis was carried out using multivariate logistic regression model.

Results

The analysis of EQDP data found that the LTP of heroin use was overall 22.4% (ranged from 7.3% in Poland to 27.5% in Spain). Female, recidivist offenders, individuals aged below 44 and with an history of mental health condition had a higher likelihood of being heroin user (p-value<0.05). The LTP of injected drug use was overall 20.6%(2176/10,587), while the prevalence of injected drug use in prison was 8.1%(745/9273) (with higher prevalence in countries that did not allow OAT initiation in prison: 17.5% in Latvia, 22.1% in Lithuania and 26.7% in Czech Republic). Among those who used heroin, 44.5%(772/1735) had access to OAT and among them 95.8(566/591) had access to OAT in prison.

Conclusions

Despite the heterogeneity of the results, there is a clear evidence that people in prison have a high prevalence of heroin and injected drug use. Prisons are an important point of access to OAT, and where treatment is available there is a reduction in risk behaviour. It is also important to implement tailored preventive interventions among vulnerable social groups at the community level.

Key messages

• People in prison in Europe have a high prevalence of heroin and injected drug use. Prisons can represent a point of access to integrated prison-community healthcare and social services for PWUD.

• In order to plan adequate healthcare interventions, there is an urgent need to assess and monitor the prevalence of drug use also in other European countries.

Risk of Sars-CoV-2 infection and disease severity in people at socioeconomic disadvantage in Italy

Background

Evidence accumulated in the past months indicating that COVID-19 affects people at socioeconomic (SE) disadvantage more strongly. This is embodied by the COVID-19 syndemic concept, i.e., the biological, economic, and social interactions between non-communicable diseases and COVID-19 increase a person's susceptibility to infection and worse health outcomes. Here, we explored the relationship among the SE position and the risk of Sars-CoV-2 infection and disease severity in Tuscany and Apulia, two Italian regions, during the 1st(Feb-Jun2020) and 2nd(Sep-Dec2020) epidemic waves.

Methods

We included all individuals tested (only for Apulia) and/or resulted positive for SARS-CoV2(for Tuscany and Apulia) and reported to regional surveillance system. We linked surveillance data with the deprivation index (DI)(1-5 scale; DI = 5 highest deprivation) of the area of living. We calculated the relative risk (RR) of acquiring Sars-CoV-2, COVID-19-related hospitalization, and death of deprived individuals compared with people in the highest SEP-we adjusted for gender and age.

Results

A total of 159507 (82897 F; 76610 M) individuals with prior or current Sars-CoV-2 infection were included in our study, 71320 from Apulia and 88187 from Tuscany. For people aged over 30, and with a DI > 2, the RR of acquiring the infection increased for individuals with higher DI. The RR of being hospitalized and of death, were significantly higher for people over 30 with DI = 5. In Apulia, test positivity rate was comparable across all population groups during the 1stwave, while it increased among individuals with higher DI during the 2ndwave.

Conclusions

According to our results, SE disadvantage is associated with an increased risk of acquiring Sars-CoV-2, and to suffer from severe outcomes when infected. Based on available data, diagnostic test access was more equitable during 1stepidemic wave. This study calls for targeted health policies and actions to protect those with the greatest SE vulnerability.

Key messages

Available Italian data, indicate that higher socioeconomic disadvantage is associated with an increased risk of acquiring Sars-CoV-2, and to suffer from severe outcomes when infected. Our study highlights the importance of adopting targeted health policies and action to protect those with the greatest socioeconomic vulnerability and enhance equity.

Impact of COVID-19 epidemic on Lombardy’s prisons (Italy): transmission and measure of prevention

Background

Early on in the COVID-19 pandemic, scientific community highlighted the potential risk of epidemics occurring inside prisons. Consequently, specific operational guidelines were promptly released and stringent containment measures quickly implemented, including access restriction to essential staff only. During the 2nd epidemic wave prevention strategies were gradually relaxed, visitors were readmitted and people in prison (PiP) activities were repristinated. Here, we describe the spread of COVID-19 in 18 detention facilities in Lombardy region, Italy, during the 1st(Mar-Jul 2020) and 2nd(Oct 2020-Feb 2021) waves and the impact of prevention and control measures implemented in prison.

Methods

We conducted a descriptive retrospective analysis of cases' distribution. Moreover, a comparison among the epidemic burden affecting POs and PiP and a correlation analysis between the number of cases occurred and prevention measures implemented were carried out.

Results

Our population consists of a monthly average of 2269 prison officers (POs) and 7604 PiP. POs were at higher risk of contracting COVID-19 during both waves. Occurrence of cases among PiP was temporally associated with cases among POs. There was heterogeneity in the size of outbreaks across different prison facilities. During the second wave, COVID-19 spread more widely in prison both among POs (2ndwave attack rate (AR) per 1000 individuals: 27.2; monthly range (MR): 0.9-64.5 vs 1stwave AR 2.4; MR: 0.0-12.1) and PiP (2ndwave AR: 23.5; MR: 11.6-50.8 vs 1stwave AR 1.6; MR: 0-5.2).

Conclusions

Prevention and control measures adopted timely during the first wave were effective to limit Sars-CoV-2 spread within prison facilities. According to our findings, POs and PiP are population groups at high risk for acquiring and transmitting COVID-19 and should be prioritized for testing, active case finding and vaccination. This study highlights the importance of including prison settings within emergency preparedness plans.

Key messages

Stringent prevention and control measures when adopted timely were effective to protect detention facilities from Sars-CoV-2 spread. Our study, reporting the burden of COVID-19 epidemic experienced by prison of Lombardy, Italy, highlights the importance of including prison settings within emergency preparedness plans.

Evaluation of the direct and indirect impact of the COVID-19 pandemic in Tuscan nursing homes

Background

Residents in long-term care facilities (LTCFs) are at higher risk of contracting and developing serious outcomes from COVID-19. Despite the media attention and the specific survey launched by the Istituto Superiore di Sanità, official data on Italian LTCFs are scarce. The objective of our study was to provide an estimate of the direct and indirect impact of COVID-19 in Tuscan LTCFs by assessing the rate of hospital admissions and the overall mortality rate among LTCF residents in 2020, comparing them with those observed in the period 2018-2019.

Methods

For the analysis two regional administrative data flows were linked. The first one providing data on the number of LTCFs residents - and deaths - affiliated with the regional health system, while the second on hospital discharges. The monthly hospitalization and mortality rates for 2020 were compared with those of the two previous years.

Results

The number of residents in LTCFs decreased significantly (-10.4%) and consistently in 2020 compared to the average of the previous two years. The rate of total admissions decreased slightly in 2020 (32.5%, -8.2% compared to 2018/19). However, excluding admissions due to COVID-19, the reduction was more pronounced (-21.9%), with large monthly variations (-33% and -43% in March and November 2020) statistically significant (RR2020/2018-19=0.66 and 0.57; 95%CI: 0.57-0.77; 0.48-0.68). A total of 581 admissions for COVID-19 occurred in 2020, with a monthly average of 0.6% and two peaks observed in April and November (1.86%; 1.82%). The overall mortality rate increased by 31% (2018/19= 18.6%; 2020= 24.4%), with a maximum (+201%) in November 2020 (RR2020/2018-19=3.01; 95%CI: 2.5-3.56).

Conclusions

The impact of the pandemic on Tuscan LTCFs in terms of deaths and patient care by hospitals has been considerable, with the greatest reduction in hospital admissions occurring mostly in the months characterised by the highest mortality rate and admissions for COVID-19.

Key messages

The direct and indirect impact of the pandemic on Tuscan LTCFs has been considerable, probably due to the reorganisation of LTCF services and limited coordination with hospital health care. The greatest reduction in hospital admissions, especially those not COVID-related, occurred mostly during the months characterised by the highest mortality rate and admissions for COVID-19.

Heart involvement in type 1 and type 2 myotonic dystrophy. Insights from a 10-year follow-up study

Background and aim

Myotonic Dystrophy (MD) is the most common inherited muscular dystrophy of the adult. Cardiac manifestation, including arrhythmias and conduction disorders, contributes significantly to the morbidity and mortality of the disease. The transition from a subclinical form of cardiac involvement to potentially life-threating manifestations is highly variable and not yet entirely understood. Aim of this work is to evaluate whether PQ interval (PQi) prolongation could be a reliable marker to predict left and right ventricle impairment and the necessity of a stricter monitoring.

Methods

In this retrospective cohort study, we selected all consecutive patients with a confirmed diagnosis of MD (type 1 and type 2) referred to our Centre. We performed clinical, laboratoristic and instrumental assessments (every 3, 6 or 12 months), tailored on each patient's features. Every patient was treated according to the latest guidelines for pharmacological and device therapy. ECG (recorded at 25 and 50 mm/sec), 24h ECG Holter and transthoracic echocardiography were performed at least yearly. Cardiac Magnetic Resonance was requested to better stratify intermediate risk patients to implantable device therapy.

Results

A total of 72 patients (age 48±15 years, 39% female) were included in the analysis. Patients with MD type 1 and type 2 were referred to our Centre after a mean period of 12 years (SD ±8 years) from initial diagnosis. After a mean follow-up of 5 years (±4 years), 8 patients died (mean age at death: 60±12.4 years), all of them for respiratory insufficiency. We evaluated PQ interval (PQi) evolution and type I AVB onset. No statistically significant differences emerged when stratifying for type I AVB. Nevertheless, a PQi increase of more than 20 ms during the follow-up (even if PQ <200 ms) is significantly associated with lower values of TAPSE and greater LVEDD, while no differences emerged for LVEF, dyastolic function and other echocardiographic parameters. Moreover, the evolution of PQ interval is associated with an increasing number of supraventricular arrhythmias and a worse prognosis (shorter interval from first cardiac symptom to death, p 0.025), despite optimal medical therapy.

Conclusions

Although relatively rare, MD is a challenge for present Cardiologists. How and when to treat those patients is not codified in guidelines or consensus papers. This study suggests PQi variation as a proxy for critical evolution of MD cardiac involvement. ECG and its modification during lifetime seem pivotal for these patients' care, qualifying as a red flag for stringent follow-up. Further evidences, on larger cohorts, are needed to validate these findings.

Funding Acknowledgement

Type of funding source: None

Knowledge, attitudes and behaviours towards vaccination: a survey of university students in Europe

Background

Immunisation programs are still facing substantial challenges in achieving target coverage rates. This has been attributed to the growing negative individual vaccination attitudes and behaviours. Most of the current studies assessing vaccination knowledge, attitude and beliefs targets adults. However, young people represent future parents and health care professionals. The objective of this study was to investigate vaccination knowledge attitudes and behaviours among university medical and non-medical students in Europe.

Methods

We performed a cross-sectional online survey between April and July 2018. The study participants were students attending different faculties at the University of Antwerp, Belgium and the University of Pisa, Italy. We described sample characteristics. The effect of risk factors was tested with univariate and multivariate logistic regressions.

Results

A total of 2079 participants completed the survey including 873 medical students and 1206 from other faculties. The average of vaccination knowledge, attitudes, and confidence was respectively 5.51 (SD: 1.41), 4.66 (SD: 0.14) and 5.28 (SD: 0.57) on the 6-points scale. Our respondents demonstrated a high level of awareness with respect to their vaccination history. In total, 67.7% (n = 1407) reported to have received at least one vaccine in the previous five years; only 6.0% (n = 35) did not receive any vaccine in the previous 10 years. According to logistic regression analysis Italian students had significantly higher knowledge, attitude and confidence scores than Belgium respondents. Students of medicine scored significantly higher compared to non-medical students.

Conclusions

In order to reduce the gaps in vaccinations knowledge between non-medical and medical students we should plan educational interventions. In this way the number of future sceptical parents could be decreased. Further studies are required to explain the differences between countries.

Key messages

Young adults are the parents and the health care professionals of the future, for this reason their vaccination knowledge attitudes and behaviours should be carefully monitored. European non-medical students have lower vaccinations knowledge, attitudes and confidence compared with medical student. In order to fill these gaps, we should plan educational interventions.

Migration and infectious disease risk: knowledge and perception among European students

Background

In the past years migration has increasingly affected the European continent. The concerns of the local population about infection spread by migrants may increase unjustified stigma. Literature has shown that stigma is a determinant of health. The aim of our study was to assess the knowledge and risk perception of infectious disease introduced by migration.

Methods

Between January and February 2020 we conducted an online survey in Italian and Spanish University students. We collected data on demographics, perception and knowledge of transmission of infectious diseases introduced by migration. We performed a descriptive and a risk factors analysis to assess correlation between our variables.

Results

We collected 1397 answers: 1022(73.16%) from Italian students (F:668/1022, M:341/1022, others:13/1022) and 375(26.84%) from Spanish students(F:253/375,M:119/375, others:3/375) The median age was 24 for Italy and 22 for Spain. In Italy and Spain, respectively, 353/1022(34,54%), 145/375(38,67%) students were from the healthcare area, 316/1022(30,92%), 74/375(19,73%) the scientific area, 349/1022(34,15%), 108/375(28,80%) the non-scientific area and 4/1022(0,39%), 48/375(12,80%) from others area. We found a statistically significant correlation between the knowledge of infectious diseases and the perception of the infectious risk associated with migration. This correlation was not confirmed for the area of study. Healthcare students had the best levels of knowledge and perception of the migratory phenomenon, but the higher perception of infectious risk.

Exposure to the news was associated with the worst perception of the migratory phenomenon and the infectious risk (p < 0.001).

Conclusions

Our study showed that students in the health area had the highest risk perception of infectious diseases. Therefore, the introduction of the course on migration medicine and the increase of practical training could help to reduce the altered risk perception of infectious diseases.

Key messages

The introduction of the course on migration medicine and the increase of practical training could help to reduce the altered risk perception of infectious diseases in healthcare students. Exposure to the news has a negative effect on the perception of the migratory phenomenon and the ìnfectious disease.

Feasibility of HCV micro-elimination: HCV test and treatment in two harm reduction services in Milan

Background

Most of Harm Reduction Service (HRS) users represent a crucial high-risk population for blood borne infections, including HCV. With the advent of new direct antiviral agents (DAAs), HCV micro-elimination in this setting has become feasible. We evaluated HCV treatment cascade in two HRSs located in Milan.

Methods

We collected data on demographics, substance abuse history, HIV prevalence, HCV prevalence, testing and treatment on all register HRS users on 1 January 2019. Data collection was closed on 1 January 2020.

Results

A total of 881 HRS users (732M,149F) were included (median age: 45). The majority was addicted to heroin 67.5% (595), 24.1%(212) to cocaine, 5.3%(47) to THC and 3.1%(27) to other substances. The 28.0%(247/881) reported current or prior judiciary problems, 168/881(19.1%) were under psychiatric treatment. HCV serological screening (HCVAb) was performed for 587/881(66.7%), 113/881(12.8%) were in process, 2/881(0.2%) refused, 179/881(20.3%) were not HRS user anymore. 364/587(62%) resulted HCVAb positive, of whom 288(79.1%) were tested for HCV RNA. Among them 123/324(37.9%) were positive, 165/324(50.9%) were negative. Among HCVAb positive, 116/364(31.9%) were tested for HIV and 92(79.3%) resulted HIV positive. Among HCV RNA positive 92/123(74.8%) were initiated on DAAs treatment. Compliance to treatment was high; one treatment failure was registered. Individuals tested for HCV and HCVAb positive people had an average age significantly higher than the individuals not tested and HCVAb negative people (p < 0.001). Heroin user had a higher likelihood of being tested both for HCVAb and for HCV RNA and of being positive to the HCVAb test (p < 0.001).

Conclusions

Our study demonstrate that it is feasible to achieve good efficacy and compliance for HCV treatment among people who use drugs when decentralising treatment to HRS. To achieve the viral hepatitis elimination agenda goals, HRS-based model of treatment provision needs to be implemented at larger scale.

Key messages

Decentralising HCV test and treatment to harm reduction services is an effective strategy to achieve HCV micro-elimination among people who use drugs. Young people and people who are addicted to other substance than heroin resulted more difficult to link to HCV care through the harm reduction services. They require tailored intervention.

Apremilast as a target therapy for nail psoriasis: a real-life observational study proving its efficacy in restoring the nail unit

PURPOSE

Psoriasis, Psoriatic Arthritis and Nail psoriasis are chronic diseases that share a common underlying etiology of immunity dysregulation, enhanced activation of inflammatory pathways and remitting-relapsing course. Although nails represent a small percentage of the body surface involvement of this site can lead to impaired quality of life, severe discomfort and even result in permanent disability. Current therapeutic options for nail psoriasis include a variety of topical and systemic treatments although they are often reported as unsatisfactory from patients either due to their poor effectiveness or disturbing side effects. Recently small molecule drugs such as the PDE4 inhibitors were introduced in clinical practice and specifically apremilast has shown to be an effective new treatment option for psoriasis and psoriatic arthritis. Considering either the specific mechanism of action of apremilast, we performed a real-life observational study of 24 weeks assessing apremilast role in nail psoriasis.

MATHERIALS AND METHODS

Patients received apremilast 30mg bid, orally. Safety and efficacy were assessed at weeks 0, 4, 8, 12 and 24 using Dermatologic Life Quality Index (DLQI) and Nail Area Psoriasis Severity Index (NAPSI). At T0 we took a nail sample to investigate the presence of onychomycosis. Culture tests were performed in all the patients to search for fungi.

RESULTS

We recruited a total of 15 patients with nail psoriasis. The analysis of variance (one-way ANOVA) showed the following results: DLQI (F.15.7; p-value < .00001) and NAPSI (F.9.4; p-value < .00001). Three patients (20%) presented also onychomycoses at the beginning of the treatment.

CONCLUSIONS

Apremilast showed fast and sustained improvement of nail psoriasis over time and a complete resolution of life quality impairment due to the disease.

A clinical case of severe disease burden: an erythrodermic psoriatic patient treated with secukinumab

Erythrodermic psoriasis is a severe variant of psoriasis characterized by prominent erythema, affecting the entire body surface. Management of erythrodermic psoriasis is difficult, not standardized, and often ineffective. As clinical studies are lacking, reporting of clinical experience with secukinumab may help to gather insight in this field. Here, we describe the case of a 55-year-old man, with a 10-year history of moderate-to-severe plaque psoriasis. He presents a flare of erythroderma involving approximately 90% of his body surface area and a Psoriasis Area and Severity Index score of 42, with an important impact on his quality of life (DLQI score was 20.0; Skindex-29 score was 67.2). The patient presented also alexithymic features. Due to severity of clinical features and poor quality of life, the patient started secukinumab treatment; we observed a striking and rapid response to therapy with an excellent safety profile and a satisfactory compliance. Furthermore, therapy with secukinumab considerably enhanced patient's quality of life. Although further studies are needed to better understand the role of the IL-23/Th17 pathway, secukinumab can be an effective therapeutic option for patients affected by erythrodermic psoriasis.

Tdap vaccination during pregnancy to protect newborns from pertussis infection

BACKGROUND

Nowadays whooping cough (pertussis) represents one of the most prevalent vaccine-preventable diseases in Western countries; even more, it is currently on rise. In many countries, the use of acellular pertussis adult vaccine in combination with tetanus and diphtheria toxoids (Tdap) is recommended for women during pregnancy to protect newborns in the first months of life, when they are too young to be vaccinated. In Italy, vaccination of women during the third trimester of pregnancy is included in the national immunization programme (PNPV 2017-2019), though up to now, this vaccination strategy has not been efficiently implemented.

OBJECTIVE

In view of the public health importance of pertussis, particularly in young infants, we undertook this review to summarise the existing evidence on immunogenicity, effectiveness, safety and uptake of pertussis vaccine in expectant mothers to protect newborns from pertussis.

CONCLUSION

There is an increasing evidence that supports the safety, immunogenicity and effectiveness of Triaxis® e Boostrix® pertussis vaccination during pregnancy to protect infants before they receive their primary immunisations. In particular, both vaccines showed 90% effectiveness in the reduction of pertussis disease and hospitalization in newborns, with 95% effectiveness in the reduction of deaths. In Italy, the implementation of antenatal vaccination against pertussis is needed to narrow the gap between the recommendation of the PNPV and the prevention strategies actually offered by the public health system. To reach a good level of vaccine coverage, providers' recommendations are critical. Hence, extensive education of vaccine givers and all primary and secondary healthcare professionals who have any contact with pregnant women is needed.