Antimicrobial resistance represents a global health challenge, with Italy among the most affected countries in Europe. In response, the Veneto Region developed governance models to enhance antimicrobial stewardship (AMS) and infection prevention in both hospital and community settings. This study assessed the implementation of these models and explored strategies for improvement. A survey targeting hospital medical and district health management, hospital pharmacies, and primary care pharmaceutical departments was conducted to evaluate governance adherence, resource allocation, training, and reporting practices. Findings were analyzed by a focus group comprising regional experts, infectious disease specialists, microbiologists, and policymakers, which identified critical gaps and proposed actionable recommendations. Results revealed disparities in AMS implementation between hospital and community care, with key challenges including limited multidisciplinary collaboration, inconsistent resource distribution, and gaps in training. The focus group emphasized the need for stronger governance, standardized protocols, and improved communication to address these shortcomings. This study underscores significant gaps and opportunities within the Veneto Region’s healthcare system and provides a framework for enhancing AMS and infection prevention strategies, bridging the divide between hospital and community care to combat antimicrobial resistance effectively.

The recent increase in parvovirus B19 (B19V) infections across Europe has underscored the need for enhanced surveillance. In Italy, B19V surveillance is not mandated nationally. This ambispective (retrospective and prospective) study aimed to assess the epidemiological and clinical characteristics of the 2024 apparent surge in the Veneto Region by implementing mandatory disease notification starting in May 2024 and collecting clinical data on confirmed cases. During the surveillance period, 3156 B19V cases were reported, with 2.9% (93/3156) requiring hospitalisation (95% CI 2.4-3.5%). Children under 1 year of age exhibited the highest hospitalisation rate (29.0%), followed by adults aged 18-40 (17.5%). Infections disproportionately affected children aged 1-5 and 6-11, and the Granger causality test showed that an increase in cases among the 1-5-year-olds was predictive of subsequent rises in other age groups (p = 0.0086). Severe complications, including myocarditis, pericarditis, and miscarriage, were observed, and one death occurred following cardiac and neurological complications in a patient without prior risk factors. The presence of concurrent pathologies, particularly haematological disorders, was associated with increased disease severity. These findings highlight the importance of early warning when cases begin rising among preschool-aged children and underscore the need for improved B19V awareness, particularly in high-risk populations. Future efforts should evaluate the feasibility of implementing a systematic, potentially EU-wide, surveillance for B19V.

Background: Contact tracing (CT) is a primary means of controlling infectious diseases, such as coronavirus disease 2019 (COVID-19), especially in the early months of the pandemic. Objectives: This work is a systematic review of mathematical models used during the COVID-19 pandemic that explicitly parameterise CT as a potential mitigator of the effects of the pandemic. Methods: This review is registered in PROSPERO. A comprehensive literature search was conducted using the PubMed, EMBASE, Cochrane Library, CINAHL, and Scopus databases. Two reviewers independently selected the title/abstract, full text, data extraction, and risk of bias. Disagreements were resolved through discussion. The characteristics of the studies and mathematical models were collected from each study. Results: A total of 53 articles out of 2101 were included. The modelling of the COVID-19 pandemic was the main objective of 23 studies, while the remaining articles evaluated the forecast transmission of COVID-19. Most studies used compartmental models to simulate COVID-19 transmission (26, 49.1%), while others used agent-based (16, 34%), branching processes (5, 9.4%), or other mathematical models (6). Most studies applying compartmental models consider CT in a separate compartment. Quarantine and basic reproduction numbers were also considered in the models. The quality assessment scores ranged from 13 to 26 of 28. Conclusions: Despite the significant heterogeneity in the models and the assumptions on the relevant model parameters, this systematic review provides a comprehensive overview of the models proposed to evaluate the COVID-19 pandemic, including non-pharmaceutical public health interventions such as CT. Prospero Registration: CRD42022359060.

Background: Nonpharmaceutical public health interventions, such as contact tracing (CT), have been widely implemented worldwide to mitigate the spread of coronavirus disease 2019 (COVID-19). Objectives: This study investigated the association between CT activity and COVID-19 cases, as well as the impact of timely contact with positive cases on hospitalizations in the Veneto region in northeastern Italy. Methods: Data sources included a CT-focused questionnaire, regional daily CT activity data, and a regional database of daily COVID-19 cases, hospitalizations, and intensive care unit (ICU) admissions. Negative binomial regression models were used to assess associations between CT activity and the number of positive cases, the number of hospitalizations, the time to contact cases, the number of positive cases traced, and the number of CT operators. Different organizational models (OMs) were compared in terms of their effectiveness. Results: Hospitalization rates decreased by 54% when index cases were contacted within 0–1 days compared with a five-day delay in the first period. During periods of increasing case numbers, hospitalizations decreased to 8% for contact ranges of 0–1 and 2–4 days. The increase in CT activity showed a 60% increase in daily activity per 100 cases in the third period, excluding external CT activities. Conclusions: These results emphasize the critical role of prompt and effective CT in controlling the spread of infectious diseases and reducing the burden on health care systems. Further research is warranted to explore the potential benefits and limitations of different organizational models in the context of contact tracing and public health management, as well as in a cross-cultural comparison.

Introduction: Invasive bacterial diseases (IBDs) such as meningitis and sepsis are significant public health concerns, particularly in pediatric populations. This study analyzes the incidence, outcomes, and bacterial serotype distribution of pediatric IBDs in the Veneto Region over 17 years. Methods: An observational study was conducted using data (2007–2023) from the surveillance system of the Veneto Region, including microbiologically confirmed cases in individuals < 18 years. Differences by age groups and trends were statistically assessed. Results: A total of 535 pediatric IBD cases were reported, with Streptococcus pneumoniae (54.6%), Neisseria meningitidis (19.6%), and Streptococcus agalactiae (13.5%) being the most common pathogens. Haemophilus influenzae infections were more commonly represented in infants under 1 year (41.5%), whereas S. pneumoniae and N. meningitidis were more frequent in the 1–4-year age group (40.8% and 37.1%, respectively). Sepsis was the most common clinical presentation (57.2%), followed by meningitis (36.3%). Serotype analysis revealed that S. pneumoniae serotype 3 was the most prevalent, while serogroup B dominated N. meningitidis cases. Temporal trends generally showed a decline in cases until 2019, a drop during the COVID-19 pandemic, and a subsequent resurgence in 2022–2023. Conclusions: Our research underscores the value of evidence-based epidemiology through robust surveillance systems in tracking IBD trends and serotype shifts, essential for guiding vaccination strategies and public health interventions. These insights highlight the effectiveness of vaccination programs and the necessity of ongoing monitoring to inform public health policies. Improved data integration and completeness are recommended to enhance surveillance accuracy.

Background: Elderly individuals over 65, along with children under 5, are the most affected by invasive pneumococcal diseases (IPDs). Monitoring vaccination coverage and conducting surveillance are essential for guiding evidence-based prevention campaigns and public health measures. Methods: Since 2007, the Veneto Region has relied on three sources for surveillance of invasive bacterial infections, contributing to an increase in reported IPD cases. This study analyzed notifications related to individuals aged ≥65 years from 2007 to 2023. Results: A total of 1527 cases of IPDs in elderly individuals were reported between 2007 and 2023. The notification rate significantly increased from 5.61 to 14.63 per 100,000 inhabitants, despite underreporting during the COVID-19 pandemic. Cases associated with sepsis increased from 3.89 to 9.58 per 100,000, while notifications of meningitis and case fatality rates remained stable at 1.5 per 100,000 and 11.8%, respectively. Serotyping was not performed in 52% of the notifications. The most common serotypes were 3 (21.6%), 8 (11.1%), and 19A (5.0%), with fluctuations over time. There was a significant decline in serotypes covered by PCV7 and PCV13 and an increase in non-vaccine serotypes. Conclusions: The regional surveillance system allows for an increasingly comprehensive profile of the epidemiological landscape of IPDs in Veneto. However, the surveillance of pneumococcal infections still presents challenges. The currently available data are likely to be underestimated, mainly referring to the most severe cases, and the serotyping necessary to identify the etiological agent is still not often performed.

The recent increase in parvovirus B19 (B19V) infections across Europe has underscored the need for enhanced surveillance. In Italy, where B19V surveillance is not mandated nationally, this study aimed to assess the epidemiological and clinical characteristics of the outbreak in the Veneto Region by implementing mandatory disease notification since May 2024 and collecting clinical data on confirmed cases. The outbreak disproportionately affected young children, with the highest incidence in the 1-5 and 6-11 age groups. The increase in cases within the 1-5 year age group was predictive of an increase in cases in other age groups. Hospitalisation was required in a small percentage of cases, but severe complications, including myocarditis, pericarditis, and miscarriage, were observed, underscoring the potential severity of B19V infection. During the surveillance period, one death was also recorded following cardiac and neurological complications in a patient without prior risk factors. The presence of concurrent pathologies, particularly haematological disorders, was associated with increased disease severity. This study emphasises the critical need for improved awareness of B19V, particularly in high-risk populations, and highlights the importance of early warning when cases start rising among 1-5-year-olds. The feasibility of implementing a systematic and potentially EU-wide surveillance system for B19V should be assessed.

HPV is the most common cause of sexually-transmitted infections the world over. The aim of this study was to assess the impact of a healthcare quality improvement strategy designed to increase the rate of vaccination against HPV in women diagnosed with cervical lesions graded as CIN2 or higher (CIN2+) during routine screening. The Veneto Regional Health Service developed a 22-item questionnaire to measure the gap between ideal procedure and real practice regarding the offer of vaccination against HPV for women undergoing routine cervical screening. The questionnaire was administered to nine expert doctors, one at each of the region's Local Health Units (LHUs). An additional specific assessment concerned the quality of the related web pages available on the LHU websites. Strategies to close the gap between ideal procedure and real practice were decided collegially, and a checklist to support good practices was developed and shared with operators at the LHUs. Changes in practice were measured using data relating to women diagnosed with CIN2+ lesions extracted from the regional oncological screening database before and after the publication of a Regional Procedure on the topic. The LHUs differed considerably in how they managed each step, in terms of training for healthcare personnel, organization and assessment of the pathway from cervical screening to HPV vaccination, and in dedicated website communication. After implementing the quality improvement strategy, the proportion of women given a first dose of HPV vaccine within 3 months of being diagnosed with CIN2+ lesions at 1st-level screening rose to 50% (compared with 30.85% beforehand), and the median time elapsing between a diagnosis of CIN2+ lesion and a first dose of HPV vaccine dropped from 158 to 90 days. These findings underscore the importance of providing training to promote vaccination for general practitioners and other clinicians. The study also confirms the need for more efforts in communication to ensure that any citizen has the opportunity to access preventive healthcare.

Amyotrophic Lateral Sclerosis (ALS) is a rare neurogenerative disorder whose median survival ranges from 2 to 4 years after symptomatic onset. Therefore, the global Quality of Life (QoL) assessment in these patients should be carefully evaluated to guarantee an adequate care level, particularly during the COVID-19 pandemic period, given the increased social isolation and the pressure on healthcare services. Caregiving has been recognized as an important source of physical and psychological burden, with a possible QoL impairment. The purpose of this study was to evaluate the QoL of ALS patients and the burden of their caregivers across Sardinia, Italy. The ALS Specific QoL Instrument-Short Form (ALSSQOL-SF) and the Zarit Burden Inventory (ZBI) tools were used to assess patient's QoL and the burden on their caregivers, respectively. The questionnaires were supplemented with items specific for the COVID-19 period. Sixty-six family units of patients with advanced ALS were interviewed between June and August 2021 across Sardinia. Patients' psychological and social well-being were found to significantly affect the patients' QoL, regardless of their physical condition. In addition, the caregiver burden resulted as being inversely proportional to the patient's perceived QoL. Lack of adequate psychological support was reported among the caregivers during the emergency period. Providing adequate psychological and social support might be useful to improve QoL in middle and late stages of ALS patients and to decrease caregivers' perceived home care burden.

The assessment of human papillomavirus (HPV) genotype dynamics could support the adoption of more tailored preventive actions against cervical cancer. The aim of the study was to describe the prevalence of HPV infection, HPV genotype distribution, and the epidemiological characteristics of women with ASC-US cytology since the introduction of HPV-DNA testing in Sardinia (Italy), (March 2016–December 2020). Specimens were tested by RT-PCR for 14 high-risk HPV genotypes. A total of 1186 patients were enrolled, with a median (IQR) age of 41 (38–48) years. Of these women, 48.1% were positive for at least one HPV genotype; 311 (26.2%) women were vaccinated with a median (IQR) age of 38 (30/47) years. The percentage of prevalence of HPV-16, -31, -66, -56, and -51 was 36.3%, 18.7%, 11.9%, 11.4% and 10.7%, respectively. The highest prevalence of infection was found in women aged <41 years, and single women. Moreover, women aged >41 years (OR: 0.51, 95% CI: 0.31–0.86; p-value: 0.01), having parity (OR: 0.57, 95% CI: 0.34–0.96, p-value: 0.04), and higher educational level (OR: 0.39, 95% CI: 0.18–0.87; p-value: 0.02) were associated with a lower CIN2+ risk. We did not find a significant difference in terms of prevalence of HPV-16 infection between vaccinated and non-vaccinated (18.3% vs. 17.1%; p-value < 0.001). Our results support the adoption of nonavalent HPV-vaccine to prevent the most prevalent infections caused by HPV-16 and -31 genotypes and underscore the need of surveillance to implement tailored vaccination programs and preventive strategies.

The COVID-19 pandemic has massively affected healthcare systems globally, causing a possible reduction in attention to traditional infection prevention programs. The objective of this study was to estimate the prevalence of healthcare-associated infections (HAIs) and the use of antimicrobials in an Italian University Hospital and to investigate whether the intensification of hospital infection control measures during the COVID-19 pandemic has affected the prevalence of bacterial HAIs. A point prevalence survey was conducted according to the simplified ECDC protocol. The survey identified a local HAI prevalence of 9.0%, revealing an increase compared to pre-pandemic values (7.3%). The survey also identified an antimicrobial exposure of 40.8%, revealing a decrease in their use compared to the study carried out in the pre-pandemic era (44.6%). Among the organizational challenges experienced during the COVID-19 pandemic, despite the greater attention paid to infection prevention measures aimed at reducing SARS-CoV-2, many healthcare facilities had to contend with the controlled availability of personnel, physical space limitations and a large number of patients. Active surveillance in hospital wards and the consequent reporting by personnel specialized in infection control is fundamental for hospitals to recognize gaps in prevention and report any observed increases in HAIs.

The aim of the study is to evaluate the preparedness of retirement and nursing homes in the city of Sassari at the end of the first wave of the severe acute respiratory syndrome coronavirus 2 epidemic, first by investigating the risk perception of epidemic outbreaks by the facility managers and subsequently by carrying out a field assessment of these facilities. To perform the field assessment, a checklist developed by the CDC (Infection Prevention and Control Assessment Tool for Nursing Homes Preparing for COVID-19) and adapted to the Italian context was used. Fourteen facilities took part in the survey (87.5%). The application of good practices for each survey area was expressed as a percentage with the following median values: restriction policies (87.5%), staff training (53.8%), resident training (67.6%), availability of personal protective equipment (41.7%), infection control practices (73.5%) and communication (80%). Among the facilities, considerable variability was observed in these evaluation fields: only the restriction policies and communication activities were applied uniformly. A discrepancy was found between perceived risk and real danger in the facilities, requiring targeted communication actions. At present, it is necessary to promote a new approach based on the prediction of critical events, thereby providing the means to effectively address them.

In April 2019, a tuberculosis (TB) outbreak, likely triggered by re-activation of a highly contagious latent tuberculosis infection (LTBI) in a school teacher, was reported in a primary school in the Veneto Region (northeastern Italy). The infection, having probably been dormant for decades, rapidly spread further to two school teachers and up to 11 pupils, a total of 13 cases of active TB that received appropriate TB treatment. Ten out of the remaining 95 school staff members (10.5%) and 34/546 (6.2%) remaining school pupils tested positive on tuberculin skin test (TST). Moreover, 2% (2/97) of pupils attending the first year of junior secondary school within the same municipality during 2017/18 (having completed the above primary school) were also found positive on TST. Since none of 3 school teachers or 84 pupils who completed the last year of primary school in 2017 and attended the second year of a junior secondary school were found to be TST positive, the beginning of the outbreak was dated from January 2018 onwards. Therefore, active TB in the index case may have been potentially infectious and undiagnosed for about 14 months, leading to extensive exposure of close contacts, especially students (1). Anyone with recognized LTBI status – among school staff or pupils – was placed on prophylaxis with isoniazid for 6 months (1). TuBerCuLoSIS SurVeILLANCe IN SChooLS: heALTh ProTeCTIoN LAWS AND PoLICIeS

The aim of this work is to evaluate the attitudes, behaviours, and knowledge of health workers employed at an Italian University Hospital on the topic of vaccinations and in regard to flu vaccination. To this end, the study provided for the articulation of a computerised questionnaire on the digital platform EUSurvey which was administered online via e-mail to a sample of 457 health workers, in the period between November 2018 and March 2019. The data were subjected to descriptive and inferential statistical analysis. In particular, a logistic regression analysis was carried out in order to evaluate the relationship between the variables collected and the dichotomous outcome (vaccinated/unvaccinated subjects in the 2018–2019 season). The results, in line with what has been reported by the literature, highlighted that vaccine hesitancy is prevalent also among health workers. Furthermore, according to our study, only 30.6% of the health care workers had the flu vaccination. The survey points out the need to plan educational and informative interventions aimed at changing the attitudes, behaviours, and knowledge of health workers in the field of flu vaccination, for the purpose of protecting the health of healthcare personnel and their patients.

Risk perception has a significant impact on decisions people make when facing a threat: a mismatch between actual hazard and perceived risk can lead to inappropriate behaviours and suboptimal compliance to recommended public health measures. The present study was conducted in the aftermath of a tuberculosis (TB) outbreak that occurred in 2019 in a primary school in Italy. The aim was to evaluate the impact of communication measures implemented by local health authorities (including face-to-face meetings between LHAs and the local population, weekly press announcements, implementation of a telephone hotline and of an information desk, and social media communication), on risk perception among parents of schoolchildren and school staff, and to identify factors related to a change in risk perception before and after the said activities. An anonymous questionnaire was administered to parents of schoolchildren (n = 846) and to school staff (n = 70). Participants were asked about the level of risk they had perceived at two distinct times: when they first became aware of the outbreak and following implementation of communication activities. A significant reduction of perceived risk was found in both groups (p < 0.001) following the communication activities. The largest reduction was found among participants who reported having appreciated the meetings with the LHA healthcare staff. Our findings suggest that keeping an open approach, explaining the actual threat to the population and adapting communication to different listening skills, are essential for health authorities to successfully manage a public health emergency.

Italy is a low-incidence country for tuberculosis (TB). We describe a TB outbreak in a primary school in north-eastern Italy, involving 10 cases of active pulmonary disease and 42 cases of latent infection. The index case was detected in March 2019, while the primary case, an Italian-born schoolteacher, was likely infectious since January 2018. Administration of a pre-employment health questionnaire to school staff with sustained contact with children should be considered in low-incidence countries.

Glyphosate is the best-selling herbicide in the world and in 2015 the International Agency for Research on Cancer listed it among the &quot;probable carcinogens for humans&quot;, opening a scientific debate that is still going on. On these premises, in 2016, extraordinary samplings of glyphosate, its metabolite AMPA, and a similar compound, ammonium glufosinate, were carried out in 12 wells of the water network intended for domestic consumption in the territory of the Local Health Unit 2 - District of Pieve di Soligo, Province of Treviso, Veneto region, Italy. The area includes 13 municipalities at high-intensity "Prosecco d.o.c.g." wine production. Traces of glyphosate (maximum reached 0.08 µg/L) and AMPA (maximum reached 0.25 µg/L, beyond the legal limit of 0.1 µg/L for drinking water) were detected in 2 wells supplying an urban area. No samples contained traces of ammonium glufosinate. Following these findings, an inter-municipal order to suspend the use of glyphosate was introduced and then entered definitively in the rural police regulation concerning all the municipalities in the Prosecco d.o.c.g. area, which led to the elimination of glyphosate and AMPA also in the initially contaminated wells. The case shows that high-consumption herbicides can reach the drinking water network of a city surrounded by territories with high agricultural activity. Moreover, the combined intervention of the institutions was fundamental to eliminate a &quot;probable carcinogen&quot; from the urban drinking water and to promote the abandonment of potentially harmful agricultural practices in favor of solutions with reduced environmental and health impact.