Danilo Cereda

Background: In late winter of 2020, the first locally transmitted outbreak of COVID-19 in Europe was reported in Lombardy, Italy. This study provides a comprehensive analysis of the epidemic’s trajectory in this heavily impacted region from March 2020 to the end of 2022. Methods: We conducted a cohort study utilizing anonymized data from Lombardy’s eight local public health authorities (LPHAs). The dataset included all individuals registered with the Regional Health Service as of January 2020, with monthly data aggregated by sex, age, country of origin, municipality or ZIP area, and comorbidities. SARS-CoV-2 lineage data from the regional repository allowed us to segment the study period into four sub-periods by predominant viral lineages. We report the temporal trends and geographical distribution of three outcomes (COVID-19 incidence, hospital admissions, and mortality) as well as COVID-19 test positivity rates and vaccination coverage across LPHAs and Local Health Districts (LHDs). Multivariable regression models were employed to identify key risk factors for COVID-19 incidence and mortality in each of the four sub-periods. Results: We describe the impact of the COVID-19 pandemic in a population of over 10 million people, of whom 45% were aged ≥ 50 years and 22% had a history of cardiac diseases. The outbreak was concentrated, in the early phases, in a few LHDs, none of which had large cities. As soon as the SARS-CoV-2 transmission increased in the population, hospital admissions and mortality decreased over time, especially for areas impacted early. Our results confirm the role of age and neurologic and renal comorbidities, as well as geographical location, hinting at the impact of local epidemic dynamics and health system factors on both outcomes. Conclusions: Our findings provide essential insights into the dynamics of COVID-19 in one of Europe’s earliest and most severely affected regions, contributing valuable evidence to the global understanding of pandemic management and public health responses.

Background: In the context of a multi-stakeholder program promoted by Regione Lombardia in collaboration with Fondazione The Bridge and the University of Pavia, the present study investigates the organization and availability of hospital-based vaccination services for high-risk patients. Framing hospitals as strategic hubs for vaccination delivery, the study aimed to map service availability, operational settings and dedicated pathways across the region. Methods: A structured questionnaire was administered in 2025 to 40 healthcare organizations, encompassing 114 hospital facilities, including Local Health and Social Care Authorities (ASSTs) and both public and private Scientific Institutes for Research, Hospitalization and Healthcare (IRCCSs). Descriptive and inferential statistical analyses were performed, and findings were compared with those from the 2023 and 2024 editions of the same survey, developed within the “Vaccination—an opportunity for high-risk patients” project, using Pearson’s chi-square test. Results: In 2025, 99 facilities (86.8% of respondents) reported providing vaccination services for at-risk individuals. Dedicated vaccination pathways were generally available in more than 50% of facilities for nearly two-thirds of the risk categories considered. Vaccination services for diabetic patients were available in 70.7% of facilities. Among healthcare workers, influenza (93%) and SARS-CoV-2 (89.5%) vaccines were the most frequently offered, with rates approximately ten percentage points higher than those of other vaccines. Conclusions: Overall, these findings indicate a regional model progressively consolidating hospital-based vaccination for high-risk groups, with a consistent upward trend in service availability from 2023 to 2025.

Objective: To investigate the real-world impact of organised mammography screening on breast cancer mortality in metropolitan areas with widespread opportunistic imaging. Methods: We conducted a population-based incidence-density case–control study among women aged 50–74 years resident in Milan, Italy. We matched 900 breast cancer deaths (diagnosed 2008–2022; died 2012–2023) to 3600 controls by age (±3 months), postcode and citizenship. Individual screening histories were reconstructed by deterministic linkage across five administrative databases. Conditional logistic regression estimated odds ratios (ORs) for breast cancer death by invitation and participation. Opportunistic mammography was modelled, and self-selection bias was corrected using a factor of 1.28. Results: Invitation was associated with lower mortality (adjusted OR 0.71, 95% CI 0.58–0.85). Participation in at least one programme screen yielded an adjusted OR of 0.44 (0.36–0.52), which attenuated to 0.64 (0.53–0.77) after self-selection correction. Adjustment for opportunistic mammography had minimal impact on programme estimates. Conclusions: In a large metropolitan setting characterised by intensive opportunistic imaging, organised screening confers a significant mortality reduction, chiefly among participants. Policies discouraging opportunistic substitution and enhancing adherence may increase population benefit.

Mosquito-borne West Nile virus (WNV) infection is a growing global health problem. About 0.5% of infected individuals develop encephalitis. We previously showed that 40% of patients in six cohorts had WNV encephalitis because of circulating autoantibodies (auto-Abs) neutralizing type I IFNs. In seven new cohorts, we found that the prevalence of auto-Abs was highest (40% [17–44%]) in patients with encephalitis and very low in a small sample of individuals with asymptomatic or mild infection. In the 13 European, Middle Eastern, and American cohorts available, odds ratios (OR) for WNV encephalitis in individuals with these auto-Abs relative to those without them in a large sample of the general population untested for WNV infection range from ∼20 (OR = 17.7; 95% CI: 13.8–22.8, P < 10−16) for auto-Abs neutralizing only 100 pg/ml IFN-α2 and/or IFN-ω to >2,000 (OR = 2,218.4; 95% CI: 125.1–39,337.7, P < 10−16) for auto-Abs neutralizing high concentrations of IFN-α2 and high or low concentrations of IFN-ω. Preexisting auto-Abs neutralizing type I IFNs are therefore causal for WNV encephalitis in about 40% of patients.

Background/Objectives: Listeria monocytogenes (Lm) is an extremely rare cause of brain abscesses, accounting for 1–10% of neurolisteriosis cases reported in the literature, associated with high mortality (approximately 23%). Data on diagnosis, management, and treatment is scarce. We report a case of listerial brain abscesses in an elderly patient in Italy who experienced progressively worsening bilateral ptosis. Methods: Diagnostic evaluation included neuroimaging, blood cultures, and microbiological investigations, followed by antimicrobial treatment according to available evidence. The isolated Lm strain underwent whole genome sequencing. Dietary history was also collected. Results: Positive early blood cultures were pivotal in identifying Lm as the aetiological agent. Neuroimaging revealed brain abscesses consistent with neurolisteriosis. The clinical course was complicated by pneumonia and opportunistic co-infecting pathogens, and despite adequate treatment according to the available literature, the outcome was fatal. Genomic characterisation revealed that the patient was infected with an strain belonged to the sequence type 206 and clonal complex 14, described as hypervirulent. The patient reported consuming several foods known to be associated with an increased risk of listeriosis. Conclusions: This case highlights the challenges involved in diagnosing and managing listerial brain abscesses, particularly in elderly patients. Even when the primary central nervous system infection is under control, the prognosis may be significantly impacted by comorbid conditions and hospital-related complications rather than the infection itself. Our findings underscore the need for improved preventive strategies and targeted risk communication regarding high-risk foods, particularly among elderly populations.

Background/Objectives: Prostate cancer is the most frequently diagnosed cancer among men in Italy, yet no national population-based screening program exists. In response to new European Council recommendations, the Lombardy Region launched a pilot in November 2024 to assess the feasibility of a digitally enabled, risk-adapted screening model. Methods: Men turning 50 were invited to voluntarily self-enroll through the regional electronic health record (FSE). A digital questionnaire assessed eligibility and family history (FH); eligible individuals (97,849 men without a PSA test in the past two years in the regional database) were offered free PSA testing. Risk stratification guided follow-up: men with PSA >3 ng/mL or a positive FH were referred to urology; others were assigned 2- or 5-year recall based on PSA level. Results: By June 2025, 8558 men had enrolled (8.7% uptake), 6072 were eligible; 644 (10.6%) reported a positive FH. Among those tested, 58.4% had PSA < 1 ng/mL and were FH-negative, 25.8% had PSA > 1 and <3 ng/mL and were FH-negative, and 15.9% met referral criteria. Digital triage was efficient and ensured care continuity without burdening specialists. Participation varied by local health authority (ATS), depending on implementation context. Preliminary data show a 25.9% reduction in urology consultations and a 35% reduction in MRI use compared to standard care, with no biopsy rate increase. Conclusions: The pilot demonstrates the technical feasibility, safety, low administrative burden, and potential sustainability of digital, risk-stratified prostate cancer screening. While participation was low without active invitations, early results support expansion with improved outreach. Lombardy’s experience offers a scalable, EU-aligned model for broader implementation across Italy and other health systems seeking to balance early detection with resource efficiency.

Bacterial meningitis remains a critical public health issue globally due to its high morbidity and mortality. Understanding regional epidemiological trends is essential to inform vaccination strategies and public health interventions. This observational, retrospective study analyzed cerebrospinal fluid (CSF) isolates collected from 731 confirmed cases of bacterial meningitis between 2014 and 2024 in Lombardy, Italy. Pathogen identification and serotyping of Streptococcus pneumoniae (SP), Neisseria meningitidis (NM), and Haemophilus influenzae (HI) were conducted using culture-based and molecular techniques. Trends were assessed across age groups and time using Kruskal–Wallis and chi-square tests. Results: SP was the predominant pathogen (78.4%), followed by NM (13.0%) and HI (8.6%). Significant temporal variation was observed for SP and NM, while HI trends remained stable. The impact of COVID-19-related restrictions was evident in a reduction in cases during 2020–2021. SP serotypes 3 and 8, HI non-typeable strains, and NM serogroup B were most frequent. No major shifts in serotype distribution were observed. Long-term surveillance data from Lombardy underscore the dominance of vaccine-targeted serotypes, ongoing circulation of resilient clones, and post-pandemic epidemiological shifts. These findings support continuous surveillance and inform vaccine strategy adjustments at the regional and national levels.

An outbreak of measles virus genotype B3 is ongoing in Milan and surrounding areas since February 2025, with 27 cases identified in 32 laboratory-confirmed measles cases. Most cases were locally acquired and young adults. Phylogenetic analysis indicated the presence of a unique lineage closely related to strains circulating in Morocco. The lack of epidemiological links between several affected individuals suggests case numbers are being underestimated. The continuous transmission raises concerns about the potential re-establishment of endemic circulation in northern Italy.

Multisystem Inflammatory Syndrome in Children (MIS-C) is a serious condition associated with SARS-CoV-2 infection. The relationship between SARS-CoV-2 variants of concern (VOCs) and the occurrence and severity of MIS-C is unknown. We analyzed the dynamics of MIS-C in the Milan metropolitan area (Italy) during the COVID-19 pandemic, focusing on the epidemiologic trends and disease severity in relation to different VOCs in a single-center study. Fifty-seven MIS-C patients (mean 8.3 ± 3.8 years) admitted to the Pediatric Department of Buzzi Children’s Hospital in Milan, Italy, between November 2020 and July 2022, were retrospectively included in the study. The SARS-CoV-2 variant was retrospectively identified from serological fingerprinting (profiles of serum antibodies targeting different variants of SARS-CoV-2 obtained by a label-free microarray biosensor) or by the variant of prevalence. Two main periods of MIS-C case accumulation were observed. The peak of MIS-C cases rate in December 2020 reached 0.6 cases per day, which is nearly double the rate observed in February 2022, despite the larger number of infected subjects. Although the WT variant exhibited a broader range of severity score values, the score distributions for the different variants do not show statistically relevant differences. Conclusion: The results clearly show a decrease in the incidence of MIS-C in relation to infections, but also support the concept that severity of MIS-C remained essentially unchanged across different virus variants, including Omicron. The course of MIS-C, once initiated, is independent from the characteristics of the triggering variants, although later variants may be considered less likely to induce MIS-C. What is known:• MIS-C is a rare systemic inflammatory disorder that arises as a post-infectious complication temporally related to SARS-CoV-2 infection.• Fluctuations in MIS-C incidence were observed throughout the pandemic, with the latest variants associated with a lower incidence. What is new:• The SARS-CoV-2 variant of infection can be retrospectively confirmed by serum antibody fingerprinting using a label-free microarray biosensor.• Despite the decreasing incidence, MIS-C severity has remained essentially unchanged across SARS-CoV-2 variants.