Daniele Petrone

Background: Bronchiolitis is the leading cause of lower respiratory tract infections in infants, with respiratory syncytial virus (RSV) as the primary pathogen. Nirsevimab, a long-acting monoclonal antibody, was introduced in Europe in late 2022 for RSV prophylaxis in all infants. In Italy, the 2024–2025 immunization campaign faced regional disparities in implementation. This study aimed to evaluate the impact of Nirsevimab in reducing bronchiolitis diagnoses and hospitalizations in infants during their first RSV season in the Lazio Region. Methods: We conducted a retrospective cohort study using data from 29 primary care pediatricians in Lazio. Infants born between August 17, 2024, and March 31, 2025, were included. Bronchiolitis diagnoses were clinically defined, and immunization status was obtained from the regional vaccination registry. We excluded premature infants (< 33 weeks) and those diagnosed before the immunization campaign began on December 9, 2024. To adjust for confounding, we applied inverse probability weighting (IPW) based on a propensity score including demographic and clinical covariates. A negative binomial mixed-effects model was used to estimate incidence rate ratios (IRRs) for bronchiolitis and hospitalizations. Results: Among 818 eligible infants, 613 (74.9%) were immunized. A total of 58 bronchiolitis cases were recorded (7.1%), with 6.5% in the immunized group and 8.8% in the non-immunized group. Crude analysis showed a 25.7% risk reduction, while IPW-adjusted analysis indicated a 50.4% reduction (95% CI: 44.4%–55.7%). Hospitalizations occurred in 2.0% of infants, with adjusted analysis showing a 49.1% reduction in hospitalization risk among immunized infants. The immunization campaign’s late start likely limited its full impact, as 40 early-season cases were excluded. Conclusions: Nirsevimab immunization significantly reduced the risk of bronchiolitis and related hospitalizations in a real-world primary care setting. This result aligns with previous studies, though it may be underestimated due to the delayed campaign start and inclusion of all-cause bronchiolitis. These findings support early and widespread implementation of Nirsevimab to optimize protection and reduce RSV burden in infants.

Sex ratio is an important population metric in animal conservation, but its study in marine species with low sexual dimorphism is often challenging. This work aimed to apply the principles of skin mark analysis to a cetacean species to test its ability to identify sex differences in markings and build a sex‐discrimination model exclusively based on photographic material. The common bottlenose dolphin (Tursiops truncatus) was chosen as the model species, and skin marks and their progression over time were identified and measured across the whole‐body surface of individuals on photographs acquired between 2016 and 2023 in the Tiber River Estuary area. Interactions with fisheries were quantified both as the proportion of encounters in presence of trawlers, and as a probability of fishing gear injuries. Non‐parametric tests were used to assess sex‐specific differences. A generalized linear model with binary response (sex) was built through a stepwise procedure, using mark‐based indices as predictors. Relevant differences between sexes emerged in markings, with males presenting more social, aggression‐related, and fishing‐related marks overall, and a stronger tendency of mark accumulation over time. The estimated model reflected the differences highlighted by the statistical tests and had a high accuracy and sensitivity toward both sexes. These results highlight the feasibility and efficacy of this methodological approach to sex‐ratio investigations and identify differences in anthropic pressures insisting on males and females, with important conservation implications. The exclusive use of photographic material makes this methodology potentially applicable and adaptable to multiple species and environments, aiding the efforts of conservationists worldwide.

Retrospective studies identified SARS-CoV-2 worldwide circulation as early as late 2019. In Italy, the first autochthonous COVID-19 case was diagnosed in a Northern Region on 20 February 2020, raising the question whether high numbers of COVID-19 pneumonia cases were previously undetected. We explored whether unusual increases in hospitalizations for pneumonia occurred from October 2019 to February 2020 in Italy, particularly in Northern Regions. We analysed the Italian National Hospital Discharge Records with pneumonia ICD-9-CM codes from 2014 to 2020. Trend analysis and generalized linear models with negative binomial distribution were applied to compare observed pneumonia trends in the study period with previous years. Analyses were stratified by major regions (NUTS1) and provinces. During the study period, 2 501 074 hospitalizations were coded as pneumonia. No unusual increases of all hospitalizations associated to pneumonia were observed until mid-February 2020. Hospitalizations with viral pneumonia ICD9-CM codes were negligible until the end of January 2020, with a significant increase in two provinces of Lombardy Region 1–2 weeks before the first autochthonous COVID-19 case. Our analysis showed that a small increase in viral pneumonia hospitalizations in Northern Italy only in the weeks immediately preceding the first locally acquired SARS-CoV-2 case in two provinces of Lombardy. This excludes large-scale circulation in the last months of 2019 and in January 2020. Given the mild 2019–2020 influenza season and lower pneumonia hospitalization burden, the initial increase could have been interpreted as a fluctuation as it did not determine an overall excess case-load of pneumonia hospitalizations.

Background/Objectives: A resurgence of measles has been observed in Europe and worldwide since 2023. The aim of this article is to describe characteristics of cases reported to the Italian national measles surveillance system and discuss reasons for the outbreak and its public health relevance. Methods: We analyzed measles cases reported to the Italian national measles surveillance system with a symptom onset from August 2023 to January 2025. Results: Overall, 1164 cases were reported, of which 1065 (91.5%) were laboratory confirmed. The median age was 30 years, but the highest incidence was in children under one year of age. Transmission occurred mainly in families and nosocomial settings. Multiple importations occurred during 2023, which initially led to localized outbreaks with limited spread but was subsequently followed by increasing local transmission in 2024. Conclusions: These findings suggest lingering immunity gaps in children and adults in Italy, highlighting the potential severity of measles and the ease with which measles crosses country borders. Besides improving routine immunization coverage, targeted vaccination opportunities should be provided to susceptible population groups. Communication activities are also needed to increase awareness about disease severity, especially among young adults. In view of the upcoming travel season, travel clinics should encourage persons without evidence of measles immunity to be vaccinated before any international travel.

The analysis of skin marks and lesions is used for many cetacean species to assess the general health status of the populations with the purpose of developing effective conservation strategies. This study applies mark analysis to characterise common bottlenose dolphin (Tursiops truncatus) skin marks and lesions, and their variation at the individual level across years, in the Tiber River Estuary area (Mediterranean Sea, Italy), to test their efficacy as proxies of individual or population health. Using high‐quality photographic data collected between 2016 and 2023 during 205 sightings, marks were identified, classified, counted and measured on 39 individuals photographed on multiple occasions. Marks related to intraspecific interactions (e.g. tooth‐rakes), anthropogenic activities (e.g. signs of interaction with fishery) and health conditions (e.g. skin diseases and emaciation) were selected as indicators, and five indices were applied to estimate their extension and progression through time. Prevalent marks in all individuals were of social origin and aggressive nature. Marks related to skin diseases and emaciation were present in 97% and 70% of individuals, respectively. Almost half of the individuals showed physical signs of interaction with fishing gears. No significant temporal trends were observed. These results highlight that the local population is under the pressure of multiple stressors, mostly related to human activities, both directly (fishing) and indirectly (malnutrition, aggression). The consequences of stressor interactions may be complex to predict and raise challenges for the conservation of this protected species—and of the ecosystem it belongs to—in a highly anthropised and currently unmanaged area.

Background/Objectives: Hand hygiene (HH) is pivotal in mitigating infectious disease transmission and enhancing public health outcomes. This study focuses on detailing the national surveillance system for alcohol-based hand rub (ABHR) consumption in healthcare facilities across Italy, presenting results from a comprehensive three-year evaluation period, from 2020 to 2022. It aims to delineate this surveillance system and report on ABHR consumption trends in various Regions/Autonomous Provinces (Rs/APs). Methods: ABHR consumption data, collected through the ABHR Italian national surveillance system, coordinated by the Istituto Superiore di Sanità (ISS), were analyzed. Statistical methods, e.g., the Mann–Whitney test, were used to assess trends in ABHR consumption, expressed in liters per 1000 patient days (L/1000PD). Results: The results show significant variation in ABHR consumption across Rs/APs and over the years studied. National median ABHR consumption decreased from 2020 to 2022, with a significant reduction from a median of 24.5 L/1000PD in 2020 to 20.4 L/1000PD in 2021 and 15.6 L/1000PD in 2022. Conclusions: The decline in ABHR consumption raises concerns about the ongoing adherence to HH practices in Italian healthcare settings. This underscores the essential role that systematic ABHR monitoring and improved surveillance play in enhancing HH compliance, suggesting that sustained and strategic efforts are fundamental to uphold high standards of hygiene and to effectively respond to fluctuating ABHR usage trends over time. Further research is needed to explore barriers to effective ABHR use and to develop targeted strategies to improve HH practices.

In Italy, despite the documented positive effects of rotavirus (RV) vaccination on reducing the burden of RV disease, an updated national assessment of its impact on clinical outcomes is still lacking. This study aims to analyze the implementation of RV vaccination in Italy, evaluating its impact on discharges for acute pediatric gastroenteritis (AGE). A retrospective analysis, including hospital discharge records and data on vaccination coverage for children aged 0–71 months from 2009 to 2019, was conducted. We examined trends in hospital discharge standardized incidence before and after vaccine introduction using a negative binomial mixture model with fixed effects to evaluate the impact of universal vaccination. The percentage of vaccination coverage increased over the years, from <5% between 2009 and 2013 to 26% in 2017, reaching 70% in 2019. The standardized incidence of discharges decreased over the period from 16.6/100,000 inhabitants in 2009–2013 to 9.9/100,000 inhabitants in 2018–2019. In this phase, about 15% of the estimated hospital discharges were avoided compared with those estimated in the first phase. The implementation of RV vaccination reduced AGE incidence discharges in children aged 0–71 months. Further efforts are needed to continue monitoring the vaccination effect over time and to increase vaccination coverage.

Background and objective: Among viruses of the _Phlebovirus genus _in the Mediterranean area, sand flies transmitted Toscana virus (TOSV) can cause human neuro-invasive disease. Due to a lack of international surveillance, its impact on human health is poorly known, and considering high...