Regional Surveillance Research Articles

#3: Gram-Negative Antibacterial Resistance Prevalence at a Tertiary Care Hospital in Central America

Abstract Background Latin America has some of the highest rates of multi-drug resistant gram-negative bacteria worldwide. However, local surveillance registries to compare rates of resistance among countries are lacking, particularly in Central America. Awareness of local resistance patterns in this region is critical to improve antibiotic use and patient outcomes. We sought to measure the prevalence of resistant gram-negative bacilli (GNB) at a tertiary hospital in Guatemala. Methods We retrospectively conducted a single-center study to measure the percentage of GNB that were non-susceptible to various antibiotics between April and October of 2017. All cultures (blood, urine, cerebrospinal fluid, and other body fluids) were collected as part of routine clinical care during the study period. Duplicate isolates, defined as multiple specimens with the same organism from the same patient, were excluded. Antibiotic susceptibility testing was performed by disk diffusion method. Bacterial isolates were categorized as susceptible, intermediate, or resistant based upon the Clinical Laboratory Standard Institute 27th edition per guidance from the National Laboratory of Guatemala. Results A total of 969 unique gram-negative isolates from 818 patients were included. Urine was the most common culture type. The most frequently isolated bacteria were Escherichia coli and Klebsiella species. The percentage of GNB which were non-susceptible to individual antibiotics are detailed in Table 1. Of the isolates tested, 12 – 66% of GNB were non-susceptible to cephalosporins, 7 – 31% were non-susceptible to carbapenems, and 14 – 44% were non-susceptible to fluroquinolones. Conclusions The prevalence of multi-drug resistant GNB is high in Escuintla, Guatemala. Continued surveillance is vital to guide judicious and appropriate empiric antibiotic use in the setting of rising rates of antibiotic resistance. Local and regional resistance rates are known to vary, underlying the importance of developing more regional and national antibiotic resistance surveillance networks within Guatemala and other countries in Central America where there is a paucity of data.

Demographics of Cystic Echinococcosis Patients Treated Surgically in Lahore, Pakistan: A Single Centre Study from 2007 - 2018.

SummaryCystic echinococcosis (CE) is a zoonotic disease caused by the larval stage of Echinococcus granulosus tapeworms. These parasites have a worldwide geographic distribution and pose a serious threat to livestock industry as well as human health in the endemic areas. CE is widely distributed in Pakistan. However, very few reports are available related to the regional transmission of E. granulosus. A retrospective analysis was conducted of surgically confirmed CE patients who were treated at Shoukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Punjab Province, Pakistan from 2007 – 2018. In total, 536 CE patients were evaluated during the study period. Cases originated from the provinces of Khyber Pakhtunkhwa (n=336), Punjab (n=147), Baluchistan (n=18), Sindh (n=3), Islamabad (n=2), Gilgit Baltistan (n=1), and Azad Jammu and Kashmir (n=1). An additional 28 cases were from Afghanistan. The highest number of CE cases was reported in 2013 (n=90). Females made up a larger proportion of cases (n=310; 57.8 %) than males (n=226; 42.2 %). Most patients were members of the Pashtun (n=197; 36.7 %), Hindku (n=142; 26.5 %), and Punjabi (n=118; 22.0 %) ethnic groups. The largest number of cysts was obtained from the liver (137/536; 25.6 %). This study showed that CE is likely present throughout Pakistan. In order to control the disease, a comprehensive control program and regional surveillance are needed.

SARS-CoV-2 antibody seroprevalence follow-up in Malagasy blood donors during the 2020 COVID-19 Epidemic

BackgroundThe incidence of the 2020 COVID-19 epidemic in Africa seems to be different from that of the rest of the world, however its true extent is probably underestimated. Conducting population based sero-surveys during the epidemic has moreover been extremely challenging, driving our group and others to study blood donor samples.MethodsWe collected regional epidemiological COVID-19 surveillance data, and simultaneously monitored anti-SARS-CoV-2 antibody seroprevalences monthly throughout the epidemic in 5 major Region-associated Blood Transfusion Centres of Madagascar over a period of 9 months.FindingsSoon after attaining the first epidemic peaks between May and August 2020, both crude and population-weighted test-performance-adjusted seroprevalences of anti-SARS-CoV-2 antibodies was in Malagasy blood donors rapidly increased up to over 40% positivity.InterpretationThese findings suggest a high cumulative incidence of infection and seroconversion, which may have contributed to the observed deceleration of infection rates, but was not sufficient to prevent the second epidemic wave that struck Madagascar in Spring 2021.FundingThis project was funded by the United States Agency for International Development.

PIN50 Leveraging Publicly Available Data to Estimate a Real-Time Reproduction Number (Rt) for Covid-19: A Comparison of Two Methods

R0, the number of cases resulting from one infectious person in a susceptible population, is a common metric in infectious disease research. Newly-developed methods for real-time approximations (Rt) offer promise for monitoring COVID-19 trends using real-world data. The objective was to compare available methods of calculating Rt and understand drivers in variability, using available regional public surveillance data.

Efficacy of regional nodal ultrasound surveillance for metastatic detection in sentinel- and complete lymph node dissection-eligible melanoma patients.

e21568 Background: Nodal ultrasound (US) is the preferred method for regional surveillance of clinically node-negative (cN0) primary cutaneous melanoma (CM) when sentinel lymph node biopsy (SLNB) is not performed or unsuccessful, and for pathologically node-positive (pN+) disease without completion lymph node dissection (CLND). Methods: Retrospective review was performed of nodal US surveillance from 2011-2021 in SLNB-eligible cN0 CM patients when SLNB was deferred or technically not feasible ( i.e., from failure of lymphoscintigraphic dye migration) or those with pN+ disease on SLNB, without subsequent CLND. Patients were followed for at least 2 years or until recurrence. The primary endpoints were US detection of regional nodal recurrence and comparison to clinical exam or cross-sectional imaging (PET-CT and/or CT). Results: In total, 67 patients met inclusion criteria and underwent a median of 4 nodal US exams (interquartile range, IQR 3-5) over 2-3 years of follow-up. Thirty-two (47.8%) patients declined or had unsuccessful SLNB, and 35 (52.2%) deferred CLND in favor of nodal US surveillance. Sixteen (23.9%) patients had clinical stage IA/IB (cIA/IB) CM, 15 (22.3%) had clinical stage II (cII) disease, and 36 (53.7%) had pathologic stage III (pIII) disease. Three (4.5%) patients developed satellite/in-transit metastasis, 6 (8.9%) had regional nodal recurrence, 4 (6.0%) had both local and regional recurrence, and 7 (10.4%) developed distant metastasis. Eighteen (26.9%) patients underwent tissue sampling, with 10 positive for melanoma. Nodal recurrence was observed in patients with initial cIB (1), cIIA (1), cIIB (1), cIIC (2), pIIIA (1), and pIIIC (4) disease. Three patients (cIIA, cIIB, and pIIIC due to microsatellites) had abnormal clinical exams with concurrent palpable regional adenopathy and in-transit metastasis. One patient (pIIIC) developed local satellite metastasis followed by palpable regional adenopathy. The most common surveillance method for metastatic detection was US (6/10), followed by clinical exam (3/10) and PET-CT (1/10). All metastatic nodes on US were metabolically active on subsequent PET-CT. One patient in whom PET-CT was the initial method of detection had no confirmatory US. Conclusions: Nodal US for CM requires specific radiologic expertise and is gaining traction as a cost-effective imaging modality in the United States. Our findings support the effectiveness of nodal US surveillance in cN0 or pN+ CM patients in whom SLNB or CLND is not performed.[Table: see text]

Evaluation of Metagenomic-Enabled Antibiotic Resistance Surveillance at a Conventional Wastewater Treatment Plant.

Wastewater treatment plants (WWTPs) receive a confluence of sewage containing antimicrobials, antibiotic resistant bacteria, antibiotic resistance genes (ARGs), and pathogens and thus are a key point of interest for antibiotic resistance surveillance. WWTP monitoring has the potential to inform with respect to the antibiotic resistance status of the community served as well as the potential for ARGs to escape treatment. However, there is lack of agreement regarding suitable sampling frequencies and monitoring targets to facilitate comparison within and among individual WWTPs. The objective of this study was to comprehensively evaluate patterns in metagenomic-derived indicators of antibiotic resistance through various stages of treatment at a conventional WWTP for the purpose of informing local monitoring approaches that are also informative for global comparison. Relative abundance of total ARGs decreased by ∼50% from the influent to the effluent, with each sampling location defined by a unique resistome (i.e., total ARG) composition. However, 90% of the ARGs found in the effluent were also detected in the influent, while the effluent ARG-pathogen taxonomic linkage patterns identified in assembled metagenomes were more similar to patterns in regional clinical surveillance data than the patterns identified in the influent. Analysis of core and discriminatory resistomes and general ARG trends across the eight sampling events (i.e., tendency to be removed, increase, decrease, or be found in the effluent only), along with quantification of ARGs of clinical concern, aided in identifying candidate ARGs for surveillance. Relative resistome risk characterization further provided a comprehensive metric for predicting the relative mobility of ARGs and likelihood of being carried in pathogens and can help to prioritize where to focus future monitoring and mitigation. Most antibiotics that were subject to regional resistance testing were also found in the WWTP, with the total antibiotic load decreasing by ∼40–50%, but no strong correlations were found between antibiotics and corresponding ARGs. Overall, this study provides insight into how metagenomic data can be collected and analyzed for surveillance of antibiotic resistance at WWTPs, suggesting that effluent is a beneficial monitoring point with relevance both to the local clinical condition and for assessing efficacy of wastewater treatment in reducing risk of disseminating antibiotic resistance.

Unprecedented increase of West Nile virus neuroinvasive disease, Spain, summer 2020.

Cases of West Nile neuroinvasive disease (WNND) in Spain increased in summer 2020. Here we report on this increase and the local, regional and national public health measures taken in response. We analysed data from regional surveillance networks and the National Epidemiological Surveillance Network, both for human and animal West Nile virus (WNV) infection. During the 2020 season, a total of 77 human cases of WNV infection (median age 65 years; 60% males) were detected in the south-west of Spain; 72 (94%) of these cases developed WNND, presenting as meningoencephalitis, seven of which were fatal. In the previous two decades, only six human cases of WNND were detected in Spain. Reduced activities for vector control this season, together with other factors, might have contributed to the massive increase. Public health measures including vector control, campaigns to raise awareness among physicians and the general population, and interventions to ensure the safety of donations of blood products, organs, cells and tissues were effective to reduce transmission. Going forward, maintenance of vector control activities and an update of the vector-borne diseases response plan in Spain is needed.

Phylogenetic Analysis of the 2020 West Nile Virus (WNV) Outbreak in Andalusia (Spain).

During recent decades West Nile Virus (WNV) outbreaks have continuously occurred in the Mediterranean area. In August 2020 a new WNV outbreak affected 71 people with meningoencephalitis in Andalusia and six more cases were detected in Extremadura (south-west of Spain), causing a total of eight deaths. The whole genomes of four viruses were obtained and phylogenetically analyzed in the context of recent outbreaks. The Andalusian viral samples belonged to lineage 1 and were relatively similar to those of previous outbreaks which occurred in the Mediterranean region. Here we present a detailed analysis of the outbreak, including an extensive phylogenetic study. As part on this effort, we implemented a local Nextstrain server, which has become a constituent piece of regional epidemiological surveillance, wherein forthcoming genomes of environmental samples or, eventually, future outbreaks, will be included.

Risk factors for major external structural birth defects among children in Kiambu County, Kenya: a case-control study.

Background: Although major external structural birth defects continue to occur globally, the greatest burden is shouldered by resource-constrained countries with no surveillance systems. To our knowledge, many studies have been published on risk factors for major external structural birth defects, however, limited studies have been published in developing countries. The objective of this study was to identify risk factors for major external structural birth defects among children in Kiambu County, Kenya. Methods: A hospital-based case-control study was used to identify the risk factors for major external structural birth defects. A structured questionnaire was used to gather information retrospectively on maternal exposure to environmental teratogens, multifactorial inheritance, and sociodemographic-environmental factors during the study participants' last pregnancies. Descriptive analyses (means, standard deviations, medians, and ranges) were used to summarize continuous variables, whereas categorical variables were summarized as proportions and percentages in frequency tables. Afterward, logistic regression analyses were conducted to estimate the effects of the predictors on the odds of major external structural birth defects in the country. Results: Women who conceived when residing in Ruiru sub-county (adjusted odds ratio [aOR]: 5.28; 95% CI: 1.68-16.58; P<0.01), and Thika sub-county (aOR: 0.27; 95% CI; 0.076-0.95; P =0.04); and preceding siblings with history of birth defects (aOR: 7.65; 95% CI; 1.46-40.01; P =0.02) were identified as the significant predictors of major external structural birth defects in the county. Conclusions: These findings pointed to MESBDs of genetic, multifactorial inheritance, and sociodemographic-environmental etiology. Thus, we recommend regional defect-specific surveillance programs, public health preventive measures, and treatment strategies to understand the epidemiology and economic burden of these defects in Kenya. We specifically recommend the integration of clinical genetic services with routine reproductive health services because of potential maternal genetic predisposition in the region.

Promoting cross-regional collaboration in antimicrobial stewardship: Findings of an infectious diseases working group survey in Arab countries of the Middle East

BackgroundAntimicrobial resistance is a significant global issue that presents an increasing threat to patients’ wellbeing. Although a global concern, the emergence of multi-drug resistant organisms is of particular significance in the Middle East. In recent years, this region has seen an alarming increase in antimicrobial resistance presenting a major challenge to physicians managing various infectious diseases. MethodsA Working Group comprising experts in infectious diseases from Arab countries of Middle East assembled to review similarities and differences in antimicrobial practices and management of multi-drug resistant organisms across the region and assess the barriers to achieving cross-regional collaboration. The Working Group conducted an anonymous online survey to evaluate current practice and understanding of management of multi-drug resistant organisms across the region. ResultsA total of 122 physicians from Arab countries of the Middle East responded to the survey. Their responses demonstrated heterogeneity between countries in awareness of local epidemiology, management of multi-drug resistant organisms and antimicrobial stewardship practices. The Working Group recognized similarities and differences in the management of multi-drug resistant organisms across the region, and these were validated by the data collected in the survey. Overall, the similarities across the region reflect several key issues that can have an impact on the management of multi-drug resistant organisms and the prevention of antimicrobial resistance. ConclusionsThis paper highlights the urgency of addressing antimicrobial resistance in Arab countries of the Middle East. The Working Group identified key barriers to effective management which may guide the development of future coherent strategies to promote effective antimicrobial stewardship in the region. Here, we outline a call to action for the region, with a need to focus on training and education, capacity building, infrastructure, regional research, and regional surveillance.

COVID-19: Learning from Past Funding Initiatives and their Dismissal in Southeast Asia

This article examines philanthropic funding of past efforts to control emerging infectious diseases in Southeast Asia and China. The recount, based on personal insights as a foundation professional and a review of both published and unpublished material, shows that American foundations and other like-minded donors identified the risks associated with zoonotic infections early on – including from the same coronavirus family that is causing the current COVID-19 pandemic – and were later followed by bilateral and multilateral donors investing greater resources. At the cusp of the 2000s, foundations played a leadership and catalyst role in advancing a transdisciplinary agenda to better understand and respond to new emerging threats and in building the necessary individual and institutional capacities for regional and local disease surveillance. For more than a decade, this concentration of resources and approaches was recognised as having contributed to better preparedness. Gradually, however, funding initiatives declined in value and intensity due to several internal and external factors. This article argues that COVID-19 arrives in the midst of an unfinished donor agenda and that it is important to reflect on why philanthropic foundations, and the development aid community more generally, found themselves unprepared for the pandemic in order to draw lessons for addressing today’s crisis – and future outbreaks of emerging infectious diseases.

Risk factors for major external structural birth defects among children in Kiambu County, Kenya: a case-control study

Background: Although major external structural birth defects continue to occur globally, the greatest burden is shouldered by resource-constrained countries with no surveillance systems. To our knowledge, many studies have been published on risk factors for major external structural birth defects, however, limited studies have been published in developing countries. The objective of this study was to identify risk factors for major external structural birth defects among children in Kiambu County, Kenya. Methods: A hospital-based case-control study was used to identify the risk factors for major external structural birth defects. A structured questionnaire was used to gather information retrospectively on maternal exposure to environmental teratogens, multifactorial inheritance, and sociodemographic-environmental factors during the study participants' last pregnancies. Descriptive analyses (means, standard deviations, medians, and ranges) were used to summarize continuous variables, whereas categorical variables were summarized as proportions and percentages in frequency tables. Afterward, logistic regression analyses were conducted to estimate the effects of the predictors on the odds of major external structural birth defects in the country. Results: Women who conceived when residing in Ruiru sub-county (adjusted odds ratio [aOR]: 5.28; 95% CI; 1.68-16.58; P<0.01), and Kiambu sub-county (aOR: 0.27; 95% CI; 0.076-0.95; P=0.04), and preceding siblings with history of birth defects (aOR: 7.65; 95% CI; 1.46-40.01; P=0.02) were identified as the significant predictors of major external structural birth defects in the county. Conclusions: These findings pointed to MESBDs of genetic, multifactorial inheritance, and sociodemographic-environmental etiology. Thus, we recommend regional defect-specific surveillance programs, public health preventive measures, and treatment strategies to understand the epidemiology and economic burden of these defects in Kenya. We specifically recommend the integration of clinical genetic services with routine reproductive health services because of potential maternal genetic predisposition in the region.

Effect of population inflow and outflow between rural and urban areas on regional antimicrobial use surveillance.

Regional-level measures can complement national antimicrobial stewardship programs. In Japan, sub-prefectural regions called secondary medical areas (SMAs) provide general inpatient care within their borders, and regional antimicrobial stewardship measures are frequently implemented at this level. There is therefore a need to conduct antimicrobial use (AMU) surveillance at this level to ascertain antimicrobial consumption. However, AMU estimates are generally standardized to residence-based nighttime populations, which do not account for population mobility across regional borders. We examined the impact of population in/outflow on SMA-level AMU estimates by comparing the differences between standardization using daytime and nighttime populations. We obtained AMU information from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. AMU was quantified at the prefectural and SMA levels using the number of defined daily doses (DDDs) divided by (a) 1,000 nighttime population per day or (b) 1,000 daytime population per day. We identified and characterized the discrepancies between the two types of estimates at the prefectural and SMA levels. The national AMU was 17.21 DDDs per 1,000 population per day. The mean (95% confidence interval) prefectural-level DDDs per 1,000 nighttime and daytime population per day were 17.27 (14.10, 20.44) and 17.41 (14.30, 20.53), respectively. The mean (95% confidence interval) SMA-level DDDs per 1,000 nighttime and daytime population per day were 16.12 (9.84, 22.41) and 16.41 (10.57, 22.26), respectively. The nighttime population-standardized estimates were generally higher than the daytime population-standardized estimates in urban areas, but lower in the adjacent suburbs. Large differences were observed in the main metropolitan hubs in eastern and western Japan. Regional-level AMU estimates, especially of smaller regions such as SMAs, are susceptible to the use of different populations for standardization. This finding indicates that AMU standardization based on population values is not suitable for AMU estimates in small regions.

COVID-19 Rapid Antigen Test as Screening Strategy at Points of Entry: Experience in Lazio Region, Central Italy, August-October 2020.

COVID-19 pandemic is a dramatic health, social and economic global challenge. There is urgent need to maximize testing capacity. Rapid Antigen Tests (RAT) represent good candidates for point-of-care and mass surveillance testing to rapidly identify SARS-CoV-2-infected people, counterbalancing lower sensitivity vs. gold standard molecular tests with fast results and possible recurrent testing. We describe the results obtained with the testing algorithm implemented at points of entry (airports and ports) in the Lazio Region (Italy), using the STANDARD F COVID-19 Antigen Fluorescence ImmunoAssay (FIA), followed by molecular confirmation of FIA-positive samples. From mid-August to mid-October 2020, 73,643 RAT were reported to the Regional Surveillance Information System for travelers at points of entry in Lazio Region. Of these, 1176 (1.6%) were FIA-positive, and the proportion of RT-PCR-confirmed samples was 40.5%. Our data show that the probability of confirmation was directly dependent from the semi-quantitative FIA results. In addition, the molecularly confirmed samples were those with high levels of virus and that were actually harboring infectious virus. These results support public health strategies based on early mass screening campaigns by RAT in settings where molecular testing is not feasible or easily accessible, such as points of entry. This approach would contribute to promptly controlling viral spread through travel, which is now of particular concern due to the spread of SARS-CoV-2 variants.

County-Level Records for Culex stigmatosoma and Culex thriambus in Texas

Populations of Culex stigmatosoma and Cx. thriambus have been documented in the southwestern USA with a southward range extension to northern South America and Central America, respectively. Studies conducted in California indicate both species are potential vectors of West Nile virus. However, vector competence studies are lacking for other parts of the USA. During a multicounty regional surveillance study west of San Antonio, Texas, multiple errors were observed in the Texas distributional literature of these species. These errors involved incorrect distributional information in Texas and US publications. Evidence to correct these errant records was found upon further analysis of Texas literature and curated specimens. Therefore, the aims of this study were to present that evidence and then combine the corrected records with additional records from the Texas Department of State Health Services and from larval collections made during other Texas surveillance studies.

Assessing efficacy of hepatocellular carcinoma prediction scores to prioritise hepatitis B surveillance in the COVID-19 era.

ObjectiveAn estimated 250 million people worldwide are chronically infected with hepatitis B virus (HBV), the leading cause of hepatocellular carcinoma (HCC) globally. The novel Sars‐cov2 virus continues to spread at an alarming rate, and with guidance at the onset of the pandemic recommending the deferral of HCC surveillance, the implications on liver cancer care are now emerging and highlight the urgent need for reorganisation of services.MethodsWe analysed how five HCC risk prediction scores could aid stratification of patients with chronic HBV. We calculated scores using parameters measured from 3 years prior (where available, n = 17) and at the time of HCC diagnosis in all adult patients with chronic HBV diagnosed with HCC (n = 46), and controls (n = 100). We compared the number of patients requiring cancer surveillance according to each score and regional surveillance guidance.ResultsThe aMAP score had the highest discriminatory performance in HCC risk prediction at 3 years (area under receiver‐operating characteristic curve (auROC) of 0.824), followed by the mREACH B score (auROC of 0.719), and mPAGE B score (auROC of 0.742). However, only the mREACH B score had a negative predictive value (NPV) >99%. Applying the mREACH B score to our HBV cohort identified 11 patients requiring HCC surveillance, compared with 62 under current guidelines.ConclusionThe use of HCC risk prediction scores could streamline the surveillance of patients with chronic HBV at a time of extremely limited resources. Overall, the mREACH B score had both a strong discriminatory performance and a high NPV, thus safely identifying low risk patients not requiring surveillance.

Effects of regular testing as a sort of Covid-19 filter, by identifying, isolating and thus filtering out currently infected persons, using antigenic tests among healthcare workers in three hospitals in the South of Italy

The use of antigen tests is proposed as a substitute for the molecular test in some conditions and the Italian Regions are preparing for massive provision. This method has been introduced and tested in the local health authority ASL BT - Puglia (Italy) and then integrated with the regional health surveillance protocol for health workers thanks to the preliminary results. In the Puglia Region there has been an Integrated Health and Safety Management System SGSL (SiRGISL) since pre-COVID times, which has standardized procedures and protocols as regards to Integrated Health and Safety for the prevention of hospital worker risks. Where the method was first tested, a screening test was introduced on 2,500 health workers operating in the three hospitals of the BT district, weekly. The nasopharyngeal swabs were carried out by the coordinators (workers safety representatives in Puglia Region SGSL), the swabs were sent to the PoCT (Point of Care Testing) analysis laboratory with immediate reading of the antigen test following by molecular test method confirmation. The study was performed in a Puglia district with high virus circulation. About 12 thousand swabs were performed, mainly in the period, which identified 192 cases of positivity to SARS CoV2 among asymptomatic operators not detected symptomatic by the usually temperature control method at the hospital entrance. During the third week a peak of cases (79) with a subsequent decline was revealed, otherwise the infection trend of the population district maintained a constant growth. Early identification and removal of asymptomatic hospital workers, by means of frequent use of rapid tests, acts as a filter and reduces the chances of contagion by cutting the chains at the origin. During a time featured by high viral circulation, the amount and the speed of the tests should be privileged over more accurate methods, difficult to manage with a very high demand. In Puglia Region, the presence of Integrated Health and Safety Management System (SiRGISL) makes the organizational structures efficiently adaptable to the rapid change of the pandemic framework by choosing suitable technologies and methods in order to anticipate the change of the pandemic curve instead of following it. Asymptomatic subjects detecting is a major problem in the management of epidemics even in controlled environments such as hospitals.

Effects of regular testing as a sort of Covid-19 filter, by identifying, isolating and thus filtering out currently infected persons, using antigenic tests among healthcare workers in three hospitals in the South of Italy

The use of antigen tests is proposed as a substitute for the molecular test in some conditions and the Italian Regionsare preparing for massive provision. This method has been introduced and tested in the local health authority ASLBT - Puglia (Italy) and then integrated with the regional health surveillance protocol for health workers thanks to thepreliminary results. In the Puglia Region there has been an Integrated Health and Safety Management System SGSL(SiRGISL) since pre-COVID times, which has standardized procedures and protocols as regards to Integrated Healthand Safety for the prevention of hospital worker risks.Where the method was first tested, a screening test was introduced on 2,500 health workers operating in the threehospitals of the BT district, weekly. The nasopharyngeal swabs were carried out by the coordinators (workers safetyrepresentatives in Puglia Region SGSL), the swabs were sent to the PoCT (Point of Care Testing) analysis laboratorywith immediate reading of the antigen test following by molecular test method confirmation. The study was performedin a Puglia district with high virus circulation.About 12 thousand swabs were performed, mainly in the period, which identified 192 cases of positivity to SARS CoV2among asymptomatic operators not detected symptomatic by the usually temperature control method at the hospitalentrance.During the third week a peak of cases (79) with a subsequent decline was revealed, otherwise the infection trend ofthe population district maintained a constant growth.Early identification and removal of asymptomatic hospital workers, by means of frequent use of rapid tests, acts as afilter and reduces the chances of contagion by cutting the chains at the origin.During a time featured by high viral circulation, the amount and the speed of the tests should be privileged over moreaccurate methods, difficult to manage with a very high demand.In Puglia Region, the presence of Integrated Health and Safety Management System (SiRGISL) makes theorganizational structures efficiently adaptable to the rapid change of the pandemic framework by choosing suitabletechnologies and methods in order to anticipate the change of the pandemic curve instead of following it.Asymptomatic subjects detecting is a major problem in the management of epidemics even in controlled environmentssuch as hospitals.

Learning Transferable Driven and Drone Assisted Sustainable and Robust Regional Disease Surveillance for Smart Healthcare.

Smart healthcare has been applied in many fields such as disease surveillance and telemedicine, etc. However, there are some challenges for device deployment, data collection and guarantee of stainability in regional disease surveillance. First, it is difficult to deploy sensors and adjust the sensor network in unknown region for dynamic disease surveillance. Second, the limited life-cycle of sensor network may cause the loss of surveillance data. Thus, it is important to provide a sustainable and robust regional disease surveillance system. Given a set of Disease surveillance Area (DsA)s and Point of disease Surveillance (PoS)s, some sensors are deployed to monitor these PoSs, and a drone collect data from the sensors as well as charge the sensors to extend their life-cycles. The drone replenish its energy by relying on the bus network. We first formulate the drone assisted regional disease surveillance problem under the constraints of life-cycle of sensors and energy of drone, and propose an approximation algorithm to find a feasible cycle of drone to minimize the traveling time cost of drone. To satisfy the diversity requirements and dynamic scalability of regional disease surveillance, we deploy one robot in each DsA instead of sensors. We further formulate the learning transferable driven regional disease surveillance problem, and propose a joint schedule algorithm of drone and robots. The results of both theoretical analysis and extensive simulations show that the proposed algorithms can reduce the total time cost by 39.71 and 48.74 percent, average waiting time by 42.00 and 50.14 percent, and increase the average accessing ratio of PoSs by 15.53 and 22.30 percent, through the assistance of bus network and learning transferable features.

Inventory of occupational exposure to asbestos with particular reference to Tuscan workers

This Catalogue is a collection of information on the use of raw asbestos and asbestos-containing materials used in several industries and occupational activities, with particular attention to the situation of Tuscany, a region of Central Italy. The work was developed at the Institute for Cancer Research, Prevention and Clinical Network (ISPRO) of Florence, where epidemiologic research and surveillance activities have been developing since 1988 and where the coordination and evaluation of the regional health surveillance programme provided to past asbestos workers started in 2016 and is still ongoing. The Catalogue aims at being a working tool for all health professionals engaged in examining and classifying the occupational asbestos exposures of subjects both affected by diseases that could be associated to this carcinogen and examined within the regional health surveillance programme. It is necessary for the health personnel engaged in the above-mentioned activities to know or to have the possibility to find exact and detailed data on asbestos exposure by occupational sector. These data are briefly described in the 29 factsheets this Catalogue consists of. In each factsheet, the presence and every use of asbestos are described, with reference to a precise occupational sector. Several occupational sectors can be considered together because of analogies on asbestos exposure. Occupations are considered on the basis of existing evidence on the use of raw asbestos or asbestos-containing materials (as semi-finished or finished products or as auxiliary materials in production processes). Besides the presence and use of asbestos, a description of the possible exposures of workers is reported. Sources of information were scientific and grey literature as well as the 7,187 occupational histories of mesothelioma registered by the specific Tuscan registry. Some factsheets have been revised and enhanced by Italian experts on the asbestos exposure with a specific competence in the examined sectors. Each factsheet includes also questions to be addressed to workers in order to examine in depth their possible asbestos exposure. For those who would like to expand their knowledge on this topic, references are reported both at the end of each factsheet and at the end of the volume. In all industrialized countries, also in those which have not already banned asbestos use, a decrease in the use of this material and in the relative exposure have been observing since the end of the Seventies, few years after the general consensus within the scientific community on asbestos carcinogenicity. This decreasing trend has been becoming greater and greater since the end of the Eighties, when more restrictive regulations have been approved and applied, especially in occupational settings. Nevertheless, nowadays asbestos-related diseases are still diagnosed due to past exposures, although during next decade a decreasing incidence of malignant mesothelioma - the cancer most specifically related to this carcinogen and characterized by a very bad prognosis and the longest latency - could be observed. Particular attention will be paid to jobs regarding renovation of old buildings containing asbestos and to decontamination activities. In conclusion, this Catalogue is a working tool - although it is not exhaustive and could be upgraded with new information - for all professionals engaged in asbestos risk prevention activities as health personnel, personnel of insurance companies, employers, and employee representatives.