European Journal of Epidemiology

Coxiella burnetii the agent of Q fever produces a variety of clinical syndromes. Central nervous system (CNS) involvement is reported to be a rare feature of the disease usually presented as a severe headache and rarely as meningoencephalitis. We retrospectively studied the medical records of 49 patients with clinical signs of CNS involvement. Among 121 patients with acute Q fever infection 49 (40.5%) had some degree of neurological involvement, varying from a severe headache in the majority of the patients (40.5%) to confusion (4.1%) and meningitis (0.8%). The majority of these patients with CNS involvement (91%) had been admitted to the hospital as community acquired pneumonia. The clinical evidence of CNS involvement is not a rare feature of acute Q fever infection and Coxiella burnetii should be considered as a possible etiology of meningitis or meningoencephalitis in endemic areas.

Possible hepatitis B immunization of all newborns, regardless of the mother's HBsAg status, is a strategy under consideration for selected hyperendemic areas in Italy. Sardinia is one such area. However, in 1987 in Sardinia, the prevalence of hepatitis B markers in children under 11 years was estimated at 1.7% and the prevalence of hepatitis B surface antigen (HBsAg) at 0.2%. A much higher prevalence of HBsAg was recently observed among adults in this area: 8.7% among men and 5.2% among pregnant women. This contrasting pattern is unlikely to be due to bias: the sampling procedures adopted were appropriate and the percentage of refusals was very low (2.2%). The observed low hepatitis B marker prevalence in young age groups might be the result of a cohort effect due to the improved socio-economic conditions and changes in behaviour that have occurred in Sardinia over the last few years. The finding of only 3 HBsAg+ individuals out of 1,826 children tested, in spite of the 5.2% HBsAg prevalence among pregnant women in that region, is probably attributable to the low proportion of HBeAg positive individuals among the HBsAg+ carrier mothers in this area. At present, immunization of all newborns in Sardinia cannot be recommended.

To examine relationship of education, occupation, and income with mortality risk, the 1998 National Health and Nutrition Survey data were linked to data on mortality. Education, occupation, and income had independent effects on mortality risk after adjustment for the remaining two socioeconomic position indicators. Educational, occupational, and financial approaches would be equally important to reduce socioeconomic mortality inequalities in South Korea.

To test the hypothesis that age at retirement is associated with dementia risk among self-employed workers in France, we linked health and pension databases of self-employed workers and we extracted data of those who were still alive and retired as of December 31st 2010. Dementia cases were detected in the database either through the declaration of a long-term chronic disease coded as Alzheimer’s disease and other dementia (International Classification of Disease codes G30, F00, F01, F03) or through the claim for reimbursement of one of the anti-dementia drugs. Data were analyzed using Cox proportional hazard model adjusting for potential confounders. Among the 429,803 retired self-employed workers alive on December 31st 2010, prevalence of dementia was 2.65 %. Multivariable analyses showed that the hazard ratio of dementia was 0.968 [95 % confidence interval = (0.962–0.973)] per each extra year of age at retirement. After excluding workers who had dementia diagnosed within the 5 years following retirement, the results remained unchanged and highly significant (p < 0.0001). We show strong evidence of a significant decrease in the risk of developing dementia associated with older age at retirement, in line with the “use it or lose it” hypothesis. Further evidence is necessary to evaluate whether this association is causal, but our results indicate the potential importance of maintaining high levels of cognitive and social stimulation throughout work and retiree life.

Intradermal (ID) vaccination has been proposed as a cost-saving alternative for administration of Hepatitis B (HB) vaccine to implement of mass vaccination of high-risk groups, particularly in developing countries. Therefore, the effectiveness of ID vaccination needs to be evaluated and verified in different ethnic backgrounds. The present study is a randomized trail using a recombinant vaccine (Heberbiovac) to compare immunogenecity and safety of an intradermal low-dose (4 μg) with standard dose (20 μg) of intramuscular (IM) vaccination in healthy Iranian population. Participants were 143 healthy Iranian medical and nursing students randomly allocated to ID or IM vaccination group. The vaccine was inoculated at 0, 1 and 6months intervals. Serum samples were collected 1month after the last vaccination and the anti-HBs response was determined using ELISA. The overall seroprotection rate (anti-HBs level ≥ 10IU/L) was 97.3% for ID vaccination group, which was not different from that of IM vaccination group (98.55%)(p= 0.99). Similarly, geometric mean titers (GMT) of anti-HBs were not significantly different between ID (1164.1IU/L) and IM (1071.8IU/L) vaccination groups (p= 0.4). There was no significant difference in seroprotection rate and GMT of anti-HBs between sexes. Although induration and hyperpigmentation at the site of injection were more frequently observed in ID vaccination group, no other clinically adverse effects were observed in both vaccination groups. We conclude that the ID route, which would require one-fifth of the standard dose, would be suitable for use in certain groups such as high-risk adults when the cost of vaccine is the inhibiting factor for mass vaccination.

The Salamanca Province of Spain is an endemic zone for Mediterranean spotted fever. In this area, only one case of Q fever has been reported and typhus group rickettsial diseases have never been diagnosed. To obtain a panoramic view of the presence of antibodies to the most ubiquitous rickettsial agents, 400 sera specimens from a statistically representative sample of the human population of Salamanca City and its surrounding province were subjected to indirect microimmunofluorescent test for antibodies against Rickettsia conorii, Coxiella burnetii, phase II, and Rickettsia typhi antigens. Titers ≥1:40 to R. conorii were found in 73.5% of the sera. Positivity was more common in subjects who reported closer contact with the natural environment and/or with domestic animals. Seropositivity to C. burnetii, phase II, was detected in 50.2% of sera. These positive cases were related to rural environmental factors and to prevoius contact with animals. The frequency of antibodies increased with age showing a progressive exposure to the rickettsial antigen. The prevalence of antibodies to R. conorii and C. burnetii in the human population of Salamanca Province is higher than that reported from any other geographic zone. The study of antibodies to R. typhi showed that 12.5% of the sera had titers ≥1:40. According to our results, seropositivity to this rickettsial antigen cannot be related to any particular group of population nor interpreted totally as cross reactivity with R. conorii. Our data show a wide distribution of R. conorii and C. burnetii antigens in Salamanca Province, and also indicate the presence of R. typhi antigens in this area.

Variations in biotypic and DNA characteristics of 21 strains ofHelicobacter pylori from patients in central Italy with histologically defined gastritis and/or peptic ulcers were studied. The strains had the same preformed enzyme biotype but differed in motility and cytotoxigenic activity. The presence or absence of these two characteristics were closely associated in 73% of strains and were used to define three phenotypic subsets. Strains of subset 1 (Mot+ Tox+) were most common (52%) particularly amongst patients with peptic ulceration (64%).H. pylori had uniqueHaeIII andHindIII ribopatterns but no one ribopattern or single band within a ribopattern was characteristic of any particular phenotypic subset.H. pylori from patients with gastritis were genomically as heterogeneous as those from patients with ulcers. Plasmid DNA was detected in four strains (25%) and although three of these were of the same biotype (phenotypic subset 1), there was no general association apparent between plasmid presence and cytotoxic activity. It was concluded that motility was a useful additional feature for biotyping ofH. pylori.

In this matched-pair study 139 pregnant women were matched on the basis of age to an equal number of non-pregnant women with no signs of genital infection. The mean age was 28.7 years (range 20–41). The cut-offs used for detection of chlamydial antibody were 1:64 and 1:128 for IgG and 1:16 for IgA. IgG antibody at 64 was detected in 37.4% of pregnant women, compared to 46% of controls (p=0.145). There was, however, a statistically significant difference between the groups for IgG at 128 (gravidae=15.8%; controls=28%;p=0.014). IgA were detected in 8.6% and 16.5% of subjects, respectively (p=0.047). IgG levels did not vary with increasing age among the pregnant women, but rose significantly with age in non-pregnant controls (logistic regressionp-values=0.011 and 0.006, for IgG at 64 and 128, respectively). IgG-positive women in the control group tended to be older than pregnant IgG-positive women (p=0.06). These differences could not be explained by marital status, parity or use of oral contraceptives. In view of the lack of epidemiological differences, biological explanations might be invoked.

To describe the relationship between sociodemographic factors, life-style habits, selected dietary indicators, smoking-related variables, and quitting smoking we analyzed data derived from the comparison group of a case-control study of colorectal and breast cancers based on a network of teaching and general hospitals in Northern Italy. A total of 2621 subjects (1215 women and 1406 men) who were ever cigarette smokers were included for analysis. Age-adjusted rates of stopping smoking (quit rates) and multivariate odds ratios (OR) of quitting smoking were computed. The overall age-adjusted quit rate was 38.6% for males and 24.9% for females, corresponding to an OR of quitting of 0.6 (95% CI: 0.5–0.7) for females vs males. The quitting rate increased with increasing age. After allowing for age, smoking cessation was more frequently reported by more educated or higher social class individuals. No relationship was present between quitting smoking and alcohol consumption, but quitting smoking was inversely related to coffee consumption. The probability of quitting smoking increased directly with number of cigarettes among males but not among females, who showed a J-shaped pattern. Older, heavy smokers were more likely to give up smoking. A general pattern of increasing rates of quitting smoking with higher consumption of vegetables and fruit, and hence β-carotene, was present. This study confirms a positive association between quitting smoking and increasing age, higher education, low coffee consumption, heaviness of smoking and high consumption of vegetables and fruit.

The control of microbial air contamination in hospital wards has assumed great importance particularly for those hospital infections where an airborne infection route is hypothesised, such as aspergillosis. Invasive aspergillosis represents one of the most serious complications in immunocompromised patients. For some authors there is a direct association between this pathology and the concentrations of Aspergillus conidia in the air; in addition, reports of aspergillosis concurring during building construction have been frequent. In this study, two haematology wards were monitored for about 2 years in order to make both a qualitative and quantitative evaluation of fungal burden in the air, also in relation to major construction and demolition work taking place in the same building. Air samples were taken from the hospital rooms of neutropenic patients, in the corridors of their ward and outside the building. Total fungal concentration resulted higher outside (mean 572 Colony Forming Units/m3 of air), lower in the corridors (147CFU/m3) and even lower in the rooms (50 CFU/m3). In all the samples we found the development of at least one fungal colony. Cladosporium was the most frequently isolated genus (57%), in contrast to Aspergillus spp. (2%). The average concentration of Cladosporium spp. was 24 CFU/m3 in the rooms, 78 CFU/m3 in the corridors and 318 CFU/m3 outside. The average concentration of Aspergillus spp. was 1.2 CFU/m3 in the rooms, 3.5 CFU/m3 in the corridors, 5.6 CFU/m3 outside. Our observations show low concentrations of Aspergillus fumigatus and A. flavus in all the environments examined and particularly in the rooms (0.09 and 0.10 CFU/m3 respectively); this observation could explain the absence of cases of invasive aspergillosis during the period of air monitoring in the two haematology wards.