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Map of Italy, showing location of tourist resort on Lecce province.
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This paper describes the third large outbreak of Norovirus (NoV) gastroenteritis reported in the Southern Italy region of Puglia.
A matched case control study was conducted, on 19 July 2005, for investigating risk factors, using a structured questionnaire on food consumption. A multivariate analysis was conducted to estimate the adjusted Odds Ratio...
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Noroviruses have emerged as a major cause of acute gastroenteritis in humans of all ages. Despite high infectivity of the virus and lack of long-term immunity, volunteer and authentic studies has suggested the existence of inherited protective factors. Recent studies have shown that histo-blood group antigens (HBGAs) and in particular secretor stat...
Noroviruses are a leading cause of acute sporadic gastroenteritis worldwide. In Sub-Saharan Africa, information regarding norovirus infections in children is scarce. A systematic review of studies performed between 1993 and June 2015 was conducted to establish the genotypic distribution and prevalence of norovirus infections in children (≤17) in Su...
CaliciNet, the outbreak surveillance network for noroviruses in the United States, was launched in March 2009. As of January 2011, twenty state and local health laboratories had been certified to submit norovirus sequences and epidemiologic outbreak data to CaliciNet. During the network's first year, 552 outbreaks were submitted to CaliciNet, of wh...
Norovirus is a major cause of infectious intestinal disease, and a substantial prevalence of asymptomatic infection has been reported. We describe the prevalence, seasonality and characteristics of asymptomatic norovirus infection in England. Healthy individuals were recruited at random from the general population during the Study of Infectious Int...
Background:
Norovirus is a leading cause of acute gastroenteritis (AGE). Noroviruses bind to gut histo-blood group antigens (HBGAs), but only 70%-80% of individuals have a functional copy of the FUT2 ("secretor") gene required for gut HBGA expression; these individuals are known as "secretors." Susceptibility to some noroviruses depends on FUT2 se...
Citations
... Indeed, the virus can persist for long periods in the springs used for irrigation, human or animal drinking water, and washing food, leading to viral spread and outbreaks [7,[15][16][17]. In Italy, waterborne norovirus outbreaks have often been associated with exposure to surface or drinking water, reinforcing the need to collect data to study viral spread, epidemiology, and possible effective control measures and strategies to prevent outbreaks [18][19][20][21][22][23][24]. ...
In June 2022, a gastroenteritis outbreak occurred in a town in Northern Italy, possibly associated with the ingestion of norovirus from public drinking water. Noroviruses are highly infectious RNA
viruses, with high stability in the environment. They are the primary cause of non-bacterial gastroenteritis worldwide, and despite the fact that the disease is mainly self-limiting, norovirus infection can lead to severe illness in the immunocompromised, the elderly and children. Immediately after the notification of the suspected norovirus outbreak, faecal specimens were collected from hospitalised patients, and water samples were collected from public drinking fountains in the affected area, to confirm the presence of norovirus. Norovirus was detected in 80 % (95 % CI 0.58–0.91) of the faecal specimens, and in 50 % (95 % CI 0.28–0.72) of the water samples using RT (reverse transcription) Real-time PCR. The identification of GII genotype in all samples confirmed public drinking water as the source of norovirus contamination. In addition, in one faeces and one water sample, the co-presence of genotypes GI and GII was detected. The strains were typed by sequencing, with most of them belonging to the genotype GII.3. Immediately after the confirmation of norovirus contamination in public drinking water, the local
competent authorities applied safety measures, resulting in a decline in number of cases. Moreover, after the application of disinfection protocols in the water plant, the sampling was repeated with negative results for norovirus in the affected area. However, positive samples were found in the neighbouring area (prevalence 10.00 %, 95 % CI 0.02–0.40) and in the water spring (prevalence 50.00 %, 95 % CI 0.21–0.78), suggesting norovirus persistence and spread from the water source. The prompt identification of the source of contamination, and collaboration with the local authorities guided the implementation of proper procedures to control viral spread, resulting in the successful control of the outbreak.
... Twelve countries reported rates of 25% or more, six of which reported AMR rates of 50% or more (Belarus, Georgia, Greece, Republic of Moldova, Russian Federation, and Ukraine) [116,[134][135][136][137][138]. ...
... Alternative therapies to the use of antibiotics include bacteriophage therapy, probiotics [133][134][135], drug repurposing [136], monoclonal antibody (MAb), and (v) faecal microbiota transplantation (FMT) [137], which are some of the many novel approaches currently being investigated to control the AMR. Balancing these factors can be challenging, and it requires collaboration between the agricultural industry, consumers, and policymakers [138]. ...
The increasing misuse of antibiotics in human and veterinary medicine and in agroecosystems and the consequent selective pressure of resistant strains lead to multidrug resistance (AMR), an expanding global phenomenon. Indeed, this phenomenon represents a major public health target with significant clinical implications related to increased morbidity and mortality and prolonged hospital stays. The current presence of microorganisms multi-resistant to antibiotics isolated in patients is a problem because of the additional burden of disease it places on the most fragile patients and the difficulty of finding effective therapies. In recent decades, international organizations like the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) have played significant roles in addressing the issue of AMR. The ECDC estimates that in the European Union alone, antibiotic resistance causes 33,000 deaths and approximately 880,000 cases of disability each year. The epidemiological impact of AMR inevitably also has direct economic consequences related not only to the loss of life but also to a reduction in the number of days worked, increased use of healthcare resources for diagnostic procedures and the use of second-line antibiotics when available. In 2015, the WHO, recognising AMR as a complex problem that can only be addressed by coordinated multi-sectoral interventions, promoted the One Health approach that considers human, animal, and environmental health in an integrated manner. In this review, the authors try to address why a collaboration of all stakeholders involved in AMR growth and management is necessary in order to achieve optimal health for people, animals, plants, and the environment, highlighting that AMR is a growing threat to human and animal health, food safety and security, economic prosperity, and ecosystems worldwide.
... (3) studies only in English; (4) open access studies; (5) clinical trials or case reports; and (6) studies relating to the use of HP and CP and their comparison, their impact on composite restorations, and their use in orthodontics. ...
Background: Dental aesthetic procedures aim to rectify flaws in dental elements’ shape, alignment, or overly dark color. One of the most common dental aesthetic procedures is tooth whitening. This study attempts to introduce key aspects of bleaching and describe the different techniques and the mechanism of action of bleaching agents, focusing on the clinical implications in orthodontic and on composite restorations. Methods: The research was performed on PubMed, Web of Science, and Science Direct databases for articles on our topic published between 2017 and 2023, and we found a total of 1512 studies. In total, 57 papers were considered for the qualitative analysis in the review. Results: This study found that both carbamide peroxide and hydrogen peroxide were clinically effective, although patients’ level of tooth sensitivity seemed to be lessened by the latter. However, the latter appears to be more effective at reducing patient-experienced tooth sensitivity. Conclusion: Carbamide and hydrogen peroxide based whitening techniques were shown to be equally successful at treating tooth discoloration after bracket composite removal, with no discernible differences between them. To increase the effectiveness of whitening on composites, more research is needed. To achieve the desired results and avoid the negative effects of whitening gels on teeth and soft tissue, a patient-specific approach is advised.
... It is caused by a variety of factors, including the impact of environmental and genetic factors on dental arch dimensions [1]. Dental crowding is defined as an inconsistency between tooth size and arch dimension that results in malocclusion; it occurs because of a lack of coordination between tooth size and arch dimensions [2][3][4][5]. The lower incisors are the teeth most frequently involved [6][7][8] (Figure 1). ...
... factors on dental arch dimensions [1]. Dental crowding is define between tooth size and arch dimension that results in malocclusion lack of coordination between tooth size and arch dimensions [2][3][4][5]. the teeth most frequently involved [6][7][8] (Figure 1). Studies show that 46 per cent of children between 6 and 12 children between 12 and 17 years old have crowding. ...
Background:
Crowding is the most frequent malocclusion in orthodontics, with a strong hereditary tendency. It already occurs in pediatric age and is mainly hereditary. It is a sign of a lack of space in the arches, and is not self-correcting, but can worsen over time. The main cause of the worsening of this malocclusion is a progressive and physiological decrease in the arch perimeter.
Methods:
To identify relevant studies investigating the most common possible treatments for mandibular dental crowding, a comprehensive search of PubMed, Scopus and Web of Science was conducted encompassing the last 5 years (2018-2023) using the following MeSH: "mandibular crowding AND treatment" and "mandibular crowding AND therapy ".
Results:
A total of 12 studies were finally included. An orthodontic treatment cannot ignore the concept of "guide arch", which concerns the lower arch, because of the objective difficulty in increasing its perimeter; the bone structure of the lower jaw is more compact than that of the upper one. Its expansion, in fact, is limited to a slight vestibularization of the incisors and lateral sectors that may be associated with a limited distalization of the molars.
Conclusions:
There are various therapeutic solutions available to the orthodontist, and a correct diagnosis through clinical examination, radiographs and model analysis are essential. The decision of how to deal with crowding cannot be separated from an overall assessment of the malocclusion to be treated.
... Interestingly there have been implied genetic variations in the IL-6 and IL-1 receptor antagonist genes that were strictly related to the inflammatory mechanism typical of bowel disease and correlated bone damage 92,93 . The possibility of changing the bone decay metabolism and increasing density and mass by reversing the inflammatory process passing through the treatment of GM, was achieved using specific probiotics that revealed an important immune-modulation activity on IGF-1, TNF-α and IL-1β and stimulated the presence of IL-7 and IFN-γ ( Figure 3) [94][95][96][97] . ...
Data collection has suggested a complex correlation between the gut microbiota (GM) and bone homeostasis involving host-mi-crobiota crosstalk. Although the GM is known to affect bone metabolism, the mechanisms linked with these effects remain unclear. The aim of this review is to current insight advances regarding how gut-derived hormones regulate bone ho-meostasis in humans, emphasizing gut-bone axis and bone regeneration. The GM may be engaged in bone metabolism and fracture risk. Additional investigations of the fundamental mi-crobiota-related pathways in bone metabolism may uncover treatment strategies and enable the prevention of osteoporosis. A better knowledge of gut hormones' action on bone homeo-stasis may lead to new strategies for preventing and treating skeletal frailty related to age.
... HAV findings in foodstuffs are summarized in Supplementary Table 1 (those linked to outbreaks were not considered in this section). It is widely documented that bivalves are one of the riskiest foods when eaten raw or undercooked (Rizzo et al., 2007), not only to HAV transmission but also to other enteric viruses, because of their filter-feeding nature. In recent years, frozen foods have been investigated more deeply for the presence of HAV (Bozkurt et al., 2020;Nasheri et al., 2019;Tavoschi et al., 2015). ...
Foodborne viruses have been recognized as a growing concern to the food industry and a serious public health problem. Hepatitis A virus (HAV) is responsible for the majority of viral outbreaks of food origin worldwide, while hepatitis E virus (HEV) has also been gaining prominence as a foodborne viral agent in the last years, due to its zoonotic transmission through the consumption of uncooked or undercooked infected meat or derivatives. However, there is a lack of scientific reports that gather all the updated information about HAV and HEV as foodborne viruses. A search of all scientific articles about HAV and HEV in food until March 2020 was carried out, using the keywords “HAV”, “HEV”, “foodborne”, “outbreak” and “detection in food”.
Foodborne outbreaks due to HAV have been reported since 1956, mainly in the USA, and in Europe in recent years, where the number of outbreaks has been increasing throughout time, and nowadays it has become the continent with the highest foodborne HAV outbreak report. Investigation and detection of HAV in food is more recent, and the first detections were performed in the 1990s decade, most of them carried out on seafood, first, and frozen food, later. On the other hand, HEV has been mainly looked for and detected in food derived from reservoir animals, such as meat, sausages and pate of pigs and wild boars. For this virus, only isolated cases and small outbreaks of foodborne transmission have been recorded, most of them in industrialized countries, due to HEV genotype 3 or 4. Virus detection in food matrices requires special processing of the food matrix, followed by RNA detection by molecular techniques. For HAV, a real-time PCR has been agreed as the standard method for virus detection in food; in the case of HEV, a consensus assay for its detection in food has not been reached yet.
Our investigation shows that there is still little data about HAV and HEV prevalence and frequency of contamination in food, prevalent viral strains, and sources of contamination, mainly in developing countries, where there is no research and legislation in this regard. Studies on these issues are needed to get a better understanding of foodborne viruses, their maintenance and their potential to cause diseases.
... However, a number of foodborne outbreaks remain obscure in terms of the source of the infection [15]. Ice [16][17][18] and drinking-water [19,20] outbreaks are also common, often involving multiple pathogens from wastewater leaking to drinking water [21][22][23]. Ice usually becomes contaminated through wastewater leakage to drinking water somewhere along the water distribution line [16][17][18]. ...
... Ice [16][17][18] and drinking-water [19,20] outbreaks are also common, often involving multiple pathogens from wastewater leaking to drinking water [21][22][23]. Ice usually becomes contaminated through wastewater leakage to drinking water somewhere along the water distribution line [16][17][18]. Airborne transmission is possible through aerosols generated by vomiting or flushing the toilet [7,24,25]. ...
A gastrointestinal outbreak was reported among 154 diners who attended a Christmas buffet on the 9 and 10 December 2016. A retrospective cohort study was undertaken. Faecal samples, water, ice and an air ventilation device were tested for indicators and routine pathogens. Altogether 26% (24/91) fulfilled the case definition of having typical viral gastrointestinal symptoms. Norovirus genogroup I was detected in faecal samples from three cases. One of these cases tested positive also for sapovirus and had a family member testing positive for both norovirus and sapovirus. A diner who drank water or drinks with ice cubes (risk ratios (RR) 6.5, 95% confidence intervals (CI) 1.5–113.0) or both (RR 8.2, 95% CI 1.7–145.5) had an increased risk in a dose-response manner. Ice cubes from three vending machines had high levels of heterotrophic bacteria. A faulty air ventilation valve in the space where the ice cube machine was located was considered a likely cause of this outbreak. Leaking air ventilation valves may represent a neglected route of transmission in viral gastrointestinal outbreaks.
... Besides these data, epidemic outbreaks of GE are largely under-reported, data on the adult population are lacking and diagnosis of NoV is performed rarely in Italy. As a consequence, only few outbreaks related to NoV have been described to date [7][8][9][10]. Although the same genotypes circulating in humans in Europe are frequently detected in food (mussels and ready to eat vegetables) in Italy [11][12][13], in the absence of an accurate surveillance, the role of this virus in the aetiology of GE is unnoticed by local public health offices. ...
... To date, only few outbreaks of GE associated to NoV have been described in detail in Italy [9,10,18,19]. More recently, several studies on sporadic NoV cases in the paediatric population have been reported [6,20,21], showing that as described worldwide, this enteric pathogen is a common cause of acute GE requiring hospitalisation among children but also an important cause of nosocomial cases that can determine the occurrence of hospital outbreaks [22]. ...
In this study, we describe the results of virological investigations carried out on cases of gastroenteritis reported in different communities within a 2-year pilot surveillance programme (January 2012 to December 2013) in the autonomous province of Bolzano (Northern Italy). Among the 162 norovirus (NoV)-positive cases out of 702 cases investigated, 76 were grouped in nine suspected outbreaks, 37 were hospital-acquired and 49 were community-acquired sporadic cases. NoV infections were found in all age groups in outbreak and community-acquired cases, while the highest peak of hospital-acquired infections occurred in the elderly. Sequence analyses helped to identify suspected outbreaks both in the community and in hospital wards. Although GII.4 is the predominant genotype, sequence data confirmed that at least seven genotypes circulate causing sporadic cases. Findings in this study confirmed the relevance of NoV infections as a cause of outbreaks, and impact of NoV infections in community-acquired sporadic cases in adults that are rarely described because of a lack of reporting.
... For this reason, mussels cannot be guaranteed to be virus free even when EU standards on microbiological quality are met. Indeed, bivalves, because of their filterfeeding nature, retain and concentrate viruses present in their growing areas polluted by faecal contamination, thus becoming a risky food especially when eaten raw or undercooked (Rizzo et al. 2007;Alfano-Sobsey et al. 2012). It is widely reported in the literature that bivalves, such as oysters and mussels, are often contaminated by enteric viruses (Henigman et al. 2015;Mesquita et al. 2016;Varela et al. 2016), and their consumption is frequently involved in the occurrence of viral outbreaks in human (Rizzo et al. 2007;Le Guyader et al. 2008;Alfano-Sobsey et al. 2012;Rajko-Nenow et al. 2014;Boxman et al. 2016). ...
... Indeed, bivalves, because of their filterfeeding nature, retain and concentrate viruses present in their growing areas polluted by faecal contamination, thus becoming a risky food especially when eaten raw or undercooked (Rizzo et al. 2007;Alfano-Sobsey et al. 2012). It is widely reported in the literature that bivalves, such as oysters and mussels, are often contaminated by enteric viruses (Henigman et al. 2015;Mesquita et al. 2016;Varela et al. 2016), and their consumption is frequently involved in the occurrence of viral outbreaks in human (Rizzo et al. 2007;Le Guyader et al. 2008;Alfano-Sobsey et al. 2012;Rajko-Nenow et al. 2014;Boxman et al. 2016). Therefore, the scope of this study was to assess the presence of enteric viruses in Mytilus galloprovincialis (Mediterranean mussel) sampled from various class A and class B production areas in the Campania region in southern Italy. ...
In this study, the prevalence of various enteric viruses in Mytilus galloprovincialis (Mediterranean mussel) belonging to class A and class B mollusc-harvesting areas in the Campania region in southern Italy was evaluated. One hundred and eight mussels were analysed using real-time reverse transcription PCR during a 2-year collection period (2014-2015) to detect the following viruses: human norovirus (genogroups I and II), rotavirus, astrovirus, sapovirus, aichivirus, hepatitis A virus and hepatitis E virus. Overall, 50.93% of mussels were contaminated by at least one of the tested viruses. Of these virus-positive mussels, 63.63% were contaminated by two or more viruses. In 2014, only three of the eight investigated viruses were detected: astrovirus, sapovirus and aichivirus, whereas in 2015, seven of the eight viruses were detected (only hepatitis E virus was not identified). Astrovirus was the most frequently detected virus in both sampling periods. In 2014, sapovirus was detected at the same frequency as astrovirus (16.00%), followed by aichivirus (8%). In 2015, astrovirus (32.53%) was most frequently detected, followed by norovirus GII (26.50%), sapovirus (18.07%), hepatitis A virus (16.87%), rotavirus (16.87%), aichivirus (13.25%) and norovirus GI (12.05%).This study describes, for the first time, the presence of aichivirus and sapovirus in mussels in Italy.
... In 2005 a large outbreak of NoV gastroenteritis occurred in the southern Italy region of Puglia (Rizzo et al., 2007), involving 400 guests in a resort in the province of Lecce. Ninety percent of total stool samples examined were positive by RT-PCR, and sequence analysis confirmed the presence of a GII NoV. ...
Noroviruses (NoVs) are the major cause of acute gastroenteritis in children and adults. Virus transmission may occur through contaminated food, water, surfaces or by person-to-person contact. In this chapter we review the available information on the epidemiology of NoVs in the Italian population, and on their prevalence and levels in water environments, food products and food production environments in Italy. A summary of the foodborne and waterborne NoV outbreaks reported in Italy since 2000 is provided.
