Objective To evaluate the SARS-CoV-2 anti-spike IgG antibodies production after the vaccination with BNT162b2 and the protection from symptomatic breakthrough infections in healthcare workers. Patients and methods This prospective observational study (RENAISSANCE) had as primary endpoint the evaluation of serologic response to BNT162b2 14-days after second dose. SARS-CoV-2 anti-spike IgG antibodies were evaluated with LIAISON® SARS-CoV-2 TrimericS IgG assay, able to detect presence of both binding and neutralizing antibodies for trimeric Spike glycoprotein. Subjects were recruited from February 1, 2021 to February 22, 2021. Occurrence of vaccine-breakthrough infections was assessed by RT-PCR on symptomatic/contact cases, up to June 6, 2021. Results Out of 2569 staff only were 4 non-responders (0.16%, 95%CI:0.04%-0.41%). All 4 non-responders were severely immunosuppressed and on treatment with mycophenolate mofetil/mycophenolic acid. At 14-days since 2° dose, the 67.5% of staff had anti-S IgG titers ≥2000 BAU/mL, 19.2% between 1500- 2000 BAU/ml, 9.8% between 1000-1500 BAU/ml, and 3.4% ≤1000 BAU/ml. Females had a higher probability of having higher titers than males (64.5% [1044/1618] vs. 58.3% [410/703]; p=0.005). This was confirmed after adjusting for age group (OR [95%CI]: 1.275 [1.062-1.531]; p=0.009). Four months after the end of vaccination program, only 13 subjects (0.26%) had experienced a breakthrough SARS-CoV-2 infection, including 1 non-responder. This subject was the only requiring hospitalization for severe COVID-19. Conclusion Vaccination campaign among healthcare workers at the ASST GOM Niguarda has resulted in a significative serologic response, and reduction of incident COVID-19 cases. Yet, the lack of protection should not be overlooked in immunocompromised subjects.

In July 2018, a large outbreak of Legionnaires’ disease (LD) caused by Legionella pneumophila serogroup 1 (Lp1) occurred in Bresso, Italy. Fifty-two cases were diagnosed, including five deaths. We performed an epidemiological investigation and prepared a map of the places cases visited during the incubation period. All sites identified as potential sources were investigated and sampled. Association between heavy rainfall and LD cases was evaluated in a case-crossover study. We also performed a case–control study and an aerosol dispersion investigation model. Lp1 was isolated from 22 of 598 analysed water samples; four clinical isolates were typed using monoclonal antibodies and sequence-based typing. Four Lp1 human strains were ST23, of which two were Philadelphia and two were France-Allentown subgroup. Lp1 ST23 France-Allentown was isolated only from a public fountain. In the case-crossover study, extreme precipitation 5–6 days before symptom onset was associated with increased LD risk. The aerosol dispersion model showed that the fountain matched the case distribution best. The case–control study demonstrated a significant eightfold increase in risk for cases residing near the public fountain. The three studies and the matching of clinical and environmental Lp1 strains identified the fountain as the source responsible for the epidemic.

Economic losses associated with the structural and non-structural damage occurring after an earthquake are of particular importance in the case of industrial buildings due to the consequences of such losses on the local economy and employment level. The seismic sequences that hit the industrial area of Emilia-Romagna region of Italy in 2012 represent an emblematic example. In this earthquake event, major damage on poorly performing precast structures was recorded: many buildings were severely damaged and experienced partial or full collapse. The level of the recorded damage was related to a design lacking modern seismic detailing and to a non-up-to-date evaluation of the seismic hazard: in fact, several industrial buildings, typically one storey precast reinforced concrete (RC) structures, were designed to transfer horizontal loads (i.e. between roof elements and supporting beam or main girder and supporting columns) through either friction or under-designed mechanical connections.The aim of this paper is to provide insights on the evaluation of direct losses in the case of precast RC structures typical of the Italian industrial sector, particularly for buildings built before the enforcement of modern seismic codes. A simplified displacement-based seismic loss assessment procedure is proposed and applied to a selected case study and comparisons are made with the results obtained from non-linear time history analyses on simplified (i.e. single column models) and complete three dimensional models. Retrofit solutions are proposed and their influence on the collapse probability of the structural elements and on the economic losses is evaluated.

Background: We quantified, among diabetic adults, the frequency, costs, and factors associated with visits to the emergency department (EDs) and subsequent hospitalizations for acute hypoglycaemic and hyperglycaemic events. Methods: We included adults with diabetes residing in the Milan Agency for Health Protection between 2015 and 2017. From healthcare databases, we identified demographic variables, comorbidities, type of treatment, insulin treatment duration, previous ED attendances for acute glycaemic events, and two indicators of glycaemic monitoring. Using a validated ICD-9-CM coding algorithm, we identified all ED attendances for acute glycaemic events from the ED database and calculated their incidence. We computed the direct costs from health databases and presented them as average annual mean costs for those having had at least an ED attendance. The analysis of the association between the number of ED attendances and potential determinants was performed using zeroinflated negative binomial regression models. These two-part models concomitantly estimate two sets of parameters: the odds-ratios (ORs) of having no attendances and the incidence rate ratios (IRRs) of attendance. Results: The cohort included 168,285 subjects, 70% of subjects were older than 64 years, 56% were males, and 26% were treated with insulin. The incidence of acute glycaemic events for those attending the ED was 7.0 per 1000 patient-years, followed by hospitalization 26.0% of the time. The total annual direct cost for ED attendances due to acute glycaemic events was 174,000 €. Type of antidiabetic treatment had the strongest association with ED attendances for hypoglycaemia. Patients assuming insulin only had a lower probability of having no attendances (OR compared to those who assumed non-insulin antidiabetic drugs =0.01, 95% CI = 0.00-0.02). These patients also had the highest rate of hyperglycaemic episodes (IRR = 7.7, 95% CI = 5.1-11.7 for insulin only vs. non-insulin antidiabetic drugs). Subjects having had a previous episode of the same type leading to an ED visit had a higher rate of subsequent attendances (IRR for hypoglycaemia = 5.3, 95% CI = 3.9-7.3 and IRR for hyperglycaemia = 3.7, 95% CI = 1.3-10.2).

ObjectivesThis paper aims to provide an estimate of the prevalence rate of autism spectrum disorder (ASD) in 8-year-olds in 2017 based on administrative databases and to investigate the change in healthcare service use during the healthcare transition age of 18.DesignThis research is based on a longitudinal retrospective cohort study.SettingThe data is drawn from the Italian Administrative Healthcare Database (2010–2017).ParticipantsWe identified 5607 ASD patients; 331 ASD patients from 2012 to 2015 in the calendar year of their 18th birthday were selected and their health service utilisation during a 5-year period—ranging from 2 years preceding and succeeding their 18th year—were investigated.InterventionsNone.Primary and secondary outcome measuresPrevalence, incidence and proportion of ASD patients receiving specific healthcare services were included in the outcome measures.ResultsPrevalence of ASD at age 8 was 5.4/1000. Global access to health and social services was lower both before and after age 18 (46.5% at 16; 68.0% at 18; 54.1% at 20). The percentage of patients receiving a neuropsychiatric consultation decreased after age 18 (30.8% at 18; 5.4% at 20). Community mental health services (CMHS) utilisation rate increased above 18 years of age. Regarding psychiatric visits, for both outpatient and CMHS, an increase was observed from 17.8% at age 18 to 25.4% at age 20. The utilisation of rehabilitation services decreased with age, dropping from 17.8% at age 16 to 1.8% at age 20. Psychiatric outpatient services remained stable across ages at about 14%.ConclusionOur findings suggest that ASD patients changed clinical reference services with age from neuropsychiatric and rehabilitative services towards psychiatric and community-based services as they transitioned from paediatric to adult healthcare services.

Background The COVID-19 pandemic has placed a huge strain on the health care system globally. The metropolitan area of Milan, Italy, was one of the regions most impacted by the COVID-19 pandemic worldwide. Risk prediction models developed by combining administrative databases and basic clinical data are needed to stratify individual patient risk for public health purposes. Objective This study aims to develop a stratification tool aimed at improving COVID-19 patient management and health care organization. Methods A predictive algorithm was developed and applied to 36,834 patients with COVID-19 in Italy between March 8 and the October 9, 2020, in order to foresee their risk of hospitalization. Exposures considered were age, sex, comorbidities, and symptoms associated with COVID-19 (eg, vomiting, cough, fever, diarrhea, myalgia, asthenia, headache, anosmia, ageusia, and dyspnea). The outcome was hospitalizations and emergency department admissions for COVID-19. Discrimination and calibration of the model were also assessed. Results The predictive model showed a good fit for predicting COVID-19 hospitalization (C-index 0.79) and a good overall prediction accuracy (Brier score 0.14). The model was well calibrated (intercept –0.0028, slope 0.9970). Based on these results, 118,804 patients diagnosed with COVID-19 from October 25 to December 11, 2020, were stratified into low, medium, and high risk for COVID-19 severity. Among the overall study population, 67,030 (56.42%) were classified as low-risk patients; 43,886 (36.94%), as medium-risk patients; and 7888 (6.64%), as high-risk patients. In all, 89.37% (106,179/118,804) of the overall study population was being assisted at home, 9% (10,695/118,804) was hospitalized, and 1.62% (1930/118,804) died. Among those assisted at home, most people (63,983/106,179, 60.26%) were classified as low risk, whereas only 3.63% (3858/106,179) were classified at high risk. According to ordinal logistic regression, the odds ratio (OR) of being hospitalized or dead was 5.0 (95% CI 4.6-5.4) among high-risk patients and 2.7 (95% CI 2.6-2.9) among medium-risk patients, as compared to low-risk patients. Conclusions A simple monitoring system, based on primary care data sets linked to COVID-19 testing results, hospital admissions data, and death records may assist in the proper planning and allocation of patients and resources during the ongoing COVID-19 pandemic.

Old precast buildings are often characterized by poor detailing that may hamper the structural performance particularly in the case of earthquakes. This is essentially related to: (i) a limited past knowledge of seismic design and behaviour, also reflected in past building codes; (ii) the evolution of seismic zonation of the Italian territory. The aim of this work is assessing the probabilistic seismic vulnerability with respect to the usability preventing damage and global collapse performance levels of four existing single-story precast buildings designed in accordance with past Italian building codes from 1960s to 1990s in three sites with increasing seismic hazard.

ObjectiveTo evaluate the mean increase of anti-S IgG antibody titer between the basal, pre-booster level to the titer assessed 14 days after the booster dose of BNT162b2.Patients and MethodsThe RENAISSANCE study is an observational, longitudinal, prospective, population-based study, conducted on healthcare workers of Niguarda Hospital in Milan, Italy who received a BNT162b2 booster dose at least 180 days after their second dose or after positivity for SARS-CoV-2 and accepted to take part in the study. The RENAISSANCE study was conducted from January 1, 2021 through December 28, 2021.Findings1,738 subjects were enrolled among healthcare workers registered for the booster administration at our hospital. Overall, 0.4% of subjects were seronegative at the pre-booster evaluation, and 1 subject had a titer equal to 50 AU/ml: none of the evaluated subjects was seronegative after the booster dose. Thus, the efficacy of the booster in our population was universal. Mean increase of pre- to post-booster titer was more significant in subjects who never had SARS-CoV-2 (44 times CI 95% 42-46) compared to those who had it, before (33 times, CI 95% 13-70) or after the first vaccination cycle (12 times, CI 95% 11-14). Differently from sex, age and pre-booster titers affected the post-booster antibody response. Nevertheless, the post-booster titer was very similar in all subgroups, and independent of a prior exposure to SARS-CoV-2, pre-booster titer, sex or age.ConclusionOur study shows a potent universal antibody response of the booster dose of BNT162b2, regardless of pre-booster vaccine seronegativity.