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      Retrospective analysis of hospital discharge records for cases of trichinellosis does not allow evaluation of disease burden in Italy Translated title: L’analyse rétrospective des dossiers de sortie de l’hôpital relatifs à la trichinellose ne permet pas d’évaluer la charge de la maladie en Italie

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          Abstract

          Human trichinellosis is a disease caused by nematode worms of the genus Trichinella. In Italy, as well as in most other European countries, notification of Trichinella infections in humans is mandatory; however, no information is available on the number of cases occurring annually. The aim of the present study was to retrospectively evaluate the burden of trichinellosis in Italy from 2005 to 2016. Hospital discharge records (HDRs) showing the code for trichinellosis (124) were registered and screened. Results were then compared with yearly reports issued by the Italian National Reference Laboratory for Trichinella (NRLT), with reports from the European Centre for Disease Prevention and Control (ECDC), and with literature data. A total of 102 HDRs revealed that the 124 code was erroneously reported in 72 (70.6%) records. Out of the 30 (29.4%) records with a correct diagnosis of trichinellosis, nine cases were reported by HDRs only, 21 cases were documented by both HDRs and the NRLT, whereas the NRLT documented 100 additional cases. In the studied period, the average yearly incidence was 0.01 cases per 100,000 inhabitants. This study highlights the limitations of using HDRs to obtain a clear picture of the prevalence and incidence of trichinellosis in Italy. These findings demonstrate the need to intensify the surveillance system for trichinellosis through the development of an Italian registry. This would allow the identification of patients with severe infections and pauci-symptomatic patients, and would avoid the need for clinical analyses and unnecessary treatments, reducing the resulting economic burden on the Italian National Health Service.

          Translated abstract

          La trichinellose humaine est une maladie causée par les nématodes du genre Trichinella. En Italie, ainsi que dans la plupart des autres pays Européens, la notification des infections à Trichinella chez l’homme est obligatoire, mais aucune information n’est disponible sur le nombre de cas survenant chaque année. La présente étude visait à évaluer de manière rétrospective la charge de la trichinellose en Italie de 2005 à 2016. Les dossiers de sortie d’hôpital (DSH) indiquant le code de la trichinellose (124) ont été enregistrés et examinés. Les résultats ont ensuite été comparés aux rapports annuels du Laboratoire national de référence italien pour Trichinella (NRLT), du Centre européen de prévention et de contrôle des maladies (ECDC) et aux données de la littérature. L’analyse des 102 dossiers de sortie a montré que le code 124 avait été utilisé par erreur pour 72 dossiers (70,6 %). Parmi les 30 dossiers (29,4 %) avec un diagnostic correct de trichinellose, neuf cas avaient été identifiés seulement par le DSH et 21 cas à la fois par le DSH et par le NRLT. Sur la même période, le NRLT avait documenté 100 cas supplémentaires. Au cours de la période de l’étude, l’incidence annuelle moyenne était de 0,01 cas pour 100 000 habitants. Cette étude a mis en évidence les limites de l’utilisation des DSH pour obtenir une image fidèle de la prévalence et de l’incidence de la trichinellose en Italie. Cette étude identifie la nécessité d’intensifier le système de surveillance de la trichinellose par la mise en place d’un registre italien. Cela permettrait d’identifier les patients pauci-symptomatiques ou atteints d’infections sévères, et éviterait le recours à des analyses cliniques et à des traitements inutiles, ce qui réduirait la charge économique qui en résulte pour le Service National de Santé italien.

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          Trichinella spp. imported with live animals and meat.

          Nematodes of the genus Trichinella are widely distributed throughout the world in omnivorous and carnivorous animals (mammals, birds, and reptiles) and in incidental hosts. To prevent the transmission of these zoonotic parasites to humans, meat samples from Trichinella spp. susceptible animals are tested at the slaughterhouse or in game processing plants. The aim of the present review was to collect documented cases on Trichinella infected animals, meat, or meat derived products which reached the international trade or were illegally introduced from one to another country in personal baggage. In the course of the last 60 years in the international literature, there have been 43 reports of importation of Trichinella spp. infected animals or meat, most of which (60%, 26/43) related to live horses or their meat. Meat or meat derived products from pigs, wild boar and bears, account only for 18.6% (8/43), 4.7% (3/43), and 14.3% (6/43), respectively. However, only live horses or their meat intended for human consumption, meat from a single wild boar, and live polar bears caught in the wild for zoos, were imported through the international market; whereas, meat from pigs, wild boars and bears were illegally introduced in a country in personal baggage. Trichinella infected animals or meat which were officially or illegally introduced in a country were the source of 3443 Trichinella infections in humans in a 40-year period (1975-2014). Most of these infections (96.8%) have been linked to horsemeat consumption, whereas meat from pigs, wild boars and bears accounted only for 2.2%, 0.7% and 0.3% of cases, respectively. This review shows the Trichinella spp. risk in the international animal and meat trade has been linked mainly to horses and only one time to wild boar, if they carcasses are not adequately tested, whereas pigs and other wild animals or their derived products infected with Trichinella spp. are unlikely to reach the international market by the official animal and meat trade.
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            Retrospective study of human cystic echinococcosis in Italy based on the analysis of hospital discharge records between 2001 and 2012.

            Cystic echinococcosis (CE) is an important zoonotic parasitic infection. The European Centre for Disease Control highlights that Italy lacks a surveillance system for CE. Due to the lack of official data, we analysed the Hospital Discharge Records (HDRs) drawn from the National Ministry of Health. The aim of this study was to analyse data from the HDRs with CE-related diagnoses in Italy from 2001 to 2012 to assess the current status and trend of disease epidemiology. A total of 16,550 HDRs related to the admission of 10,682 Italian patients were examined. The HDRs were analysed according to the patient's region and province code to evaluate the demographic and clinical characteristics of each case, together with the annual incidence rates of hospital cases (AIh) in administrative divisions in rural and urban areas. Lesions occurred frequently in the liver (83.6%) and lungs (8.4%). Patients ranged in age from 1 to 100 years (mean 59.8), and 57% were over 60 years old. The highest average AIh was registered in the Islands with 4.6/10(5) inhabitants (6.9/10(5) in Sardinia and 4.3/10(5) in Sicily), followed by the South with an average AIh of 1.9/10(5) inhabitants (5.4/10(5) inhabitants) and the Centre with an average AIh of 1.07/10(5) inhabitants (there was an AIh of 1.65/10(5) in Latium). The analysis for trend showed a statistically significant decrease in the AIh throughout the study period (e.g., in the Islands r(2)=0.98, p<0.001). An AIh over 2/10(5) inhabitants was observed in 31/110 provinces. Rural areas with comprehensive development problems had a relative risk of CE of 5.7 (95% CI, 5.3 to 6.9) compared to urban areas. The relative risk increased between areas where sheep breeding is widespread compared to those where it is less prevalent. This study shows a detailed picture of the geographic distribution and the epidemiological situation of CE in Italy, indicating that CE continues to be a significant public health problem in Italy. The retrospective study of HDRs is useful for the evaluation of the status of disease epidemiology; however, a surveillance system is needed to report confirmed cases of human CE.
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              Trichinellosis outbreak caused by meat from a wild boar hunted in an Italian region considered to be at negligible risk for Trichinella.

              The wild boar is an important source of trichinellosis for people in European countries as a large number of hunted animals escape veterinary control. In November 2012, uncooked sausages made with meat from wild boar were consumed by 38 persons in a village of the Lucca province (Tuscany region, Italy). Of them, 34 were serologically positive, 32 developed clinical signs and symptoms of trichinellosis, and two were asymptomatic. Trichinella britovi larvae were detected in vacuum-packed sausages made with the same batch of sausages consumed raw which had been prepared with meat from wild boar hunted in the Lucca province. As no case of trichinellosis had been reported in this region during the last 20 years, the regional public health authority considered the risk for this zoonosis to be negligible and put in place a surveillance programme on Trichinella spp. in indicator animals (mainly foxes and including wild boar for private consumption), by testing only a percentage of heads. The experience from this outbreak shows that the definition of a region with a negligible risk for Trichinella infection is not applicable to wild boar and stresses the need to test all Trichinella-susceptible wild animals intended for human consumption and to implement risk communication to consumers and hunters.
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                Author and article information

                Journal
                Parasite
                Parasite
                parasite
                Parasite
                EDP Sciences
                1252-607X
                1776-1042
                2019
                16 July 2019
                : 26
                : ( publisher-idID: parasite/2019/01 )
                : 42
                Affiliations
                [1 ] Department of Infectious Diseases, Istituto Superiore di Sanità viale Regina Elena 299 00161 Rome Italy
                [2 ] Department of Translational Research, N.T.M.S. Università di Pisa via Roma 55 56126 Pisa Italy
                Author notes
                Author information
                http://orcid.org/0000-0001-9116-4948
                Article
                parasite190053 10.1051/parasite/2019043
                10.1051/parasite/2019043
                6632111
                31309926
                7de35a20-4fd2-47bf-ab11-73b4ebc55486
                © E. Pozio et al., published by EDP Sciences, 2019

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 April 2019
                : 27 June 2019
                Page count
                Figures: 1, Tables: 2, Equations: 0, References: 45, Pages: 7
                Categories
                Research Article

                trichinella,hospital discharge records,epidemiology,italy,prevalence,incidence

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