en

VIRAL DENGUE FEVER: where it is found and what the risks are in individual countries (AFRICA)
Our review of dengue continues. Where is this increasingly talked about disease most prevalent and what is the risk in countries in Africa?

INTRODUCTION ON DENGUE DISTRIBUTION
At the end of the Covid-19 pandemic, the urge to travel in all of us has become unstoppable. Travelers are distributed everywhere in the world to discover new and unknown tourist destinations. It is necessary to understand the whereabouts of this disease, caused by a virus that, through the bite of a mosquito, has spread to most countries in the world. The incidence of dengue has increased dramatically in recent decades. Cases, reported to WHO, have risen from more than 600,000 in 2000 to more than 6 million in 2020. The vast majority of cases are asymptomatic or paucisymptomatic, that is, characterized by mild, self-managing symptoms. For this reason, the actual number of dengue cases is greatly underestimated and most cases are misdiagnosed as other febrile, flu-like illnesses.

HOW MANY DENGUE INFECTIONS AND CASES ARE THERE

One estimate based on epidemiological models puts dengue virus infections at more than 400 million per year. Of these, nearly 100 million manifest clinically; the remaining infections are without or with mild symptoms. Another recent study on dengue prevalence estimates that more than 3.9 billion people are at risk of virus infection, particularly in countries in the tropical belt.
The disease is now endemic in more than 100 countries in the WHO regions of Africa, the Americas, the Eastern Mediterranean, Southeast Asia, and the Western Pacific. The Americas, Southeast Asia, and Western Pacific regions are the most affected, with Asia accounting for about 70 percent of the global burden of dengue virus disease.
A particularly aggressive form of Dengue Type 2 is emerging in some Latin American countries in early 2023, with an increase in deaths. Among them Argentina, Peru, and Brazil are the most represented.

For the past several years dengue has been spreading to new areas, including Europe. Local transmission was first reported in France and Croatia in 2010, and imported cases have been found in other European countries, particularly in the Mediterranean belt.
The number of dengue cases is steadily increasing. The U.S. region (South, Central and Caribbean) reported more than 3.5 million cases in 2019, of which more than 30,000 were classified as severe. A high number of cases were reported in Bangladesh (101,000), Malaysia (131,000), the Philippines (420,000), and Vietnam (320,000) in Asia in 2019.
In 2023, dengue viral fever is steadily increasing in almost all countries but widespread outbreaks are reported in Brazil, Colombia, Argentina, Peru, Cook Islands, Fiji, India, Kenya, Paraguay, Peru, Philippines, Reunion Islands, and Vietnam with exponential increases from 2021.
Today let us focus on countries on the African continent. Where do we find dengue fever in 2023 and with what risk assessment?
The following data are from the CDC and show the occurrence of dengue disease in different nations, with seasonal variations due to the presence of mosquitoes in the environment. This review of countries allows us to assess where most we can come in contact with the virus and what level of risk we find.

Today, in addition to a focus on the Aedes-type mosquito bite, prophylaxis is possible through
vaccination with the new QDENGA vaccine.The evaluation should always be done by asking for information from medical experts and specialists in the field.
To whom can it be administered?
Dengue vaccine is administered to all travelers who travel to areas at risk for business or tourism. Two doses are given starting at age 4 years and spaced 3 months apart. Booster should be given after 3 to 5 years, The vaccine is safe and effective So traveling to the countries listed below, especially those reported as (frequent/continuous) it is good to protect yourself from the disease by requesting vaccination.

Occurrence of DENGUE outbreaks and risk levels in African countries.

Country Level of risk
Angola Sporadic/Inconclusive
Benin Sporadic/Inconclusive
Burkina Faso Frequent/Continuous
Burundi Sporadic/Incontinuous
Cameroon Sporadic/Incertain
Cape Verde Sporadic/Incertain
Central African Republic Sporadic/Incertain
Chad Sporadic/Incertain
Comoros Sporadic/Incertain
Congo Sporadic/Incertain
Congo (Democratic Republic of) Sporadic/Inconclusive
Ivory Coast Sporadic/Incertain
Djibouti Frequent/Continuous
Egypt Sporadic/Incontinuous
Equatorial Guinea Sporadic/Incontinuous
Eritrea Frequent/Continuous
Ethiopia Frequent/Continuous
Gabon Sporadic/Inconstant
Gambia Sporadic/Incertain
Ghana Sporadic/Inconcert
Guinea Sporadic/Incontinuous
Guinea Bissau Sporadic/Incontinuous
Kenya Frequent/Continuous
Liberia Sporadic/Incertain
Madagascar Sporadic/Incertain
Malawi Sporadic/Incertain
Mali Sporadic/Incertain
Mauritius Sporadic/Incertain
Mayotte Sporadic/Incertain
Mozambique Sporadic/Incertain
Namibia Sporadic/Incertain
Niger Sporadic/Incertain
Mozambique Sporadic/Incertain
Namibia Sporadic/Incertain
Nigeria Sporadic/Incertain
Reunion Sporadic/Incertain
Rwanda Sporadic/Incertain
Sao Tome and Principe Sporadic/Incertain
Senegal Sporadic/Incertain

Seychelles Sporadic/Inconclusive
Sierra Leone Sporadic/Inconclusive
Somalia Frequent/Continuous
South Sudan Sporadic/Incontinuous
Sudan Frequent/Continuous
Uganda Sporadic/Incontinuous
United Republic of Tanzania Frequent/Continuous
Zambia Sporadic/Incontinuous
Zimbabwe Sporadic/Incontinuous

Update March 2023
Editorial Board Dr. Paolo Meo.
Dr. Paolo Meo is available to anyone who wishes to request information or book a consultation before leaving or returning from a trip or requesting dengue vaccination. One can email seg.cesmet@gmail.com or write a request message on WhatsApp at 3466000899

CURRENT WEATHER IN ITALY AND SHORT-TERM FORECAST

UPDATES TO 23 April 2023

WEATHER TENDENCY FOR SUMMER 2023: Seasonal forecasts

After the Winter ’22/’23 characterised by almost spring-like temperatures with a prevailing drought, the first part of Spring was characterised by rain and thunderstorms, localised but strong. A trend that is now well established. But these rains have not solved the serious problem of drought.
The forecasts confirm the trend of recent years. Summer 2023 will be marked by above-average temperatures of between +1.5°C and +2°C between June and July, in Italy but over most of the European continent.

For the countries of the Mediterranean basin, and in particular for Italy due to the infamous African anticyclone, heat and humidity will dominate. Until 10-15 years ago, the high pressure of the Azores, coming from the Atlantic, was characterised by mild air is
bearable. In recent years, on the other hand, we are witnessing an increasing presence of hot air masses from North Africa. Strong and persistent heat waves enveloping Italy but taking over the whole of Europe.
Very high temperatures between June and July (Source: ECMWF)

Climate change is becoming more and more evident and pressing, everywhere. Studies have always shown that among the effects of the changing climate, the increase in the frequency of heat waves is a constant.
The humidity, or rather the mugginess, creates a condition of unbearable heat. The reason lies in the characteristics of the ‘boot’: in fact, the ‘mare nostrum’ enriches the hot air masses arriving from the African continent with humidity, causing a series of negative effects in the organism.

In addition to increased physical discomfort, excessive perspiration, heart and lung problems for those already suffering from them, and much more.
Another problem is the risk of extreme weather events. Heat causes an increase in potential energy at play and thermal contrasts. This facilitates the development of massive storm cells, up to 10 to 15 km high. The risk of hailstorms, even tornadoes, is increasing.
For the month of August, the very long-term forecasts indicate very high temperature values above the averages we are used to.

All of this will have health repercussions for each and every one of us. We will soon begin to address the questions of how to defend ourselves against these events

THE EFFORTS OF THE EUROPEAN ENVIRONMENT AGENCY

From ECMWF European Centre for Medium-Range Weather Forecasts

 

 

 

Climate: Italy’s mild and temperate climate is certainly one of the factors that attracts millions of tourists every year. Only rarely do we have temperatures higher than 38°C in summer or below 8 degrees below zero in winter. The influence of the two mountain systems (Alps and Apennines) and the presence of the sea contribute to determine as many as 6 climate zones. Alpine: with long, very cold winters and abundant snowfall. Summers are short and cool, with frequent rainfall in spring and autumn. Padana: less long but cold and wet winters and muggy summers. Rainfall is frequent in spring and autumn. Ligurian-Tyrrhenian: the winters are warm and the summers hot but windy make it the ‘ideal’ climate. Spring and autumn rains are abundant, especially in the Ligurian region. Apennine: with cold winters and cool summers. Rains are frequent in autumn. Adriatic: cold but not too long winters, hot and not too sultry summers. Rainfall is moderate in autumn and winter. Mediterranean: winters are warm and allow swimming in the sea until late October, summers are very hot and long. Rainfall is only frequent in winter.

Malarone: an increasingly ineffective preventive drug. At the “Cesmet Traveller’s Clinic”, book consultations for information on malaria prevention; assistance during the trip with the THCARD insurance; specialised laboratory tests and tropical examinations on return. Call 0639030481 or write to ambulatorio@ cesmet.com

“Atovaquone-Proguanil (Malarone): the drug has been on the market for almost 30 years. For more than a decade, its efficacy has been declining due to an increase in plasmodium resistance to the drug.  The countries of South East Asia were the first where this type of resistance appeared and grew. Doxycycline 100 mg has been indicated for years in these areas. Increased resistance of the malarial parasite to these molecules has also been shown in many African and Latin American countries. This increase in parasite resistance to Atovaquone has forced the drug’s use in therapy to be avoided. Indeed, to treat malaria, Malarone has for years been replaced by combination drugs based on Artemisia, a principle that is still particularly active on Plasmodia. And if the parasites are so strongly resistant that this molecule cannot be used, it has also often proved to be fallacious in prevention. And this resistance continues to spread and increase in many areas of the equatorial and intertropical belt. And this is proven by clinical practice. More and more cases of malaria are occurring while taking the drug as chemo prophylaxis.
The drug is generally well tolerated although several people complain of adverse effects.  For this reason, when prescribing Malarone for use in prophylaxis, some travellers complain about the potential deleterious effects of this drug on their metabolism and in particular on their ‘poor liver’. In malaria prevention, however, the opposite is true: if a traveller falls ill with malaria, the problems for the ‘poor liver’ will be real and serious. Point necrosis of liver cells is typical of the disease. Liver toxicity from Malarone at preventive and therapeutic doses is absent. The drug was put on the market after years of research into its safety. The most common complaints are discomfort and heaviness in the stomach, vomiting, fever, headache, mild insomnia, cough, and rare cases of hair loss.

Contraindications
When Malarone should not be used

In case of allergy to atovaquone, proguanil hydrochloride or any of the other components of this medicinal product.
In case of severe renal disease.
Malarone is contraindicated in patients with intolerance to the drug and renal insufficiency.
Its use during pregnancy is still not recommended, although definite data on possible teratogenicity in the foetus have never been provided. On the other hand, with regard to the time interval between discontinuation of the drug and conception of a child, a very conservative estimate is that one month is more than sufficient. Thus, after a trip to tropical territory, even a few weeks after stopping taking malarone are sufficient to become pregnant without worry. And if one has taken the drug and become pregnant while taking it, one should not think about malarone because the data tell us that there are no negative effects on the foetus in such cases. Children weighing less than five kilograms should not take the drug while breastfeeding.

It continues to be used and prescribed, mainly for prophylaxis and less so for treatment, but as the drug’s efficacy is greatly reduced, if suspicious symptoms, malaise, tiredness, heaviness of the head, and perhaps fever and chills appear after a trip, do not hesitate to immediately ask for a malaria test and a specialist visit.

How to use Malarone in malaria prophylaxis

Malarone should be taken on a full stomach, or after drinking milk, to facilitate absorption, at a dose of one tablet per day, from one day before departure, for the duration of the stay, and up to seven days after return from the malaria-risk zone. Always at the same time of day.

The paediatric dose to be administered to children is shown in the following table:

Daily dosage    

Body weight Atovaquone (mg) Proguanil (mg) No. of tablets
11-20 62.5 25 1 cpr of Malarone Children
21-30 125 50 2 cpr of Malarone Child
31-40 187.5 75 3 cpr of Malarone Children

40 250 100 Persons over 40 kg should take 1 cpr per day of Malarone 250/100 mg

Undesirable effects
What are the side effects of Malarone

Like all medicines, this medicine can cause undesirable effects in some people.

Very common side effects

Headache, dizziness, nausea and vomiting, stomach upset, diarrhoea, insomnia, strange dreams, depression;

Allergic reactions also important but very rare: rash and itching; difficulty breathing; sudden swelling of eyelids, face and lips; rarely rashes.

Mechanism of action

The constituents of Malarone, Atovaquone and Proguanyl hydrochloride, interfere with two different pathways involved in the biosynthesis of pyrimidines, which are required for replication of Plasmodium nucleic acids. This dual mechanism is synergistic and particularly effective.
The mechanism of action of Atovaquone is through the inhibition of mitochondrial electron transport at the cytochrome bc1 complex and a fall in mitochondrial membrane potential. Proguanyl hydrochloride inhibits ‘dihydrofolate reductase’, a key substance in the reproduction of malaria parasites: these two molecules have for years formed the framework for highly effective prophylaxis.

Malarone has a different mechanism of action from the other drugs, i.e. a causal activity: it blocks the malaria parasites inside the liver cells. Proguanil has an antimalarial activity independent of its metabolisation into ‘cycloguanil’, and proguanil, but not cycloguanil, is able to enhance the ability ofatovaquone to break down the mitochondrial membrane potential in malaria parasites. This latter mechanism could explain the synergy observed when ‘atovaquone and proguanil’ are used in ssociation.

A bit of history

When Wellcome launched Atovaquone for the treatment of ‘Pneumocystosis’ in AIDS patients more than twenty years ago, they perhaps did not think that, on the one hand, the clinical course of HIV+ patients would change so radically within a few years, but also that the molecule would become important in the treatment of another parasitic disease, malaria. Treated with Malarone, in fact, pneumocystosis, a lethal manifestation secondary to the dreaded viral infection, decreased in prevalence. The valuable antiprotozoal (anti-parasitic) properties could still be recovered at the clinic, and the combination of Atovaquone and Proguanil, a chemotherapeutic drug, was conceived to treat a no less important disease: Plasmodium malaria.

The resulting drug was called Malarone and was intended for use in prophylaxis but also in the treatment of malaria. Malarone tablets currently contain: Atovaquone 250 mg / Proguanil hydrochloride 100 mg.

Read the full sheet

Compulsory vaccinations
YELLOW FEVER se….

YELLOW FEVER: Any person (except children under 9 months of age), arriving by air or sea without a certificate of vaccination is isolated for a maximum of 6 days, (i) if he/she has left an area where there is a risk of transmission of the disease less than 6 days before his/her arrival or (ii) if it has passed through one of those areas in transit, with the exception of those passengers and crew members who, for the duration of their transit through an airport situated in an area where there is a risk of transmission of the disease, stay in the buildings of the airport, provided that the airport doctor allows this exemption or (iii) if it has arrived in a ship which has left or touched a port situated in an area where the risk of transmission of the disease is present less than 30 days before its arrival in India, unless that ship has been disinfected in accordance with the procedure laid down by WHO, or (iv) if it has arrived in an aircraft which, having been in an area where the risk of transmission of the disease is present, has not been disinfected in accordance with the provisions of the Indian Air Navigation (Public Health) Regulations, 1954 or the provisions recommended by WHO. The following countries and areas are considered to be at risk of transmission: -Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Chad, Congo, Ivory Coast, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea Bissau, Equatorial Guinea, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Central African Republic, Democratic Republic of Congo, Rwanda, Senegal, Sierra Leone, Sudan, South Sudan, Togo, Uganda. -America: Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Panama, Paraguay, Peru, Suriname, Trinidad and Tobago, Venezuela. Note: When a case of yellow fever is reported in a country other than those mentioned above, that country is considered by the Government of India as an area where the risk of transmission of the disease is present and is added to this list.

This country considers the Yellow Fever vaccination certificate valid for life (amendment 0MS 11.07.2016). However, we recommend direct verification before travelling, considering the constant changes in the regulations of individual countries.

Updated January 2023

Recommended vaccinations
HEPATITIS A

read more….

EPATITIS B

read more….

TYPHOID FEVER

read more….

POLIO

read more…

DIARRHOEAL AND CHOLERIFORM SYNDROMES

• Vaccination is not compulsory, but should be considered depending on the type of trip and stay, and above all on the epidemiological situation of the country at the time of the trip. The new ‘oral’ formulation of the cholera vaccine now also protects against intestinal infections caused by many enterotoxic agents that cause ‘traveller’s diarrhoea’. The vaccine is therefore recommended for travel to many countries in the world.

TETANUS

read more…

ROUTINE VACCINATIONS

Make sure you have had all the vaccinations required by the National Health System. These include: tetanus, diphtheria, polio, pertussis, haemophilus B, hepatitis B, measles, mumps, rubella, chickenpox.

JAPANESE ENCEPHALITIS

Japanese Encephalitis is a viral disease carried by mosquitoes of the genus Culex, endemic in a vast area of Asia, from China to Australia, from Pakistan to Japan and the Philippines.
Transmission is generally predominant in agricultural and rural areas, often associated with rice production,
but more and more cases are also found in large urban agglomerations.

Learn more about malaria
WHAT IT IS

Malaria is an infectious, acute disease present in the country, very much linked to wet, rainy environments, seasons and weather conditions. Check your travel itinerary and the weather conditions in the areas where you will be staying before you leave. Remember that Malaria is a potentially serious and even fatal disease. Do not underestimate it. It can be prevented by paying attention to clothing that covers your uncovered parts at sunset and at night, the use of repellents and the use of appropriate prophylaxis drugs in the seasons of greatest risk.

IN THE COUNTRY

The risk of malaria (P. vivax 50%, P. falciparum 40%, P. malariae and P. ovale rare) exists year-round throughout the country, including the cities of Bombay (Mumbai) and Delhi, except in areas > 2,000 m (6,562 ft) in Himachal Pradesh, Jammu and Kashmir and Sikkim . 

Updated to January 2023

from CDC- YELLOW BOOK 2020

PROFILASIS

It is advisable to enquire at specialised centres about the need for pharmacological prophylaxis and with which drug.In areas at risk for Pl. Vivax the use of Chloroquine is recommended, without other drugs; in other areas, where the presence of Pl. Falciparum, the use of the following drugs is recommended: doxycycline, above 12 years of age, even for prolonged periods, in adventurous stays, in tents, or for treccking, or atovaquone-proguanil, in the under-12 population, and in the adult population, as an alternative to bassado.

It is advisable to inquire at specialised centres about the need for pharmacological prophylaxis and with which drug. In areas at risk for Pl. Vivax, the use of Chloroquine is recommended, without other drugs; in other areas, where Pl. Falciparum the use of the following drugs is recommended: doxycycline, over 12 years of age, even for prolonged periods, in adventurous stays, in tents, or for trekking, or atovaquone-proguanil, in the under-12 population, and in the adult population, as an alternative to doxycycline.
Mefloquine, in young adults in good health and subjects free of cardiovascular, neurological and psychiatric diseases. Do not use in states of anxiety and in cases of insomnia.

RETURN

In the event of fever, diarrhoea or otherwise feeling unwell, it is essential to consult a specialist doctor or expert in tropical diseases without delay (if possible within 24 hours, due to the possibility of having contracted malaria, if you are returning from a risk zone).

MANTOUX or TST test: the tuberculin test on the arm

updates 24 october 2022

you can book your MANTOUX test here (click here)

Apply for your TB test (MANTOUX or TST – IGRA or QUANTIFERON) at the CESMET Traveller’s Clinic – Etimedica authorised by the Lazio region (GU. N-G11683 of 09/10/20).
The centre is authorised to carry out tests for university, school, armed forces and public competitions (for the Convention for Universities and Competitions ask the secretariat directly). The answer is accompanied by an infectious diseases assessment and certification.

You can write and leave your details here to book. or call +390639030481

In order to identify a ‘latent tubercular infection’ or to study your immune status against the Tuberculous Bacillus, i.e. to undergo a screening test, you can use and request two different tests that are able to provide you with precise information on ‘possible contacts’ or possible ‘contagion’ with the ‘tuberculous bacterium’, being able to assess your ‘cell-mediated immune status’.  Naturally, the tests are used to help the clinician diagnose any latent or ongoing tuberculosis.

Let us consider the mantoux test – an in vivo test, with a reading of the cellular response in situ, where the tubercular antigen is injected, a more sensitive and more interpretable test, related to the person’s clinical parameters.
The QUANTIFERON test replaces skin tests (Tine-Test, Mantoux intradermal test) and detects the amount of cytokine ‘Interferon Gamma’ released following stimulation of T lymphocytes with two highly specific TB antigens (ESAT-6 and CFP-10).
The in vitro response, although specific and quantitative, does not replace the cellular reaction in response to antigens inoculated into the forearm.

Where to do the tst test or mantoux test
You can request the tst test or mantoux test at Cesmet-Clinica del Viaggiatore – Etimedica. The medical centre specialising in infectious, tropical diseases and parasitology is officially authorised by the Region of Lazio by decree published in the official gazette (OJ. N-G11683 of 09/10/20). The reports and certifications attesting the test result are therefore officially recognised for competitions, university institutions and other official requests. Naturally, the test is used to provide an answer in cases where tuberculosis is suspected. Agreements are in place for university and public competitions.
The performance of the test, assessment of the skin reaction, and interpretation is performed by experienced infectious disease physicians. Click here for information, leaving your details and the reason for the booking call, or phone the centre’s secretariat +390639030481

The tests you can undergo are:
(1) tuberculin skin test (Mantoux Test)
(2) interferon gamma release serum test (IGRA), which includes the Quantiferon test.

The test is performed to identify a ‘latent state’ at an early stage, which is possible in those who have lived for a long time in hyperendemic environments, i.e. where a lot of Mycobacterium is found, particularly in areas of tropical countries. These findings enable early treatment of latent tuberculous infection (LTBI), and greatly reduce the possible risk of reactivation of tuberculous disease.
This is why carrying out tubercular tests, first the skin test and eventually the confirmation test, can be important for the protection of your health.
Testing and possible treatment for LTBI, in the event of a positive result, should be performed in the categories of persons considered to be at risk. Among
these doctors, healthcare personnel, healthcare workers.
International travellers to areas where Mycobacterium is present should perform the Mantoux test before leaving and upon return from their trip.  This is because they work in risky situations or in healthcare environments or because of repeated work and contact with local people and workers, especially in closed and crowded environments. Teachers, volunteers, religious, workers of all kinds in contact with counterparts.
If you fall into one of these categories, you should consider taking an initial and periodic test.

The tuberculin skin test (TST or MANTOUX) evaluates the delayed intradermal response, i.e. under the skin, from hypersensitivity to the administered antigen, a purified protein derivative (PPD) from Mycobacterium tuberculosis.
Normally, a period of up to two to three months is necessary, after any contact and infection with the tubercle bacillus, for the conversion of the tuberculin skin test to occur, i.e. for this test to become positive and signal contact with the bacterium.
In the case of international travellers in the categories identified above, it would be desirable to carry out a MANTOUX test before travelling and 2 months after returning. In the case of prolonged stays, in working environments where prolonged contact is encouraged, it would be advisable to perform the test once a year.
For immuno-compromised persons, with weak or compromised immune defences, who have recently had close contact with known infectious cases of tuberculosis, treatment for LTBI may be initiated even if the TST is negative.
Patients who test positive for TST or IGRA should undergo clinical evaluation to exclude active tuberculosis and to assess the possible need for therapy against latent infection. A clinical evaluation of symptoms, pulmonary and systemic objectivity is always necessary, followed by a chest X-ray examination, after a positive Mantoux test.

TUBERCULIN SKIN TEST
The tuberculin skin test is considered the main test to detect infection or contact with the tuberculosis (or TB) bacterium.
Tuberculin is a fraction of the tubercle bacillus that, when injected, provokes an immune response in the body, which is manifested by an inflammatory reaction on the skin.
The test is harmless and safe and has no health consequences. If positive, it may provoke an even intense reaction at the site of inoculation characterised by swelling, soreness and a few lines of fever.
It is performed to find out whether there has been contact in the past with ‘Mycobacterium Tubercolosis’, the bacterium responsible for tuberculosis disease. A positive test indicates past or recent contact with the tuberculosis bacterium, but this is not the same as being ill.

How it is performed:
A small area of the forearm is chosen and disinfected and a dose of tuberculin is injected superficially with an insulin syringe with a very fine needle. A pompho on the skin appears, which slowly reabsorbs (Mantoux intradermal reaction). The skin response occurs 48 to 72 hours after inoculation.
A negative test leaves no trace, in the case of a positive test an area of inflamed skin with a central indurated papule appears.

The response is classified as follows

negative: absence of induration and erythema of less than 2 mm in diameter;
doubtful: with appearance of induration and erythema between 2 and 4 mm in diameter;
positive: with evident dermal induration and erythema greater than 5 mm in diameter.
intensely positive: if the papule necrotises centrally and the inflammatory reaction is very evident.

The negative test shows absence of contact with the tuberculosis bacillus.

The positive test shows contact with the tubercle bacillus and the response is proportional to the state of disease activity. In any case it must be emphasised that the test does not diagnose tuberculosis but only highlights the presence of an immunological response, the diagnosis being purely clinical with the aid of the radiological picture.

A clear contribution to the interpretation of the Mantoux test

1) Countries at risk of transmission

*In these countries, the risk of transmission is limited to certain areas.

Africa:

Angola
Benin
Burkina Faso
Burundi
Cameroon
Chad*
Congo, Rep
Ivory Coast
Ethiopia*
Gabon
Gambia
Ghana
Guinea
Guinea Bissau
Equatorial Guinea
Kenya*
Liberia
Mali*
Mauritania*
Niger*
Nigeria
Central African Republic
Democratic Republic of Congo*
Senegal
Sierra Leone
Sudan*
South Sudan
Togo
Uganda

America

Argentina*
Bolivia*
Brazil*
Colombia*
Ecuador*
Guyana
French Guiana
Panama*
Paraguay
Peru*
Suriname
Trinidad and Tobago*
Venezuela*

2) Countries at low risk of transmission

 Eritrea
 Rwanda
 Sao Tome
 Somalia
 Tanzania
 Zambia

INFORMATION services in Telemedicine are available daily by requesting :
– Online consultations before travelling;
– advice on infectious diarrhoeas: how to prevent them, how to treat them, what to do when travelling;
– INFO on Chemoprophylaxis for malaria online;
– Online consultations for INFO on COVID19 and LONG COVID;
– Online consultations Infectious and Tropical Diseases.
These services can be requested (CLICK HERE) or by writing a request to seg.cesmet@gmail.com , or by sending a WhatsApp message to +39 346 6000899.

Comparing drugs for Traveller’s Diarrhoea – Bassado and Normix a winning combination

Information and advice, examinations and tests. Book at Cesmet

Diarrhoea, traveller’s diarrhoea, dysentery, abdominal discomfort, gastro enteritis, enterocolitis. First symptoms, immediate use of drugs such as Bassado (doxycycline) and Normix (rifaximin). From the classic bellyache with lots of air inside, to unbearable colic with very high fever. Antibacterial drugs are of first choice. Bimixin, now a second-rate drug. Imodium a symptomatic drug to watch out for.

Traveller’s diarrhoea: more than 60% of all travellers worldwide are affected by this problem. The World Health Organisation (WHO) provides us with accurate data and descriptions of what happens worldwide. Countries most affected, favourable environments, risk behaviour.  Traveller’s diarrhoea can affect any of us, anywhere, in any city or country. We have to prevent it, first and foremost, and if necessary, nullify the symptoms right from the start. Bassado as prevention or treatment, normix to be added in case of symptoms. Bimixin used less and less and imodium, locked in the drawer.  Of each drug we have put the package leaflets.
But reality is experienced in the field. And on the basis of years of experience I want to give you a few pointers.

DIARRHEA according to WHO

Some rules before travelling: to protect our health.

• Think about fair and correct information. Know the risks, the characteristics of the environment where you are travelling, the weather situation and the occurrence of illnesses, and how to behave to maintain good health. Then ask for specialised and direct advice that answers your doubts and questions.
• Go to an international vaccination centre and request, wherever you go, the 3 basic vaccinations to protect your gut from even serious infections.
  Vaccinate against Hepatitis A, a ubiquitous and aggressive virus; vaccinate also against Typhoid Fever, i.e. Salmonella, a ubiquitous, dangerous and particularly drug-resistant bacterium; vaccinate especially against Traveller’s Diarrhoea, i.e. against those bacteria that are enemies of our intestines, i.e. pathogenic E. Coli, as well as against the Vibrio cholerae, i.e. (Dukoral), an oral vaccine that is particularly effective and useful at all ages.
• Then prepare your ‘Travel Pharmacy’ by including some ‘drugs to prevent or treat’ diarrhoea, and its worsening to the presence of blood and mucus (dysentery) with fevers and particularly severe symptoms.
  Doxycycline 100 mg, an old tetracycline, widely used in the prevention of many bacterial forms, especially intestinal aggression by enterobacteria; but also in the treatment of particularly aggressive forms, up to the treatment of Cholera.  You can find it in pharmacies under the trade name Bassado or Miraclin

Normix 200 mg, is a strong intestinal antiseptic and therefore anti-diarrhoeal drug. Both for prevention of bacterial attacks and also as a treatment for diarrhoea. You can find it in pharmacies under the trade name Normix; Rifaximin has a broad spectrum of action on both aerobic and anaerobic gram-positive and gram-negative species. It is poorly absorbed in the body and therefore carries out bactericidal activity exclusively in the intestinal canal, avoiding toxic problems in the body resulting from absorption.
Doxycycline is preferred to Rifaximin, during travel, because of its multiple covers; from efficacy on skin infections, to prevention and treatment for tick bite infections and many other infections. Among the most effective drugs as an antimalarial.
Neomycin and Bacitracin, a combination drug, Bimixin, has become obsolete since bacteria no longer respond to the action of Neomycin; it is still in high demand and prescribed, but is really not very effective; in the past it had a broad spectrum of action, which has now almost disappeared;

Loperamide, is the active ingredient in the famous Imodium, a drug found in most travellers’ luggage. It is frequently used at the first diarrhoeal discharge. Nothing could be more negative. Imodium should not be taken alone, but always in combination with antibacterial drugs. It decreases intestinal muscle motility, slows down the transit of food and water and liquids, facilitates absorption at the level of the villi, decreasing the frequency of discharges. It decreases colon movements by reducing the gastrocolic reflex and thus the urge to evacuate. But all this facilitates the stagnation of liquids and thus of bacteria that increase in number, to the point of worsening the infection.

When you travel, whether to Italy or to any country in the world, take your ‘little travel pharmacy’ first of all with you your packet of Doxycycline 100 mg, for all the coverage and efficacy in many infections; supplement this drug with Normix (Rifaximin) to increase its efficacy in treating diarrhoea; Bimixin I no longer recommend because of its reduced efficacy; never use Imodium alone to treat infectious type diarrhoea as it can have the unwanted effect of strengthening enteropathogenic bacteria causing a worsening of the already delicate intestinal situation. If it is really necessary, and this is rare, add it to Doxycycline or Rifaximin.

Read also Normix- Package Leaflet
Read also Bimixin leaflet
Read also Imodium – Package Leaflet
Read also Rifacol – Package Leaflet

INTRODUCTION

Malaria is an acute infectious disease caused by infection with a parasite, Plasmodium, transmitted by the bite of a mosquito called Anopheles. This is widespread in most equatorial tropical territories, where the humid, warm environment and the presence of water, especially stagnant water, favor its reproduction and growth.

Many different symptoms of malaria occur with increasing gradations and levels. After the bite of the infected mosquito, most individuals, especially those who have always lived in at-risk areas, remain asymptomatic, that is, although infected, they do not manifest any symptoms. Other individuals, however, manifest the disease with a crescendo of symptoms and increasingly strong and severe manifestations. Delay in diagnosis and treatment can cause symptoms to worsen to the point of death. This may be due to “brain” forms, kidney failure, or other internal deficits. Speed in dealing with this disease can be vital. Waiting and letting time pass unnecessarily can be lethal, as is often the case.

MALARIA IN RESIDENTS OF ENDEMIC AREAS AND TRAVELERS

Living in endemic areas, where infected Anopheles coexist with humans, sting to feed on their blood, and inoculate Plasmodium frequently, means fostering a mechanism for eliciting the cellular immune or antibody response, a protective factor against the parasite. Repeated and symptomless infections are typical situations for those living in malarial areas. In contrast, in these areas, infants and young children, who have not yet developed full immunity against malaria, are at serious risk of disease and are the age groups with the greatest deaths.

In travelers coming from areas where the malarial parasite is absent, the bite of an infected mosquito can cause an infection that, without immune coverage, allows Plasmodium to develop and invade with the “erythrocyte cycle the blood cells,” with gradually exponential growth.

The presence or absence of symptoms and their “degree” of manifestation is greatly conditioned by the response of the immune system.

THE VARIETY OF SYMPTOMS

Worsening malaise; a sense of dizziness; increasing headaches; fatigue and muscle aches; these may be the first symptoms that occur after a few days to those who have been bitten by an infected mosquito. After a few days, heaviness and soreness in the nape of the neck and neck may appear; dull, severe pain in the muscles of the legs and arms; initial sensation of moist skin, particularly noticeable in the abdomen and back. Approximately one week after the first Plasmodium infestation a fever may begin, not always, to present first, accompanied by mild chills; increased sweating and fronto-occipital headache; these symptoms in the following hours or days tend to increase, with an asthenia that does not allow arms and legs to move. Lightheadedness increases and fever may begin to disappear and to reappear with an undulating characteristic every three to four days. Over the next few days, if no action is taken, the sufferer may present with a heavy, reddish, sometimes dark urine; a feeling of heaviness and swelling in the upper abdomen, spleen and liver; worsening mental confusion to a semi-comatose state and eventually irreversible coma and death due to blockage of cerebral circulation by encephalic microthrombosis.

Irritative abdominal symptoms such as even watery diarrhea and feeling of nausea and vomiting are common at the onset of the disease.

 

All of these symptoms can rarely occur simultaneously. It is more common for a few, the less severe, to occur with a widely varying degree of intensity. Fever, considered a pathognomonic symptom, often does not appear or occurs late. The typical symptom and almost always present is the generalized feeling of malaise and headache, in the early stage with that sense of head muffling.

Malaria is called the “great deceiver” precisely because of this variety of such different symptoms and unpredictable gradations.

As mentioned earlier, fever, mild or very high, is considered the typical symptom of malaria, accompanied by chills and sweating. This set of symptoms result from the body’s response to the lysis of blood cells, the release of endotoxins, catabolites and the release of parasites into the circulatory stream with a defensive reaction of the body’s systems. But this set of symptoms, regularly taken as the only clinical evidence of the presence of plasmodium, is to be considered unreliable in diagnosing the disease because it is often not present. That is, the absence of these symptoms does not rule out diagnostic doubt. “Algid malarias,” i.e., those without fever, are very common, especially in individuals who have had malaria, in those who live for long periods in risk areas, and in those who have developed specific immunity.

The life of the different types of Plasmodium within the organism; their presence and long cohabitation in blood cells and in those within the “liver acini,” which are cell formations that constitute the internal structure of the liver; the presence within certain families of lymphatic cells; all these events affecting the presence of the parasite in the human organism is strongly conditioned by the immune response of each individual.

The reproductive cycles of Plasmodium in the liver and blood cells occur with well-timed and well-timed but conditioned by the response and modulation of the immune system, which also regulates the occurrence of symptoms.

Native populations, living in areas densely populated by Anopheles, due to the constant bites of infected mosquitoes and the constant presence of the malarial parasite in the “red and white” blood cells and also in the lymphocyte organs, constantly reinforce their defensive capacity against Plasmodium. This situation, typical of malarial territories, of “attack” (Plasmodium) and defense (immunity), permanent, allows to arrive at a coexistence between the two

organisms (parasite and host).

Individuals then coexist in malarial environments with mosquitoes and parasites in a form of “commensalism” (peaceful living) but which should not be considered long-lasting. It only takes a decrease in defense systems due to other infections, or traveling to areas where Anopheles and Plasmodium are not present, to lose immunity and defense. This is a typical phenomenon of those living in infected areas: (1) suffering from periodic states of fatigue; (2) experiencing generalized malaise; (3) losing muscle strength; (4) losing work capacity; and (5) slowing down body activities.

In this period of climate change, long dry spells condition the presence of Anopheles in the environment for long periods. The arid climate prevents mosquito life. Then sudden floods, a frequent phenomenon after long periods of drought, induce new reproductive waves of insects. All this favors the disappearance and presence of Plasmodium in these countries with multiple, periodic infections that, due to the periodic loss of defenses, produce serious and often fatal malaria in the population, especially children, which is unforeseen and unpredictable.

This is the same phenomenon that happens to people who expatriate for medium to long periods from their countries and lose their resistance to Plasmodium. Back home they are just as likely to get sick, even with severe forms as any traveler from areas free of the Malaria Plasmodium.

“The great deception of malaria,” with the most diverse symptoms in type and gradation thus stems from the relationship between the immune system and the parasite and explains the onset of different symptoms, and the progression of the disease to increasingly aggressive situations.

 

From the above it is good to reflect on the following:

– Anyone traveling to malarial areas, coming from countries with this disease, is subject to infection. The manifestation of the disease and symptoms depends on his or her immune response;

– The most important defense against malaria is definitely the use of natural (Neem) or chemical (DEET) repellents that ward off the risk of mosquito bites;

– Prophylaxis with suitable and effective drugs helps decrease the incidence of the disease by chemically attacking Plasmodium. But it is important to know that a weak “natural and innate immune response of the individual” increases the chance of manifesting symptoms after Plasmodium inoculation; (The Covid example is emblematic. During the pandemic, the induced reduction of immune defenses caused a sharp increase in malaria symptoms and even deaths in indigenous populations – WHO statistics 2022). This demonstrates the defensive power of the immune system.

– During the stay and also upon return from a trip from malaria-prone areas, the occurrence of discomfort, such as those described above, even nuanced, should kindle doubt that one has been infected with Plasmodium. The event should be considered possible and probable even for short or very short stays in areas with the presence of Anopheles. Even a few hours is enough to receive infected stings;

– Returning from a trip from malarial-risk areas, if there is discomfort, headache, fever, or other symptoms, first think of the malarial risk and rule out the disease, then think of any other disease you may have developed.

– The statement that in the presence of symptoms of suspected malaria, laboratory tests are always positive, including the highly sensitive PCR, is not true.

“If the slide read in the laboratory is negative, malaria is not there.” This statement is not true and is dangerous. Significant immunity present in an individual can make the presence of the parasite negative. A slide reading made by inexperienced or hasty eyes can give a negative answer even though the parasite is present.  The clinical diagnosis, derived from an evaluation of symptoms, cannot be erased by a negative test, the answer to which is not always true.

– A symptomatic individual, with symptoms that worsen over time and with typical manifestations, even with presumed negative tests, should be treated with effective medicine.

– “Intervening as early as possible saves and does no harm, waiting can kill.”

 

Update: January 2023                                                                         Book your vaccination here

Vaccination against Yellow Fever (or Anti-Amharillic Vaccine), an acute viral disease transmitted by mosquito bite, is the only preventive practice that can be mandatorily required by a country’s health authorities in order to enter through border crossings. This occurs irrespective of the presence of manifest cases or epidemic outbreaks of the disease, but is an international provision designed to prevent the spread of the disease when the vector insect (Aedes aegypti) is still present in the country. The example is the Asian countries where the virus is absent but the vector, i.e. the mosquito, is present. Remember that Yellow Fever is a zoonosis (disease of animals – monkeys) that can be transmitted to humans through the bite of the Aedes type mosquito.

This is why vaccination is made compulsory in some cases, and in any case is strongly recommended in countries where the virus is present with the vector. It is necessary, before leaving for a country considered to be at risk, to find out about the international regulations adopted in this regard. Regardless of this, however, it is a good idea to check with experts where there is a real risk of infection or where the presence of infected animals is likely, and therefore in which cases vaccination is recommended before travelling. Currently, the areas at risk of transmission are in Central and South America, as well as in many countries in Africa. In Asia, the presence of this virus is not reported.

Vaccination is risk-free; it rarely produces a fever after 24 hours at most, which is easily controlled with antipyretics
It is not recommended for individuals allergic to egg proteins.
Can be administered from the age of 6 months.
Use during pregnancy: not recommended.

Period of activity of the live attenuated virus once injected with the vaccine

During the first 48/72 hours, the live attenuated virus, which is harmless to the organism, reproduces and activates the defence system, simulating the disease. The immunological cellular part is activated and anti-virus antibodies (neutralising the virus) are formed. This fact serves to disprove the urban legend that the harmful action of the ‘live attenuated virus’ present in the vaccine is active for 3 or even 6 months (one cannot conceive for this length of time). It is reiterated that already after two to three days the virus is neutralised by the immune response, which reaches its maximum cellular response as early as the seventh day. Its action therefore on the product of conception is practically non-existent. Therefore, all women who think they might become pregnant in the immediate future can be vaccinated without any problem after vaccination.

To learn about the disease please visit our disease fact sheet on Yellow Fever.

To find out about the vaccination please visit our Yellow Fever vaccination factsheet

If you would like further information, please contact us by e-mail at seg.cesmet@gmail.com or phone +39 06/39030481, or whatsapp +393466000899

IRELAND: The Health Protection Surveillance Centre has confirmed 4 recent cases of meningitis/meningococcal septicaemia reported in the last week of October in the country.
Three cases have already been confirmed and one is under investigation. The three confirmed cases are all caused by meningococcal serogroup B. The cases were reported from different regions of the country and have no known links to each other. Three of the cases concern young adults between 12 and 18 years of age and one case is less than ten years old. The public health authorities have identified close contacts, who will be placed under close surveillance and under preventive antibiotic treatment. The latest information gives 2 deaths from the cases reported.

Meningitis

Meningococcal meningitis and septicaemia are caused by various serogroups of Neisseria meningitidis (meningococcus), an encapsulated aerobic Gram-negative bacterium. There are at least 12 serotypes of meningococcus, of which groups A, B and C account for about 90% of meningococcal disease, together with strains Y and W135.
TRANSMISSION: Meningococcus is transmitted by aerosol or by direct contact with the respiratory secretions of infected persons and healthy carriers. The disease occurs mainly in children, adolescents and persons with risk factors.
INCUBATION: The incubation period is different for each organism and can vary from two to ten days for bacterial meningitis.
SYMPTOMS: Generally, signs and symptoms may include: severe headache, stiff or sore neck, high fever, photosensitivity, confusion, convulsions, rash, joint pain, vomiting.
In children, signs may include: difficult feeding, excessive tiredness, irritable state, difficulty breathing, fever, stiff neck, convulsions, vomiting, rash, pale or blotchy skin.
PREVENTION: Vaccination is, without doubt, the most effective tool for preventing bacterial meningitis.

Several types of anti-meningococcal vaccine are available in Italy:

the conjugate vaccine against meningococcal serogroup C (MenC): this is the most frequently used and only protects against serogroup C
the tetravalent conjugate vaccine: protects against serogroups A, C, W and Y
the serogroup B meningococcal vaccine: protects against this serogroup only.
The vaccination card currently in force provides for vaccination against meningococcus C or ACWY in children over one year of age, while a booster with tetravalent vaccine A, C, W, Y is recommended for adolescents. The tetravalent vaccine is also recommended for adults with risk factors and those travelling to countries endemic for these serogroups.

The vaccine against meningococcal B meningitis is especially recommended for children within the first year of age.
Meningococcal B disease is prevented by vaccination.
The MenB vaccine was introduced for all children born on or after 1 October 2016 because children under one year of age are at a higher risk of meningococcal B disease. All children are offered the MenB vaccine at 2 and 4 months of age with a booster dose of the MenB vaccine given at 12 months.

WHAT COP27 IS (watch video)

From RIO 1992 and Berlin 1995 to Glasgow 2021. The 26 Conferences on the Climate and Health of OUR ‘planet earth’ organised by the United Nations. Decades of reflections, studies, observations, joint efforts to mitigate the effects of climate change. Climate change is now a reality for all to see. Particularly in the year 2022, the earth was scorching hot with a dramatic shortage of water.
And in the year 2022, still with Europe in a heat vice, in Egypt in Sharm el Shake we seek new results, more inclusive, more concrete, based on clear rules; on concrete guidelines to be followed by all participating states. Results commensurate with the challenge, based on scientific research, the word and the work of researchers, and guided by actions based on ‘agreements, promises and commitments’. Agreements promises and commitments that have marked previous Conferences with growing interest but few concrete actions.

ITALY PRESENT WITH COUNCIL PRESIDENT GIORGIA MELONI

Goals and vision from the Conference in Egypt

On the part of all participants there is now an awareness of where we are, of environmental disasters, of the disruption of weather and seasons, and an awareness that only an acceleration on global and joint climate action, through (1) a reduction of carbon emissions, (2) an increase in adaptation efforts and (3) the enhancement of adequate funding streams towards renewable, green and less polluting energies, can bring about a change of course. The recognition that the ‘just transition’ remains a priority for all countries, from the advanced to the developing world.

The key words of the COP 27 Conference: Mitigation; Adaptation; Financing; Collaboration;

The COP27 (Egyptian) chairmanship has as its determining objective the strengthening and facilitation of agreement in negotiations between states and representations to achieve tangible results in a balanced manner. The effort to forge partnerships and collaborations between states will help to achieve the four goals mentioned above and ensure that the world adopts a more resilient and sustainable economic model, in which the survival of human beings is at the heart of the climate negotiations.

As these UN-driven negotiations are based on consensus and reaching an agreement among all stakeholders, this will require the inclusive and active participation of all these stakeholders.

The Egyptian Presidency of COP27 is working hard to ensure adequate representation and participation of all stakeholders at COP27, particularly vulnerable communities and representatives of countries in the African region that are increasingly affected by the impacts of climate change. We need to transform the theoretical outcomes of Glasgow into concrete actions and start implementing them.

At this conference it is the organisers’ wish that human beings are at the centre of the climate talks.

The goal of COP 27 is that the governments present, big business and the private sector, and civil society must work together to transform the way we all interact with our planet. New solutions and innovations must be sought and introduced in our everyday lives. Innovations and solutions that help alleviate the negative impacts of climate change. It is a priority to rapidly replicate and disseminate all climate-friendly solutions in order to implement them also and especially in developing countries.

Italy will also be present at the International Climate Conference with Prime Minister Giorgia Meloni who will travel to Sharm El Shake on 7 and 8 November. (CLICK HERE – Giorgia Meloni in Sharm El Shake)

COP27: Italy is represented at the International Climate Conference by Prime Minister Giorgia Meloni.
Prime Minister Giorgia Meloni will attend the Cop27 Summit of Heads of State and Government in Sharm El Sheich on 7 and 8 November. Italy’s commitment will be full and active according to President Giorgia Meloni.

The issues on the ground discussed at the COP27 conference in Sharm El-Shaike.
Cop27 is the 27th annual UN climate conference, which began in Berlin in 1995. It will be held in Egypt from 6 to 18 November. More than 100 leaders including heads of state and government from around the world are expected to attend. This testifies to the delicacy and global involvement on an issue that is crucial for the maintenance of the planet’s natural balance, and for mankind’s very survival.

Climate and Coal

The COP 27 Conference will focus on the guidelines for combating climate change effectively. Glasgow 2021 marks the starting point. During the COP 26 in Glasgow, political choices were marked and many concrete actions to be taken. The start of the Sharm Conference is an opportunity to take stock of the commitments made at Cop26 in Glasgow. The first commitment was to keep global warming within 1.5° C. This goal is almost impossible to achieve as things stand, since average global temperatures have already risen by 1°C and global greenhouse gas emissions are not and are not falling. On the contrary, the trend is towards increasing emissions.
Compared to 2021, a year ago, the scenario has even worsened and serious issues have emerged that threaten to undermine climate change action in the short and long term. Among the events that held back the common effort to counter harmful emissions was the war in Ukraine, with the subsequent economic recession; the energy crisis with heavy investments and actions on fossil fuels such as gas and coal. All factors that contribute to producing greenhouse gases.

The UNFCCC UN climate agency and the Egyptian chairmanship of the conference have prepared a very broad agenda to address, discuss and find concrete solutions to most of the topics.
From 6 to 18 November, one topic is dedicated to each day: (1) finance; (2) agriculture; (3) water; (4) decarbonisation; (5) biodiversity; (6) energy.

The UNFCCC report that will be presented at COP 27, produced by dozens of research teams of specialists in the field, shows that the commitments made by the 193 signatory countries of the Paris Climate Agreement, almost all of the world’s countries, will lead to a predictable increase in global average temperatures of 2.5° C, compared to pre-industrial levels, by 2100. Instead, the Agreement should provide that global warming should be kept below 2°C, possibly within 1.5°. Yet, despite temperatures rising steadily and peaking in 2022, the trend shown by global emissions is growing further than the rapid decrease that science believes is needed this decade. Increasing the much hoped-for decarbonisation commitments of individual countries no longer seems to be a priority for states at this juncture but will remain one of the central themes at Cop27.

 

Flu vaccine, pneumococcal vaccine and ‘winter respiratory disease prevention vaccine package

“to book your vaccination click here”

I look forward to seeing you at the “Cesmet Vaccination Centre Clinica del viaggiatore” to get your flu vaccination and provide you with further advice on the situation regarding the 2022/23 autumn-winter season. (Dr Paolo Meo).

If you need it, you can also book the pneumococcal vaccine (bacterial pneumonia protection). A ‘vaccine package for winter respiratory disease prevention’ is offered at the centre.

In order to understand the need to vaccinate against influenza this year (what is influenza – click here), it is necessary to consider the increase in cases of Covid-19, between September and October 2022, and the simultaneous arrival of the influenza virus in Europe, with the first cases already recorded in the UK, Germany and other countries. It is important that you avoid the risk of co-infections (i.e. simultaneous infections of Covid-19, influenza and pneumococcus) that can cause aggressive respiratory forms. My advice is to anticipate the flu vaccination, as early as mid-October. I think it is important this year to decide to vaccinate against influenza, caused by that specific virus that can be confused with Covid-19, which can worsen the health condition if it co-acts negatively with this virus and pneumococcus.

Even WHO and the Italian Ministry of Health recommend influenza vaccination for everyone, precisely to prevent co-infection between influenza virus and Covid-19. As with Covid-19, vaccination for ‘the flu’ also aims to prevent severe and complicated forms of the disease and help reduce mortality in groups at increased risk of severe illness. Find out if you are also part of one of the reported groups to make your decision.

The flu vaccine is recommended for:

• people aged 65 years or older;
• children between the ages of 6 months and 6 years;
• parents of children 0 – 6 months, and people in contact, to avoid spreading the virus;
• pregnant women or women in the ‘postpartum’ period;
• all healthcare personnel working in facilities in contact with the sick;
• the elderly and RSA staff;
• all persons from 6 months to 65 years of age suffering from ‘chronic diseases’ that, in contact with the influenza virus,
• may worsen the symptoms of their illness;
• chronic diseases of the respiratory system (including severe asthma, bronchopulmonary dysplasia, cystic fibrosis and
• chronic obstructive pulmonary disease (COPD));
• diseases of the cardio-circulatory system, including congenital and acquired heart diseases, and major hypertensive states;
• diabetes mellitus and other metabolic diseases (including obese persons)
• chronic renal/renal insufficiency
• diseases of the haemopoietic organs and haemoglobinopathies;
• cancer and undergoing chemotherapy treatment;
• congenital or acquired diseases involving deficient antibody production, drug-induced immunosuppression or HIV;
• chronic inflammatory diseases and intestinal malabsorption syndromes (Chron and others);
• diseases for which major surgery is planned;
• diseases associated with an increased risk of aspiration of respiratory secretions (e.g. neuromuscular diseases);
• chronic liver disease;
• individuals of any age admitted to long-term care facilities;
• family members and contacts (adults and children) of individuals at high risk of complications.

• employees of public services of primary interest and categories of workers:

• physicians and health care workers in facilities who, through their activities, are able to transmit influenza to those at high risk of influenza complications;
• police forces;
• firefighters.

• personnel in contact with animals that could be a source of infection with non-human influenza viruses:

• breeders
• livestock keepers
• live animal transporters
• slaughterers and vaccinators
• public and freelance veterinarians

These are the vaccines recommended by WHO for the 2022-2023 Northern Hemisphere influenza season.

Egg vaccines (quadrivalent):

– an A/Victoria/2570/2019 (H1N1)pdm09-like virus;

– a virus similar to A/Darwin/9/2021 (H3N2);

– a virus similar to B/Austria/1359417/2021 (B/Victoria lineage);

– a virus similar to B/Phuket/3073/2013 (B/Yamagata lineage).

Vaccines based on cell cultures or recombinant (quadrivalent):

– an A/Wisconsin/588/2019 (H1N1)pdm09-like virus;

– a virus similar to A/Darwin/6/2021 (H3N2);

– a virus similar to B/Austria/1359417/2021 (B/Victoria lineage); and

– a virus similar to B/Phuket/3073/2013 (B/Yamagata lineage).

To learn more about this topic, please consult the full document published by the WHO on 25 February 2022 ‘Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season’.

For questions or technical issues please write your query to seg.cesmet@gmail.com, addressed to Dr. Paolo Meo