Rotaviruses (RVs) are a leading cause of viral gastroenteritis among children younger than 5. The incidence of RV disease can be reduced through the widespread use of vaccination, but coverage is low in many countries, including Italy. This fact reflects the poor consideration given to the RV vaccine, both by the population and by healthcare workers. Peoples’ opinions are strictly dependent on the attitude of doctors and nurses. The aim of this work is the evaluation of healthcare workers’ knowledge, attitudes and opinions regarding RV vaccination. The results of two surveys were compared; the first was carried out in 2017, soon after the Italian National Immunization Plan introduced the recommendation for the RV vaccine. The second was performed at the end of 2018, approximately 1 year after the adoption of a Law that introduced new compulsory vaccinations, not including the RV vaccine. In 2017, 182 questionnaires were collected, and 111 in 2018. An increase was observed in the percentage of participants who reported recommending the RV vaccine and a significant increase was found in the coverage the participants claimed to reach. Education of healthcare workers after the introduction of compulsory vaccination may prompt them to actively offer also recommended vaccines.

BackgroundRheumatoid arthritis (RA) prevalence is believed to be around 1% worldwide, although it varies considerably among different populations.[1] Several environmental factors such as smoking, certain infections, and diet contribute to the risk of RA and differ between populations.[2] The pooled prevalence of RA was estimated to be 0.54% (95% CI 0.50–0.59) in Europe,[1] but no studies have recently evaluated the epidemiology of RA in Italy.ObjectivesWe aimed at estimating the incidence and prevalence of RA in northeastern Italy over the period 2012–2020.MethodsA retrospective population-based study was conducted in the Veneto Region (4.9 million people) using the Population Registry, an administrative health database where all residents are recorded. The population registry was linked with healthcare co-payments exemptions, hospital discharge records, and mortality records. Between 2012 and 2020, RA prevalence was defined by a healthcare copayment exemption for RA (national registry code 006) or any hospital diagnosis of RA (ICD-9-CM 714.x), whichever came first. Incident RA was defined from 2013 to 2020 to exclude prevalent cases. Standardized incidence and prevalence rates were reported by age and gender.ResultsDuring the study period, we identified 37,996 prevalent RA patients, with 12,875 incident cases. Across the study period, RA standardized prevalence increased from 0.50% (95% CI 0.50; 0.51) to 0.57% (95% CI 0.57; 0.58). RA point prevalence in 2020 according to gender and age is reported in Figure 1. RA incidence corresponded to 33.1 (32.5; 33.7) per 100,000 person-years, with the lowest incidence observed in the last two years of the study: 27.4 (25.9; 28.9) in 2020 and 32.2 (30.6; 33.8) in 2019 (Table 1). The peak for both prevalence and incidence was around the eighth decade of life. Incidence was 2-times higher in females: female-to-male incidence rate ratio (IRR) 2.3 (2.2; 2.4) (p<0.0001), with a peak among people aged 20-29 years, where female-to-male IRR was 3.1 (2.4; 3.9) and the lowest value among patients aged ≥70 years, where F:M IRR was 1.6 (1.4; 1.8).ConclusionThe prevalence of RA in Italy is 0.57%, in line with data from other European countries. Incidence was confirmed to be higher among females, especially in younger patients.References[1]Almutairi K et al. The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review. Rheumatol Int 2021;41:863–877.[2]Tobon, GJ, et al. The environment, geo-epidemiology, and autoimmune disease: Rheumatoid arthritis. J Autoimmun 2010;35:10–14.Figure 1.The point prevalence of Rheumatoid Arthritis in The Veneto Region in 2020 by age and gender.Table 1.Incidence of Rheumatoid Arthritis in the Veneto Region between 2013 and 2020.YearNew diagnosis, numberPopulationCrude rate (95%IC) x 100,000Standardized IR (95%IC)x100,000*New diagnosis, numberStandardized IR (95%IC)x100,000*MaleFemaleMaleFemale20131.6154.901.41532.9 (31.3; 34.6)34.2 (32.5; 35.8)475114020.8 (18.9; 22.7)46.9 (44.1; 49.6)20141.7384.905.71235.4 (33.8; 37.1)36.4 (34.7; 38.1)508123021.9 (20.0; 23.9)50.2 (47.3; 53.0)20151.5754.902.69432.1 (30.5; 33.7)32.7 (31.1; 34.3)462111319.8 (18.0; 21.6)45.0 (42.4; 47.7)20161.6254.890.64833.2 (31.6; 34.8)33.5 (31.9; 35.2)487113820.7 (18.8; 22.5)45.8 (43.1; 48.5)20171.6514.883.37333.8 (32.2; 35.4)33.8 (32.2; 35.4)461119019.4 (17.6; 21.1)47.6 (44.9; 50.3)20181.7104.880.93635.0 (33.4; 36.7)34.8 (33.1; 36.4)504120620.9 (19.1; 22.7)48.0 (45.3; 50.7)20191.5964.884.59032.7 (31.1; 34.3)32.2 (30.6; 33.8)463113319.0 (17.3; 20.8)44.8 (42.2; 47.4)20201.3654.879.13328.0 (26.5; 29.5)27.4 (25.9; 28.9)40695916.5 (14.9; 18.1)37.8 (35.4; 40.2)TOT**12.87539.128.50132.9 (32.3; 33.5)33.1 (32.5; 33.7)3766910919.9 (19.2; 20.5)45.7 (44.8; 46.6)Acknowledgements:NIL.Disclosure of InterestsMargherita Zen Speakers bureau: Abbvie, Ely Lilly, GSK, Galapagos, AstraZeneca, Laura Salmaso: None declared, Claudio Barbiellini Amidei: None declared, Alessandro Giollo Speakers bureau: Galapagos, Abbvie, Ugo Fedeli: None declared, Stefania Bellio: None declared, Federico Arru: None declared, Ilenia Gennaio: None declared, Mario Saia: None declared, Andrea Doria Speakers bureau: GSK, AstraZeneca, UCB, Pfizer, Consultant of: GSK, AstraZeneca.

BackgroundWhether late-onset (LO) SLE is associated with a different, more benign disease course and better prognosis than early-onset SLE is still contradictory.[1-3]ObjectivesTo describe the prevalence and clinical features of LO-SLE and very late onset (VLO) SLE and to compare their outcomes with those of non-LO SLE.MethodsWe performed a retrospective study using prospectively collected data from our cohort involving 516 patients with SLE (ACR criteria) followed between 2008 and 2022. Patients older than 50 or older than 60 years at SLE onset were defined as LO-SLE and VLO-SLE, respectively. Demographic data, and clinical and treatment history were retrieved from clinical charts. SLEDAI-2K, daily prednisone dose, SLICC Damage Index (SDI), and low disease activity (according to LLDAS definition)[1]at last follow-up in 2022 were assessed. Early mortality, within 10 years after diagnosis, was assessed in patients diagnosed in the last 15 years.ResultsAmong 516 SLE patients regularly followed, 38 (7.4%) were LO-SLE: mean±SD age at diagnosis 56.5 ±5.7 years (range 50-72), females 78%. Of them, 10 (2% of the overall cohort) were VLO-SLE: mean±SD age at diagnosis 65 ±4.0 years (range 60-72), females 60%. Compared to early-SLE patients, LO-SLE patients had more frequently skin involvement and positive antiSSA/SSB antibodies (Table 1). Compared to non-LO-SLE, no difference in life-threatening manifestations was observed, including renal and neuropsychiatric involvement. The same trend was found in VLO-SLE. Accordingly, the use of immunosuppressants (including types of drugs) and biologics was similar (Table 1). At last follow-up, SLEDAI-2K was lower in LO-SLE patients (1±2 vs. 2±3, p=0.01), whereas the proportion of patients on glucocorticoids (21% vs 37%) and in LLDAS (84% vs 74%) was similar to that observed in non-LO-SLE. Despite that, SDI was higher in LO-SLE (2, range 0-8) than in non-LO-SLE patients (1, range 0-10, p=0.004) but after excluding items possibly related to aging (cataract, osteoporosis, low GFR, malignancy) the difference was not significant anymore. Among 165 patients diagnosed in the last 15 years, mortality was similar in LO and early-onset SLE, although deaths within 10 years after diagnosis (2 cases) all occurred in early-SLE patients.ConclusionAccording to our data, LO- and VLO-SLE are uncommon and seem not to be associated with more benign disease outcomes. Since life-threatening manifestations can occur in LO-SLE, these patients deserve regular follow-up.References[1] Arnaud L, et al. Late-onset systemic lupus erythematosus: epidemiology, diagnosis and treatment1 Drug Aging 2012;29(3):181-189.[2] Lin H et al. Survival analysis of late-onset systemic lupus erythematosus: a cohort study in China. Clin Rheumatol 2012;31(12):1683-9.[3] Riveros Frutos A et al. Late-onset versus early-onset systemic lupus: characteristics and outcome in a national multicentre register (RELESSER) Rheumatology 2021 6;60(4):1793-1803.Table 1.Clinical and therapeutic features of late-onset and early-onset SLELate onset SLE(N=38)Early onset SLE(N=478)P valueSkin rash13 (34.2)262 (54.8)0.027Alopecia3 (7.8)60 (12-.5)n.s.Cutaneous vascu-litis1 (2.6)45 (9.4)n.s.Arthritis23 (61)353 (73.8)n.s.Leukopenia17 (44.7)191 (40)n.s.Thrombocitopenia11 (29.9)86 (18)n.s.Serositis8 (21)91 (19)n.s.Lupus nephritis16 (42.1)258 (54)n.s.Neuro-SLE8 (21)81 (16.9)n.s.Anti-dsDNA Abs25 (66)335 (70)n.s.Anti-SSA/SSB Abs23 (61)201 (42)0.044Anti-U1RNP Abs9 (23.6)129 (27)n.s.Antiphospholipid Abs13 (34.2)138 (28.9)n.s.Immunosuppressants everMMFCYCAZAMTXBelimumabRituximab23 (61)13 (34.2)4 (10.5)6 (15.7)8 (15.7)6 (16)3 (7.6)339 (71-)210 (44)103 (21.5)143 (29.9)87 (18.1)75 (15.7)39 (8.2)n.s.HCQ ever35 (92)454 (95)n.s.Acknowledgements:NIL.Disclosure of InterestsIlenia Anna Gennaio: None declared, Margherita Zen Speakers bureau: GSK, AstraZeneca, Enrico Fuzzi: None declared, Mariele Gatto Speakers bureau: GSK, AstraZeneca, Maddalena Larosa: None declared, Luca Iaccarino Speakers bureau: GSK, AstraZeneca, Andrea Doria Consultant of: GSK, AstraZeneca.

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