Surveillance of hepatitis A virus in urban sewages and comparison with cases notified in the course of an outbreak, Italy 2013
Identifieur interne : 000008 ( Main/Exploration ); précédent : 000007; suivant : 000009Surveillance of hepatitis A virus in urban sewages and comparison with cases notified in the course of an outbreak, Italy 2013
Auteurs : Giuseppina La Rosa [Italie] ; Simonetta Della Libera [Italie] ; Marcello Iaconelli [Italie] ; Anna Rita Ciccaglione [Italie] ; Roberto Bruni [Italie] ; Stefania Taffon [Italie] ; Michele Equestre [Italie] ; Valeria Alfonsi [Italie] ; Caterina Rizzo [Italie] ; Maria Elena Tosti [Italie] ; Maria Chironna [Italie] ; Luisa Roman [Italie] ; Alessandro Remo Zanetti [Italie] ; Michele Muscillo [Italie]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2014.
Abstract
Over the past 20 years, Hepatitis A notifications in Italy have been in decline. Since the beginning of 2013 however, Italy has been experiencing a foodborne hepatitis A outbreak caused by genotype IA, involving hundreds of cases. Consumption of frozen mixed berries was deemed the potential vehicle of infection.
We aimed to investigate the spread of hepatitis A virus (HAV) in Italy through the monitoring of urban sewages collected at Wastewater Treatment Plants (WTPs) and a subsequent comparison of environmental surveillance data with data from the clinical surveillance performed during the epidemic.
The study covered 15 months, from July 2012 to September 2013, comprising the outbreak and the preceding six months. Environmental surveillance consisted of the analysis of urban sewage samples collected at 19 WTPs in seven of the Italian regions most affected by the epidemic. HAV isolates were detected and typed using a nested RT-PCR targeting the VP1/2A junction. Parallel clinical surveillance was performed by the sentinel surveillance system for acute viral hepatitis (SEIEVA) and by the ministerial Central Task Force on Hepatitis A, established with the purpose of determining the source of the outbreak and adopting appropriate outbreak control strategies.
A total of 38/157 wastewater samples (24.2%) were positive for HAV, 16 collected in 2012 and 22 in 2013. Several HAV strains were detected, including the IA variant implicated in the outbreak and isolated from clinical cases over the same period. The vast majority of sequences belonged to genotype IB. Interestingly however, although these included variants related to strains that had been involved in past Italian epidemics, none were detected in recent clinical samples, probably due to underreporting or asymptomatic circulation. Conversely, a number of sequences were identified in clinical samples that were not found in wastewaters.
The percentage of sewage samples detected as HAV-positive in this study are consistent with the classification of Italy as a country with low/intermediate endemicity. A combined environmental/clinical surveillance is able to provide a more complete picture of the spread of HAV and of the genotypes circulating in the population, allowing a better understanding of changes in disease trends.
Url:
DOI: 10.1186/1471-2334-14-419
PubMed: 25074676
PubMed Central: 4122772
Affiliations:
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Libera</name><affiliation wicri:level="1"><nlm:aff id="Aff66">Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Iaconelli, Marcello" sort="Iaconelli, Marcello" uniqKey="Iaconelli M" first="Marcello" last="Iaconelli">Marcello Iaconelli</name><affiliation wicri:level="1"><nlm:aff id="Aff66">Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 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Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Taffon, Stefania" sort="Taffon, Stefania" uniqKey="Taffon S" first="Stefania" last="Taffon">Stefania Taffon</name><affiliation wicri:level="3"><nlm:aff id="Aff67">Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Equestre, Michele" sort="Equestre, Michele" uniqKey="Equestre M" first="Michele" last="Equestre">Michele Equestre</name><affiliation wicri:level="3"><nlm:aff id="Aff68">Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Alfonsi, Valeria" sort="Alfonsi, Valeria" uniqKey="Alfonsi V" first="Valeria" last="Alfonsi">Valeria Alfonsi</name><affiliation wicri:level="3"><nlm:aff id="Aff69">National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Rizzo, Caterina" sort="Rizzo, Caterina" uniqKey="Rizzo C" first="Caterina" last="Rizzo">Caterina Rizzo</name><affiliation wicri:level="3"><nlm:aff id="Aff69">National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Tosti, Maria Elena" sort="Tosti, Maria Elena" uniqKey="Tosti M" first="Maria Elena" last="Tosti">Maria Elena Tosti</name><affiliation wicri:level="3"><nlm:aff id="Aff69">National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Chironna, Maria" sort="Chironna, Maria" uniqKey="Chironna M" first="Maria" last="Chironna">Maria Chironna</name><affiliation wicri:level="1"><nlm:aff id="Aff70">Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari-Aldo Moro, Bari, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari-Aldo Moro, Bari</wicri:regionArea><wicri:noRegion>Bari</wicri:noRegion></affiliation></author><author><name sortKey="Roman, Luisa" sort="Roman, Luisa" uniqKey="Roman L" first="Luisa" last="Roman">Luisa Roman</name><affiliation wicri:level="1"><nlm:aff id="Aff71">Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan</wicri:regionArea><wicri:noRegion>Milan</wicri:noRegion></affiliation></author><author><name sortKey="Zanetti, Alessandro Remo" sort="Zanetti, Alessandro Remo" uniqKey="Zanetti A" first="Alessandro Remo" last="Zanetti">Alessandro Remo Zanetti</name><affiliation wicri:level="1"><nlm:aff id="Aff71">Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan</wicri:regionArea><wicri:noRegion>Milan</wicri:noRegion></affiliation></author><author><name sortKey="Muscillo, Michele" sort="Muscillo, Michele" uniqKey="Muscillo M" first="Michele" last="Muscillo">Michele Muscillo</name><affiliation wicri:level="1"><nlm:aff id="Aff66">Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25074676</idno><idno type="pmc">4122772</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4122772</idno><idno type="RBID">PMC:4122772</idno><idno type="doi">10.1186/1471-2334-14-419</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000006</idno><idno 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xml:lang="fr">Italie</country><wicri:regionArea>Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Della Libera, Simonetta" sort="Della Libera, Simonetta" uniqKey="Della Libera S" first="Simonetta" last="Della Libera">Simonetta Della Libera</name><affiliation wicri:level="1"><nlm:aff id="Aff66">Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Iaconelli, Marcello" sort="Iaconelli, Marcello" uniqKey="Iaconelli M" first="Marcello" last="Iaconelli">Marcello Iaconelli</name><affiliation wicri:level="1"><nlm:aff id="Aff66">Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Ciccaglione, Anna Rita" sort="Ciccaglione, Anna Rita" uniqKey="Ciccaglione A" first="Anna Rita" last="Ciccaglione">Anna Rita Ciccaglione</name><affiliation wicri:level="3"><nlm:aff id="Aff67">Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Bruni, Roberto" sort="Bruni, Roberto" uniqKey="Bruni R" first="Roberto" last="Bruni">Roberto Bruni</name><affiliation wicri:level="3"><nlm:aff id="Aff67">Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Taffon, Stefania" sort="Taffon, Stefania" uniqKey="Taffon S" first="Stefania" last="Taffon">Stefania Taffon</name><affiliation wicri:level="3"><nlm:aff id="Aff67">Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Equestre, Michele" sort="Equestre, Michele" uniqKey="Equestre M" first="Michele" last="Equestre">Michele Equestre</name><affiliation wicri:level="3"><nlm:aff id="Aff68">Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Alfonsi, Valeria" sort="Alfonsi, Valeria" uniqKey="Alfonsi V" first="Valeria" last="Alfonsi">Valeria Alfonsi</name><affiliation wicri:level="3"><nlm:aff id="Aff69">National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Rizzo, Caterina" sort="Rizzo, Caterina" uniqKey="Rizzo C" first="Caterina" last="Rizzo">Caterina Rizzo</name><affiliation wicri:level="3"><nlm:aff id="Aff69">National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Tosti, Maria Elena" sort="Tosti, Maria Elena" uniqKey="Tosti M" first="Maria Elena" last="Tosti">Maria Elena Tosti</name><affiliation wicri:level="3"><nlm:aff id="Aff69">National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Chironna, Maria" sort="Chironna, Maria" uniqKey="Chironna M" first="Maria" last="Chironna">Maria Chironna</name><affiliation wicri:level="1"><nlm:aff id="Aff70">Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari-Aldo Moro, Bari, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari-Aldo Moro, Bari</wicri:regionArea><wicri:noRegion>Bari</wicri:noRegion></affiliation></author><author><name sortKey="Roman, Luisa" sort="Roman, Luisa" uniqKey="Roman L" first="Luisa" last="Roman">Luisa Roman</name><affiliation wicri:level="1"><nlm:aff id="Aff71">Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan</wicri:regionArea><wicri:noRegion>Milan</wicri:noRegion></affiliation></author><author><name sortKey="Zanetti, Alessandro Remo" sort="Zanetti, Alessandro Remo" uniqKey="Zanetti A" first="Alessandro Remo" last="Zanetti">Alessandro Remo Zanetti</name><affiliation wicri:level="1"><nlm:aff id="Aff71">Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan</wicri:regionArea><wicri:noRegion>Milan</wicri:noRegion></affiliation></author><author><name sortKey="Muscillo, Michele" sort="Muscillo, Michele" uniqKey="Muscillo M" first="Michele" last="Muscillo">Michele Muscillo</name><affiliation wicri:level="1"><nlm:aff id="Aff66">Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Over the past 20 years, Hepatitis A notifications in Italy have been in decline. Since the beginning of 2013 however, Italy has been experiencing a foodborne hepatitis A outbreak caused by genotype IA, involving hundreds of cases. Consumption of frozen mixed berries was deemed the potential vehicle of infection.</p><p>We aimed to investigate the spread of hepatitis A virus (HAV) in Italy through the monitoring of urban sewages collected at Wastewater Treatment Plants (WTPs) and a subsequent comparison of environmental surveillance data with data from the clinical surveillance performed during the epidemic.</p></sec><sec><title>Methods</title><p>The study covered 15 months, from July 2012 to September 2013, comprising the outbreak and the preceding six months. Environmental surveillance consisted of the analysis of urban sewage samples collected at 19 WTPs in seven of the Italian regions most affected by the epidemic. HAV isolates were detected and typed using a nested RT-PCR targeting the VP1/2A junction. Parallel clinical surveillance was performed by the sentinel surveillance system for acute viral hepatitis (SEIEVA) and by the ministerial Central Task Force on Hepatitis A, established with the purpose of determining the source of the outbreak and adopting appropriate outbreak control strategies.</p></sec><sec><title>Results</title><p>A total of 38/157 wastewater samples (24.2%) were positive for HAV, 16 collected in 2012 and 22 in 2013. Several HAV strains were detected, including the IA variant implicated in the outbreak and isolated from clinical cases over the same period. The vast majority of sequences belonged to genotype IB. Interestingly however, although these included variants related to strains that had been involved in past Italian epidemics, none were detected in recent clinical samples, probably due to underreporting or asymptomatic circulation. Conversely, a number of sequences were identified in clinical samples that were not found in wastewaters.</p></sec><sec><title>Conclusions</title><p>The percentage of sewage samples detected as HAV-positive in this study are consistent with the classification of Italy as a country with low/intermediate endemicity. A combined environmental/clinical surveillance is able to provide a more complete picture of the spread of HAV and of the genotypes circulating in the population, allowing a better understanding of changes in disease trends.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Pinto, Rm" uniqKey="Pinto R">RM Pinto</name></author><author><name sortKey="Bosch, A" uniqKey="Bosch A">A Bosch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vaughan, G" uniqKey="Vaughan G">G Vaughan</name></author><author><name sortKey="Goncalves Rossi, Lm" uniqKey="Goncalves Rossi L">LM Goncalves-Rossi</name></author><author><name sortKey="Forbi, Jc" uniqKey="Forbi J">JC Forbi</name></author><author><name sortKey="De Paula, Vs" uniqKey="De Paula V">VS de Paula</name></author><author><name sortKey="Purdy, Ma" uniqKey="Purdy M">MA Purdy</name></author><author><name sortKey="Xia, G" uniqKey="Xia G">G 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Girones</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fiore, A" uniqKey="Fiore A">A Fiore</name></author><author><name sortKey="Baxter, Lc" uniqKey="Baxter L">LC Baxter</name></author><author><name sortKey="Bell, Bp" uniqKey="Bell B">BP Bell</name></author><author><name sortKey="Hershow, R" uniqKey="Hershow R">R Hershow</name></author><author><name sortKey="Passaro, D" uniqKey="Passaro D">D Passaro</name></author><author><name sortKey="Twiddy, S" uniqKey="Twiddy S">S Twiddy</name></author><author><name sortKey="Baxter, R" uniqKey="Baxter R">R Baxter</name></author><author><name sortKey="Levy, Ps" uniqKey="Levy P">PS Levy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sinclair, Rg" uniqKey="Sinclair R">RG Sinclair</name></author><author><name sortKey="Choi, Cy" uniqKey="Choi C">CY Choi</name></author><author><name sortKey="Riley, Mr" uniqKey="Riley M">MR Riley</name></author><author><name sortKey="Gerba, Cp" uniqKey="Gerba C">CP Gerba</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Italie</li></country><region><li>Latium</li></region><settlement><li>Rome</li></settlement></list><tree><country name="Italie"><region name="Latium"><name sortKey="La Rosa, Giuseppina" sort="La Rosa, Giuseppina" uniqKey="La Rosa G" first="Giuseppina" last="La Rosa">Giuseppina La Rosa</name></region><name sortKey="Alfonsi, Valeria" sort="Alfonsi, Valeria" uniqKey="Alfonsi V" first="Valeria" last="Alfonsi">Valeria Alfonsi</name><name sortKey="Bruni, Roberto" sort="Bruni, Roberto" uniqKey="Bruni R" first="Roberto" last="Bruni">Roberto Bruni</name><name sortKey="Chironna, Maria" sort="Chironna, Maria" uniqKey="Chironna M" first="Maria" last="Chironna">Maria Chironna</name><name sortKey="Ciccaglione, Anna Rita" sort="Ciccaglione, Anna Rita" uniqKey="Ciccaglione A" first="Anna Rita" last="Ciccaglione">Anna Rita Ciccaglione</name><name sortKey="Della Libera, Simonetta" sort="Della Libera, Simonetta" uniqKey="Della Libera S" first="Simonetta" last="Della Libera">Simonetta Della Libera</name><name sortKey="Equestre, Michele" sort="Equestre, Michele" uniqKey="Equestre M" first="Michele" last="Equestre">Michele Equestre</name><name sortKey="Iaconelli, Marcello" sort="Iaconelli, Marcello" uniqKey="Iaconelli M" first="Marcello" last="Iaconelli">Marcello Iaconelli</name><name sortKey="Muscillo, Michele" sort="Muscillo, Michele" uniqKey="Muscillo M" first="Michele" last="Muscillo">Michele Muscillo</name><name sortKey="Rizzo, Caterina" sort="Rizzo, Caterina" uniqKey="Rizzo C" first="Caterina" last="Rizzo">Caterina Rizzo</name><name sortKey="Roman, Luisa" sort="Roman, Luisa" uniqKey="Roman L" first="Luisa" last="Roman">Luisa Roman</name><name sortKey="Taffon, Stefania" sort="Taffon, Stefania" uniqKey="Taffon S" first="Stefania" last="Taffon">Stefania Taffon</name><name sortKey="Tosti, Maria Elena" sort="Tosti, Maria Elena" uniqKey="Tosti M" first="Maria Elena" last="Tosti">Maria Elena Tosti</name><name sortKey="Zanetti, Alessandro Remo" sort="Zanetti, Alessandro Remo" uniqKey="Zanetti A" first="Alessandro Remo" last="Zanetti">Alessandro Remo Zanetti</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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