Evidence of Cross-Reactive Immunity to 2009 Pandemic Influenza A Virus in Workers Seropositive to Swine H1N1 Influenza Viruses Circulating in Italy
Identifieur interne : 000B57 ( Pmc/Curation ); précédent : 000B56; suivant : 000B58Evidence of Cross-Reactive Immunity to 2009 Pandemic Influenza A Virus in Workers Seropositive to Swine H1N1 Influenza Viruses Circulating in Italy
Auteurs : Maria A. De Marco [Italie] ; Stefano Porru [Italie] ; Paolo Cordioli [Italie] ; Bruno M. Cesana [Italie] ; Ana Moreno [Italie] ; Laura Calzoletti [Italie] ; Lebana Bonfanti [Italie] ; Arianna Boni [Italie] ; Antonio Scotto Di Carlo [Italie] ; Cecilia Arici [Italie] ; Angela Carta [Italie] ; Maria R. Castrucci [Italie] ; Isabella Donatelli [Italie] ; Paola Tomao [Italie] ; Vittoria M. Peri [Italie] ; Livia Di Trani [Italie] ; Nicoletta Vonesch [Italie]Source :
- PLoS ONE [ 1932-6203 ] ; 2013.
Abstract
Pigs play a key epidemiologic role in the ecology of influenza A viruses (IAVs) emerging from animal hosts and transmitted to humans. Between 2008 and 2010, we investigated the health risk of occupational exposure to swine influenza viruses (SIVs) in Italy, during the emergence and spread of the 2009 H1N1 pandemic (H1N1pdm) virus.
Serum samples from 123 swine workers (SWs) and 379 control subjects (Cs), not exposed to pig herds, were tested by haemagglutination inhibition (HI) assay against selected SIVs belonging to H1N1 (swH1N1), H1N2 (swH1N2) and H3N2 (swH3N2) subtypes circulating in the study area. Potential cross-reactivity between swine and human IAVs was evaluated by testing sera against recent, pandemic and seasonal, human influenza viruses (H1N1 and H3N2 antigenic subtypes). Samples tested against swH1N1 and H1N1pdm viruses were categorized into sera collected before (n. 84 SWs; n. 234 Cs) and after (n. 39 SWs; n. 145 Cs) the pandemic peak. HI-antibody titers ≥10 were considered positive. In both pre-pandemic and post-pandemic peak subperiods, SWs showed significantly higher swH1N1 seroprevalences when compared with Cs (52.4% vs. 4.7% and 59% vs. 9.7%, respectively). Comparable HI results were obtained against H1N1pdm antigen (58.3% vs. 7.7% and 59% vs. 31.7%, respectively). No differences were found between HI seroreactivity detected in SWs and Cs against swH1N2 (33.3% vs. 40.4%) and swH3N2 (51.2 vs. 55.4%) viruses. These findings indicate the occurrence of swH1N1 transmission from pigs to Italian SWs.
A significant increase of H1N1pdm seroprevalences occurred in the post-pandemic peak subperiod in the Cs (p<0.001) whereas SWs showed no differences between the two subperiods, suggesting a possible occurrence of cross-protective immunity related to previous swH1N1 infections. These data underline the importance of risk assessment and occupational health surveillance activities aimed at early detection and control of SIVs with pandemic potential in humans.
Url:
DOI: 10.1371/journal.pone.0057576
PubMed: 23469029
PubMed Central: 3585202
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<author><name sortKey="Bonfanti, Lebana" sort="Bonfanti, Lebana" uniqKey="Bonfanti L" first="Lebana" last="Bonfanti">Lebana Bonfanti</name>
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<author><name sortKey="Boni, Arianna" sort="Boni, Arianna" uniqKey="Boni A" first="Arianna" last="Boni">Arianna Boni</name>
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<author><name sortKey="Di Carlo, Antonio Scotto" sort="Di Carlo, Antonio Scotto" uniqKey="Di Carlo A" first="Antonio Scotto" last="Di Carlo">Antonio Scotto Di Carlo</name>
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<author><name sortKey="Donatelli, Isabella" sort="Donatelli, Isabella" uniqKey="Donatelli I" first="Isabella" last="Donatelli">Isabella Donatelli</name>
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<author><name sortKey="Tomao, Paola" sort="Tomao, Paola" uniqKey="Tomao P" first="Paola" last="Tomao">Paola Tomao</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Evidence of Cross-Reactive Immunity to 2009 Pandemic Influenza A Virus in Workers Seropositive to Swine H1N1 Influenza Viruses Circulating in Italy</title>
<author><name sortKey="De Marco, Maria A" sort="De Marco, Maria A" uniqKey="De Marco M" first="Maria A." last="De Marco">Maria A. De Marco</name>
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<author><name sortKey="Cordioli, Paolo" sort="Cordioli, Paolo" uniqKey="Cordioli P" first="Paolo" last="Cordioli">Paolo Cordioli</name>
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<author><name sortKey="Cesana, Bruno M" sort="Cesana, Bruno M" uniqKey="Cesana B" first="Bruno M." last="Cesana">Bruno M. Cesana</name>
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<author><name sortKey="Moreno, Ana" sort="Moreno, Ana" uniqKey="Moreno A" first="Ana" last="Moreno">Ana Moreno</name>
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</nlm:aff>
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<author><name sortKey="Calzoletti, Laura" sort="Calzoletti, Laura" uniqKey="Calzoletti L" first="Laura" last="Calzoletti">Laura Calzoletti</name>
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</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>
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<author><name sortKey="Bonfanti, Lebana" sort="Bonfanti, Lebana" uniqKey="Bonfanti L" first="Lebana" last="Bonfanti">Lebana Bonfanti</name>
<affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy</addr-line>
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<country xml:lang="fr">Italie</country>
<wicri:regionArea>Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua</wicri:regionArea>
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<author><name sortKey="Boni, Arianna" sort="Boni, Arianna" uniqKey="Boni A" first="Arianna" last="Boni">Arianna Boni</name>
<affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Rome, Italy</addr-line>
</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Rome</wicri:regionArea>
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<author><name sortKey="Di Carlo, Antonio Scotto" sort="Di Carlo, Antonio Scotto" uniqKey="Di Carlo A" first="Antonio Scotto" last="Di Carlo">Antonio Scotto Di Carlo</name>
<affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy</addr-line>
</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Experimental and Applied Medicine, University of Brescia, Brescia</wicri:regionArea>
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<author><name sortKey="Arici, Cecilia" sort="Arici, Cecilia" uniqKey="Arici C" first="Cecilia" last="Arici">Cecilia Arici</name>
<affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy</addr-line>
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<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Experimental and Applied Medicine, University of Brescia, Brescia</wicri:regionArea>
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<author><name sortKey="Carta, Angela" sort="Carta, Angela" uniqKey="Carta A" first="Angela" last="Carta">Angela Carta</name>
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</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Experimental and Applied Medicine, University of Brescia, Brescia</wicri:regionArea>
</affiliation>
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<author><name sortKey="Castrucci, Maria R" sort="Castrucci, Maria R" uniqKey="Castrucci M" first="Maria R." last="Castrucci">Maria R. Castrucci</name>
<affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy</addr-line>
</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>
</affiliation>
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<author><name sortKey="Donatelli, Isabella" sort="Donatelli, Isabella" uniqKey="Donatelli I" first="Isabella" last="Donatelli">Isabella Donatelli</name>
<affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy</addr-line>
</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>
</affiliation>
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<author><name sortKey="Tomao, Paola" sort="Tomao, Paola" uniqKey="Tomao P" first="Paola" last="Tomao">Paola Tomao</name>
<affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Department of Occupational Medicine, Italian Workers' Compensation Authority-Research Area (INAIL), Monteporzio Catone, Rome, Italy</addr-line>
</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Occupational Medicine, Italian Workers' Compensation Authority-Research Area (INAIL), Monteporzio Catone, Rome</wicri:regionArea>
</affiliation>
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<author><name sortKey="Peri, Vittoria M" sort="Peri, Vittoria M" uniqKey="Peri V" first="Vittoria M." last="Peri">Vittoria M. Peri</name>
<affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Department of Occupational Medicine, Italian Workers' Compensation Authority-Research Area (INAIL), Monteporzio Catone, Rome, Italy</addr-line>
</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Occupational Medicine, Italian Workers' Compensation Authority-Research Area (INAIL), Monteporzio Catone, Rome</wicri:regionArea>
</affiliation>
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<author><name sortKey="Di Trani, Livia" sort="Di Trani, Livia" uniqKey="Di Trani L" first="Livia" last="Di Trani">Livia Di Trani</name>
<affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Rome, Italy</addr-line>
</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Rome</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Vonesch, Nicoletta" sort="Vonesch, Nicoletta" uniqKey="Vonesch N" first="Nicoletta" last="Vonesch">Nicoletta Vonesch</name>
<affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Department of Occupational Medicine, Italian Workers' Compensation Authority-Research Area (INAIL), Monteporzio Catone, Rome, Italy</addr-line>
</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Occupational Medicine, Italian Workers' Compensation Authority-Research Area (INAIL), Monteporzio Catone, Rome</wicri:regionArea>
</affiliation>
</author>
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<series><title level="j">PLoS ONE</title>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Pigs play a key epidemiologic role in the ecology of influenza A viruses (IAVs) emerging from animal hosts and transmitted to humans. Between 2008 and 2010, we investigated the health risk of occupational exposure to swine influenza viruses (SIVs) in Italy, during the emergence and spread of the 2009 H1N1 pandemic (H1N1pdm) virus.</p>
</sec>
<sec><title>Methodology/Principal Findings</title>
<p>Serum samples from 123 swine workers (SWs) and 379 control subjects (Cs), not exposed to pig herds, were tested by haemagglutination inhibition (HI) assay against selected SIVs belonging to H1N1 (swH1N1), H1N2 (swH1N2) and H3N2 (swH3N2) subtypes circulating in the study area. Potential cross-reactivity between swine and human IAVs was evaluated by testing sera against recent, pandemic and seasonal, human influenza viruses (H1N1 and H3N2 antigenic subtypes). Samples tested against swH1N1 and H1N1pdm viruses were categorized into sera collected before (n. 84 SWs; n. 234 Cs) and after (n. 39 SWs; n. 145 Cs) the pandemic peak. HI-antibody titers ≥10 were considered positive. In both pre-pandemic and post-pandemic peak subperiods, SWs showed significantly higher swH1N1 seroprevalences when compared with Cs (52.4% vs. 4.7% and 59% vs. 9.7%, respectively). Comparable HI results were obtained against H1N1pdm antigen (58.3% vs. 7.7% and 59% vs. 31.7%, respectively). No differences were found between HI seroreactivity detected in SWs and Cs against swH1N2 (33.3% vs. 40.4%) and swH3N2 (51.2 vs. 55.4%) viruses. These findings indicate the occurrence of swH1N1 transmission from pigs to Italian SWs.</p>
</sec>
<sec><title>Conclusion/Significance</title>
<p>A significant increase of H1N1pdm seroprevalences occurred in the post-pandemic peak subperiod in the Cs (p<0.001) whereas SWs showed no differences between the two subperiods, suggesting a possible occurrence of cross-protective immunity related to previous swH1N1 infections. These data underline the importance of risk assessment and occupational health surveillance activities aimed at early detection and control of SIVs with pandemic potential in humans.</p>
</sec>
</div>
</front>
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</TEI>
<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">plosone</journal-id>
<journal-title-group><journal-title>PLoS ONE</journal-title>
</journal-title-group>
<issn pub-type="epub">1932-6203</issn>
<publisher><publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">23469029</article-id>
<article-id pub-id-type="pmc">3585202</article-id>
<article-id pub-id-type="publisher-id">PONE-D-12-33342</article-id>
<article-id pub-id-type="doi">10.1371/journal.pone.0057576</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
<subj-group subj-group-type="Discipline-v2"><subject>Biology</subject>
<subj-group><subject>Immunology</subject>
<subj-group><subject>Immunity</subject>
<subj-group><subject>Immunity to Infections</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group><subject>Population Biology</subject>
<subj-group><subject>Epidemiology</subject>
<subj-group><subject>Infectious Disease Epidemiology</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v2"><subject>Medicine</subject>
<subj-group><subject>Clinical Immunology</subject>
<subj-group><subject>Immunity</subject>
<subj-group><subject>Immunity to Infections</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group><subject>Infectious Diseases</subject>
<subj-group><subject>Viral Diseases</subject>
<subj-group><subject>Influenza</subject>
</subj-group>
</subj-group>
<subj-group><subject>Zoonoses</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v2"><subject>Veterinary Science</subject>
<subj-group><subject>Veterinary Diseases</subject>
<subj-group><subject>Zoonotic Diseases</subject>
<subj-group><subject>Animal Influenza</subject>
</subj-group>
</subj-group>
<subj-group><subject>Veterinary Virology</subject>
</subj-group>
</subj-group>
</subj-group>
</article-categories>
<title-group><article-title>Evidence of Cross-Reactive Immunity to 2009 Pandemic Influenza A Virus in Workers Seropositive to Swine H1N1 Influenza Viruses Circulating in Italy</article-title>
<alt-title alt-title-type="running-head">Influenza Serosurvey in Italian Swine Workers</alt-title>
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<contrib-group><contrib contrib-type="author"><name><surname>De Marco</surname>
<given-names>Maria A.</given-names>
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<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
<xref ref-type="corresp" rid="cor1"><sup>*</sup>
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</contrib>
<contrib contrib-type="author"><name><surname>Porru</surname>
<given-names>Stefano</given-names>
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<xref ref-type="aff" rid="aff3"><sup>3</sup>
</xref>
</contrib>
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<given-names>Paolo</given-names>
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<xref ref-type="aff" rid="aff4"><sup>4</sup>
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<given-names>Bruno M.</given-names>
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<xref ref-type="aff" rid="aff5"><sup>5</sup>
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<given-names>Ana</given-names>
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<xref ref-type="aff" rid="aff4"><sup>4</sup>
</xref>
</contrib>
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<given-names>Laura</given-names>
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<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bonfanti</surname>
<given-names>Lebana</given-names>
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<xref ref-type="aff" rid="aff6"><sup>6</sup>
</xref>
</contrib>
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<given-names>Arianna</given-names>
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<xref ref-type="aff" rid="aff7"><sup>7</sup>
</xref>
</contrib>
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<given-names>Antonio Scotto</given-names>
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<xref ref-type="aff" rid="aff3"><sup>3</sup>
</xref>
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<given-names>Cecilia</given-names>
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<xref ref-type="aff" rid="aff3"><sup>3</sup>
</xref>
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<given-names>Angela</given-names>
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<xref ref-type="aff" rid="aff3"><sup>3</sup>
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<xref ref-type="aff" rid="aff1"><sup>1</sup>
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<xref ref-type="aff" rid="aff1"><sup>1</sup>
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<given-names>Paola</given-names>
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<xref ref-type="aff" rid="aff8"><sup>8</sup>
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</contrib>
<contrib contrib-type="author"><name><surname>Peri</surname>
<given-names>Vittoria M.</given-names>
</name>
<xref ref-type="aff" rid="aff8"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Di Trani</surname>
<given-names>Livia</given-names>
</name>
<xref ref-type="aff" rid="aff7"><sup>7</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vonesch</surname>
<given-names>Nicoletta</given-names>
</name>
<xref ref-type="aff" rid="aff8"><sup>8</sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff1"><label>1</label>
<addr-line>Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy</addr-line>
</aff>
<aff id="aff2"><label>2</label>
<addr-line>Institute for Environmental Protection and Research (ISPRA), Ozzano Emilia, Bologna, Italy</addr-line>
</aff>
<aff id="aff3"><label>3</label>
<addr-line>Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy</addr-line>
</aff>
<aff id="aff4"><label>4</label>
<addr-line>Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, Brescia, Italy</addr-line>
</aff>
<aff id="aff5"><label>5</label>
<addr-line>Department of Biomedical Sciences and Biotechnologies, University of Brescia, Brescia, Italy</addr-line>
</aff>
<aff id="aff6"><label>6</label>
<addr-line>Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy</addr-line>
</aff>
<aff id="aff7"><label>7</label>
<addr-line>Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Rome, Italy</addr-line>
</aff>
<aff id="aff8"><label>8</label>
<addr-line>Department of Occupational Medicine, Italian Workers' Compensation Authority-Research Area (INAIL), Monteporzio Catone, Rome, Italy</addr-line>
</aff>
<contrib-group><contrib contrib-type="editor"><name><surname>Kobinger</surname>
<given-names>Gary P.</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1"><addr-line>Public Health Agency of Canada, Canada</addr-line>
</aff>
<author-notes><corresp id="cor1">* E-mail: <email>mariaalessandra.demarco@iss.it</email>
</corresp>
<fn fn-type="COI-statement"><p><bold>Competing Interests: </bold>
The authors have declared that no competing interests exist.</p>
</fn>
<fn fn-type="con"><p>Collected data and biological samples: CA AC ASDC. Conceived and designed the experiments: NV PT SP MADM LDT ID. Performed the experiments: MADM LDT PC AM LC AB. Analyzed the data: MADM SP BMC VMP ASDC LB MRC. Wrote the paper: MADM LDT NV PT SP VMP.</p>
</fn>
</author-notes>
<pub-date pub-type="collection"><year>2013</year>
</pub-date>
<pub-date pub-type="epub"><day>28</day>
<month>2</month>
<year>2013</year>
</pub-date>
<volume>8</volume>
<issue>2</issue>
<elocation-id>e57576</elocation-id>
<history><date date-type="received"><day>26</day>
<month>10</month>
<year>2012</year>
</date>
<date date-type="accepted"><day>23</day>
<month>1</month>
<year>2013</year>
</date>
</history>
<permissions><copyright-statement>© 2013 De Marco et al</copyright-statement>
<copyright-year>2013</copyright-year>
<copyright-holder>De Marco et al</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.</license-p>
</license>
</permissions>
<abstract><sec><title>Background</title>
<p>Pigs play a key epidemiologic role in the ecology of influenza A viruses (IAVs) emerging from animal hosts and transmitted to humans. Between 2008 and 2010, we investigated the health risk of occupational exposure to swine influenza viruses (SIVs) in Italy, during the emergence and spread of the 2009 H1N1 pandemic (H1N1pdm) virus.</p>
</sec>
<sec><title>Methodology/Principal Findings</title>
<p>Serum samples from 123 swine workers (SWs) and 379 control subjects (Cs), not exposed to pig herds, were tested by haemagglutination inhibition (HI) assay against selected SIVs belonging to H1N1 (swH1N1), H1N2 (swH1N2) and H3N2 (swH3N2) subtypes circulating in the study area. Potential cross-reactivity between swine and human IAVs was evaluated by testing sera against recent, pandemic and seasonal, human influenza viruses (H1N1 and H3N2 antigenic subtypes). Samples tested against swH1N1 and H1N1pdm viruses were categorized into sera collected before (n. 84 SWs; n. 234 Cs) and after (n. 39 SWs; n. 145 Cs) the pandemic peak. HI-antibody titers ≥10 were considered positive. In both pre-pandemic and post-pandemic peak subperiods, SWs showed significantly higher swH1N1 seroprevalences when compared with Cs (52.4% vs. 4.7% and 59% vs. 9.7%, respectively). Comparable HI results were obtained against H1N1pdm antigen (58.3% vs. 7.7% and 59% vs. 31.7%, respectively). No differences were found between HI seroreactivity detected in SWs and Cs against swH1N2 (33.3% vs. 40.4%) and swH3N2 (51.2 vs. 55.4%) viruses. These findings indicate the occurrence of swH1N1 transmission from pigs to Italian SWs.</p>
</sec>
<sec><title>Conclusion/Significance</title>
<p>A significant increase of H1N1pdm seroprevalences occurred in the post-pandemic peak subperiod in the Cs (p<0.001) whereas SWs showed no differences between the two subperiods, suggesting a possible occurrence of cross-protective immunity related to previous swH1N1 infections. These data underline the importance of risk assessment and occupational health surveillance activities aimed at early detection and control of SIVs with pandemic potential in humans.</p>
</sec>
</abstract>
<funding-group><funding-statement>The study was co-funded by the Italian Workers' Compensation Authority (INAIL) and by the Ministry of Health, Progetto Finalizzato RF-IPS-2006–364585. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement>
</funding-group>
<counts><page-count count="9"></page-count>
</counts>
</article-meta>
</front>
</pmc>
</record>
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