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Epidemiologia
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Local Healthcare Preparedness and Alert Systems—How to Prevent Future Pandemics?
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Local Healthcare Preparedness and Alert Systems—How to Prevent Future Pandemics?

A special issue of Epidemiologia (ISSN 2673-3986).

Deadline for manuscript submissions: 30 November 2025 | Viewed by 7973

Special Issue Editors

Dr. Giuseppe Stirparo

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Guest Editor
Agenzia Regionale Emergenza Urgenza (AREU), Via Campanini 6, 20124 Milan, Italy
Interests: medical education; cardiopulmonary resuscitation; emergency medical service; public health measures; surveillance
Special Issues, Collections and Topics in MDPI journals
Dr. Alberto Arnedo-Pena

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Guest Editor
1. Health Science Department, Public University Navarra, 3100 Pamplona, Spain
2. Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain
Interests: epidemiology; infectious diseases; allergic diseases; outbreaks; coronavirus diseases; salmonellosis and pork product; vitamin D and tuberculosis; cardiovascular and cerebrovascular disease mortality
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

 Dear Colleagues, 

Infectious diseases have become relevant in recent years following the COVID-19 pandemic and the increasing trend of diseases related to antibiotic resistance. COVID-19 had a major impact on the healthcare systems of different countries. However, there is currently a lack of information on the resilience potential of healthcare systems, as it is unclear whether healthcare activities have returned to the same level of efficiency and effectiveness that they had before. Furthermore, it is not fully understood what pro-active alarm systems have been developed in different countries, as well as national or local pandemic plans, recommended by international organisations such as the WHO and OECD.

With this knowledge gap, this Special Issue aims to share updated information on the topic in order to identify three elements that are useful for the entire scientific community. The first one is to highlight the resilience of local healthcare systems, which should hopefully show a return to a level of performance similar to the pre-pandemic phase. The second one is to highlight the infectious diseases alert systems of the different settings in order to share innovative alerting methods. The third and final point is studying the models used and the way in which the different local pandemic plans have been set in order to understand how different healthcare systems have implemented specific plans at the local level.

This Special Issue could also be useful in sharing important information with all the stakeholders in the field of infectious disease prevention and improving the resilience of healthcare systems in the event of future pandemics. Research articles, as well as reviews and expert opinions, are welcome and will be carefully assessed.

Dr. Giuseppe Stirparo
Dr. Alberto Arnedo-Pena
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Epidemiologia is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • infectious diseases
  • epidemiology
  • COVID-19
  • healthcare systems
  • vaccination
  • surveillance
  • transmission
  • chemical, biological, radiological, and nuclear (CBRN) hazards

 

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Published Papers (6 papers)

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Research

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11 pages, 897 KiB  
Article
Epidemiological and Socioeconomic Disparities in the 1742–1743 Epidemic: A Comparative Analysis of Urban Centers and Indigenous Populations Along the Royal Road
by Jorge Hugo Villafañe
Epidemiologia 2025, 6(2), 25; https://doi.org/10.3390/epidemiologia6020025 - 12 May 2025
Viewed by 211
Abstract
Background/Objectives: Epidemics have historically shaped societies, influencing demographic structures, social organization, and economic stability. The 1742–1743 epidemic had a profound impact on populations along the Royal Road (Camino Real), the main colonial corridor between Buenos Aires and Lima. However, its specific demographic and [...] Read more.
Background/Objectives: Epidemics have historically shaped societies, influencing demographic structures, social organization, and economic stability. The 1742–1743 epidemic had a profound impact on populations along the Royal Road (Camino Real), the main colonial corridor between Buenos Aires and Lima. However, its specific demographic and socio-economic effects remain underexplored. This study aims to examine these impacts of the 1742–1743 epidemic through a comparative analysis of urban centers and Indigenous communities. Methods: A historical–comparative approach was employed, analyzing secondary sources including parish records and colonial administrative documents. This study assessed excess mortality and socio-economic consequences across different population groups and settlement types. Results: Mortality rates increased dramatically—up to twelve times the pre-epidemic average in Cordova (Córdoba) and by 45% in Santa Fe—disproportionately affecting Indigenous and enslaved populations. Urban centers experienced severe economic disruption and slow recovery, whereas Indigenous communities and Jesuit missions demonstrated greater resilience. Their communal strategies and early isolation measures contributed to a faster demographic stabilization. Additionally, the epidemic weakened colonial governance in some areas, altering local power structures. Conclusions: The epidemic of 1742–1743 revealed divergent patterns of vulnerability and resilience. Comparative analysis underscores recurring themes in the epidemic response and recovery, drawing relevant parallels with contemporary crises such as COVID-19. Recognizing these historical patterns of adaptation can inform present and future public health strategies. The terminology “plague” is used based on contemporary sources and not confirmed clinically. Full article
(This article belongs to the Special Issue Local Healthcare Preparedness and Alert Systems—How to Prevent Future Pandemics?)
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16 pages, 1538 KiB  
Article
Monitoring and Early Warning System: Regional Monitoring Strategy in Lombardy Region
by Sarah Cataldi, Elena Maria Ticozzi, Federica Morani, Annalisa Bodina, Maurizio Migliari, Gabriele Perotti, Massimo Lombardo, Fabrizio Ernesto Pregliasco and Danilo Cereda
Epidemiologia 2025, 6(1), 7; https://doi.org/10.3390/epidemiologia6010007 - 11 Feb 2025
Viewed by 744
Abstract
Background: This article examines the infectious disease surveillance system in the Lombardy region of Italy, with a focus on its response mechanisms to respiratory syndromes. This study aims to describe the alert system and the organizational procedures in place, assessing their effectiveness in [...] Read more.
Background: This article examines the infectious disease surveillance system in the Lombardy region of Italy, with a focus on its response mechanisms to respiratory syndromes. This study aims to describe the alert system and the organizational procedures in place, assessing their effectiveness in managing health crises. Methods: This study is based on the analysis of Lombardy’s regional resolution No. 1125, developed by regional public health experts. Surveillance levels were categorized based on incidence thresholds and healthcare system impacts, establishing specific indicators and activation protocols. Information flows are managed through real-time data portals, enabling the real-time monitoring of COVID-19, influenza, and other infectious respiratory diseases. Results: A multi-level response system was established, with levels ranging from ordinary regimes to critical epidemic activation. Each level includes specific actions, such as resource reallocation, emergency department support, and the suspension of elective procedures. The use of technological tools, such as electronic health records, streamlined reporting processes, and real-time data flow management, has strengthened the region’s response capabilities. Conclusions: This study underscores the value of a structured, multi-level response system for infectious disease management, showing that a unified regional approach improves crisis response efficiency. It suggests that sharing activation indicators and protocols within the scientific community can help harmonize national and international responses to future pandemics. The system, while effective in its current context, may require adaptation for future health challenges. Full article
(This article belongs to the Special Issue Local Healthcare Preparedness and Alert Systems—How to Prevent Future Pandemics?)
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12 pages, 918 KiB  
Article
Underreporting of Cases in the COVID-19 Outbreak of Borriana (Spain) during Mass Gathering Events in March 2020: A Cross-Sectional Study
by Salvador Domènech-Montoliu, Maria Rosario Pac-Sa, Diego Sala-Trull, Alba Del Rio-González, Manuel Sanchéz-Urbano, Paloma Satorres-Martinez, Roser Blasco-Gari, Juan Casanova-Suarez, Maria Gil-Fortuño, Laura López-Diago, Cristina Notari-Rodríguez, Óscar Pérez-Olaso, Maria Angeles Romeu-Garcia, Raquel Ruiz-Puig, Isabel Aleixandre-Gorriz, Carmen Domènech-León and Alberto Arnedo-Pena
Epidemiologia 2024, 5(3), 499-510; https://doi.org/10.3390/epidemiologia5030034 - 9 Aug 2024
Viewed by 1762
Abstract
Determining the number of cases of an epidemic is the first function of epidemiological surveillance. An important underreporting of cases was observed in many locations during the first wave of the COVID-19 pandemic. To estimate this underreporting in the COVID-19 outbreak of Borriana [...] Read more.
Determining the number of cases of an epidemic is the first function of epidemiological surveillance. An important underreporting of cases was observed in many locations during the first wave of the COVID-19 pandemic. To estimate this underreporting in the COVID-19 outbreak of Borriana (Valencia Community, Spain) in March 2020, a cross-sectional study was performed in June 2020 querying the public health register. Logistic regression models were used. Of a total of 468 symptomatic COVID-19 cases diagnosed in the outbreak through anti-SARS-CoV-2 serology, 36 cases were reported (7.7%), resulting in an underreporting proportion of 92.3% (95% confidence interval [CI], 89.5–94.6%), with 13 unreported cases for every reported case. Only positive SARS-CoV-2 polymerase chain reaction cases were predominantly reported due to a limited testing capacity and following a national protocol. Significant factors associated with underreporting included no medical assistance for COVID-19 disease, with an adjusted odds ratio [aOR] of 10.83 (95% CI 2.49–47.11); no chronic illness, aOR = 2.81 (95% CI 1.28–6.17); middle and lower social classes, aOR = 3.12 (95% CI 1.42–6.85); younger age, aOR = 0.97 (95% CI 0.94–0.99); and a shorter duration of illness, aOR = 0.98 (95% CI 0.97–0.99). To improve the surveillance of future epidemics, new approaches are recommended. Full article
(This article belongs to the Special Issue Local Healthcare Preparedness and Alert Systems—How to Prevent Future Pandemics?)
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9 pages, 795 KiB  
Article
Reshaping Emergency Care: Dynamics of OHCA and STEMI in a Three-Year Analysis
by Francesca Bottega, Erika Kacerik, Gabriele Perotti, Carlo Signorelli and Giuseppe Ristagno
Epidemiologia 2024, 5(3), 362-370; https://doi.org/10.3390/epidemiologia5030026 - 9 Jul 2024
Viewed by 1132
Abstract
The COVID-19 pandemic drastically reshaped healthcare in Lombardy, Italy, notably impacting EMS and emergency departments and altering the epidemiology of time-dependent pathologies such as STEMI and OHCA. While previous studies focused on modifications during the pandemic peak, with an increase in the number [...] Read more.
The COVID-19 pandemic drastically reshaped healthcare in Lombardy, Italy, notably impacting EMS and emergency departments and altering the epidemiology of time-dependent pathologies such as STEMI and OHCA. While previous studies focused on modifications during the pandemic peak, with an increase in the number of OHCA diagnoses and a reduction in the number of STEMI, little evidence exists regarding the inter-pandemic phases. We analyzed OHCA and STEMI accesses to the ED in the regional emergency department access register (EUOL) for 2019–2021. The analysis revealed a significant difference in monthly diagnosis averages. For STEMI, the change was statistically significant (F(2, 33) = 4.45, p = 0.02), while it was not for OHCA (F(2, 33) = 0.18, p = 0.83). Despite the monthly decreases, the likelihood of receiving a STEMI diagnosis increased with total accesses, OR 1.40 [95% CI 1.25–1.58, p < 0.0001]. Additionally, there was a significant increase in March 2020 discharge diagnoses for OHCA compared to March 2019, OR 3.35 [95% CI 2.88–3.90, p < 0.0001], corresponding to the first pandemic wave. Therefore, our analysis indicates that the epidemiology of STEMI and OHCA was altered during the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Local Healthcare Preparedness and Alert Systems—How to Prevent Future Pandemics?)
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9 pages, 958 KiB  
Article
Italy’s Post-COVID-19 Stroke Network: Has It Returned to Pre-Pandemic Standards?
by Erika Kacerik, Francesca Bottega, Aida Andreassi, Giuseppe Sechi, Alberto Zoli, Marco Botteri, Carlo Signorelli and Nazzareno Fagoni
Epidemiologia 2024, 5(3), 353-361; https://doi.org/10.3390/epidemiologia5030025 - 9 Jul 2024
Cited by 1 | Viewed by 1528
Abstract
The COVID-19 pandemic strongly transformed the healthcare system in the Lombardy region (Italy), forcing a rapid reorganization of hospital structures. The emergency medical service (EMS) system and emergency departments (EDs) were among the most affected departments. Several studies have shown a change in [...] Read more.
The COVID-19 pandemic strongly transformed the healthcare system in the Lombardy region (Italy), forcing a rapid reorganization of hospital structures. The emergency medical service (EMS) system and emergency departments (EDs) were among the most affected departments. Several studies have shown a change in the epidemiology of time-dependent pathologies, such as stroke, during the pandemic’s peak. However, there is little scientific evidence regarding the interpandemic phase. The regional register for ED accesses (EUOL) was analyzed, taking into consideration all accesses for stroke and stroke-like syndromes during the years 2019, 2020, and 2021. The analysis shows a significant difference in the average number of diagnoses per month [2092 vs. 1815 vs. 2015, respectively (p < 0.05)] and an increase in the percentage of transports carried out by EMS vehicles to EDs [17% vs. 25% vs. 22%, respectively (p < 0.05)]. The length of stay (LOS) increased for both discharged patients (9.0 vs. 10.1 vs. 11.2 h, respectively; p < 0.005) and hospitalized patients (7.5 vs. 9.7 vs. 10.6 h, respectively; p < 0.005). During the COVID-19 pandemic, the overall number of stroke diagnoses decreased, while the percentage of patients transported to EDs by EMS vehicles increased. Furthermore, an increased processing time in EDs was highlighted. Full article
(This article belongs to the Special Issue Local Healthcare Preparedness and Alert Systems—How to Prevent Future Pandemics?)
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Review

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16 pages, 1705 KiB  
Review
Examining South Tyrol’s Experience: Digital Health Adoption and Workforce Issues in Implementing Italy’s Primary Care Reform Under Ministerial Decree No. 77/2022
by Christian J. Wiedermann, Angelika Mahlknecht, Verena Barbieri, Dietmar Ausserhofer, Barbara Plagg, Carla Felderer, Pasqualina Marino, Adolf Engl and Giuliano Piccoliori
Epidemiologia 2024, 5(4), 838-853; https://doi.org/10.3390/epidemiologia5040057 - 23 Dec 2024
Cited by 2 | Viewed by 1165
Abstract
Background: Ministerial Decree (D.M.) 77/2022 aims to reform Italy’s primary care system by establishing community health centres and integrating digital tools to address healthcare access disparities and workforce shortages. This review focuses on frailty assessment tools, digital health innovations, and workforce challenges in [...] Read more.
Background: Ministerial Decree (D.M.) 77/2022 aims to reform Italy’s primary care system by establishing community health centres and integrating digital tools to address healthcare access disparities and workforce shortages. This review focuses on frailty assessment tools, digital health innovations, and workforce challenges in the Autonomous Province of Bolzano, South Tyrol, emphasising interprofessional trust and collaboration issues. Methods: Using a narrative custom review approach guided by the SANRA checklist, this study synthesised findings from PubMed, official health websites, and regional surveys on frailty, workforce dynamics, interprofessional collaboration, and digital infrastructure in South Tyrol. Results: General practitioners (GPs) exhibited high professional motivation but expressed concerns about autonomy and administrative burdens in collaborative care models. Trust issues between GPs and specialists hinder workforce cohesion and care coordination, highlighting the need for structured inter-professional communication. Frailty assessments, such as the PRISMA-7 tool, identify over 33% of community-dwelling individuals aged 75 years and older as frail, necessitating targeted interventions. Digital health adoption, particularly electronic health records and telemedicine, is slow because of workforce shortages and infrastructure limitations. Conclusions: The successful implementation of D.M. 77/2022 in South Tyrol requires addressing workforce challenges, improving interprofessional trust, expanding digital infrastructure, and integrating frailty assessment findings into care strategies. These measures are critical for achieving a more resilient, equitable, and effective primary healthcare system. Full article
(This article belongs to the Special Issue Local Healthcare Preparedness and Alert Systems—How to Prevent Future Pandemics?)
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