Acute Hepatitis B 14 Years after the Implementation of Universal Vaccination in Italy: Areas of Impr

February 18, 2008

Clin Infect Dis. 2008 Feb 12 [Epub ahead of print]

Acute Hepatitis B 14 Years after the Implementation of Universal Vaccination in

Italy: Areas of Improvement and Emerging Challenges.

Mele A, Tosti ME, no A, Pizzuti R, Ferro A, Borrini B, Zotti C, Lopalco P,

Curtale F, Balocchini E, Spada E; National Surveillance System for Acute Viral

Hepatitis (SEIEVA) Collaborating Group.

1National Centre of Epidemiology, Surveillance and Health Promotion, Istituto

Superiore di Sanità, 2Clinical Research Department, National Institute for

Infectious Diseases Lazzaro Spallanzani, and 3Public Health Agency of the Lazio

Region, Rome, 4Regional Health Authority, Regione Campania, Naples, 5Service of

Public Health and Screening, Regione Veneto, Venezia, 6Regional Health

Authority, Regione Emilia Romagna, Bologna, 7Department of Public Health and

Microbiology, University of Turin, Turin, 8Institute of Hygiene, University of

Bari, Bari, and 9Regional Health Authority, Toscana Region, Florence, Italy.

Background. @nbsp; Italy had intermediate-level endemicity for hepatitis B virus

(HBV) infection in the 1970s and 1980s. In 1991, vaccination of infants and

adolescents became mandatory. We report the impact of universal vaccination 14

years after its beginning. Methods. @nbsp; We performed a case-control study

within a population-based surveillance for acute viral hepatitis. The incidence

of acute hepatitis B (AHB) was estimated for the time since 1991, and the

association between AHB and the considered risk factors was analyzed for the

period 2001-2005. Results. @nbsp; The incidence of AHB progressively decreased

from 1991 to 2005, mainly for persons in the age groups targeted by the

universal vaccination campaign: there was a 24-fold and 50-fold decrease in the

15-24-year and 0-14-year age groups, respectively; for the>/=25-year age group,

the incidence halved. Owing to the persons' ages, approximately 3% of total AHB

cases should have been the target of vaccination campaign. In 2004-2005,

foreigners accounted for 14% of total cases and for 57% of persons who should

have been targets for vaccination. Missed opportunities for immunization were

documented for approximately 50% of patients with AHB who reported cohabitation

with HBV carriers and for 70% of those who reported injection drug use. The

strongest associations with AHB were found for blood transfusion (adjusted odds

ratio [OR(adj)], 8.4; 95% confidence interval [CI], 2.7-26), cohabitation with

HBV carriers (OR(adj), 5.3; 95% CI, 3.6-7.7), injection drug use (OR(adj), 3.8;

95% CI, 2.5-5.8), and unsafe sexual practices (OR(adj), 2.8; 95% CI, 1.9-4.2).

Conclusion. @nbsp; Universal vaccination has contributed to a decreasing AHB

incidence in Italy, especially by reducing the risk of infection among persons

aged 15-24 years. Most infections occur in persons aged>/=25 years in

association with injection drug use, unsafe sexual activity, percutaneous

treatment, and iatrogenic exposure. Improvement of vaccine coverage in high-risk

groups and adherence to infection control measures during surgery and

percutaneous treatment are needed. The high risk still associated with blood

transfusion needs to be further investigated, with consideration of occult HBV

infection in blood donors. The potential spread of HBV infection from the

immigrant population deserves adequate health policy prevention programs.

PMID: 18269332 [PubMed - as supplied by publisher]

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February 18, 2008