Clinical Infectious Diseases
Volume 46, Issue 6, 2008, Pages 868-875

Acute hepatitis B 14 years after the implementation of universal vaccination in Italy: Areas of improvement and emerging challenges (Article) (Open Access)

Mele A. , Tosti M.E. , Mariano A. , Pizzuti R. , Ferro A. , Borrini B. , Zotti C. , Lopalco P. , Curtale F. , Balocchini E. , Spada E.*
  • a National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
  • b National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
  • c Clinical Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
  • d Regional Health Authority, Naples, Italy
  • e Service of Public Health and Screening, Venezia, Italy
  • f Regional Health Authority, Bologna, Italy
  • g Department of Public Health and Microbiology, University of Turin, Turin, Italy
  • h Institute of Hygiene, University of Bari, Bari, Italy
  • i Public Health Agency of the Lazio Region, Rome, Italy
  • j Regional Health Authority, Florence, Italy
  • k National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy, Istituto Superiore di Sanità, National Center of Epidemiology, Surveillance and Health Promotion, Clinical Epidemiology Unit, Via Giano Della Bella, 34, 00162 Rome, Italy

Abstract

Background. 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. 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. 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, ∼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?∼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 [ORadj], 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 (ORadj, 3.8; 95% CI, 2.5-5.8), and unsafe sexual practices (ORadj, 2.8; 95% CI, 1.9-4.2). Conclusion. 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. © 2008 by the Infectious Diseases Society of America. All rights reserved.

Author Keywords

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Index Keywords

National Health Programs methodology Population Surveillance human controlled study priority journal acute disease Hepatitis B virus Unsafe Sex Humans Adolescent Infant, Newborn male preschool child female Infant preventive health service risk factor Risk Factors Child, Preschool newborn acute hepatitis immunology prevalence Incidence Article Hepatitis B Vaccines adult major clinical study infection risk hepatitis B vaccine Italy Case-Control Studies Immunization Programs vaccination hepatitis B case control study immunization blood transfusion Child public health health survey
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-40749091277&doi=10.1086%2f528687&partnerID=40&md5=ea6ca29508aa6756183266a0e44639ba
DOI: 10.1086/528687
ISSN: 10584838
Cited by: 65
Original Language: English