Approximately 3 million healthcare workers per year receive an injury with an occupational instrument, with around 2000000 exposures to hepatitis B virus (HBV) and 1000000 to hepatitis C virus (HCV). Although an effective HBV vaccine has been available since the early eighties, and despite the worldwide application of universal vaccination programs started in the early nineties, HBV still remains a prominent agent of morbidity and mortality. There is no vaccine to limit the diffusion of HCV infection, which progresses to chronicity in the majority of cases and is a major cause of morbidity and mortality worldwide due to a chronic liver disease. Healthcare workers are frequently exposed by a mucosal-cutaneous or percutaneous route to accidental contact with human blood and other potentially infectious biological materials while carrying out their occupational duties. Mucosal-cutaneous exposure occurs when the biological material of a potentially infected patient accidentally comes in contact with the mucous membranes of the eyes or mouth or with the skin of a healthcare worker. Percutaneous exposure occurs when an operator accidentally injures himself with a sharp contaminated object, like a needle, blade or other sharp medical instrument. About 75% of the total occupational exposure is percutaneous and 25% mucosal-cutaneous, the risk of infecting a healthcare worker being higher in percutaneous than in mucosal-cutaneous exposure. All healthcare workers should be considered for HBV vaccination and should meticulously apply the universal prophylactic measures to prevent exposure to HBV and HCV.

The actual Coronavirus Disease (COVID 19) pandemic is due to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the coronavirus family. Besides the respiratory involvement, COVID 19 patients frequently develop a pro-coagulative state caused by virus-induced endothelial dysfunction, cytokine storm and complement cascade hyperactivation. It is common to observe diffuse microvascular thrombi in multiple organs, mostly in pulmonary microvessels. Thrombotic risk seems to be directly related to disease severity and worsens patients' prognosis. Therefore, the correct understanding of the mechanisms underlying COVID-19 induced prothrombotic state can lead to a thorough assessment of the possible management strategies. Hence, we review the pathogenesis and therapy of COVID 19-related thrombosis disease, focusing on the available evidence on the possible treatment strategies and proposing an algorithm for the anticoagulation strategy based on disease severity. Keywords COVID-19 • SARS-CoV-2 • Thrombosis • Anticoagulation Highlights • SARS-CoV-2 induced complement hyperactivation, endothelial dysfunction and cytokine storm have a prothrombotic effect. • COVID 19 patients develop a pro-coagulative state directly related to disease severity. • In COVID 19 critical patients, thrombotic lesions in pulmunary microvessels have a prevalence twice higher than critical non-COVID 19 patients. • Anticoagulant treatment is associated with lower mortality. Hence, we propose an algorithm for the anticoagulation strategy based on disease severity.

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BackgroundUniversal hepatitis B virus (HBV) vaccination of newborn babies was introduced in Italy in 1991 and was extended to 12-years-old children for the first 12 years of application so as to cover in a dozen years the Italian population aged 0-24 years. The aim of this study was to identify factors associated with long-term immunogenicity against HBV 17 years after primary vaccination in students attending medical schools in Naples, Italy.Methods1,704 students attending the school of medicine, schools of the healthcare professions, or postgraduate medical schools of the Second University of Naples, Italy, from September 2012 to December 2013 were enrolled in this study. Of these, 588 had been vaccinated against HBV in infancy and 1,116 when 12 years old. Multivariate logistic regression analysis was used to identify factors associated with the level of long-term immunogenicity.ResultsAll vaccinated subjects were HBsAg/anti-HBc negative: 270 (15.8%) had an anti-HBs titer between 1 and 9 IU/L, 987 (57.9%) between 10 and 400 IU/L, and 447 (26.3%) over 400 IU/L. When compared with the latter two subgroups, those with anti-HBs titers lower than 10 IU/L were younger (24 ± 5.2 years vs. 26 ± 4.9 years, p < 0.000), more frequently students attending a healthcare school (59% vs. 47%, p < 0.001), and more frequently had been vaccinated in infancy (50% vs. 31.5%, p < 0.0001). Multivariate logistic regression identified age at vaccination as the only factor independently associated with an anti-HBs titer <10 IU/L (OR: 2.43; C.I. 95%: 1.57–3.76, p = 0.001).ConclusionsUniversal HBV vaccination in Italy has been more effective in generating a prolonged protective response in subjects vaccinated at adolescence than in infancy. Students with a low anti-HBs titer should be considered for a booster dose because most will be exposed to the risk of acquiring HBV for decades.