Epidemiology of acute and chronic hepatitis B and delta over the last 5 decades in Italy

Abstract

The spread of hepatitis B virus (HBV) infection has gradually decreased in Italy in the last 5 decades as shown by the steady reduction in the incidence rates of acute hepatitis B, from 10/100000 inhabitants in 1984 to 0.85/100000 in 2012, and by the reduced prevalence of hepatitis B surface antigen (HBsAg)-positive cases among chronic hepatitis patients with different etiologies, from 60% in 1975 to about 10% in 2001. The prevalence of HBsAg chronic carriers in the general population also decreased from nearly 3% in the 1980s to 1% in 2010. Linked to HBV by its characteristics of defective virus, the hepatitis delta virus (HDV) has shown a similar epidemiological impact on the Italian population over time. The incidence of acute HDV infection decreased from 3.2/100000 inhabitants in 1987 to 0.8/100000 in 2010 and the prevalence of HDV infection in HBsAg chronic carriers decreased from 24% in 1990 to 8.5% in 2006. Before the beneficial effects of HBV mass vaccination introduced in 1991, the decreased endemicity of HBV and HDV infection in Italy paralleled the improvement in screening blood donations, the higher standard of living and impressive reduction in the birth rate associated with a marked reduction in the family size. A further contribution to the decline in HBV and HDV infections most probably came from the media campaigns to prevent the spread of human immunodeficiency virus infection by focusing the attention of the general population on the same routes of transmission of viral infections such as unsafe sexual intercourse and parenteral exposures of different kinds.

Hepatitis B Virus Epidemiology

“…This decrease in prevalence through the impact of vaccination has also been shown in intermediate-prevalence countries in Europe (Salleras et al 2005;Sagnelli et al 2014). …”

Hepatitis delta virus: From biological and medical aspects to current and investigational therapeutic options

“…But for the last 15 years, no further decline has been observed. In Italy, where an HDV epidemic spreading occurred during the 80's, there was a steady decrease during the two following decades, but recent data suggest that no further decrease was achieved, with steady prevalence rates of 8,1% of HBsAg carriers in 2008 (107,108). In France, the latest data suggest that the prevalence of HDV infection among HBsAg carriers is also stable, if not increasing (109).…”

Epidemiological and clinical scenario of chronic liver diseases in Italy: Data from a multicenter nationwide survey

“…Several factors can be considered responsible for this decline: the improvement in socio-economic conditions starting in the 60s and still ongoing in 2001, the intensive national mass media campaigns to limit the spread of AIDS in the 80s and 90s and the universal HBV vaccination that started in 1991 and had covered by 2001 the age classes 0-10 and 12-21 [22][23][24]. In apparent contrast with the progressive extension of universal HBV vaccination, which by 2014 had covered all Italian subjects aged 0-34, the rate of HBV-related cases had increased by 2014 to 20.2%.…”