UNIVERSAL IMMUNIZATION OF HEPATITIS B IN ITALY

• Newborns of HBsAg+ mothers at birth

• Infants of HBsAg- mothers at 3 months of age

• Children 12 years old

HBV vaccination is strongly recommended and offered free of charge for high risk groups such as:

• Households of HBsAg carriers• Healthcare workers• Polytransfused patients• Dialysis patients• Drug addicts• Male homosexuals

HEPATITIS B VACCINATION COVERAGE AMONG HEALTHCARE WORKERS IN ITALY. 1996

Geographical area N° of subjects Coverage studied (%)

Ferrara (North) 903 77.6a

Rome (Center) 1327 67.7b

Naples (South) 927 44.3c

Total 3157 64.5

a vs c P < 0.01b vs c P < 0.01

Stroffolini et al. Infect. Control Hosp Epidemiol. 1998

Characteristics associated with HB vaccination acceptance among healthcare workers in Italy.

Adjusted O.R. derived by multiple logistic regression analysis

Characteristic Vaccine O.R. (C.I. 95%) coverage(%)Age (years):

> 50 41.9 136 - 50 58.8 1.8 (1.4 - 2.3)20 - 35 85.6 5.3 (3.7 - 7.6)

Years ofemployment:

> 10 55.2 16 - 10 74.3 1.2 (0.9 - 1.5)< 6 84.2 1.9 (1.4 - 2.7)

Stroffolini et al. Infect. Control Hosp. Epidemiol. 1998

Proportion of acute hepatitis B cases in Italy reporting the risk factor “ Household of HBsAg + carrier”*. 1987- 2001

0

5

10

15

20

25

%

Year

* 28% of these subjects were aware of the carrier condition of the cohabitant, but were not vaccinated.

The natural cycle of HBsAg carriage

Mother HBsAg+

Newborn

HBV infected

Newborn HBsAg+

chronic carrier

Female

Male

IMMUNIZATION POLICY FOR NEWBORNS OF HBsAg + MOTHERS

• Immunoglobulins within 24 h after birth

PLUS

• Vaccine within 7 days after birth

Effectiveness of hepatitis B vaccination in newborns of HBsAg positive mothers in Italy, 2001

N° %

Pregnant women selected 11858

Pregnant women screened for HBsAg 10881 (91.8)

Pregnant women found HBsAg+ 182 (1.7)

Infants immunized 172 (95.0)

Stroffolini et al, Vaccine (In Press)

Factors associated with not adherence to HBsAg screening among pregnant women in Italy.

Adjusted Odds Ratios derived by multiple logistic regression analysis.

Characteristic O.R. (C.I. 95%)

Geographic areaItaly 1Foreign 2.0 (1.3 - 3.0)

Age (years)15 - 34 1 > 34 1.0 (0.8 - 1.4)

Years of schooling > 8 1 < 8 1.0 (0.8 - 1.2)

Number of subjects in the household < 4 1 > 4 3.5 (2.7 - 4.6)

HospitalPublic 1Private 1.9 (1.3 - 2.8)

Prevalence of HBsAg among pregnant women in Italy by area of birth, 2001.

Area of N. positive/birth N. screened (%)

Italy 139/9929 (1.4)

Eastern Europe Asia, Africa,Central and South America 35/597 (5.9)

Unknown 8/355 (2.3)

Total 182/10881 (1.7)

Effectiveness of hepatitis B vaccination in newborns of HBsAg positive mothers in Italy, by area of birth of the mother, 2001

Italian Foreign

Percentage of women 93.0 % 88.0 %

screened for HBsAg

Percentage of newborns of 92.8 % 100 %

HBsAg+ mothers immunized

Overall effectiveness 86.6 % 87.5 %

Effectiveness of hepatitis B vaccination in newborns of HBsAg positive mothers in Italy, 2000

N° %

Infants vaccinated 522 Infants infected ( Anti-HBc+) 17 (3.3)Infants Anti-HBc+ alone 14* (2.7)Infants chronic carriers (HBsAg+/Anti-HBc+) 3** (0.6)

Immunized children were exposed for 5-14 years to HBsAg+ mothers* None was HBV-DNA positive by PCR** All were HBV-DNA positive by PCR

Mele et al. J. Infect. Dis. 2001