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1 February 2007

Volume 44, Number 3
Clinical Infectious Diseases 2007;44:e17–e24
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4403-00E1$15.00
DOI: 10.1086/510433
MAJOR ARTICLE

Acute Hepatitis Delta Virus Infection in Italy: Incidence and Risk Factors after the Introduction of the Universal Anti–Hepatitis B Vaccination Campaign

Alfonso Mele,1

Andrea Mariano,1

Maria Elena Tosti,1

Tommaso Stroffolini,2

Renato Pizzuti,4

Giovanni Gallo,5

Pietro Ragni,6

Carla Zotti,7

Pierluigi Lopalco,8

Filippo Curtale,3

Emanuela Balocchini,9 and

Enea Spada1 on behalf of the

SEIEVA Collaborating Groupa

1National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, 2Gastroenterology Unit, San Giacomo Hospital, and 3Public Health Agency of the Lazio Region, Rome, 4Regional Health Authority, Regione Campania, Naples, 5Service of Public Health and Hygiene, Unita Locale Socio Sanitaria 9, Treviso, 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, Regione Toscana, Florence, Italy

Background.Updates on the incidence of and risk factors for acute hepatitis delta virus infection in Italy, as well as in other countries, are lacking, and the impact of the mandatory anti–hepatitis B vaccination has not been evaluated.

Methods.We performed a case‐control study within a population‐based surveillance for acute viral hepatitis.

Results.During 1993–2004, 344 cases of acute hepatitis delta virus infection were reported. After a peak in 1993 (2.8 cases per 1 million population), the incidence decreased from 1.7 to 0.5 cases per 1 million population. Coinfections were prevalent. The decrease in incidence particularly affected young adults, and it paralleled the decrease in incidence of acute hepatitis B. In 1993, being an injection drug user (adjusted odds ratio [ORadj], 67.9; 95% confidence interval [CI], 18.1–254.5) or being a member of a household with a carrier of hepatitis B surface antigen (ORadj, 14.8; 95% CI, 3.0–72.9) were the only independent predictors of infection. During 1994–2004, being an injection drug user (ORadj, 36.8; 95% CI, 20.7–65.4), cohabitation with an injection drug user (ORadj, 4.2, 95% CI, 1.7–12.3), hospitalization (ORadj, 3.5; 95% CI, 1.9–6.6), receipt of dental therapy (ORadj, 2.3; 95% CI, 1.4–3.6), promiscuous sexual activity (ORadj, 2.2; 95% CI, 1.4–3.6), and receipt of beauty treatment (ORadj, 2.0; 95% CI, 1.3–3.2) were independently associated with infection.

Conclusions.Incidence of acute hepatitis delta infection is markedly decreasing in Italy. Undergoing invasive medical procedures, engaging in promiscuous sexual activity, and receiving beauty treatments are emerging, in addition to injection drug use, as important risk factors for infection. Further efforts are needed to increase vaccine coverage in high‐risk groups and to implement the safety of invasive procedures performed both inside and outside health care facilities.

Received 3 August 2006; accepted 19 September 2006; electronically published 22 December 2006.

Reprints or correspondence: Dr. Enea Spada, Istituto Superiore di Sanità, National Center of Epidemiology, Surveillance and Health Promotion, Clinical Epidemiology Unit, Via Giano Della Bella, 34‐ 00162 Rome, Italy ().

Cited by

Pierluigi Cocco, Giovanna Piras, Maria Monne, Antonella Uras, Attilio Gabbas, Maria G. Ennas, Angelo Palmas, Marco Murineddu, Stefania Collu, Massimo Melis, Marco Rais, Pierfelice Todde, Maria G. Cabras, Emanuele Angelucci, Giovannino Massarelli, Alexandra Nieters. (2008) Risk of malignant lymphoma following viral hepatitis infection. International Journal of Hematology 87:5, 474-483
Online publication date: 1-Jul-2008.
CrossRef
Alfonso Mele, Maria Elena Tosti, Andrea Mariano, Renato Pizzuti, Antonio Ferro, Bianca Borrini, Carla Zotti, Pierluigi Lopalco, Filippo Curtale, Emanuela Balocchini, and Enea Spada, for the National Surveillance System for Acute Viral Hepatitis (SEIEVA) Collaborating Group. (2008) Acute Hepatitis B 14 Years after the Implementation of Universal Vaccination in Italy: Areas of Improvement and Emerging Challenges. Clinical Infectious Diseases 46:6, 868-875
Online publication date: 15-Mar-2008.
Abstract-Full Text-PDF Version (235 kB)
Evangelista Sagnelli, Tommaso Stroffolini, Alfonso Mele, Michele Imparato, Piero L. Almasio, and the Italian Hospitals’ Collaborating Group. (2008) Chronic Hepatitis B in Italy: New Features of an Old Disease—Approaching the Universal Prevalence of Hepatitis B e Antigen–Negative Cases and the Eradication of Hepatitis D Infection. Clinical Infectious Diseases 46:1, 110-113
Online publication date: 1-Jan-2008.
Abstract-Full Text-PDF Version (234 kB)
R. S. KOFF. (2007) Review article: vaccination and viral hepatitis - current status and future prospects. Alimentary Pharmacology & Therapeutics 26:10, 1285-1292
Online publication date: 1-Dec-2007.
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Giovanni B. Gaeta, Tommaso Stroffolini, Antonina Smedile, Grazia Niro, Alfonso Mele. (2007) Hepatitis delta in Europe: Vanishing or refreshing?. Hepatology 46:4, 1312-1313
Online publication date: 1-Nov-2007.
CrossRef

  • Members of the Sistema Epidemiologico Integrato dell'Epatite Virale Acuta (SEIEVA) group are listed at the end of the article.

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