Hepatitis B in children in Italy: Incidence and risk factors

The objectives of the present report were to give a baseline picture of hepatitis B notification incidence rates in children before the campaign of mass vaccination for newborns and adolescents (12–13 years old), and to study the role of different risk factors. Data from a specific national surveillance system of acute viral hepatitis (SEIEVA, Sistema Epidemiologico Integrato dell'Epatite Virale Acuta) were used and acute hepatitis B cases were compared to acute hepatitis A patients with the case-control study method to estimate the associations with the considered risk factors. Since the system began, one hundred and sixty-three local health departments have joined SEIEVA covering 30% of the Italian population. The incidence of acute hepatitis B notifications among 0–14 aged children was 9 per 100,000 in 1985 and 1 per 100,000 in 1990. Such decline in incidence was observed in both the North and the South of Italy. Surgical interventions, dental therapy and household contacts with a HBsAg chronic carrier were found to be associated with acute hepatitis B. The point estimate of the odds ratio was 10 for the latter risk factor. Other preventive measures in addition to vaccination are needed to control the risk of hepatitis B infection and other parenteral diseases due to surgical intervention and dental therapy.     

Integrated epidethiological system for acute viral hepatitis in Italy (SEIEVA): Description and preliminary results

An integrated epidemiological system for the surveillance of acute viral hepatitis SEIEVA which linked notifications to available serology results and used a standard risk factor questionnaire is described. Results of over 1300 cases reported by 35 participating local health units (USL's) during the first 18 months of the programme are presented. Overall the annual reported incidence of acute viral hepatitis was 70 per 100,000. There were marked regional and age specific differences in the incidence of each type of viral hepatitis. The annual incidence per 100,000 of hepatitis A in southern children was 133 while in northern young adults the incidence of hepatitis B was 88 and hepatitis non-A non-B was 43. The possible roles of shellfish consumption in the transmission of non-A non-B hepatitis at all ages were highlighted.     

Update on hepatitis B vaccination in Italy 10 years after its implementation

Since the beginning of the Italian program of immunization against hepatitis B, vaccine has been given to more than 9 million children, with an outstanding record of safety and efficacy. The coverage rate is globally around 94%, with differences between Northern and Southern regions, the latter having the lower acceptance rate. According to the National Surveillance System (SEIEVA), the incidence of acute hepatitis B per10(5) inhabitants declined from 5.4 in 1990 to 2.9 in 1998. The reduction was even greater among 15-24-year-old individuals, where the incidence rate per 10(5) decreased from 17.3 to 4.2 in the same period. In parallel with the decline of hepatitis B, Delta hepatitis has also dropped significantly. We expect that by the year 2003 (12 years after the beginning of the program) this vaccination strategy will have led to the protection of all Italians aged 0-24 years, who are those at the higher risk for acquiring hepatitis B virus (HBV) and for developing the chronic carrier state.     

Social determinants and risk of acute viral hepatitis

The authors examined the relationship between viral hepatitis risk and social determinants in Piedmont region population surveyed by SEIEVA (sistema epidemiologico integrato dell'epatite virale acuta). The education and the working position showed different correlation with incidence rates of different types of viral hepatitis A, B, non-A non-B. The hepatitis A risk is proportional to education and the probability of hepatitis B and non-A non-B is higher in low social classes. This situation is only apparently a balanced risk: the clinical seriousness and the strong probability of complications of hepatitis B and non-A non-B make the risks deeply unequal.     

Travel-associated hepatitis A: effect of place of residence and country visited.

The association between hepatitis A and domestic or international travel from Italy was investigated. Data from a nationwide surveillance system (SEIEVA) for type-specific acute viral hepatitis were used to compare 1102 hepatitis A cases with 3671 hepatitis B cases. An association between hepatitis A and travel was found in northern Italy, where most young and adult people are susceptible. Estimates of odds ratios vary dramatically according to geographical area of travel. Travellers to Mediterranean countries, Eastern Europe, Africa, Asia, and South and Central America had the highest education and age-adjusted odds ratios for hepatitis A, ranging from 6 to 25. Prophylaxis against hepatitis A for such travellers is recommended.     

Acute hepatitis B infection in Aboriginal Australians

Abstract: The apparent incidence of acute hepatitis B infection in the Top End of the Northern Territory was estimated from notification data and hospital data to be 12 per 100 000 per year, with a marked difference between Aborigines (42 per 100 000) and non-Aborigines (4 per 100 000), and an odds ratio of 9.7 (95 per cent confidence intervals 3 to 33). Sixty percent of Aboriginal cases of acute hepatitis B occurred in children under 10 years of age, whereas non-Aboriginal cases occurred in adults aged 20 to 29, most with behavioural risk factors. These findings confirm the importance of immunising Aboriginal children to reduce the future incidence of hepatitis B infection and hepatoma.     

Comparative evaluation of 2 epidemiologic surveillance systems of hepatitis A

Epidemiological surveillance represents an important tool for the prevention of hepatitis A. In Italy, the surveillance of hepatitis A is based on the routine notification system of infectious diseases (from 1996 it was replaced by SIMI, Computerised System of Infectious Diseases) and on SEIEVA (Epidemiological Integrated System of Acute Viral Hepatitis). From 1997 to 2000 the two surveillance systems have been compared in Puglia region to evaluate match rate, completeness and sensitivity. A total of 7.018 records from SIMI and 4.413 from SEIEVA have been analyzed. During this period, the 37.0% of cases notified to SIMI match SEIEVA records whereas the 58.8% of cases reported to SEIEVA match cases notified to SIMI. Therefore, the match rate between the two systems was 29.0%. The sensitivity of SIMI and SEIEVA resulted 79.4% and 49.9% respectively. The comparison of the two surveillance systems allowed to recognise problems in local organisation. Therefore, a more adequate training should be supplied to workers involved in the surveillance activities.     

A severe and explosive outbreak of hepatitis B in a rural population in Sirsa district, Haryana, India: unnecessary therapeutic injections were a major risk factor

Most outbreaks of viral hepatitis in India are caused by hepatitis E. This report describes an outbreak of hepatitis B in a rural population in Haryana state in 1997. At least 54 cases of jaundice occurred in Dhottar village (population 3096) during a period of 8 months; 18 (33.3%) of them died. Virtually all fatal cases were adults and tested positive for HBsAg (other markers not done). About 88% (21/24) of surviving cases had acute or persistent HBV/HCV infections; 54% (13/24) had acute hepatitis B. Many other villages reported sporadic cases and deaths. Data were pooled from these villages for analysis of risk factors. Acute hepatitis B cases had received injections before illness more frequently (11/19) than those found negative for acute or persistent HBV/HCV infections (3/17) (P = 0.01). Although a few cases had other risk factors, these were equally prevalent in two groups. The results linked the outbreak to the use of unnecessary therapeutic injections.     

Incidence of acute hepatitis B--United States, 1990-2002

Hepatitis B virus (HBV) is a bloodborne and sexually transmitted virus that is acquired by percutaneous and mucosal exposure to blood or other body fluids of an infected person. Clinical manifestations of acute hepatitis B can be severe, and serious complications (i.e., cirrhosis and liver cancer) are more likely to develop in chronically infected persons. In the United States, approximately 1.2 million persons have chronic hepatitis B virus (HBV) infection and are sources for HBV transmission to others. However, since the late 1980s, the incidence of acute hepatitis B has declined steadily, especially among vaccinated children. To characterize the epidemiology of acute hepatitis B in the United States, CDC analyzed national notifiable disease surveillance data for 1990-2002. This report summarizes the results of that analysis, which indicated that, during 1990-2002, the incidence of reported acute hepatitis B declined 67%. This decline was greatest among children and adolescents, indicating the effect of routine childhood vaccination. The decline was lowest among adults, who accounted for the majority of cases; incidence increased among adults in some age groups. To reduce HBV transmission further in the United States, hepatitis B vaccination programs are needed that target men who have sex with men (MSM), injection-drug users (IDUs), and other adults at high risk.     

中国2013-2020年乙型肝炎发病情况估算和病例特征分析

目的 为了解我国乙型肝炎（乙肝）病例的发病特征,为评估我国消除乙肝目标的实现情况,制定乙肝防控规划提供科学依据。方法 对2013-2020年我国高、中、低流行区的全国法定传染病报告系统（NNDRS）中报告的乙肝病例进行调查,分析报告的病例的诊断信息,通过报告信息和诊断信息对2013-2020年的乙肝病例发病情况进行估算。分析急性乙肝和慢性乙肝的病例特征。结果 NNDRS中共报告了27 013例病例,其中急性乙肝病例4 070例,慢性乙肝病例21 971例,未分类乙肝病例972例。报告急性乙肝病例中,诊断为急性乙肝的占69.9%（2 845/4 070）,报告慢性乙肝病例中,诊断为急性乙肝的占2.1%（452/21 971）,诊断为慢性乙肝的占89.0%（19 548/21 971）。通过对发病情况进行估算,2013-2020年全国估计急性乙肝发病率为4.6/10万,慢性乙肝发病率为54.5/10万。急性乙肝中以31~45岁组最多,占35.3%（1 164/3 297）,≤ 15岁儿童仅占0.4%（13/3 297）。慢性乙肝中以46~60岁组最多,占34.4%（7 211/20 932）。结论 我国急性乙肝发病率逐年下降,慢性乙肝发病率有上升趋势,应进一步加强对慢性乙肝的规范化诊断和治疗,降低因慢性乙肝导致的疾病转归和死亡的发生。同时需要对NNDRS中报告的乙肝病例报告进行规范化的管理和报告,以提高乙肝病例分类报告的准确性。     

Viral hepatitis in the US Navy, 1975-1984

The epidemiology of viral hepatitis in US Navy enlisted personnel was reviewed for the years 1975-1984. Hospital discharge summaries of all active duty enlisted personnel admitted to a US Navy treatment facility were used for the study. From 1975 to 1984, total first hospitalizations for viral hepatitis declined from 128 per 100,000 personnel (95% confidence interval (Cl) 118-139) to 56 per 100,000 personnel (95% Cl 50-63). The highest incidence of acute viral hepatitis (115 per 100,000 personnel) was found in the youngest age groups aged 24 years and less. Risk factors for acute hepatitis included a previous hospitalization with either drug abuse (relative risk = 363) or a sexually transmitted disease (relative risk = 25) listed among the discharge diagnoses. Having a medical job classification was also associated with an increased risk of acute hepatitis. The steep decline in the incidence of viral hepatitis during this 10-year period may have been due to decreasing drug abuse in the US Navy. Immunization of high-risk groups in the US Navy with hepatitis B vaccine could be an effective policy for the prevention of acute viral hepatitis.     

Epidemiology of chronic hepatitis B and C in Victoria,Australia: insights and impacts from enhanced surveillance

Objective : To assess the impact of an enhanced viral hepatitis surveillance program on data completeness and on epidemiological assessment of affected populations. Methods : Notified cases of non‐acute hepatitis B and C were analysed to determine demographic characteristics and risk factors during the period prior to July 2015–June 2016, and during enhanced surveillance of the period July 2016–June 2017, during which time doctors were contacted for information about new diagnoses. Results : During the enhanced period, completeness for country of birth and Indigenous status doubled for both hepatitis B and hepatitis C, from 18–37% to 48–65%. The incidence ratio of hepatitis C among Aboriginal and Torres Strait Islander people increased from eight‐fold to 11.4‐fold, and the proportion of hepatitis B cases reported as born in China and Vietnam relative to other countries increased. New data fields identified that 12% of hepatitis C diagnoses occurred in a correctional facility, and 2% of hepatitis B cases were healthcare workers. Conclusions : Improved data completeness highlighted the underlying epidemiology of chronic viral hepatitis, demonstrating the increased burden of infection among specific priority populations. Implications for public health : Enhanced surveillance provides greater insight into the epidemiology of chronic viral hepatitis, identifying groups at risk and opportunities for public health action.     

台山市2010年乙型病毒性肝炎病例报告及发病率评估分析

目的了解疾病监测信息报告管理系统中乙肝病例的报告准确性，评估台山市乙肝的实际发病水平。方法收集2010年台山市的报告发病率资料，对台山市报告的本辖区乙肝病例进行流行病学调查，采集血清后采用化学发光微粒子免疫分析法，使用雅培试剂进行HBsAg、抗-HBeIgM和抗-HAVIgM检测，根据流行病学调查结果和实验室检测结果按照卫生部发布的《乙肝诊断标准》进行诊断和复核分类，根据复核分类结果对台山市实际发病率进行估算。结果2010年台山市通过疾病监测信息报告管理系统报告乙肝病例659例，其中急性、慢性和未分类病例分别为7、327、325例，报告年发病率为31．21／10万。共报告474例本辖区病例，其中急性、慢性和未分类分别为5、193、276例，其中已检测HBsAg、抗-HBeIgM、抗-HAVIgM、HBV—DNA的病例分别占97．89％（464／474）、26．37％（125／474）、17．93％（85／474）、4．64％（22／474）。69．201（328／474）的病例有肝炎症状或体征，69．83％（331／474）的病例肝功能异常，2种合并的病例有235例（49．58％）。403例病例采血经实验室检测复核分类，急性乙肝、慢性乙肝、乙肝病毒携带者和其他病例分别为26、341、28和8例，分别占6．46％、84．62％、6．95％和1．99％，急性病例和慢性病例报告诊断和复核诊断一致的分别为2例（40．00％）和142例（89．31％）。根据复核分类结果估算2010年台山市实际发病率为3．95／10万。结论2010年台山市报告乙肝发病率可能高于实际发病水平，报告病例中实验室特异性诊断的比例较低。提示应在各级医院推广开展抗-HBeIgM等实验室特异性诊断项目，统一和修订乙肝报告标准，以保证病例报告的质量和准确性。     

2012-2018年江西省急性乙型病毒性肝炎流行病学特征分析

目的 分析2012-2018年江西省急性乙型病毒性肝炎(乙肝)的流行病学特征,为评价乙肝免疫策略效果和制定防控措施提供依据。方法 从中国疾病预防控制信息系统(NNDRS)中下载江西省2012-2018年急性乙肝疫情资料,运用流行病学方法对其流行特征进行分析。结果 2012-2018年江西省共报告急性乙肝病例10409例,年平均发病率为3.27/10万,报告发病数和发病率均呈逐年下降趋势;各设区市均有急性乙肝病例报告,报告发病率最高的设区市为萍乡市(13.90/10万);报告发病率最高的年龄组为25~岁组(6.58/10万),最低的为5~岁组(0.18/10万);15~45岁病例6524例(62.68%),<15岁病例283例(2.72%);男性发病率高于女性,男女性别比为2.38〖DK〗∶1;病例以农民最多(6347例,占60.98%),其次是家务及待业人群(1234例,占11.86%)。结论 2012-2018年江西省急性乙肝病例以男性、农民、15~45岁人群为主,报告发病数和发病率均逐年降低,地区间发病水平及其变化趋势有差异。     

Evaluation of hepatitis C surveillance in Poland in 1998

The aim was to evaluate hepatitis C surveillance in Poland during 1998. Hepatitis C reports were obtained from epidemiology offices. Public health staff were interviewed to collect information on surveillance operations. To estimate the proportion of acute cases among the total reported, a study was conducted in the Warsaw district to validate case reports. A total of 1661 (97.2%) hepatitis C cases were studied. Hepatitis C surveillance was timely and acceptable to the user, but did not provide a number of information elements required to differentiate acute from chronic cases of infection. Of the 268 case reports available in the Warsaw district, only 15 (5.6%) met the acute hepatitis C case definition. It is concluded that hepatitis C surveillance in Poland cannot provide useful incidence estimates and information regarding risk factors for acute infection. A strict case definition and a modified case form with specific questions for HCV transmission routes should be applied.     

广东省1990-2019年急性病毒性肝炎疾病负担分析

目的 了解1990-2019年广东省急性病毒性肝炎的疾病负担情况及变化趋势,为广东省肝炎防治提供参考依据。方法 资料来源于2019全球疾病负担研究数据库广东省1990-2019年的相关数据。急性病毒性肝炎包括甲型肝炎（甲肝）、乙型肝炎（乙肝）、丙型肝炎（丙肝）和戊型肝炎（戊肝）。对不同时期的分年龄、性别构成的发病、死亡以及伤残调整寿命年（DALY）数据进行描述与分析,以及年估计变化百分比（EAPC）,以描述急性病毒性肝炎疾病负担的变化趋势。结果 1999- 2019年广东省急性病毒性肝炎疾病负担均呈逐年下降趋势,其中死亡率与DALY年龄标化率下降趋势尤为明显。2019年在急性病毒性肝炎患者4 365 221例中,急性乙肝患者占51.43%（2 245 087例）,而急性乙肝的死亡病例占急性病毒性肝炎死亡病例的77.18%（106/138）。在不同年龄组中,除急性乙肝高发于成年人外,急性甲肝、急性乙肝和急性戊肝等其他肝炎发病率总体随着年龄增长呈下降趋势。除<5岁年龄组的急性病毒性肝炎死亡率稍高外,其他年龄组的急性病毒性肝炎死亡率均随年龄增长呈上升趋势。男性的急性病毒性肝炎总体发病率和死亡率均高于女性。结论 1999-2019年广东省急性病毒性肝炎疾病负担总体有所下降,但始终高于全国平均水平,须进一步加强对广东省不同人群尤其是儿童及老年人的肝炎预防与筛查工作。     

Acute hepatitis B among children and adolescents--United States, 1990-2002

Since the 1991 adoption of a comprehensive strategy to eliminate hepatitis B virus (HBV) transmission in the United States, the incidence of acute hepatitis B cases has declined steadily. Declines have been greatest among children born after the 1991 recommendations for universal infant hepatitis B vaccination were implemented. In 1995, the elimination strategy was expanded to include routine vaccination of all adolescents aged 11-12 years and, in 1999, to include children aged < or =18 years who had not been vaccinated previously. To describe the epidemiology of acute hepatitis B in children and adolescents in the United States, CDC analyzed notifiable disease surveillance data collected during 1990-2002 and data collected during 2001-2002 through enhanced surveillance of reported cases of acute hepatitis B in children born after 1990. This report summarizes the results of that analysis, which indicated that the rate of acute hepatitis B in children and adolescents decreased 89% during 1990-2002 and that racial disparities in hepatitis B incidence have narrowed. Many confirmed cases in persons born after 1990 occurred among international adoptees and other children born outside the United States. Continued implementation of the hepatitis B elimination strategy and accurate surveillance data to monitor the impact of vaccination are necessary to sustain the decline of acute hepatitis B among children.     

2006 - 2017年青岛市急性乙型病毒性肝炎流行趋势及特征分析

目的 分析青岛市急性乙型病毒性肝炎（乙肝）发病趋势和流行特征,为乙肝防控工作提供科学依据。方法 采用描述性流行病学方法对2006 - 2017年青岛市急性乙肝发病特征进行分析,发病率的趋势性检验采用直线回归分析,自变量为年份,因变量为发病率的自然对数值。结果 2006 - 2017年青岛市共报告急性乙肝病例2 415例,年均发病率为2.29/10万,发病率呈逐年下降趋势（t = -8.306,P＜0.001）。病例季节分布不明显,发病率较高地区为黄岛区、李沧区、市北区,发病率分别为3.38/10万、2.82/10万、2.70/10万。男性发病率高于女性,男性为3.28/10万,女性为1.30/10万,男女性别比为2.52∶1,发病年龄集中在20～49岁,农民、工人、家务及待业发病较多,分别占总病例数的36.44%,16.27%和12.38%。结论 青岛市急性乙肝发病率逐年下降,男性15岁以上人群为重点防控人群,应在提高儿童乙肝疫苗接种率的基础上加强对其他易感人群的免疫接种,并将健康教育与人群免疫结合起来。     

Incidence and prevalence of hepatitis B. A community-based survey in the Philippines

In a rural village in the Philippines, sera were collected from 744 residents and tested for evidence of hepatitis B virus infection. In the subsequent year, every household was visited every other week for a period of three months in an attempt to identify clinically apparent cases. At the end of the year, sera were obtained from 78% of persons initially negative for hepatitis B virus and 97% of those initially positive for hepatitis B surface antigen (HBsAg). Overall, HBsAg was found in 8.8% of the population tested, of whom 86% were still HBsAg-positive at the end of the year. Susceptibility to hepatitis B virus infection declined significantly with age, to only 16% in the age group 50 years and older. No difference in the prevalence of markers by sex was observed. The risk of infection in children appeared to increase if one or both parents were infected, compared with both parents susceptible (odds ratio = 3.3 and 7.6, respectively); the risk increased if older siblings were infected, compared with all older siblings susceptible. The overall incidence rate of hepatitis B virus infection was 3.3% per year. For those aged five years or younger, the incidence rate was 9.2%. None of the seroconverters manifested acute symptoms of infection. Despite the evident clustering in families of persons with hepatitis B virus markers, which is suggested by the prevalence survey, only two of nine incident infections observed were in children with HBsAg-positive close relatives. The findings support the impression that in countries endemic for hepatitis B virus, most new cases occur in the young and are clinically inapparent. Furthermore, screening families of young children for chronic carriers in an effort to identify children at high risk for hepatitis B virus infection would have a low sensitivity in the Philippine setting.     

福建省2013年急性乙型肝炎监测分析

目的分析福建省6个监测点急性乙肝报告的病例资料,评价其实际发病情况。方法对报告的急性病例进行流行病学调查,采集血清进行实验室复核。结果 2013年共报告乙肝4 086例,初始报告急性乙肝692例（16.9%）、慢性乙肝3 373例（82.7%）、未分类21例（0.5%）。经流行病学调查及抗-HBc-IgM 1∶1000检测排除,审核订正后报告急性乙肝269例（6.6%）,慢性乙肝3 796例（92.9%）,订正后急性乙肝病例占比下降;乙肝发病性别比2.1∶1。抗HBc-IgM估算的急性乙肝发病率明显低于中国疾病预防控制系统报告发病率。结论应提高医务人员对乙肝诊断标准的认识,及时利用实验室检测结果进行乙肝分类诊断,客观评价福建省乙肝发病水平。