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World J Gastroenterol. Jun 28, 2014; 20(24): 7635-7643
Published online Jun 28, 2014. doi: 10.3748/wjg.v20.i24.7635
Epidemiology of acute and chronic hepatitis B and delta over the last 5 decades in Italy
Evangelista Sagnelli, Caterina Sagnelli, Mariantonietta Pisaturo, Margherita Macera, Nicola Coppola
Evangelista Sagnelli, Mariantonietta Pisaturo, Margherita Macera, Nicola Coppola, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
Caterina Sagnelli, Department of Clinical and Experimental Medicine and Surgery "F. Magrassi e A. Lanzara", Second University of Naples, 80131 Naples, Italy
Author contributions: All authors contributed equally to this work, designed the study and wrote the manuscript.
Correspondence to: Evangelista Sagnelli, Professor, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Via: L. Armanni 5, 80131 Naples, Italy. evangelista.sagnelli@yahoo.com
Telephone: +39-81-5666719 Fax: +39-81-5666013
Received: October 25, 2013
Revised: January 28, 2014
Accepted: April 8, 2014
Published online: June 28, 2014
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.

Keywords: Acute hepatitis B, Acute hepatitis delta, Chronic viral hepatitis, Hepatitis B virus epidemiology, Hepatitis delta virus epidemiology

Core tip: Although an impressive reduction in the spread of hepatitis B virus (HBV) and hepatitis delta virus (HDV) infection has been observed over the last few decades, these infections are still a heavy burden for the Italian Health Care System. This review article analyzes these epidemiological variations in relation to the changing impact of the single risk factors for the acquisition of both infections and to the most important socio-economic events contributing to the progression to lower levels of HBV and HDV endemicity. The paper also identifies strategies for maintaining and possibly further reducing the low level of endemicity reached in recent years.