From hepatitis B to hepatitis A and B prevention: the Puglia (Italy) experience

Abstract

The incidence of hepatitis B virus infection in Italy is 10 per 100,000 population, with most cases occurring in young adults. Vaccination against hepatitis B has been compulsory since 1991 for all newborns and 12-year-olds. In the Puglia region, this programme has reduced the incidence of hepatitis B from 7.4 per 100,000 population in 1990 to 2.4 per 100,000 population in 1996. The number of notified cases of hepatitis B in Puglia decreased from 212 in 1992 to 73 in 1997. As 50% of these cases occurred in young adults, the main aim of the current vaccination programme is to achieve high coverage rates among teenagers and young adults within the next few years. Although the incidence of hepatitis A is only about 5 per 100,000 overall in Italy, Puglia is an area of intermediate endemicity with a seroprevalence of antibodies to hepatitis A virus (anti-HAV) of about 40% in 18-year-olds. The incidence of hepatits A is up to 30 per 100,000 between the periodic outbreaks that occur every 2–4 years. Most notified cases occur in adolescents and young adults. The last outbreak of about 11,000 cases of hepatitis A in the Puglia region occurred in 1996–1997, mainly in the summer months in towns with harbours or near the coast. The most important risk factor was initially consumption of raw seafood, but later was personal contact, probably between children. A vaccination programme against hepatitis A was initiated in Puglia in 1997, aiming to vaccinate all infants of 15–18 months and all 12-year-olds against hepatitis A. Infants receive monovalent hepatitis A vaccine with the first dose of mumps/measles/rubella vaccine. Monovalent hepatitis vaccine can be given with the second and third doses of hepatitis B vaccine in 12-year-olds, but use of combined hepatitis A and B vaccine is recommended to aid compliance and reduce the commitment of physician/nurse time. Vaccination can be performed in school.