In 1991, a mass immunization campaign against the hepatitis B virus (HBV) for children and teenagers was introduced in Italy. This study evaluated the impact of the immunization campaign on the ...incidence and modes of HBV transmission.
Acute HBV cases of viral hepatitis were reported to the National Surveillance System (SEIEVA). Hepatitis A cases reported to the same system were used as controls to calculate the adjusted odds ratios and the population attributable risk for potential risk factors.
The incidence of acute HBV declined from 5.0 in 1990 to 0.4 in 2019 per 100,000 population. The fall was almost total in people targeted by the campaign: in 2019, zero cases (100% reduction) in the age-group 0-14 years and 0.1 cases per 100,000 population (99.4% reduction) in the age-group 15-24 years were reported. In the decade 2010-2019, nearly one-fifth (19.3%) of cases occurred in foreigners. Intravenous drug use is no longer a risk factor (OR = 0.7; 95% CI = 0.5-1.02). Beauty treatments, risky sexual exposure, and household contact with an HBsAg carrier were found to be independent predictors of acute hepatitis B.
The HB vaccination campaign proved effective in minimising acute HBV in Italy. Control of the infection is close to being reached for the first time in Europe.
Surgical interventions and invasive diagnostic/therapeutic procedures are known routes of transmission of viral hepatitis. Using data from the Italian surveillance system for acute viral hepatitis ...(SEIEVA), the aim of this study was to investigate the association between specific types of invasive procedures and the risk of acute HBV and HCV infections.
Data from SEIEVA (period 2000-2021) were used. The association between acute HBV and HCV infection and potential risk factors, i.e. surgical interventions and diagnostic/therapeutic procedures (given according to the ICD-9-CM classification), was investigated in comparison to age-matched hepatitis A cases, used as controls, by conditional multiple logistic regression analysis.
A total of 8,176 cases with acute HBV, 2,179 with acute HCV, and the respective age-matched controls with acute HAV infection were selected for the main analysis. Most of the procedures evaluated were associated with the risk of acquiring HBV or HCV. The strongest associations for HBV infection were: gynaecological surgery (odds ratio OR 5.19; 95% CI 1.12-24.05), otorhinolaryngological surgery (OR 3.78; 95% CI 1.76-8.09), and cardiac/thoracic surgery (OR 3.52; 95% CI 1.34-9.23); while for HCV infection, they were: neurosurgery (OR 11.88; 95% CI 2.40-58.85), otorhinolaryngological surgery (OR 11.54; 95% CI 2.55-52.24), and vascular surgery (OR 9.52; 95% CI 3.25-27.87). Hepatitis C was also strongly associated with ophthalmological surgery (OR 8.32; 95% CI 2.24-30.92). Biopsy and/or endoscopic procedures were significantly associated with both HCV (OR 3.84; 95% CI 2.47-5.95) and, to a lesser extent, HBV infection (OR 1.48; 95% CI 1.16-1.90).
Despite the progress made in recent years, invasive procedures still represent a significant risk factor for acquiring parenterally transmitted hepatitis viruses, thus explaining the still numerous and unexpected cases diagnosed among the elderly population in Italy. Our results underline the importance of observing universal precautions to control the iatrogenic transmission of hepatitis viruses.
Cases of parenterally transmitted acute viral hepatitis in the elderly population, that are difficult to explain based on the most widely recognised risk factors, continue to be diagnosed in Italy. Based on the Italian SEIEVA surveillance of acute viral hepatitis data, this study highlights an increased risk of acquiring hepatitis B and C following exposure to invasive procedures, which might explain the observed cases in elderly individuals. Furthermore, this finding emphasises the need to observe universal precautions strictly, in healthcare settings, including in the case of minor surgical procedures.
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•An increased risk of acquiring hepatitis B and C following exposure to invasive procedures was observed.•Compared with hepatitis A (controls), the risk was two times higher for HBV and over five times higher for HCV.•Most of the procedures (surgical specialties) evaluated were associated with the risk of acquiring HBV or HCV.•Minor surgeries, biopsy and endoscopy showed the greater association with both HCV and HBV infection.•Complying with universal precautions in healthcare settings is crucial.
BACKGROUND
Very little information is presently available regarding risk factors for essential thrombocythemia (ET).
METHODS
A case–control study was performed to study the possible association ...between ET and selected behavioral, occupational, and environmental exposures.
RESULTS
Thirty‐nine patients aged 20 years or older and 156 controls were enrolled in 2 Italian Hematology Departments located in Rome and Pavia. Controls were recruited among outpatients seen in the same hospitals and matched 4:1 to the patients after stratification by age and sex. Odds ratio (OR) estimates suggest an association between ET and hair dye use (in particular the use of dark hair dye for periods longer than 10 years: OR = 5.3; 95% confidence interval CI, 1.4–19.9), living in houses built with tuff (a material with a high concentration of gamma‐emitting radionuclides and radon) for longer than 9 years (OR = 5.1; 95% CI, 1.2–22.1), and selected occupations (electrical worker and shoemaker, OR +∞ and 2.7; 95% CI, 0.5–16 respectively).
CONCLUSIONS
Behavioral exposures such as hair dyes, living in a tuff house, and working as an electrician are significantly associated with ET development. The data are consistent with those observed in acute leukemias. Cancer 1996;77:2157‐61.
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