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Byline: R. Giacchino (1), L. Zancan (2), P. Vajro (3), G. Verucchi (4), M. Resti (5), C. Barbera (6), A. Maccabruni (7), M. Marcellini (8), F. Balli (9), A. Cascio (10), G. Nebbia (11), C. Crivellaro (12), F. Bortolotti (13), M.G. Clemente (14), P. Bragetti (15), P. Valentini (16), N. Mazzoni (17), G. Losurdo (1), E. Cristina (1) Keywords: Key Words Hepatitis B virus hepatitis; Adopted children; Immigrant; HBV vaccination Abstract: Background: Compulsory vaccination of children against hepatitis B virus (HBV) infection was introduced in Italy in 1991. Patients and Methods: To evaluate the current importance of pediatric HBV infection, we studied 359 HBsAg-positive children admitted to 16 centers in Italy from 1991 to 1998. 185 patients were natives of Italy and 174 (39 immigrants and 135 adopted) came from highly endemic countries (eastern Europe: 60.9%, Asia: 16.7%, Africa: 14.9% and Central and South America: 5.7%). Results: Transaminase levels were moderately altered in both Italian (mean 134 UI/l) and foreign children (mean 168 UI/l). In total, 77% of Italian children and 88% of foreign children tested HBeAg postive. High transaminase levels and HBeAg positivity were more frequent in adopted children. Follow-up of 317 patients showed that the incidence of HBeAg/anti-HBe serum conversion was similar in all cohorts, but in adopted children it occurred at an earlier age and was associated with HBsAg clearance in 5%. Conclusion: HBV is not frequent in Italian children today, but it is common among children comming from highly endemic areas. The vaccination of nonimmune native populations must be strongly recommended. Author Affiliation: (1) Infectious Diseases Unit, 'Giannini Gaslini' Children's Hospital, Largo G. Gaslini 5, I-16147 Genova, Italy Phone (+39/010) 5636220, Fax: -3776590 e-mail: raffaellagiacchino@ospedale-gaslini.ge.it, IT (2) Clinic of Pediatrics, Padova, Italy, IT (3) Dept of Pediatrics, Napoli, Italy, IT (4) Institute of Infectious Diseases Bologna, Italy, IT (5) Dept of Pediatrics, Firenze, Italy, IT (6) Dept of Pediatric Sciences, Torino, Italy, IT (7) Clinic of Infectious Diseases, Pavia, Italy, IT (8) Hepatology, Bambin Gesu, Rome, Italy, IT (9) Clinic of Pediatrics, Modena, Italy, IT (10) Infectious Pathology and Virology, Palermo, Italy, IT (11) Clinic of Pediatrics, Milano, Italy, IT (12) O. Monselice, Padova, Italy, IT (13) Dept. of Clinical Experimental Medicine, Padova, Italy, IT (14) Clinic of Development Age, Cagliari, Italy, IT (15) Clinic of Pediatrics, Perugia, Italy, IT (16) Clinic of Pediatrics, Cattolica University, Roma, Italy, IT (17) Clinic of Pediatrics, Ancona, Italy, IT Article note: Received: September 20, 2000 * Revision accepted: March 26, 2001

Copyright of Infection is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Infection is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

During a survey of acute symptomatic viral hepatitis conducted in Padua over the last 16 years, 404 (20%) cases of non-A, non-B hepatitis were observed, including 55% with overt parenteral exposure (35% drug abusers) and 45% with unknown exposure. Between 1978 and 1982 the attack rate of the disease increased significantly (p < 0.01) in males, (from 3.8 to 17.3/10(5) inhabitants), in adolescents and in youths. The prevalence of drug abusers rose up to 58% in 1982 suggesting the occurrence of an outbreak in this risk group. In subsequent years the attack rate returned to initial levels in males, although drug abuse still remains the single most important route of infection, and declined in females, especially after the disappearance of post-transfusion hepatitis since 1991. Retrospective anti-HCV testing of patients seen up to 1990 and prospective investigation of patients hospitalized later have shown an antibody prevalence of 88% among parenterally transmitted cases, and of 29% in the other patients, without significant differences between the prospective and the retrospective study. These findings suggest that an outbreak of hepatitis C occurred in our area in the early eighties and that drug abuse is still the most important mode of transmission of acute hepatitis C.

During a seven-year survey of acute symptomatic viral hepatitis in Padua (Northern Italy), the epidemiological features of hepatitis A were evaluated in 207 consecutive patients (120 males, mean age 22.7 +/- 11.4 years). The annual attack rate of the disease decreased significantly (p less than 0.05) between 1978 and 1979 (0.11/1000 inhabitants) and 1981 and 1984 (0.04-0.03/1000 inhabitants), mainly due to its declining prevalence in the pediatric age. In parallel with the shifting of hepatitis A towards adulthood, single sources of infection, mainly associated with adult life-style such as foreign travel and raw shellfish ingestion, have become more and more prominent. The spread of drug abuse has not influenced the epidemiology of hepatitis A in our area.

During a prospective study of acute symptomatic viral hepatitis, started in 1978, 664 consecutive adult patients, including 223 drug abusers, fulfilled the diagnostic criteria (anti-HBc IgM positivity) for acute type B hepatitis. In order to evaluate the outcome of the disease, 443 patients were followed for up to 12 months after the onset. 2.4% of the infections became chronic; the rate did not significantly differ between drug addicts and non-drug abusers, suggesting that chronic hepatitis is a rare complication of acute symptomatic hepatitis type B. Ongoing liver damage after clearance of HBsAg from serum was observed in drug abusers only (14% of the cases). Clinical, biochemical and virological features of the acute phase in patients with ongoing infection were compared with those of uncomplicated cases. Anicteric hepatitis and lower transaminase values were significantly (p less than 0.05) associated to a chronic evolution of the disease, as well as a higher prevalence of HBV-DNA, DNA polymerase and HBcAg positivity in serum. Testing HBV-DNA and DNA polymerase early in the course of the infection appeared to be of high predictive value for the subsequent outcome of the illness.