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Background Hepatitis B virus (HBV) reactivation in patients positive for antibody to HB core antigen (anti-HBc), negative for HB surface antigen (HBsAg) and HBV-DNA (potential occult HBV carriers), treated with anti-tumor necrosis factor (TNF)α, is a debated question. The aim of the study was to evaluate the safety of anti-TNFα therapy in anti-HBc positive/HBsAg negative subjects with rheumatoid arthritis (RA) and spondyloarthropathy (SpA). Methods All consecutive HBsAg negative RA and SpA outpatients referring to the Immuno-Rheumatology Institute at the S. Andrea hospital, Sapienza, University of Rome who had to undergo anti-TNFα therapy. Results Among the 169 enrolled subjects, 20 (12%) were potential occult HBV carriers (anti-HBc positive, HBsAg and HBV-DNA negative patients with or without anti-HBs). During the follow-up (mean ± SD 45 ± 22 months), aminotransferases and HBV-DNA, tested every two and six months respectively, did not change. Conclusion This study confirms the substantial safety of anti-TNFα therapy in potential occult HBV carriers RA and SpA patients.

Background The epidemiology of acute hepatitis C has changed during the past decade in Western countries. Acute HCV infection has a high rate of chronicity, but it is unclear when patients with acute infection should be treated. Methods To evaluate current sources of hepatitis C virus (HCV) transmission in Italy and to assess the rate of and factors associated with chronic infection, we enrolled 214 consecutive patients with newly acquired hepatitis C during 1999-2004. The patients were from 12 health care centers throughout the country, and they were followed up for a mean (+/- SD) period of 14+/-15.8 months. Biochemical liver tests were performed, and HCV RNA levels were monitored. Results A total of 146 patients (68%) had symptomatic disease. The most common risk factors for acquiring hepatitis C that were reported were intravenous drug use and medical procedures. The proportion of subjects with spontaneous resolution of infection was 36%. The average timespan from disease onset to HCV RNA clearance was 71 days (range, 27-173 days). In fact, 58 (80%) of 73 patients with self-limiting hepatitis experienced HCV RNA clearance within 3 months of disease onset. Multiple logistic regression analyses showed that none of the variables considered (including asymptomatic disease) were associated with increased risk of developing chronic hepatitis C. Conclusions These findings underscore the importance of medical procedures as risk factors in the current spread of HCV infection in Italy. Because nearly all patients with acute, self-limiting hepatitis C--both symptomatic and asymptomatic--have spontaneous viral clearance within 3 months of disease onset, it seems reasonable to start treatment after this time period ends to avoid costly and useless treatment.

In 1995, the intrafamilial spread of hepatitis C virus (HCV) was evaluated among 1379 household contacts of 585 HCV antibody-positive HCV RNA-positive subjects (index cases) in Italy. All index cases were patients with histologically proven chronic liver disease. The presence of antibodies to HCV (anti-HCV) was assessed by third-generation enzyme-linked immunosorbent assay (ELISA); the polymerase chain reaction (PCR) was used to test for HCV RNA. The overall anti-HCV prevalence among household contacts of index cases was 7.3% (101/1379); it was 15.6% in spouses and 3.2% in other relatives (P < 0.05; odds ratio (OR), 6.5; 95% confidence interval (CI), 3.5-8.6). Spouses married to index cases for longer than 20 years had a significantly higher anti-HCV prevalence than those married 20 years or less (19.8% vs 8.0%; P< 0.05; OR, 2.8; 95% CI, 1.5-5.3). Parenteral risk factors were more likely to be reported in anti-HCV positive than in anti-HCV negative household contacts. After adjustment for confounders by multiple logistic regression analysis, age greater than 4 5 years (OR, 3.1; 95% CI, 1.6-5.3) and any parenteral exposure (OR, 3.7; 95% CI, 1.7-8.1), were the only independent predictors of the likelihood of anti-HCV positivity among household contacts. Spouses versus other relatives and length of marriage were both no longer associated. These findings suggest that sexual transmission does not seem to play a role in the intrafamilial spread of HCV infection.

There is a lack of updated nationwide records regarding hepatitis C virus (HCV) infection among drug addicts in Italy. The prevalence and characteristics of HCV infection in a national sample of drug addicts in Italy were determined. Five hundred forty-three drug addicts (mean age 35.3 years, 85.1% males), selected from 25 Italian Centers for Substance Dependence were enrolled to be evaluated for anti-HCV, HCV-RNA, HCV genotype, HBV markers, anti-HDV, and anti-HIV during the period of April-November 2009. Anti-HCV prevalence was 63.9%. HCV-RNA was detected in 68.3% of patients positive for anti-HCV. Genotypes 1 and 3 prevailed (49.3% and 39.7%, respectively). However, 9.3% of the subjects had genotype 4, a rate over threefold higher than the one observed in 1996 among drug addicts in central Italy. Needle sharing was the strongest independent predictor of the likelihood to contract an HCV infection (OR 8.9; 95% CI: 5.0-16.0). Only 19.3% of subjects received antiviral treatment for HCV. The prevalence of HBsAg and HIV positivity was 2.8% and 3.1%, respectively. The pattern of HBV markers showed that nearly one-third of subjects had been vaccinated, while 42.3% were negative for any marker of HCV. The prevalence of HCV infection is high among drug addicts in Italy. The incidence of Genotype 4 is increasing and this may lead to the spreading of the disease to the general population in the near future. Efforts should be made to improve the rate of antiviral treatment for drug addicts with HCV infection and vaccination against hepatitis B.

Obiettivi: la trasmissione dell’HCV per via sessuale non è stata ancora confermata in modo inequivocabile. Dai dati della letteratura emerge che il tasso di infezione da HCV in partner sessuali di soggetti anti-HCV positivi varia da valori molto bassi a valori elevati (fino al 30%). Scopo dello studio è stato quello di valutare prospetticamente il rischio di acquisire l’infezione da HCV in una coorte di partner monogami di soggetti con infezione cronica da HCV.Metodi: è stata studiata una coorte di 895 partner sessuali monogami di soggetti HCV infetti afferenti al Dipartimento di Medicina Interna dell’Università di Modena. Le coppie sono state seguite prospetticamente per un periodo di 10 anni. I dati disponibili al termine del follow-up riguardavano 776 delle 895 (86.7%) coppie arruolate. Tutte le coppie hanno negato rapporti anali, sesso durante il periodo mestruale o uso di profilattico. Il tasso medio settimanale di rapporti sessuali è risultato di 1.8. Tutti i soggetti sono stati annualmente testati per anti-HCV e HCV RNA. Risultati: durante il follow-up sono state osservate 3 nuove infezioni da HCV (tasso di incidenza = 0.37 per 1000 persone-anno). Tuttavia, il genotipo di HCV presente in un coniuge (2a) era differente da quello del rispettivo partner (1b). Le rimanenti due coppie avevano genotipo concordante ma l’analisi filogenetica delle sequenze della regione NS5b del genoma di HCV ha indicato che gli isolati virali dei rispettivi partner erano differenti, escludendo quindi la possibilità di una trasmissione per via sessuale.Conclusioni: i dati del presente studio indicano che il rischio di trasmissione sessuale di HCV tra coppie eterosessuali monogame è estremamente basso o addirittura assente. Alcuna raccomandazione generale all’uso del profilattico sembra pertanto richiesta per coppie monogami con un partner HCV positivo.

Universal anti-hepatitis B vaccination of infants and of 12-year-old children became mandatory in Italy in 1991. The purpose of this study was to evaluate the persistence of anti-hepatitis B surface (HBs) antibodies several years after a primary course of vaccination. In 2010, anti-HBs titers were measured in all subjects aged between 5 and 25 years residing in a southern Italian town. Individuals with an anti-hepatitis B antibody concentration of 10 IU/ml or more were considered to be protected. Of the 671 subjects evaluated, 149 (30%) lacked protective antibodies. Fifty-three (29.4%) of the subjects had been vaccinated ≤10 years earlier and 96 (30.3%) more than 10 years earlier (P = not significant). Subjects vaccinated in infancy were more likely to lack protective anti-HBs antibodies than subjects vaccinated at 12 years of age, regardless of the years elapsed since immunization. Most subjects maintained protective antibodies for a considerable number of years after vaccination. Vaccination in adolescence results in more prolonged immunogenicity than vaccination in infancy.

SUMMARY Serum antibodies to the capsular polysaccharides A and C (PSA and PSC) of N. meningitidis in healthy adults before and after vaccination with the sole polysaccharides were analysed by isoelectric focusing (IEF). Before vaccination, 49% and 28% had naturally acquired antibodies against PSA and PSC, respectively, whereas 18 days after vaccine administration 84% and 91%, respectively, showed a detectable spectrotypic pattern. Oligoclonality appeared to be the main feature of naturally acquired and vaccine-induced antibodies for both polysaccharides. In all subjects the anti-PSA response, showing dominant bands at the same pH position, was more homogeneous than anti-PSC one. Most subjects with naturally acquired antibodies (25 out of 38 for PSA and 20 out of 22 for PSC) showed a spectrotypic pattern after vaccination, similar to that observed before vaccination (any differences were just related to band intensity), suggesting that PSA and PSC are able to recruit the same B cell clones previously primed with a T-dependent form of the antigen, i.e. the whole bacterium. However, in one-third of subjects with naturally acquired anti-PSA antibodies, the appearance of new alkaline bands after vaccination was observed. Furthermore, in subjects with absence of detectable natural antibodies, the vaccine-induced antibody response started in correspondence of alkaline pH areas, subsequently extending to neutral and acidic areas. Therefore, it may be hypothesized that alkaline antibody-secreting B cell clones are the first to be recruited. The final spectrotype in these subjects was similar to that observed in subjects with naturally acquired antibodies. This observation, together with the above reported data, allow us to conclude that natural (T-dependent pathway) and vaccine (T-independenl pathway) immunization induce the expression of the same antibody repertoire, for both meningococcal PSA and PSC.

SUMMARYA high attack rate (17·3/100 000) of meningococcal disease in army recruits in Italy, with 95% of the cases due to serogroup C, constituted the motivating factors to make bivalent serogroup A + C meningococcal vaccination compulsory by law for army recruits starting January 1987. Because the vaccine was given only to the new recruits entering the army, full coverage was not achieved until January 1988. Nearly 900 000 subjects (300 000 yearly) were vaccinated between January 1987 and December 1989. There were no reports of any untoward reactions to the vaccine. Of the 300 000 recruits in service each year, 52, 21, 15, 5 and 4 cases of the disease occurred in 1985, 1986, 1987, 1988 and 1989, respectively (P < 0·001).Of the 24 cases occurring since the start of the vaccination, only two (due to serogroup C) were attributable to vaccine failure. The remaining cases were in unvaccinated recruits (15 cases) or were due to serogroups other than A or C (7 cases). The cumulative incidence of meningococcal serogroup C in the 600 000 vaccinated recruits during the period 1988–89 was 0·2/100 000 (1 case amongst 600 000 recruits), while the corresponding figure in the 600 000 unvaccinatred recruits during the period 1985–6 was 11·3/100000 (68 cases amongst 600 000 recruits) (P < 0·001). The protective efficacy of the vaccine in 1987 was 91·2% (12 cases of meningococcal serogroup A and C disease from an average of 150 000 unvaccinated recruits observed for 1 year, and 1 case from the corresponding average of 150 000 vaccinated ones). In 1988 and in 1989 this figure could not be calculated because all recruits were vaccinated.The incidence of meningitis caused by other serogroups of meningococci remained low, both before and after the mass vaccination campaign.

Cirrhosis from any cause is present in the majority (93.1%) of hepatocellular carcinoma (HCC) cases in Italy, it seems to be the common pathway by which several risk factors extent their carcinogenic effect. The mortality rate of HCC in Italy has progressively increased during the period 1969-1994, reflecting the rising number of persons living with cirrhosis as consequence of the remarkable advances in medical management of such patients. Most HCC develops in cirrhosis caused by known and preventable risk factors (hepatitis B virus, HBV, hepatitis C virus, HCV, alcohol and possibly non-alcoholic steatohepatitis, NASH). Unlike alcohol and NASH, HBV and HCV chronic infections act as a risk factors for HCC both because they induce cirrhosis and because they increase the risk in patients with cirrhosis. Moreover, case-control and prospective studies have shown a synergistic effect on HCC risk, when both viral infections occur. Currently, HCV infection is detected in the majority (76.4%) of HCC cases in Italy, reflecting the large cohort of subjects infected with this virus via the iatrogenic route during the 1950s and 1960s. The low rate of HCV infection in the younger Italian generations may generate a downward trend in the HCC mortality rate in the years to come.

Using data from the surveillance system for type-specific acute viral hepatitis, the temporal incidence trend of non-A, non-B acute hepatitis and risk factors for acute hepatitis C have been evaluated in Italy. The association between hepatitis C and the potential risk factors (odds ratios, OR) was estimated using hepatitis A patients as controls. The independent roles of the different risk factors were estimated by multiple logistic regression analysis. The incidence of non-A, non-B acute hepatitis declined from 5 per 100 000 to 1 per 100 000 between 1985 and 1996. Anti-HCV data collected by SEIEVA since 1991 showed that 60% of patients with non-A, non-B acute hepatitis were positive for antibodies to the hepatitis C virus (anti-HCV) at the time of hospitalization. During the 6 months prior to the disease onset, the most frequently reported risk factors were multiple sexual partners, other parenteral exposure and intravenous drug use; transmission by blood transfusion declined from 20% in 1985 to 2% in 1996. On multivariate analysis, intravenous drug use (OR=35.5; 95% CI=23.1-54.4), surgical intervention (OR=4.6; 95% CI=3.3-6.5), dental treatment (OR=1.5; 95% CI=1.1-1.9) and two or more sexual partners (OR=2.2; 95% CI=1.6-3.0) were all independent predictors of hepatitis C. These findings indicate that HCV infection is decreasing in Italy. Intravenous drug use, multiple sexual partners, surgical intervention and dental therapy are the main modes of transmission.

Vertical transmission is an uncommon route of hepatitis C virus (HCV) infection. Little is known about the way of virus spread between relatives. Furthermore, the nucleotide sequence variability studies that can be used for the definition of cases of HCV transmission still need accurate standardization. In this study, we analyzed the HCV positive sera from subjects belonging to one family. Five out of seven individuals were positive both for anti-HCV and HCV-RNA. The epidemiological data, in our knowledge, excluded the possible risk of parenteral exposure to HCV for the members of the family. The genetic relatedness of the viruses infecting the members of this family was demonstrated by the phylogenetic analysis of sequences from E1 genome region. The analysis included the calculation of the genetic divergence specific index, based on the ratio of synonymous/non-synonymous mutations. By the analysis of this genome region, we demonstrated the occurrence of HCV transmission among family members. In 2 cases out of 3, Mother-to-Infant transmission was demonstrated that involved three generations of the family. Transmission by sexual route was absent. A method of sequence analysis of E1 HCV genome region is proposed as molecular approach for the definition of transmission cases of HCV.

To evaluate the efficacy of a 12-month course of recombinant interferon alpha (IFN-alpha2b), and to assess predictive factors of successful response to IFN therapy in chronic active hepatitis C (HCV CAH), 242 patients with histologically proven HCV CAH were assigned randomly to two groups, one treated with IFN-alpha2b (3 MU three times weekly, intramuscularly), the other untreated. To determine the efficacy of IFN-alpha2b 12 months after therapy, a second liver biopsy was carried out on 100 treated patients and 27 untreated patients. The biochemical, virological, and serological response of patients followed up for at least 50 months after treatment was also evaluated to confirm the efficacy of IFN-alpha2b. The genotypes of infecting HCV, anti-HCV core IgM, and HCV-RNA concentrations were also analysed and the predictors of response determined by univariate and multivariate analyses. Response was defined in terms of the normalisation of aminotransferase activities and the disappearance of HCV-RNA. The overall long-term response was 39.4%. Anti-HCV core IgM levels were significantly lower in long-term responders. Patients with increased levels of IgM anti HCV core (3.8 sample/cut-off), infected with genotype 1b were nonresponders. Liver histology improved significantly in patients with long-term response. Multivariate analysis identified three independent predictors of the likelihood of long-term response to IFN therapy: age younger than 40 years, basal anti-HCV core IgM levelsor = 3.8, and genotypes other than 1b. These data indicate that the treatment with IFN-alpha2b used in this randomised controlled trial is effective in HCV CAH. Anti-HCV core IgM was the strongest predictor of long-term response in the present study.

Prevalence of and risk factors for hepatitis B virus (HBV) infection were determined among 252 homosexual men with no history of intravenous drug use (median age 33 years, range 18-77) treated at a sexually transmitted disease (STD) clinic in Rome. The overall prevalence of antibodies to HBV core antigen (anti-HBc) was 50.8%, a rate nearly nine times as high as the 5.8% found recently in a national sample of young male adults, aged 18-26 years, and twice as high as the 22% found in heterosexuals attending the same clinic over the same period of time. Multiple logistic regression analysis showed that the risk of anti-HBc positivity was independently associated with increasing age, five or more sexual partners in the previous year, positive HIV serology and positive syphilis serology. Lower level of schooling, lack of condom use, history of non-ulcerative STD, current or past history of genital herpes, and positive anti-HCV serology were not associated with anti-HBc positivity. These findings corroborate the importance of sexual transmission of HBV in homosexual men. Behavioural factors, such as multiple sexual partners, probably enhance the efficiency of this mode of HBV transmission.

In 1990-1991, the prevalence of antibodies to hepatitis A virus infection (anti-HAV) was assayed by the ELISA method among 1528 apparently healthy subjects, 20-85 years old in the Republic of San Marino. Subjects were selected from the list of residents by a random stratified sampling procedure with a proportional allocation by age, sex and district of residence. The overall anti-HAV prevalence was 64.7%; it increased from 28.6% in subjects 20-30 years old to 97% in those60 years (p0.01). No gender difference was observed. At the multivariate analysis age40 years (OR: 39.5; 95% CI: 12.4-126) and lowest level of schooling (OR: 1.8; 95% CI: 1.1-2.9), which is a good indirect indicator of socio-economic status, resulted both independent predictors of anti-HAV seropositivity. These findings reflect the improved sanitation standards in this area and indicate that the proportion of non-immune adults is increasing with a higher risk of symptomatic infection in the near future.

This study aimed to evaluate the incidence of and risk factors for acute viral hepatitis A (HAV) in Italy.Data were from a surveillance system for type-specific acute viral hepatitis (SEIEVA). To estimate the association of hepatitis A cases with the potential risk factors (Odds Ratios) and the proportion of all hepatitis A cases attributable to a given risk factor (population attributable risk), hepatitis B cases were used as controls. Independent predictors of HAV were estimated by conditional multiple logistic regression.During the period 1985-1994, 25553 viral hepatitis cases were reported. Of these, 6408 (25%) were due to hepatitis A (HAV). HAV incidence declined from 10/100000 in 1985 to 2/100000 in 1987. Since 1991, however, an increase in HAV has been observed. The majority of cases were 15-24 years old; the incidence was higher in males and in subjects residing in southern Italy. Only one death (0.02%) was observed. Shellfish consumption was the most frequently reported risk factor (62%). The proportion of cases reporting personal contact with an icteric case, travel to a high-medium endemic areas, and family contact with a child attending a day-care centre (household of day-care child) was 17%, 19% and 15%, respectively. The results of multivariate analysis showed that shellfish consumption (OR=2.6; 95% CI=2.4-2.9), travel to endemic areas for people residing in northern and central Italy (OR=5.4; 95% CI=4.6-6.2) and household of day-care child (OR=1.2; 95% CI=1.03-1.4), were all types of exposure independently associated with HAV. The estimates of population-attributable risk show that shellfish consumption explained as many as 42.2%, travel to high-medium endemic areas for people residing in northern and central Italy 24.2%, and household of day-care child only 1.4% of all acute hepatitis A cases in Italy.These findings indicate that HAV in Italy is mainly a food-borne disease. Vaccination against hepatitis A is strongly recommended for travellers to endemic areas.

During 1994, 603 cases of bacterial meningitis were reported in Italy. Seventy-five percent of cases with determined etiology was due to three agents: Neisseria meningitidis (33.4%), Streptococcus pneumoniae (23.4%) and Haemophilus influenzae (18.6%). The majority of cases due to N. meningitidis and H. influenzae occurred in subjects below five years of age (35.7% and 84.8%, respectively) while S. pneumoniae accounted for 52.8% of meningitis cases in subjects older than 44 year of age. The estimated incidence of N. meningitidis on the national population in 1994 was 0.27 per 100,000. Serogroup B accounted for 62.5% of the serotyped isolates, group C for 23.1%, group A for 7.2%, group W135 for 3.6%, group Y for 1.8%. All tested meningococcal strains were susceptible to penicillin as well as to rifampin. Incidence of meningococcal meningitis in 1994 has been low suggesting that its relative importance compared to other bacteria causing meningitis is likely to change in the future. Therefore, extended surveillance on bacterial meningitis by other etiological agents has to be maintained and implemented in order to undertake the appropriate control measures and evaluate their effect.

In the spring of 1994, the occurrence of Hepatitis E virus antibodies was evaluated in 653 subjects representing all age-groups in the general population of a Central Italian town, where a high hepatitis C virus prevalence had been reported. The overall anti-HEV prevalence was 2.6% ranging from 1.4% in the 30-49 age-group to 5.7% (p0.01) in the 60-70 age-group; none of the subjects under 30 years of age were positive. Sociodemographic variables, such as family size and years of schooling were not associated with HEV exposure. Anti-HEV positivity was found in 1.8% (1/56) of the subjects who were positive for anti-HCV and in 2.7% (16/597) of those who were anti-HCV negative (O.R 1.5; C.I.: 95% = 0.2-11.7). Thus no association was found between HEV and HCV infections. These data suggest a past spread of HEV in this area and underline the occurrence of long-lasting antibodies in infected subjects.

In the spring of 1994, anti-HCV prevalence and associated risk factors were evaluated in 681 subjects representing all age-groups in the general population of a small central Italian town. The overall anti-HCV prevalence was 8.4%, ranging from 3.7% in the 30-39 age-group to 18.2% (p0.01) in the 60-70 age-group; no subject below 30 years of age was positive. Multiple logistic regression analysis showed that the only variables independently associated with anti-HCV positivity were awareness of unspecified liver disease (O.R. 3.58), age45 years (O.R. 2.72), and lowest number of years of schooling (O.R. 11.0) while no association was found with any parenteral exposure such as blood transfusion, intravenous drug use, major or minor surgical intervention, use of glass syringes or dental therapy. The HBsAg prevalence in this population was 1.3%, which corresponds to the rate reported in central Italy. These findings show a high level of HCV endemicity, with no evidence of parenteral exposure.

A retrospective survey on the epidemiology of H. Influenzae type b (Hib) meningitis was carried out in seven Italian hospitals. During the period 1987-1991, 95 (16.3%) Hib meningitis cases out of 581 bacterial meningitis cases were observed. The proportion of Hib meningitis was lowest in 1987 (11.3%); elevated in 1988 (17.9%); thereafter it did not change. A male preponderance was observed (Sex ratio 1.6). The age distribution showed that 93.7% of cases occurred in subjects5 years, 53.7% of cases in those1 year. Although Hib meningitis accounts for a small proportion of all bacterial meningitis, it is also a major problem in Italy in early childhood, because nearly all cases occur in children5 years.

The hospitalization rate and the mean days of hospitalization of notified viral hepatitis cases in Italy were estimated by a specific surveillance system for acute viral hepatitis over the period 1987-1992. The hospitalization rate was very high, ranging from 88.8% for hepatitis A to 90.9% for non-A, non-B hepatitis. No changes were observed over time. For each type of hepatitis the highest figure was observed in the 15-24 year age group. The mean days of hospitalization of hepatitis B (24.2) and non-A, non-B (20.5) hepatitis was significantly higher (p0.05) than that of hepatitis A (16.5). The highest mean days of hospitalization of hepatitis A and B occurred in the 0-14 year age group, while for non-A, non-B hepatitis it was observed in subjects over 24 years of age. These findings indicate a nearly similar rate of hospitalization of all types of hepatitis. Hepatitis B and non-A, non-B hepatitis show a more prolonged course than hepatitis A.

The incidence of hepatitis Delta virus in the general Italian population was estimated by a specific surveillance system for acute viral hepatitis over the period 1987-1992. The hepatitis Delta virus incidence rate declined from 3.1/1,000,000 inhabitants in 1987 to 1.2/1,000,000 in 1992. Males predominated (83.8% of cases); the sex ratio was 5.2. Only 2.5% of cases occurred in subjects younger than 15 years. There were 119 (49.4%) coinfections of Delta and B hepatitis and 122 (50.6%) Delta superinfections in chronic HBsAg carriers. Jaundice was present in 83.6% of cases. The hospitalization rate was 97.5%; median stay in hospital was 25 days (range 1-98 days). The results of multivariate analysis showed that a history of intravenous drug abuse (odds ratio 34.9; confidence interval 95% = 16.8-72.5), household contact with an HBsAg+ carrier (odds ratio 10.7; confidence interval 95% = 4.36-23.30) and a history of two or more sexual partners within the previous 6 months (odds ratio 2.44; confidence interval 95% = 1.34-4.43) were independent risk factors associated with Delta hepatitis. No association was found with the other risk factors considered, such as blood transfusion, surgical intervention, hospitalization, other percutaneous exposures, dental therapy, contact with an icteric case, and household contact with an i.v. drug abuser. These findings indicate that, in Italy, Delta hepatitis currently has a minor impact. In addition to intravenous drug abuse and household contact with an HBsAg+ carrier, heterosexual activity appears to be an efficient route of HDV transmission.

Using the second generation ELISA test, we studied the prevalence of antibodies against hepatitis C virus (anti-HCV) among 159 household contacts of 86 anti-HCV positive subjects (index cases). Fourteen (8.8%) relatives were found anti-HCV positive, a rate higher than the corresponding figure reported among the general population in the same area. The prevalence of anti-HCV was significantly higher among sexual partners than among household contacts without sexual relations with the index case (18% vs. 3.1%; P0.01). These findings indicate that sexual transmission may be the main route for intrafamily HCV spread.

In 1989, the prevalence of antibody to cytomegalovirus (CMV) was determined by the ELISA method in serum samples from 198 apparently healthy children 4-14 years old in Kumba City (Cameroon). Children were randomly recruited from six primary schools located in different districts of the city. The overall prevalence was 94.0%, increasing from 88.5% in 4-6 years old to 98% in subjects 11-14 years old. A slight male predominance was observed (96.2% versus 92.4%), which was not statistically significant. Family size and father's occupation were not associated with anti-CMV prevalence. These findings demonstrate a virtually total exposure to CMV infection by late childhood in Cameroon. However, the undesirable consequences of congenitally acquired CMV infection are rare, because nearly 100% of the women are seropositive by the time they reach childbearing age.

Reactivation of hepatitis B virus (HBV) infection in subjects receiving cytotoxic treatment for non-Hodgkin's lymphoma (NHL) is well documented. This report describes the case of a 69-year-old male chronic HBV carrier who developed severe flare-up of hepatitis B following chemotherapy for large B-cell NHL. Prior to chemotherapy, the patient had normal liver function tests and was negative for HBV DNA by polymerase chain reaction (PCR) assay. HBV reactivation consisted of a rise in hepatic transaminases (peak alanine aminotransferase=1178 IU/ml), hyperbilirubinemia (7.1 mg/dl), and high levels of serum HBV DNA (63.6 x 10(6) copies/ml). A liver biopsy revealed highly active hepatitis and confluent necroses. Lamivudine treatment (100 mg daily) resulted in rapid loss of hepatitis B virus DNA, resolution of hepatitis, and clinical recovery. The patient is still in remission for NHL. Lamivudine is effective in the control of HBV reactivation following chemotherapy.

The epidemiology of HDV infection in Italy was assessed in a retrospective study involving 1556 HBsAg chronic carriers on their first presentation at one of the 35 Liver Units in 1987. Total anti-HD was detected in 23.4% of HBsAg carriers and was significantly more frequent in southern than in northern Italy (26.6% vs. 19.1%, p less than 0.01). Age distribution showed that 73% of the anti-HD-positive subjects, but only 56% of the anti-HD-negative subjects, were under 40 years of age (p less than 0.01). Anti-HD prevalence increased with the severity of the liver disease from 3.8% in healthy carriers to 42.5% in cirrhosis. No geographical statistical difference was found among HBsAg healthy carriers or subjects with chronic persistent hepatitis (CPH), while among patients with chronic active hepatitis (CAH) or cirrhosis anti-HD prevalence was much higher in the south (p less than 0.01). The various potential risk factors were evaluated by multiple logistic regression analysis. HDV infection was independently related to young age, residence in the south, i.v. drug abuse, a large family and household contact with an anti-HD-positive carrier. No association was found with blood transfusion or male homosexuality. These findings confirm that HDV infection is endemic in Italy, particularly in some southern areas, where intrafamily contact probably at a young age may favour the spread of the infection.

Hepatitis C Virus (HCV) is the principal agent of non-A, non-B hepatitis and its spread in the community is not well defined. We evaluated the prevalence of anti-HCV (ortho ELISA System) in 696 children (4-14 years) in Kumba, Cameroon. Children were selected by systematic random sampling in six primary schools. A seroprevalence of 14.5% (101 children) was found which increased steadily with age. No significant differences were observed with respect to sex or to family size. There was a highly significant association both with parents' social class, the lowest class presenting a 2.2-fold risk factor, and with area of residence, suburban children showing a significantly higher prevalence (P less than 0.01). These results suggest that Cameroon is endemic for HCV infection, that children are infected at an early age and that infection increases with age. We can therefore hypothesize that transmission of HCV infection in this population is from child to child. Furthermore, the infection seems to be influenced by social factors but not by demographic ones.The seroprevalence of anti-hepatitis C virus antibodies in a randomly selected group of 696 urban and suburban children from Kumba City, South West Province, Cameroon, was estimated with ELISA kits (Ortho Diagnostic Systems). The children, aged 4-14 years, were selected from 6 primary schools. Sera were frozen and shipped in a thermocooled container within 15 hours to Rome for analysis at the laboratory of Virology, National Institute of Health. The overall seroprevalence was 14.5%, increasing from 6.6% in children aged 4-6, to 17.5% in those aged 11 (p0.001). There was no difference between sexes or among those with different family sizes. Those among lower classes, based on parents' occupation, had a 2.2-fold greater risk for positive anti-HCV antibodies. Children of single parents were not at increased risk. Suburban children had higher seroprevalence, 21.0%, compared to urban children, 11.5%. Since hepatitis C is transmitted parenterally, and ritual scarification and tattooing now are rare, it was hypothesized that transmission may have occurred from contact sports or play, or by an insect vector.

Meningococcal disease in Italy decreased by 13.4% from 1988 to 1989. The incidence rate was 0.5/100,000 in the general population and 1.3/100,000 in army recruits. The highest proportion of cases (27%) was seen in subjects 5-14 years old. The sex ratio was 1.3. Forty-four percent of the isolates belonged to serogroup B; 37% belonged to group C. Forty-six percent of the strains were resistant to sulphonamides and 10% were resistant to minocycline; only 4% were resistant to rifampicin. None of the four military cases observed could be attributed to vaccine failure. One secondary case and no coprimary cases were observed among civilians. The shift in prevalence from serogroup C to serogroup B isolates is the most important finding of this study.

The incidence of meningococcal disease in Italy in 1990 was 0.5/100,000 in the general population and 0.7/100,000 in army recruits. The highest proportion of cases (32%) was seen in subjects 1-4 years old. The sex ratio was 1.0 Serogroup B constituted 72% of the isolates; 16% belonged to group A and 12% belonged to group C. The proportion of strains resistant to suphonamides was 56%, while no strain was resistant to minocycline or rifampicin. Two secondary cases, but no comprimary cases occurred among civilians. The predominance of serogroup B and the further decline in military cases constitute the findings of major interest.

Using figures from the official death registry, we studied the descriptive epidemiology of primary liver cancer (PLC) in Italy from 1969 to 1985. The annual age-standardized mortality rate rose from 3.7/100,000 in 1969 to 4.7/100,000 in 1985, reaching the peak of 6.5/100,000 in 1983. The male/female ratio increased from 1.2:1 in 1969 to 2:1 in 1985. The age-specific mortality rate was very low in subjects under 55 years of age and peaked in subjects in their seventies and eighties. The rate was higher for men in all age-groups. The highest proportion of deaths (32%) was observed in the 65-74 year age group. The median age of death for patients with PLC was 10 years older than the median age for patients who died of alcoholic liver cirrhosis, but similar to that of patients who died of liver cirrhosis due to other causes. The highest regional age-standardized mortality rate was reported in Lombardia, Lazio and Veneto respectively, where hepatitis B virus (HBV) infection is less endemic than in the southern regions and the Islands. It should be kept in mind that these findings are not extremely accurate because they are based on mortality figures, where the contamination with metastatic cases is practically unavoidable; furthermore, their validity and comparability are not first-rate due to the wide variation in diagnostic accuracy and registration completeness.(ABSTRACT TRUNCATED AT 250 WORDS)

In January 1989, the prevalence of antibodies to hepatitis A virus (anti-HAV) was determined by ELISA in 702 apparently healthy children 5-14 years old in Kumba City, Cameroon. Children were recruited from those attending six different primary schools, representative of the socio-demographic characteristics of the inhabitants, using a systematic random sampling. The overall IgG anti-HAV prevalence was 96.9%, reaching 100% by the age of 11 years. In primary school beginners the prevalence was very high, 94.0%, contrary to what has been observed in developed countries. The anti-HAV prevalence was not associated with family size, but was related to parent's occupation, children from the lower class having a 5.9 fold risk (C.I. = 1.9-18.3) of past exposure to HAV. These results suggest a persistently high prevalence of anti-HAV in children despite improving hygienic conditions. The spread of HAV in this population may be the result of domestic water and/or food contamination.

Hepatitis B infection was endemic in Italy and household transmission has been considered to be the main mode of HBV spread. Prevalence of HBsAg positive subjects was therefore higher in children than in adults. Serum samples from 500 children (aged 6-15 year) without overt liver disease were tested for HBV serum markers in 1979. Serological evidence of HBV infection was present in 16% of the subjects. To verify a possible decline of HBV infection we designed a seroepidemiological study in school children from the same town. Three classes of age (6 yrs, 10 yrs, 14 yrs) were selected. Children were recruited from those attending primary and secondary schools using a systematic cluster sampling. After parents' informed consent sera were collected in May 1989. All were tested for anti-HBc: anti-HBc + ve sera were then tested for HBsAg and anti-HBs (EIA Abbott Lab., Chicago, Ill. USA). Of the 1635 children one was HBsAg positive and 21 were positive for any HBV marker. Both the prevalence of HBsAg and that of any HBV marker were significantly lower (p less than 0.001) in 1989 when compared to the corresponding age-class of 1979.

A comparative seroepidemiological study (1979 vs 1989) on HAV infection, was carried out in children and adolescents from North-East Italy. Anti-HAV was tested in 850 subjects 6 to 8 years of age and the results were compared to those observed in 1979, in 462 subjects of the same age range and from the same geographical area. Overall anti-HAV prevalence was 1.9% (ranging from 0.5 to 5.2) in 1989 vs 32.5% (ranging from 7.8 to 70.7) in 1979. This dramatic decline of HAV infection in children and adolescents reflects the improved sanitation standard of our country but, on the other hand, indicates that the number of non-immune adults is increasing, with a higher risk of symptomatic infection in the near future.

Between 1987 and 1989, the prevalence of antibodies to Toxoplasma gondii was determined by ELISA in serum samples from 1,494 apparently healthy subjects, 3-18 years old. Subjects were selected by a systematic cluster sampling from five geographical areas in Italy. The overall prevalence of antibodies was 17.9%, increasing from 4.7% in 4-6 year olds to 28.4% in 17-18 year olds (P less than 0.01). A slight predominance was observed among males (18.2% vs. 17.5% in females), as well as among subjects residing in Southern Italy and the Islands (21.9% vs. 19.2% in subjects residing in the North), but neither difference was statistically significant. Toxoplasma infection was associated with sociodemographic factors. Subjects belonging to a household with six or more persons had a 1.8-fold risk (C.I. 95% = 1.3-2.6) and subjects whose fathers had less than six years of schooling had a 2.7-fold rosk (C.I. 95% = 1.8-3.9) of previous exposure to toxoplasma infection. Considering the large proportion (70%) of young women entering childbearing age without toxoplasma antibodies, it appears that the risk of congenital toxoplasmosis will not be negligible in Italy in forthcoming years.

We studied the interaction between HBV and HDV infection in 149 consecutive subjects with HBsAg positive chronic hepatitis and in 22 chronic HBsAg healthy carriers. Liver HBcAg was detected in 52 (30.4%) of the 171 subjects. Of these 52, 35 were HBV-DNA and HBeAg positive, 11 HBV-DNA positive only; two HBeAg positive only and four were negative for both HBeAg and HBV-DNA. None of the 119 HBcAg-negative subjects had detectable HBV-DNA in serum. HD-Ag in hepatocytes was detected in 31 of the 171 subjects (18%); it was detectable in none of the 22 HBsAg healthy carriers, in four of the 56 patients with chronic persistent hepatitis (7.2%), in six of the 24 patients with chronic lobular hepatitis (25%), in 16 of the 40 patients with chronic active hepatitis (40%) and in five of the 29 with cirrhosis (17%). A presence of anti-HD in serum in the absence of liver HD-Ag was found in 54 of the 171 subjects (32%). This condition was observed not only in patients with a progressive disease (37.7% of chronic active hepatitis or cirrhosis and 33% of chronic lobular hepatitis), but also in healthy carriers (36%) and in chronic persistent hepatitis patients (21.4%). Liver HBcAg was detected in 6.4% of the 31 HD-Ag-positive patients, in 12.9% of the 54 HD-Ag-negative/anti-HD positive, but in 50% of the 86 with no marker of HDV infection. HDV appears to inhibit HBV genome and such inhibition may persist even when anti-HD is the only HDV marker detectable.

In this study we evaluated, by a standard bactericidal assay, the antibody response to the meningococcal group A and C polysaccharide vaccine used for the immunization programme of the Italian military recruits, compulsory by law since 1987. The percentage of responders, those who developed a four-fold increase in the bactericidal titre to polysaccharide A and C, was 96% and 98%, respectively. No significant side effects were observed after vaccination.

In 1989, the prevalence of antibodies to hepatitis A virus (anti-HAV) in a sample of 1350 Sardinian teenagers aged 14 to 19 years was estimated by Elisa method. The overall anti-HAV prevalence was 20%; it increased from 12.3% among 14-16 year old subjects to 27.4% in subjects aged 17-19 years (P less than 0.01). A slight female preponderance was observed (22.1% versus 17.9) but no statistically significant difference was attained. Compared with the corresponding figure (71.6% of prevalence rate) observed in North Sardinia in 1980, the results of the present study show a dramatic reduction in anti-HAV prevalence among teenagers. A significant association was found with sociodemographic factors: subjects whose fathers had less than six years of schooling, had a 2.1-fold risk (C.I. 95% = 1.5-3.1) and subjects belonging to a household of 6 or more under one roof had a 1.7-fold risk (C.I. 95% = 1.2-2.3) of previous exposure to hepatitis A virus (HAV) infection. These findings indicate that exposure to HAV in Sardinia is decreasing, probably because of improvements in socio-economic conditions during recent years. However, overcrowding and short paternal education appear to be important determinants of infection.

In 1989, the prevalence of hepatitis B virus (HBV) markers was studied using Elisa method in a sample of 1357 healthy high school 14-19 year old teenagers in Sardinia. The overall prevalence of any HBV marker was 4.7%, increasing from 3.6% among 14-16 year old teenagers to 5.7% in 17-19 year olds. The overall prevalence of hepatitis B surface antigen (HBsAg) was 1.1%, similar in both age groups. A slight male preponderance was observed (5% versus 4.4% for any HBV marker and 1.7% versus 0.6% for HBsAg, respectively). The prevalence of any HBV marker was not associated with the family size (O.R. 1.5; CI 95% = 0.6-4.5), but it was inversely related to the number of years of education received by the father. Teenagers whose fathers had received less than six years of schooling had a 2.3 fold risk (CI 95% = 1.1-5.2) of previous exposure to HBV infection. Comparing these findings with recent results in children and adults in the same area, a cohort effect is likely evident.