Impact of universal vaccination programmes on the epidemiology of hepatitis B: 10 years of experience in Italy

January 11, 2003

Vaccine, Vol. 21 (7-8) (2003) pp. 685-691

PII: S0264-410X(02)00580-7

Impact of universal vaccination programmes on the epidemiology of hepatitis

B: 10 years of experience in Italy

Paolo Bonanni a * bonanni@... , Giovanna Pesavento a,

Bechini a, Emilia Tiscione a, Francesco Mannelli b, Cristiana Benucci b and

Antonella Lo Nostro a

a Public Health Department, University of Florence, Viale G.B. Morgagni 48,

50134 Florence, Italy

b Pediatric Hospital A. Meyer, Florence, Italy

Abstract

Ten years have elapsed since routine vaccination of infants and of

12-year-old adolescent was implemented in Italy.

In this period, evidence has accumulated on the epidemiological impact of

universal immunisation.

Coverage is on average >90% and is 95% in many areas of the country.

Incidence of acute hepatitis B, that was already declining before 1991, was

further decreased by routine vaccination programmes.

This is particularly evident in adolescents and young adults (cohorts

involved by mandatory vaccination), while incidence shows little changes in

older subjects according to data of the last years. Prevalence of hepatitis

B virus (HBV) markers detected by sero-epidemiological studies on anonymous

sera confirms both the very high coverage with hepatitis B vaccination and

the virtual absence of chronic HBsAg carriers in cohorts involved by routine

vaccination programmes. The system of passive surveillance on adverse events

following hepatitis B vaccination supports the excellent safety record of

hepatitis B vaccines.

In a hyperendemic area of Southern Italy, where a pilot programme was

firstly implemented, it was also possible to document the decline of the

involvement of hepatitis B in chronic liver pathologies (from 48% in 1982 to

18% in 1997).

If coverage rates are maintained at the present levels, elimination of HBV

transmission in Italy may be envisaged in few decades.

Keywords: Hepatitis B; Vaccination programmes; Epidemiology

*Corresponding author. Tel.: +39-55-3262437; fax: +39-55-3262436.

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January 11, 2003