The evolving incidence of hepatitis C virus infection in Italy.
Article: Changing epidemiology of HCV and HBV infections in Northern Italy: a survey in the general population.[show abstract] [hide abstract]
ABSTRACT: To evaluate the hepatitis B virus (HBV) and the hepatitis C virus (HCV) epidemiology in the general population of Northern Italy, a cohort of 965 subjects, all residents (including 47 immigrants), were anonymously tested for HBV and HCV infections. Serum samples were assayed for anti-HCV and anti-HBV markers by enzyme-linked immunosorbent assay and for HCV-RNA by polymerase chain reaction, and the positive cases were genotyped. HBsAg-positive cases were assayed for HBeAg/anti-HBe, whereas HBsAg negatives were tested for both anti-HBc and anti-HBs. The overall prevalence of anti-HCV was 2.6%, with a bimodal distribution characterized by the highest prevalence (12%) in subjects over 75 years old. None of the subjects under 25 years old was anti-HCV positive. Anti-HCV positivity was similar in males and females (2.4% vs. 2.7%). HCV-RNA was positive in 40% of cases and genotype 1 was the most common. The HBsAg prevalence was 1%, with a significant difference according to country of origin (0.8% in Italian subjects vs. 6.4% in immigrants, P=0.01). HBsAg positivity increased significantly with age (R2=0.57, P<0.02). The overall percentages for the prevalence of isolated anti-HBs, anti-HBs+/anti-HBc+, and isolated anti-HBc were 23.8%, 8.4%, and 4.2%, respectively. Our study provides a new picture of HCV and HBV epidemiology in Northern Italy, with these features: (1) a cohort effect showing a reduction of HCV infection in the elderly, possible due to age-related mortality; (2) an unchanged overall prevalence of HBV infection, despite continuing immigration of subjects from endemic countries.Journal of Clinical Gastroenterology 04/2008; 42(5):527-32. · 3.16 Impact Factor
Article: Practice guidelines for the diagnosis and management of nonalcoholic fatty liver disease. A decalogue from the Italian Association for the Study of the Liver (AISF) Expert Committee[show abstract] [hide abstract]
ABSTRACT: CI: Copyright (c) 2010; JID: 100958385; 2010/01/27 [received]; 2010/01/28 [accepted]; 2010/02/19 [aheadofprint]; ppublishDigestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 42(4):272-282.
Article: Epidemiological impact of mandatory vaccination against hepatitis B in Italian young adults.[show abstract] [hide abstract]
ABSTRACT: Viral hepatitis caused by hepatitis B virus (HBV) is a leading cause of acute and chronic liver diseases worldwide. In Italy, a mandatory vaccination policy was introduced in 1991 and was established for all newborns and 12-year-old individuals. In 2004, vaccination of 12-year old adolescents was discontinued, and that of infants was maintained. We evaluated the seroprevalence of HBV markers in 806 individuals, who were vaccinated at birth or at 12 years of age, to assess the effectiveness of the national policy against HBV. The overall prevalence of anti-HBs antibodies was 90.32% (95% confidence interval [CI]: 88.28-92.36%); 2.23% (95% CI: 1.21-3.25%) of the subjects were positive for both antibodies to HBsAg (anti-HBs) and antibodies to hepatitis B core antigen (anti-HBc), whereas 5.83% (95% CI 4.21-7.45) of the subjects were negative for all markers tested. Further, 1.61% (95% CI: 0.74-2.48%) of the subjects were positive for hepatitis B surface antigen (HBsAg). Our data provide additional evidence that HBV vaccination can confer long-term immunity when performed at birth and when performed for healthy adolescents; moreover, the results show the effectiveness of the application of a national vaccination strategy.Hepatitis Monthly 09/2011; 11(9):750-2. · 2.19 Impact Factor
The Evolving Incidence of Hepatitis C Virus Infection in Italy
Rinaldo Pellicano 1*, Sharmila Fagoonee 2
1 Department of Gastroenterology and Hepatology, Molinette Hospital, Turin, Italy
2 Molecular Biotechnology Center, University of Turin, Turin, Italy
A R T I C L E I N F O
Received: 24 Dec 2012
Revised: 01 Jan2012
Accepted: 12 Jan 2012
Letter to Editor
Please cite this paper as:
Pellicano R, Fagoonee S. The Evolving Incidence of Hepatitis C
Virus Infection in Italy. Hepat Mon. 2012;12(2):124-5. DOI: 10.5812/
Copyright c 2012 Kowsar M. P. Co. All rights reserved.
Hepat Mon. 2012;12(2):124-125. DOI: 10.5812/hepatmon.820
* Corresponding author: Rinaldo Pellicano. Surgeries of Gastroenterology
and Hepatology, Hospital-Based Molinette SGAS Via Cavour 31-rd floor,
10123, Torino, Italy. Tel: +39-6333565 (ext: 011), Fax: +39-6333623; (ext: 011),
Copyright c2012 Kowsar M.P.Co. All rights reserved.
The epidemiology of chronic liver diseases (CLD) in Ita-
ly is changing. This is due to the decreasing rate of viral
hepatitis (1) and the increased number of steatosis and
nonalcoholic steatohepatitis cases, which are emerging
as a new epidemic with a wide spectrum of metabolic
disorders (2). This scenario reflects what has occurred
in Italy over the last few decades, as the vaccination
program against the Hepatitis B virus (HBV), mandatory
since the 1991, has helped to achieve complete immuni-
zation of newborns, adolescents and young adults (3). Si-
multaneously, the epidemiology of the Hepatitis C virus
(HCV) has evolved, due to factors such as increased blood
transfusion safety, improvements in healthcare condi-
tions, continuing expansion of intravenous drug use
(IDU) and immigration from endemic areas. The lack of
a prophylactic vaccine or universally active therapy has
made the prevention of this chronic infection extremely
important. Identification of infected persons and of the
risk factors associated with acquiring a HCV infection
may allow the development of strategies to reduce its in-
cidence and control the resulting epidemic (4).
The prevalence of the HCV in Europe is nearly 1%, but
this varies geographically along a north-south gradient,
ranging from approximately 0.5% in Northern countries
to 2% in Mediterranean areas (5). In Northern Italy, the
Dionysos study collected data regarding 6,917 inhabit-
ants of two towns (Campogalliano and Cormons). The
overall prevalence of positivity to the HCV antibody was
found to be 3.2%. When the prevalence was analysed ac-
cording to different age groups, it was relatively low ( <
1%) up to 40 years, but the rate rose sharply thereafter, to
reach a value of 10% in subjects older than 60 years (6).
This suggested a cohort effect. In a rural area of Central
Italy, Raffaele et al. carried out a prevalence study, which
included 344 subjects selected by random sampling
among 3,308 inhabitants older than 16 years. The in-
ferred HCV positivity prevalence rate was 22.4% with an
increased trend particularly evident as a result of ageing
(7). In a Southern Italian town, Cozzolongo et al. found a
seroprevalence for anti-HCV positivity of 2.6%; this preva-
lence increased from 1% in subjects aged < 30 years to 7.7%
in those > 70 years (8). The incidence of HCV infection is
very difficult to estimate accurately because many pa-
tients with acute HCV infection are asymptomatic, and
thus, do not present themselves for diagnosis (4). Data
from the US suggests that the annual incidence of HCV
infection fell from 230,000 new cases per year in the
The Evolving Incidence of Hepatitis C
Hepat Mon. 2012;12(2):124-125
late 1980s to approximately 35,000 new cases per year
in the 1990s (4). In Northern Italy, Mazzeo et al. carried
out a study on the ten year incidence of HCV infection in
a representative cohort of 1,646 adults from the general
population of two Apennine hill towns. The incidence
was 50.3 cases per 100,000 inhabitants/year while 16.9%
of anti-HCV positive subjects spontaneously cleared the
virus while 7 out of 11 also lost HCV-RNA from both serum
and leukocytes (9). Although Italian scientific literature
is rich with controversial epidemiological data obtained
in limited populations, the pattern of HCV infection in
the whole population overall is poorly defined. In a re-
cent issue of Hepatitis Monthly, La Torre et al. estimated
HCV infection trends in Italy during the years 1996-2006
(10). To evaluate the incidence rates, the authors inte-
grated specific ministerial data (Ministry of Health) with
population data from the National Institute of Statistics
(ISTAT), a public and independent research organization.
A strong reduction was observed in the analyzed years
(-12,45%), distributed equally among males (-12,23%) and
females (-12,8%). Considering all age groups, the inci-
dence rate decreased from 2.02 to 0.55 per 100,000. This
reduction was significant in all age groups (10). Reported
prevalence and incidence rates of HCV infection in the
community vary, not only depending on the specificity
and sensitivity of the method used, but also according
to the study design, geographical origin, and other char-
acteristics of the included populations (4). Many studies
have been carried out in blood donors or in other spe-
cific populations (for example intravenous drug users).
Scarce data is however available in the general popula-
tion. The strengths of the study by La Torre et al. lie in the
study design, which included the whole population over
a long period of follow-up, and in the use of the joinpoint
regression method. The latter is useful in determining
the occurrence of changes during distinct periods of
time in trend data. Thus, it identifies the calendar years
in which statistically significant changes in the trends
occur, and the annual percentage of change within the
identified period. On the other hand, the potential limi-
tations, as reported by the authors, are the poor quality
of reporting. In conclusion, studies such as that of La
Torre et al. (10), are crucial in increasing our knowledge
of worldwide HCV infection rates and to plan health pol-
R.P: idea, literature reviewing and manuscript writing;
S.F literature reviewing and contribution to manuscript
1. Fabris P, Baldo V, Baldovin T, Bellotto E, Rassu M, Trivello R, et al.
Changing epidemiology of HCV and HBV infections in Northern
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Loria P, Adinolfi LE, Bellentani S, Bugianesi E, Grieco A, Fargion
S, et al. Practice guidelines for the diagnosis and management
of nonalcoholic fatty liver disease. A decalogue from the Italian
Association for the Study of the Liver (AISF) Expert Committee.
Dig Liver Dis. 2010;42(4):272-82.
Campagna M, Siddu A, Meloni A, Murru C, Masia G, Coppola RC.
Epidemiological impact of mandatory vaccination against Hep-
atitis B in Italian young adults. Hepat Mon. 2011;11(9):750-2.
Pellicano R, Mladenova I, Dimitrova SM, Bruno CM, Sciacca C,
Rizzetto M. The epidemiology of hepatitis C virus infection. An
update for clinicians. Minerva Gastroenterol Dietol. 2004;50(1):1-7.
Touzet S, Kraemer L, Colin C, Pradat P, Lanoir D, Bailly F, et al.
Epidemiology of hepatitis C virus infection in seven European
Union countries: a critical analysis of the literature. HENCORE
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search. Eur J Gastroenterol Hepatol. 2000;12(6):667-78.
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Cozzolongo R, Osella AR, Elba S, Petruzzi J, Buongiorno G, Gi-
annuzzi V, et al. Epidemiology of HCV infection in the general
population: a survey in a southern Italian town. Am J Gastroen-
Mazzeo C, Azzaroli F, Giovanelli S, Dormi A, Festi D, Colecchia A,
et al. Ten year incidence of HCV infection in northern Italy and
frequency of spontaneous viral clearance. Gut. 2003;52(7):1030-
10. La Torre G, Gualano MR, Semyonov L, Nicolotti N, Ricciardi W,
Boccia A. Hepatitis C virus infection trends in Italy. Hepat Mon.