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Letter
Hepatitis A, Italy
Raffaele D'Amelio,*†
Alfonso Mele,‡ Andrea Mariano,‡ Luisa Romanò,§ Roberto Biselli,¶ Florigio
Lista,# Alessandro Zanetti,§ and Tommaso Stroffolini‡**
*Direzione Generale della Sanità Militare, Rome, Italy; †Università degli
Studi "La Sapienza" II Facoltà di Medicina e Chirurgia, Rome,
Italy; ‡Istituto Superiore di Sanità, Rome, Italy; §Istituto di Virologia,
Università degli Studi, Milano, Italy; ¶Centro Sperimentale di
Volo, Pratica di Mare, Italy; #Centro Studi e Ricerche di Sanità e Veterinaria,
Rome, Italy; and **Ospedale S. Giacomo, Rome, Italy
Suggested
citation for this article
To the Editor: Hepatitis A virus (HAV) infection rates are very
low in industrialized countries. A noticeable fall in the prevalence of
HAV antibodies (anti-HAV) has been reported in southern European and Mediterranean
countries such as Spain (1) and Greece (2),
reflecting improvements in hygiene standards in the last decades.
An HAV prevalence of 66.3% in 1981 (3) and 29.4% in
1990 (4) was shown in studies conducted in military recruits
from all Italian regions. In both studies, subjects from southern regions
had a higher HAV prevalence than those from north-central regions. In
2003, we conducted a study of recruits to show changes in HAV infection
prevalence in younger Italian generations.
Military service was compulsory in Italy at that time; all men 18–26
years of age were included. From September to December 2003, 323 recruits
18–26 years of age (mean age 20 years), representing all Italian regions,
who had been accepted for Air Force military service were tested for anti-HAV
in the recruitment center at Viterbo. This recruitment center, used in
the 1990 study, was chosen again because it is located near Rome and adherence
to protocol was easier to control.
A standard, precoded questionnaire was designed to collect information
in the same sequence as questions asked by military personnel during the
examination. The same information was collected as in the previous studies:
date of birth, residence, father's years of education, and family size.
After informed consent was obtained, blood samples were collected and
stored at –30°C until tested. No person was vaccinated against HAV.
Anti-HAV assay was performed by using commercial immunoenzymatic method
(Abbot Laboratories, North Chicago, IL, USA). The methods used in the
1981 and 1990 studies have similar sensitivity and specificity between
them and in relation to that used in the current study, and are detailed
elsewhere (3,4).
The prevalence of anti-HAV declined from 66.3% in 1981 to 5.3% in 2003
(p<0.01, χ2 test). In 2003, the prevalence was 2.1%
in the north-central region and 7.9% in southern regions (Figure).
However, southern residents were more likely to have been exposed to HAV
than north-central residents (p<0.02, χ2 test). No statistical
difference relative to father's years of education or family size was
shown. Basic requirements for Navy (1981 study) and Air Force (1990 and
2003 studies) enrollment were similar. Thus, the 3 studies are comparable
and a valid estimation of epidemiologic changes over time.
The anti-HAV prevalence shown in this study (5.3%) indicates that Italy
has very low endemicity of HAV infection, at least in the young male population.
The decline of HAV infection for >20 years is a consequence of good
sanitation and hygienic conditions (vaccination against HAV is rarely
performed in Italy) and has generated an increasing proportion of adults
who are susceptible to this virus at an age characterized by the likely
occurrence of a more severe clinical illness (5). This
situation will likely necessitate costly interventions, such as vaccinating
risk groups (e.g., military personnel, healthcare workers), to prevent
HAV infection. Thus, HAV vaccination has been included in the compulsory
vaccination schedule of the Italian military personnel since 1998 (6).
Acknowledgments
We thank A. Fantera,
G. Grieco, G. Pascali, and A. Piergiovanni of the Health Service of
Viterbo recruitment center for crucial support in developing this project.
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Suggested citation
for this article:
D'Amelio R, Mele A,
Mariano A, Romanò L, Biselli R, Lista F, et al. Hepatitis A, Italy [letter].
Emerg Infect Dis [serial on the Internet]. 2005 Jul [date cited].
Available from http://www.cdc.gov/ncidod/EID/vol11no07/04-1157.htm
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