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Hepatitis B virus infection in children in Sardinia, Italy
T Stroffolini1, E Franco, G Romano
1Laboratorio di Epidemiologia - Istituto Superiore di Sanità, Rome, Italy.
Insights
Universal newborn hepatitis B immunization is being considered for Sardinia. However, low hepatitis B surface antigen (HBsAg) prevalence in children, despite higher adult rates, suggests current immunization is not recommended.
Area of Science:
- Hepatology
- Immunology
- Public Health
Background:
- Hepatitis B virus (HBV) infection remains a significant public health concern globally.
- Sardinia, Italy, is considered a hyperendemic area for HBV, prompting consideration of universal newborn immunization strategies.
- Previous studies indicated varying HBV marker prevalence across different age groups in Sardinia.
Purpose of the Study:
- To evaluate the feasibility and necessity of universal hepatitis B immunization for all newborns in Sardinia.
- To assess the current prevalence of hepatitis B markers, including hepatitis B surface antigen (HBsAg), in different age demographics in Sardinia.
- To understand the epidemiological patterns of HBV infection in Sardinia to inform public health strategies.
Main Methods:
- Cross-sectional serological survey conducted in Sardinia.
- Analysis of hepatitis B markers (including HBsAg and HBeAg) in children under 11 years and adult populations (men and pregnant women).
- Statistical analysis to determine prevalence rates and identify potential biases, considering sampling procedures and refusal rates.
Main Results:
- In 1987, hepatitis B markers prevalence in Sardinian children under 11 was 1.7%, with an HBsAg prevalence of 0.2%.
- Recent adult HBsAg prevalence in Sardinia was significantly higher: 8.7% in men and 5.2% in pregnant women.
- Only 3 out of 1,826 children tested were HBsAg positive, despite the higher prevalence in pregnant women, likely due to low HBeAg positivity among carrier mothers.
Conclusions:
- The observed low prevalence of HBV markers in young Sardinian populations may be attributed to a cohort effect possibly linked to improved socioeconomic conditions and behavioral changes.
- The low HBsAg positivity in children, contrasted with higher adult rates, suggests that universal newborn immunization might not be the most effective strategy at present.
- Further epidemiological surveillance and targeted interventions may be necessary, considering the specific HBV transmission dynamics in Sardinia.
Abstract:
Possible hepatitis B immunization of all newborns, regardless of the mother's HBsAg status, is a strategy under consideration for selected hyperendemic areas in Italy. Sardinia is one such area. However, in 1987 in Sardinia, the prevalence of hepatitis B markers in children under 11 years was estimated at 1.7% and the prevalence of hepatitis B surface antigen (HBsAg) at 0.2%. A much higher prevalence of HBsAg was recently observed among adults in this area: 8.7% among men and 5.2% among pregnant women. This contrasting pattern is unlikely to be due to bias: the sampling procedures adopted were appropriate and the percentage of refusals was very low (2.2%). The observed low hepatitis B marker prevalence in young age groups might be the result of a cohort effect due to the improved socio-economic conditions and changes in behaviour that have occurred in Sardinia over the last few years. The finding of only 3 HBsAg+ individuals out of 1,826 children tested, in spite of the 5.2% HBsAg prevalence among pregnant women in that region, is probably attributable to the low proportion of HBeAg positive individuals among the HBsAg+ carrier mothers in this area. At present, immunization of all newborns in Sardinia cannot be recommended.