Silvia Majori

Occupational risk of blood-borne viruses in healthcare workers: a 5-year surveillance program.

OBJECTIVE This study presents the results of a 5-year surveillance program involving the prospective follow-up of healthcare workers (HCWs) in the Veneto region of Italy exposed to blood-borne viruses. DESIGN All HCWs who reported an occupational exposure to blood-borne infection joined the surveillance program. Both HCWs and patients were tested for viral markers (hepatitis B surface antigen [HBsAg], antibody to hepatitis B surface antigen [anti-HBs], antibody to hepatitis B core antigen [anti-HBc], antibody to hepatitis C virus [anti-HCV], HCV RNA, and antibody to human immunodeficiency virus [HIV]) and had these markers plus transaminases assayed at 3, 6, and 12 months and then yearly thereafter. Moreover, a program of hepatitis B virus (HBV) prophylaxis was offered to those whose anti-HBs levels were less than 10 IU/mL. PARTICIPANTS Two hundred forty-five HCWs (156 women and 89 men) with a mean age of 37 (+/- 10) years who reported occupational exposure during the 5-year period. RESULTS At the time of exposure, 1 HCW was positive for HBsAg (0.4%) and 2 were positive for HCV RNA (0.8%). Among the patients involved, 28 (11.4%) were positive for HBsAg, 68 (27.8%) were positive for HCV RNA, 6 (2.4%) were positive for HIV, and 147 (60.0%) were negative for all viral markers (4 patients were positive for both HCV and HIV). During the follow-up period after exposure (mean, 2.7 [+/- 1.6] years), there was no increase in transaminases or seroconversions to any of the viral markers. CONCLUSION Our accurate postexposure follow-up revealed a lack of transmission of HBV, HCV, and HIV.

Epidemiological aspect of traumatic brain injury in Northeast Italy

Background: Traumatic brain injuries (TBIs) remain an important public health problem in developed countries. Hospital records were reviewed to ascertain the epidemiology of TBIs in Northeast Italy. Methods: The annual rates of TBI-associated hospitalisation were estimated by analysing data collected from hospital records from 1996 to 2000. TBIs were identified according to the Centers for Disease Control and Prevention definition and the ICDMAP-90 was used to assess their severity. Findings: 55,368 TBIs were collected between 1996 and 2000, with an overall 29.4% decline in the number of cases. As for severity, moderate TBIs dropped by 34.1%, whereas a less conspicuous decline was observed for mild injuries. Severe injuries remained stable between 1996 and 1999, but rose in 2000, when the unclassified injuries were better distributed. Concerning outcome, fatal TBIs dropped slightly, but only in 2000. Causes of TBI were recorded in 59.2% of cases: 48.5% were motor vehicle accidents, 8.8% occurred at work and 12.2% at home. There were more males than females in all age groups. The highest number of cases per 100,000 person of motor vehicle accidents was recorded among 16–25 year-old and 36.5% occurred at weekends. Domestic accidents showed two age peaks, in children and the elderly. Occupational accidents occurred at all working ages, tending to decline with older age. Interpretation: Better health care and educational campaigns may have contributed to the declining rate of TBI-associated hospitalisation. Special efforts should be made to further reduce the motor vehicle accidents involving young people and welfare programs are needed to limit the risk of falls and contain functional impairment in the elderly.

National pathfinder survey on children's oral health in Italy: pattern and severity of caries disease in 4-year-olds.

This paper describes the dental health status of Italian 4-year-olds in 2004/2005 and analyzes the association between caries in preschool children and some background characteristics in children and parents. Caries was recorded according to WHO criteria. 5,538 subjects were examined. Information on the children’s and their parents’ social, behavioral, ethnic and demographic status was obtained through a series of closed questions. Bivariate analysis was performed to investigate the association between caries and background characteristics. The probability of being an extra zero for the dmfs index was estimated via the zero-inflated negative binomial regression model (ZINB). 78.4% (95% CI = 77.2–79.6) of the children were caries-free. The national mean dmfs index was 1.36 (95% CI = 1.15–1.57), ranging from 1.22 (95% CI = 1.03–1.42) in the Italian North-East to 1.73 (95% CI = 0.83–2.63) in the South section. Significant bivariate associations between caries experience and risk factors were observed for parents’ nationality (not Italian vs. Italian: p < 0.001), parents’ educational levels (low vs. high: p < 0.001), preterm birth (yes vs. no: p = 0.011), prolonged breastfeeding (≤13 months vs. >13 months: p = 0.038) and early tooth eruption (<6 months as reference: p = 0.004). Multivariable analysis (ZINB) showed that children with a low caries risk level had a higher probability of being an extra zero; in particular, children from fathers with a high educational level showed a probability of being an extra zero of 0.22. The results suggest a need to plan preventive programs to reduce oral health disparities among Italian preschool children, based on educational intervention with parents and children concerning oral health and caries prevention.

Persistence of anti-HBs antibodies in health care personnel vaccinated with plasma-derived hepatitis B vaccine and response to recombinant DNA HB booster vaccine

Long-term persistence of specific antibodies after primary immunization against HBV infection has been reported. In this study, we evaluated the persistence of anti-HBs in vaccinees 6 years after primary immunization and the response to a booster dose using a recombinant DNA yeast-derived HB vaccine. An 85.4% seroprotection rate was observed after 6 years with a significantly higher seroprotective rate in those subjects who received four doses of vaccine primary immunization as compared with those who received three doses (93.9% versus 67.2%, p < 0.001). One month after receiving the booster dose, 98.6% of the subjects had an anamnestic type of response. The GMTs were found to decrease progressively with increasing age. The antibody levels after booster dose were higher than those attained at the end of primary immunization and reflected the trend seen before the administration of the booster. These results are consistent with the existence of an effective immunological memory in HB vaccine responders. Subjects who received four doses during primary immunization were better seroprotected and had a higher seroprotection rate after the booster dose.

Prevalence of HCV antibodies in health-care workers from northern Italy

SummaryThe prevalence of HCV antibodies was assessed in 407 health-care workers and in 253 control subjects by means of immunoassays based on recombinant antigens. The seroprevalence in the study group was fairly low (1.2%) and not statistically different from that of controls (0.8%). The relation of HBV and HCV infections was evaluated in 83 health-care workers and in 82 controls: in both groups anti-HCV positivity was weakly related (p<0.05) to the HBV infection. HCV infection was associated with working in high risk wards (4/5 cases) and with report of accidental needle pricks (4/5 cases). As evaluated by means of the available markers, HCV infections in health-care workers seem to be rare.ZusammenfassungEine Untersuchung zur Prävalenz von Anti-HCV-Antikörpern wurde bei 407 in Krankenhäusern Beschäftigten und 253 Kontrollpersonen mittels Immunoassay mit rekombinanten Antigenen durchgeführt. Zwischen Studien- und Kontrollgruppe ergaben sich keine statistisch signifikanten Unterschiede in den Prävalenzraten von 1,2 beziehungsweise 0,8%. Bei 83 Ärzten und Pflegepersonen und 82 Kontrollpersonen wurde die Assoziation von HBV- und HCV-Infektionen geprüft. In beiden Gruppen bestand eine schwache Korrelation zwischen anti-HCV-Positivität und durchgemachter HBV-Infektion (p<0,05). Die HCV-Infektion war assoziiert mit der Arbeit auf Stationen mit hohem Infektionsrisiko (4/5 Fällen) und mit versehentlichen Nadelstichen (4/5). Die Ergebnisse der Untersuchung mit derzeit verfügbaren Markern läßt auf eine geringe Rate von HCV-Infektionen bei Krankenhauspersonal schließen.

Two different dosages of yeast derived recombinant hepatitis B vaccines: a comparison of immunogenicity

The efficacy of a 10 or 20 micrograms antigen load of HB recombinant vaccines is still being debated. A comparison of anti-HBs titres in two groups of healthy subjects vaccinated by the same schedule (0, 1 and 6 months) employing recombinant HB vaccines with different antigen loads, 20 micrograms (group A, 251 subjects) and 10 micrograms (group B, 256 subjects) was carried out. A seroprotection rate of 99.6 and 99.2% was observed for group A and group B, respectively, at the end of primary immunization. No statistically significant difference in seroprotection rate was observed. Group A showed significantly higher GMTs than group B for all age groups and for both sexes except for males above 25 years. The difference was more marked for younger age groups and for the female sex. These data support the higher immunogenicity of vaccine with 20 micrograms antigen load as compared to vaccines with 10 micrograms antigen load.

Hepatitis A, B, and C Infection in a Community of Sub‐Saharan Immigrants Living in Verona (Italy)

BACKGROUND In Italy, about 5% of the population is represented by immigrants. The epidemiology of hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infection in Africa is very different from Europe; the present study aimed to assess the seroprevalence of viral hepatitis infections in sub-Saharan African immigrants living in Verona. METHODS A total of 182 illegal immigrants were interviewed concerning sociodemographic characteristics and epidemiological information. Their serum was tested for anti-HAV [immunoglobulin (Ig) G and IgM], HBV (HBsAg, anti-HBs, anti-HBc, HBeAg, and anti-HBe), and HCV (anti-HCV) markers. RESULTS The immigrants (age: 3 mo-60 y) were mostly single and males, with a higher education; only 50% of them declared having a regular job. Anti-IgG HAV+ prevalence was 99.5% (100% HAV positivity in the younger age bracket). As for HBV, 67.6% (123) of the immigrants were naturally infected and 9.3% had chronic infection; 4.4% were anti-HBs+ isolated (vaccinated). For HBV infection (any HBV marker), a significant difference was only found for increasing age ( p < 0.01) and married people ( p < 0.001). A statistically significant prevalence of HBsAg was found among the unemployed ( p < 0.001) and those with a lower education ( p < 0.05). Five cases (2.7%) resulted in HCV+ with no reported specific risk factors and with no significantly different sociodemographic features; these people tended to report a low level of education and unemployment. CONCLUSIONS HAV and HBV positivity is higher than in the autochthonous population. While HAV positivity merely represents past infection, the high prevalence of HBsAg in immigrants and the presence of HBsAg/HBeAg in the same group may represent a risk for HBV transmission. The HCV positivity rate resulted similar to the prevalence of the Italian population.

Hepatitis A infection: A seroepidemiological study in young adults in North-East Italy

During the period from January to May 1994, the prevalence of antibodies to hepatitis A virus infection (anti-HAV) was tested by immunoenzyme assay in the serum samples of 620 apparently healthy subjects (81% males, 19% females), from 10 to 29 years old, resident in North-East Italy (Pordenone and surrounding district). The overall prevalence of anti-HAV was 3.7%. There was a significant lower prevalence in the group aged 10-19 than in the one aged 20–29 years (0.7% vs 6%; p < 0.001). Moreover, a significant sex difference was observed for the 20–29 year age group (p < 0.001). Among the various risk factors considered, family size and travelling abroad to endemic areas were significantly associated with HAV infection. Since a valid and effective vaccine against HAV infection has recently become available, anti-HAV vaccination campaigns can feasibly be programmed. However, different geographical regions present different epidemiological situations, so its use should be adapted to each region, with special attention to the cost-effectiveness of the immunisation programme. Our data suggest that in our region such vaccination could initially be proposed to high-risk subjects such as those travelling to endemic areas.

Response to an Extra Dose of Hepatitis B Vaccine and Specific Antibody Persistence in Non-Responders to Primary Immunization

BACKGROUND In a campaign to vaccinate health care workers, a three-dose schedule (0, 1, and 6 months) and a four-dose schedule (0, 1, 2, and 14 months) with hepatitis B (HB) vaccine were used. After primary immunization 26 subjects vaccinated with the 3-dose schedule and 4 subjects vaccinated with the 4-dose schedule had undetectable anti-HBs titres. METHODS All these 30 non-responders received an extra dose of the same vaccine 2 months after primary immunization and a booster dose with a yeast-derived vaccine 6 years later. Anti-HBs levels were evaluated 1 month after the extra dose and after the booster dose. RESULTS One month after the extra dose 26.9% (7 of 26) of the subjects vaccinated with the 3-dose schedule became positive for anti-HBs. Six years later only two of these subjects had detectable anti-HBs. After the booster dose the seven subjects who responded to the extra dose showed an anamnestic type of response, and five additional subjects became positive for anti-HBs. Responders to the extra dose were significantly younger than the non-responders. In the four-dose group only one subject responded to the extra dose, and that subject maintained protective anti-HBs. CONCLUSION About 25% of non-responders to primary HB vaccination could benefit from an extra dose, and these subjects show an anamnestic type of response to HBs antigen even after 6 years. This response seems to be influenced by age.

Hepatitis C virus infection in homosexual men: a seroepidemiological study in gay clubs in north-east Italy

Seroprevalence of Hepatitis C virus (HCV), Hepatitis B virus (HBV) and HIV antibodies was studied in a group of 259 apparently healthy homosexual men of the Veneto Region (Italy). Subjects were recruited between 1987 and 1989 from homosexual mens clubs.Seropositivity was evaluated in relation to main risk factors associated with the lifestyle and sexual behaviours of this population. Serological evaluation revealed an overall prevalence of HCV infection of 18.9% in the study population as a whole, but on breaking the samples down into three subgroups according to optical density (O.D.) values and to the year of sera collection, different seroprevalences were observed. Prevalence of anti-HCV was higher in 1987 and steadily decreased in 1988 and 1989; 4.1% of subjects gave positive results at O.D. > 2.0, while 6.2% were positive at O.D. between 0.8 and 2.0 and 9.6% at O.D. between cut-off and 0.8.Anti-HCV positivity was not correlated with HIV nor HBV positivity. No correlation was found between HCV seropositivity and either the type of anogenital intercourse or sexual promiscuity, but the prevalence increased (p = n.s.), as observed for HIV (p < 0.05) and HBV (p = n.s.), with the number of intercourses per month. Epidemiological and preventive aspects arising from the investigation are discussed herein.