Hepatitis cases on the rise in Italy in 2023: ISS data

Hepatitis cases on the rise in Italy in 2023: ISS data

In 2023, cases of hepatitis A, B and E increased slightly, while those of hepatitis C decreased. This is confirmed by the data from surveillance system bulletin Seieva (integrated epidemiological system of acute viral hepatitis) coordinated by the Istituto Superiore di Sanità.

Here are the main data:

Hepatitis A – in 2023, 267 cases of hepatitis A were notified to Seieva, with an increasing trend compared to the previous year. The regions that recorded a higher number of cases were, in order: Lombardy (55), Tuscany (43), Emilia-Romagna (29), Marche (28), Lazio (27). The age groups most affected were adults: 35-54 (25.1%) and 25-34 years (19.1%). There were 45 pediatric cases, a slight increase compared to the previous year in which there were 37. The majority of cases occurred in female individuals (59%). The most frequently reported risk factors were: consumption of raw or undercooked shellfish contaminated by the virus (35.5%), travel to endemic areas (31.9%), sexual intercourse between men (24.6%) and consumption of berries (17.4%).

Hepatitis B – in 2023, 153 new cases of acute hepatitis B were reported in Italy, a slight increase compared to 2022 in which there were 109 cases. The regions that reported the majority of cases were Emilia-Romagna (33 cases), Lombardy (31 cases) and Tuscany (21 cases). The most affected subjects are those aged between 35 and 54 years old, 46.4% of cases fell into this age group, and the 55-64 year old group (24.8%). The median age is 53 years (range 17-89). As in past years, a higher percentage of cases is observed in male subjects (78.4%). The most frequently reported risk factors are exposure to beauty treatments such as manicures, piercings and tattoos (38% of cases), dental care (28.7%) and risky sexual behavior (25.2%); nosocomial exposure (hospitalisation, surgery, hemodialysis or blood transfusion) is reported by 19.9% ​​of cases.

Hepatitis C – in 2023, 51 new cases of acute hepatitis C were reported to Seieva, 4 fewer than those recorded in 2022. The regions with the highest number of cases were Lombardy (33.3% of cases), Lazio (25.5 %) and Veneto (9.8%). A greater number of cases is observed among men (72.5% of cases) and in the 35-54 age group (52.4%), in line with observations from previous years. The most important risk factor was the use of aesthetic treatments (manicure/pedicure, piercing and tattoos), reported by 40.4% of cases, which exceeded nosocomial exposure for the first time in recent years (29, 4%) which represented the main risk factor in recent years. The use of drugs was recorded in 27.1% of the sample, the use of dental treatments in 23.9%. Finally, sexual exposure (multiple sexual partners or failure to use a condom during casual intercourse) is observed in 16 subjects among those aged > 15 years.

Hepatitis E – during 2023, 58 cases of hepatitis E were reported, mainly occurring in the Lazio region (20.7% of cases), Lombardy (17.2%), Emilia-Romagna (15.5%), Umbria (10, 3%) and Abruzzo (10.3%). Given that the number of cases slightly exceeds that of cases with acute hepatitis C, hepatitis E appears to have been the third most frequent cause of viral hepatitis in Italy in 2023. In line with what was observed in previous years, the infection mostly affected male subjects (70.7%) and in 96.5% of cases aged > 34 years, 20 cases occurred in elderly subjects ( age>64 years). Four of the recorded cases had traveled to endemic areas and in particular to Ivory Coast, India, Malawi and South Africa, while 54 (93.1%) are indigenous cases. As regards risk factors, more than half of the cases (53.1%) reported having consumed raw or undercooked pork meat, while 10.2% of the subjects reported consuming raw or undercooked wild boar meat. undercooked.

Focus on hepatitis D: test more to treat better – hepatitis delta virus (hdv) is a satellite virus that can co-infect or superinfect subjects also affected by HBV. In Italy, the prevalence of HDV in HBSAG positive patients is estimated between 4.5% and 13.0% and superinfection with HDV causes a more rapid progression to cirrhosis, a significant increase in the risk of developing hepatocellular carcinoma (HCC), hepatic decompensation, need for transplant and increased mortality.

Analyzing the data from the Seieva surveillance, the execution of the test for the detection of HDV among cases of acute hepatitis ninth-none or unknown is certainly insufficient; in fact, the percentage of cases tested remains below 50% throughout the entire observation period (1991-2023). In general, the trend in the percentage of those tested is fluctuating, with values ​​between 40% and 50% in the 90s, in the following years it decreases to below 30% (indicating less attention towards the problem), only in recent years the proportion of subjects tested for anti-hdv igm has been growing from 35.4% in 2019 to 48.8% in 2023. Overall, as expected, in the period between 1991 and 2023, hbsag subjects positive cases (among nine-none acute hepatitis cases) were tested more frequently than negative ones (42.9% vs 34.5%).

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