In 2023, cases of hepatitis A, B and E increased slightly in Italy, while those of hepatitis C decreased.. This is what emerges from the data in the bulletin of the Seieva surveillance system (Integrated epidemiological system of acute viral hepatitis), coordinated by the Higher Institute of Health. For these three forms of hepatitis, a total of 529 cases were reported.
Hepatitis A
In detail, for hepatitis A, 267 cases were reported to Seieva last year, with an increasing trend compared to the previous year. The Regions that recorded a higher number of cases were Lombardy (55), Tuscany (43), Emilia Romagna (29), Marche (28) and Lazio (27). The age groups most affected were adults: 35-54 (25.1% of cases) and 25-34 years (19.1%). There were 45 pediatric cases, a slight increase compared to the previous year when there were 37. The majority of cases occurred in women (59%). The most frequently reported risk factors were consumption of raw or undercooked shellfish contaminated by the virus (in 35.5% of cases), travel to endemic areas (31.9%), sexual intercourse between men (24.6%) and consumption of berries (17.4%).
The Regions with the most cases
For thehepatitis B 153 new cases were reported, a slight increase compared to 2022 when there were 109. The Regions that reported the most cases were Emilia Romagna (33), Lombardy (31) and Tuscany (21). Most affected are people between the ages of 35 and 54 (46.4% of cases fell into this age group) and the 55-64 age group (24.8%). The median age is 53 years (range 17-89). As in past years, a higher percentage of cases is observed in males (78.4%). The most frequently indicated 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
There were 51 new cases of acute hepatitis C in 2023 – the ISS still reports – 4 fewer than those recorded in 2022. The Regions with the highest number of cases were Lombardy (33.3%), Lazio (25, 5%) and Veneto (9.8%). Men (72.5% of cases) and the 35-54 age group (52.4%) are more affected, 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%), 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%. Sexual exposure (multiple sexual partners or failure to use a condom during casual intercourse) is observed in 16 people over the age of 15.
Hepatitis E
For hepatitis E, 58 cases were notified, mainly recorded in Lazio (20.7%), 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, 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 they were over 34 years of age; 20 cases occurred in elderly subjects (over 64 years of age). 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 native cases. Regarding risk factors, more than half of the cases (53.1%) reported having consumed raw or undercooked pork. 10.2% reported the consumption of raw or undercooked wild boar meat.
Iss: still few tests for hepatitis D, do more for better treatment
Get more tests for hepatitis D to treat it better. This is the indication of the Higher Institute of Health, which dedicates a focus to this infection in the bulletin of the Seieva surveillance system (Integrated epidemiological system of acute viral hepatitis).
The Hepatitis Delta virus (HDV) – remember – is a satellite virus that can co-infect or superinfect people also affected by hepatitis B. In Italy, the prevalence of HBsAg positive patients (i.e. with hepatitis B infection) is estimated at between 4.5% and 13.0%, and superinfection with HDV causes more rapid progression to cirrhosis, a significant increase in the risk of developing hepatocellular carcinoma, hepatic decompensation, need for transplantation and increased mortality.
Analyzing the data from Seieva surveillance, the execution of the test for the detection of HDV among cases of acute nonA-nonE or unknown hepatitis is defined as “certainly insufficient”: the percentage of cases tested remains below 50% during 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 1990s, which in subsequent years drop to below 30% (indicating less attention towards the problem) and only in recent years have they emerged. The proportion of subjects tested for anti-HDV IgM increased from 35.4% in 2019 to 48.8% in 2023. Overall, as expected, in the period between 1991 and 2023, HBsAg positive people, among cases of acute nonA-nonE hepatitis, were tested more frequently than negative ones (42.9% versus 34.5%).
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