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SEIEVA. Integrated Epidemiological System for Acute Viral Hepatitis Alfonso Mele Catania, November 7-8 2002. SEIEVA AIMS. • Monitor epidemiological trends • Identify risk factors • Formulate and monitor prevention strategies. SEIEVA METHODOLOGY.

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SEIEVA

Integrated Epidemiological System for Acute Viral HepatitisAlfonso MeleCatania, November 7-8 2002

slide2

SEIEVA AIMS

•Monitor epidemiological trends• Identify risk factors• Formulate and monitor prevention strategies

slide3

SEIEVA METHODOLOGY

•Notification•Interview•Ascertainment of markers•Weekly line listing of cases and questionnaires are forwarded to ISS

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SEIEVA participating ASL 2001:133/243 (56% Italian population)

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1/44

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5/22

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Incidence of notified case of hepatitis B in Italy by age-groups. SEIEVA 1985-2001

Anti-hepatitis B

vaccination

slide17

Risk factors of hepatitis B: adjusted* O.R.

SEIEVA 1998-2000

Risk factors adjusted OR 95% CI

Blood transfusion 2.35 (0.56 - 9.92)

Intravenous drug use 6.78 (3.32 - 13.9)

Surgical intervention 2.44 (1.42 - 4.19)

Dental therapy 1.35(0.99 - 1.84)

Other parenteral exposures 1.67 (1.26 - 2.33)

> 1 sexual partner ** 1.75 (1.31 - 2.33)

Household of HBsAg+ 10.1 (4.52 - 22.7)

*Adjusted for sex, age, area of residence, educational level and the other variables of the table.

** Subjects > 14

slide18

Risk factors of hepatitis C: adjusted* O.R.

SEIEVA 1998-2000

Risk factors adjusted OR 95% CI

Blood transfusion 2.43 (0.63 - 9.42)

Intravenous drug use 38.0 (19.1 - 75.6)

Surgical intervention 7.02 (3.99 - 12.4)

Dental therapy 1.53(1.00 - 2.33)

Other parenteral exposures 1.65 (1.11 - 2.46)

> 1 sexual partner ** 0.76 (0.49 - 1.19)

*Adjusted for sex, age, area of residence, educational level and the other variables of the table.

** Subjects > 14

slide19
Adjusted OR and 95% CI for different types of invasive procedure among hepatitis B cases. SEIEVA 1996-2000.

Intervention type Hepatitis B Hepatitis A Odds ratio*

(2689 cases) (6701 cases) (95% CI)

n % n %

Minor surgery 44 1.6 37 0.6 1.98 (1.19- 3.29)

Gynaecological** 21 0.8 18 0.3 3.69 (1.77 - 7.73)

Orthopaedic 19 0.7 29 0.4 1.93 (0.96 - 3.28)

Abdominal 41 1.5 30 0.4 3.75 (2.09 - 6.72)

Cardiovascular 21 0.8 5 00.7 6.56 (2.20 - 19.5)

Dermatological 31 1.1 15 0.2 3.00 (1.53 - 5.86)

Oral surgery 63 2.3 40 0.6 3.14 (1.97 - 4.99)

Ophtalmological 10 0.4 5 00.7 3.85 (1.17 - 12.8)

Urological 13 0.5 6 00.9 4.88 (1.54 - 15.4)

Other intervention 66 2.4 62 0.9 2.37 (1.57 - 3.57)

Biopsy/endoscopy 80 2.9 55 0.8 2.03 (1.39 - 2.96)

Subjects < 14, intravenous drug users, and transfused patients were excluded from the analysis.

* Adjusted for sex, age, instruction level and area of residence in multiple logistic regression analysis.

** For females.

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Adjusted OR and 95% CI for different types of invasive procedure among hepatitis C cases. SEIEVA 1996-2000.

Intervention type Hepatitis C Hepatitis A Odds ratio*

(709 cases) (6701 cases) (95% CI)

n % n %

Minor surgery 13 1.8 37 0.6 3.18 (1.58 - 6.39)

Gynaecological ** 19 2.7 18 0.3 16.6 (7.40 - 37.2)

Orthopaedic 17 2.4 29 0.4 5.70 (2.82 - 11.5)

Abdominal 13 1.8 30 0.4 6.01 (2.90 - 12.4)

Cardiovascular 19 2.7 5 00.7 34.9 (12.0 - 102)

Dermatological 6 8.4 15 0.2 2.72 (0.98 - 7.51)

Oral surgery 15 2.1 40 0.6 3.60 (1.87 - 6.93)

Ophtalmological 14 2.0 5 00.7 30.4 (9.98 - 92.3)

Urological 6 8.4 6 00.9 10.7 (8.88 - 39.7)

Other intervention 30 4.2 62 0.9 4.46 (2.72 - 7.32)

Biopsy/endoscopy 40 5.6 55 0.8 4.57 (2.91 - 7.18)

Subjects < 14, intravenous drug users, and transfused patients were excluded from the analysis.

* Adjusted for sex, age, instruction level and area of residence in multiple logistic regression analysis.

** For females.

slide21
Risk factors associated to HAV: adjusted* O.R. (hepatitis B cases have been used by controls ) SEIEVA 1996-2000

Risk Hepatitis A Controls Adjusted O.R.

factors N. % N. % 95% CI

Shellfish 7085 (70.6) 1325 (41.9) 2.41

consumption (2.17-2.68)

Travel to high 1519 (15.5) 315 (10.3) 4.11

endemic areas (3.53-4.79)

Household of 1227 (12.0) 246 (6.8) 1.51

day-care child (1.26-1.82)

Contact with an 1021 (10.7) ---- ----

icteric cases

N. of cases 10438 3620

*Adjusted for sex, age, area of residence, educational level and the other variables of the table.

association between travel and hepatitis a virus infection adjusted o r seieva 1996 2000

Association between travel* and hepatitis A virus infection: adjusted** O. R., SEIEVA 1996-2000

Area of Adjusted O.R. 95% CI

destination

No travel 1.00 --

Northern Europe, 1.46 0.92-2.34

Northern America

Northern/Central Italy 0.95 0.78-1.15

Southern Italy 3.03 2.35-3.91

Mediterranean Area, 3.15 2.42-4.11

Eastern Europe

Latin America, Asia, 9.30 6.71-12.9

Africa

*Reported in the 6 weeks before the onset of the disease.

** Adjusted for age, gender, educational level, area of residence, shellfish consumption, contact with an icteric case and household of day-care child.

association between travel and hepatitis a virus infection by area of residence seieva 1996 2000

Association between travel* and hepatitis A virus infection: by area of residence. SEIEVA 1996-2000

adjusted** O.R. 95% CI

Area of residence Northern and central Italy Southern Italy/Islands

Area of

destination

No travel 1.00 -- 1.00 --

Northern Europe, 1.60 1.00-2.57 0.63 0.07-5.34 Northern America

Northern/Central Italy 1.03 0.84-1.26 0.67 0.37-1.20

Southern Italy 3.70 2.82-4.85 1.25 0.66-2.39

Mediterranean Area, 3.21 2.47-4.19 1.76 0.19-16.3

Eastern Europe

Latin America, Asia, 9.49 6.83-13.2 0.72 0.15-3.52

Africa

*Reported in the 6 weeks before the onset of the disease.

** Adjusted for age, gender, educational level, shellfish consumption, contact with an icteric case and household of day-care child.

slide24

SEIEVA FOR MONITORING PREVENTION PROGRAMS

Vaccination of households of HBsAg carriers

Vaccination of healthcare workers

hepatitis b cases among adolescents seieva 1992 2001

SEIEVA FOR MONITORING PREVENTION PROGRAMS

Hepatitis B cases among adolescents. SEIEVA 1992-2001

Years

Age 92 93 94 95 96 97 98 99 2000 2001

13 4 2 0 0 1 0 0 3 2 0

14 3 6 4 2 1 1 1 0 1

15 5 1 2 0 0 1 0 1

16 5 1 10 3 2 1 0

17 9 2 4 3 1 1

18 13 2 3 3 3

19 10 3 4 2

20 15 6 5

21 13 5

22 15

cases of nanb hepatitis associated with blood transfusion by year seieva 1987 2001

SEIEVA FOR MONITORING PREVENTION PROGRAMS

Cases of nAnB hepatitis associated with blood transfusion by year. SEIEVA 1987-2001

Years Hepatitis (95% CI)

nonA-nonB

1987 4.4 (3.2-5.6)

1988 4.5 (3.5-5.6)

1989 4.1 (3.1-5.1)

1990 2.9 (2.1-3.7)

1991 1.4* (0.8-2.0)

1992 0.3** (0.1-0.6)

1993 0.4 (0.2-0.7)

1994 0.1 (0.0-0.3)

1995 0.4 (0.1-0.6)

1996 0.2 (0.2-0.4)

1997 0.3 (0.2-0.5)

1998 0.5 (0.2-10.5)

1999 0.2 (0.05-0.4)

2000 0.2 (0.1-0.4)

2001 0.3 (0.2-0.6)

*Compulsory of the ELISA-I test in the total blood bank

** Introduction of the ELISA-II test

slide27

Conclusions 1

Lessons from SEIEVA

•SEIEVA is a useful tool for monitoring trends of acute viral hepatitis, for understanding the role played by each risk factor, and for establishing the priority and effectiveness of prevention programs.

slide28

Conclusions 2

Lessons from SEIEVA

•Incidence of hepatitis B was decreasing in Italy before the vaccination campaign was launched. • Vaccination against hepatitis B has further contributed to the decline of HBV infection.•Invasive medical procedures represent an important mode of HBV and HCV transmission.• Intensive effort should be employed to increase vaccination coverage of specific risk groups.• Shellfish consumption and travels to endemic areas are major risk factors for hepatitis A.