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World J Gastroenterol. Jul 14, 2022; 28(26): 3081-3091
Published online Jul 14, 2022. doi: 10.3748/wjg.v28.i26.3081
Epidemiological and clinical aspects of hepatitis B virus infection in Italy over the last 50 years
Caterina Sagnelli, Antonello Sica, Massimiliano Creta, Armando Calogero, Massimo Ciccozzi, Evangelista Sagnelli
Caterina Sagnelli, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
Antonello Sica, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
Massimiliano Creta, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples 80138, Italy
Armando Calogero, Department of Advanced Biomedical Sciences-UO General Surgery, University Federico II of Naples, Naples 80127, Italy
Massimo Ciccozzi, Medical Statistics and Molecular Epidemiology Unit, Campus Bio-Medico University, Rome 80138, Italy
Author contributions: Sagnelli C, Sica A, and Creta M contributed to conceptualization, methodology, validation, formal analysis, investigation, data curation, and original draft preparation; Calogero A and Ciccozzi M contributed to validation and data curation; Sagnelli E contributed to manuscript writing, review, and editing, visualization, and supervision; all authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Caterina Sagnelli, Doctor, MD, PhD, Doctor, Postdoc, Professor, Research Scientist, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania “Luigi Vanvitelli”, 5 Via L. Armanni, Naples 80138, Italy. caterina.sagnelli@unicampania.it
Received: January 12, 2022
Peer-review started: January 12, 2022
First decision: March 8, 2022
Revised: March 16, 2022
Accepted: June 18, 2022
Article in press: June 18, 2022
Published online: July 14, 2022
Processing time: 181 Days and 21.8 Hours
Abstract

A relevant gradual reduction of both the incidence rate of acute hepatitis B (AHB) and prevalence of chronic hepatitis B has occurred in Italy in the last 50 years, due to substantial epidemiological changes: Improvement in socioeconomic and hygienic conditions, reduction of the family unit, accurate screening of blood donations, abolition of re-usable glass syringes, hepatitis B virus (HBV)-universal vaccination started in 1991, use of effective well tolerated nucleo(t)side analogues able to suppress HBV replication available from 1998, and educational mediatic campaigns against human immunodeficiency virus infection focusing on the prevention of sexual and parenteral transmission of infections. As an example, AHB incidence has gradually decreased from 10/100000 inhabitants in 1985 to 0.21 in 2020. Unfortunately, the coronavirus disease 2019 (COVID-19) pandemic has interrupted the trend towards HBV eradication. In fact, several HBV chronic carriers living in the countryside have become unable to access healthcare facilities for screening, diagnosis, clinical management, and nucleo(t)side analogue therapy in the COVID-19 pandemic, mainly for anxiety of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), movement restrictions, and reduced gains from job loss. In addition, one-third of healthcare facilities and personnel for HBV patients have been devolved to the COVID-19 assistance.

Keywords: Hepatitis B virus; Hepatitis B virus epidemiology; Acute hepatitis B; COVID-19

Core Tip: An impressive reduction in the spread of hepatitis B virus (HBV) infection has been observed over the past 5 decades in Italy. This review article analyzes, in Italy, the effects of various events on HBV endemicity: Reduction of the impact of several risk factors, HBV-universal vaccination started in 1991, the nucleo(t)side analogue therapy started in 1996, the increased immigration flows from countries at high HBV endemicity, and the restrictions generated by the coronavirus disease 2019 (COVID-19) pandemic. Particular attention has been directed at the negative effects of the COVID-19 pandemic that threaten to interrupt the favorable trend towards HBV eradication.