急性乙肝普遍接种在意大利实施后：结果从22岁监察（1993年

StephenW

Acute Hepatitis B After the Implementation of Universal Vaccination in Italy: Results From 22 Years of Surveillance (1993–2014)

    Maria Elena Tosti1, Valeria Alfonsi1, Eleonora Lacorte1, Alfonso Mele1, Cristina Galli2, Alessandro Remo Zanetti2, and Luisa Romanò2 for the SEIEVA Collaborating Groupa

    1Istituto Superiore di Sanità, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Rome
    2Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy

    Correspondence: M. E. Tosti, Istituto Superiore di Sanità - Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Viale Regina Elena 299, Rome, Italy 00161 (mariaelena.tosti{at}iss.it).

    ↵a Members of the SEIEVA Collaborating Group are listed in the Acknowledgments.

Abstract

Background. Hepatitis B vaccination has proven to be very safe and highly effective. This study assessed the proportion of successfully vaccinated individuals among cases with acute hepatitis B, the proportion of preventable cases if individuals were vaccinated as recommended, and the reasons for failures.

Methods. We analyzed data reported to the Italian Surveillance System for Acute Viral Hepatitis from 1993 to 2014.

Results. A total of 362 of 11 311 (3.2%) cases with acute hepatitis B were vaccinated. Of the 277 cases for whom immunization data were available, 50 (18%) received a complete vaccination course according to the correct schedule and before exposure to hepatitis B virus. Molecular characterization of 17 of these cases showed that 6 were infected with S-gene mutants. Among the 10 949 unvaccinated cases, 213 (1.9%) escaped mandatory vaccination and 2821 (25.8%) were not vaccinated despite being at increased risk of infection. Among the latter, the most common risk factors were cohabitation with hepatitis B surface antigen (HBsAg) carriers, intravenous drug use, and homosexual/bisexual practices. Thirty-seven percent of the unvaccinated households with HBsAg carriers were aware of their risk. Lack of trust in the vaccination, negative attitude, and inaccurate beliefs followed by lack of or poor communication and low perceived severity of the disease were the most frequent reasons for vaccine hesitancy.

Conclusions. Development of acute disease in successfully vaccinated individuals is a rare event. Further efforts are needed to enhance the vaccine coverage rate in individuals at increased risk of infection.
Key words

    HBV surveillance hepatitis B vaccination breakthrough infections vaccination failure

    Received January 12, 2016.
    Accepted March 10, 2016.

    © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions{at}oup.com.

StephenW

急性乙肝普遍接种在意大利实施后：结果从22岁监察（1993年至2014年）

    玛丽亚·埃莱娜Tosti1，瓦莱里娅Alfonsi1，爱莲Lacorte1，阿方索Mele1，克里斯蒂娜Galli2，亚历山德罗雷莫Zanetti2和路易莎Romanò2为SEIEVA合作GROUPA

    1Istituto Superiore的迪SANITA，国立中心迪Epidemiologia，SorveglianzaêPromozione della Salute的，罗马
    2Dipartimento迪Scienze Biomediche每拉礼炮，UNIVERSITA阿布鲁Studi住宅米兰，意大利

    函授：M. E. Tosti，因诺琴蒂基金会Superiore的双SANITA - 国立中心迪Epidemiologia，SorveglianzaêPromozione della Salute的，里贾纳的Viale埃琳娜299，罗马，意大利00161（mariaelena.tosti {}在iss.it）。

    在SEIEVA协作组的成员↵a列在致谢。

抽象

背景。乙肝疫苗已被证明是非常安全和非常有效的。这项研究评估成功接种的个体与急性乙型肝炎，可预防病例的比例案件中所占的比例，如果个人接种了疫苗的建议，并说明理由失败。

方法。我们分析报道意大利监测系统的急性病毒性肝炎1993年至2014年的数据。

结果。共有362 11 311（3.2％）例急性乙肝接种了疫苗。的277案件为谁是可利用的免疫的数据，50（18％），根据正确的时间表和暴露于乙型肝炎病毒前接收一个完整的疫苗接种过程。的这些病例17分子表征表明，6被感染S基因突变体。其中10 949未接种疫苗的情况下，213（1.9％）逃脱强制接种和2821（25.8％），尽管处于感染的危险性增加并没有接种疫苗。在后者中，最常见的危险因素为同居乙肝表面抗原（HBsAg）携带者，静脉用药，和​​同性恋/双性恋的做法。与HBsAg携带者未接种疫苗的家庭37％的人知道自己的风险。缺乏信任，在疫苗接种，消极的态度，和不准确的信念其次是缺乏或沟通不畅和疾病的低感知严重性是疫苗犹豫不决的最常见的原因。

结论。在成功接种的个体的急性疾病的发生发展是一个罕见的事件。需要进一步努力，以提高个人的疫苗覆盖率感染的危险性增加。
关键词

    HBV监控接种乙肝疫苗突破感染的疫苗失效

    收到2016年1月12日。
    接受2016年3月10日。

    ©的美国传染病学会出版由牛津大学出版社的作者2016年。版权所有。对于权限，电子邮件journals.permissions {}在oup.com。