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SEIEVA

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

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

  2. SEIEVA AIMS •Monitor epidemiological trends• Identify risk factors• Formulate and monitor prevention strategies

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

  4. SEIEVA participating ASL 2001:133/243 (56% Italian population) 1/5 2/6 1/1 1/44 22/22 11/22 13/13 5/5 13/13 12/12 2/5 2/6 12/12 1/5 12/12 13/13 2/5 5/22 1/11 2/9

  5. Serological definition of types of viral hepatitisSEIEVA

  6. Incidence

  7. Distribution of notified cases of viral hepatitisSEIEVA 1987 - 1990 1997 - 2001

  8. Case fatality rate of viral hepatitis in Italy by type 1985 - 1994 1995 - 2001

  9. Incidence rates (cases x 100,000) of viral hepatitis in Italy by type, SEIEVA 2001

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

  11. Incidence of notified case of hepatitis nAnB in Italy by age and year. SEIEVA 1985-2001

  12. Incidence of notified case of hepatitis A in Italy by age and year. SEIEVA 1985-2001

  13. Incidence (cases per 100,000) of hepatitis A in Italy by geographical area. SEIEVA 1985-2001

  14. Risk Factors

  15. 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

  16. 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

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  21. 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.

  22. SEIEVA FOR MONITORING PREVENTION PROGRAMS Vaccination of households of HBsAg carriers Vaccination of healthcare workers

  23. 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

  24. 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

  25. 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.

  26. 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.

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