title: Incidence of and risk factors for hepatitis A in Italy: public health indications from a 10-year surveillance. SEIEVA Collaborating Group.
abstract: OBJECTIVE
  This study aimed to evaluate the incidence of and risk factors for acute viral hepatitis A (HAV) in Italy.
  
  
  METHODS
  Data were from a surveillance system for type-specific acute viral hepatitis (SEIEVA). To estimate the association of hepatitis A cases with the potential risk factors (Odds Ratios) and the proportion of all hepatitis A cases attributable to a given risk factor (population attributable risk), hepatitis B cases were used as controls. Independent predictors of HAV were estimated by conditional multiple logistic regression.
  
  
  RESULTS
  During the period 1985-1994, 25553 viral hepatitis cases were reported. Of these, 6408 (25%) were due to hepatitis A (HAV). HAV incidence declined from 10/100000 in 1985 to 2/100000 in 1987. Since 1991, however, an increase in HAV has been observed. The majority of cases were 15-24 years old; the incidence was higher in males and in subjects residing in southern Italy. Only one death (0.02%) was observed. Shellfish consumption was the most frequently reported risk factor (62%). The proportion of cases reporting personal contact with an icteric case, travel to a high-medium endemic areas, and family contact with a child attending a day-care centre (household of day-care child) was 17%, 19% and 15%, respectively. The results of multivariate analysis showed that shellfish consumption (OR=2.6; 95% CI=2.4-2.9), travel to endemic areas for people residing in northern and central Italy (OR=5.4; 95% CI=4.6-6.2) and household of day-care child (OR=1.2; 95% CI=1.03-1.4), were all types of exposure independently associated with HAV. The estimates of population-attributable risk show that shellfish consumption explained as many as 42.2%, travel to high-medium endemic areas for people residing in northern and central Italy 24.2%, and household of day-care child only 1.4% of all acute hepatitis A cases in Italy.
  
  
  CONCLUSIONS
  These findings indicate that HAV in Italy is mainly a food-borne disease. Vaccination against hepatitis A is strongly recommended for travellers to endemic areas.
authors.affiliation: Laboratorio di Epidemiologia e Biostatistica, I.S.S., Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mele
authors.forename: T
authors.initials: T
authors.lastname: Stroffolini
authors.forename: F
authors.initials: F
authors.lastname: Palumbo
authors.forename: G
authors.initials: G
authors.lastname: Gallo
authors.forename: P
authors.initials: P
authors.lastname: Ragni
authors.forename: E
authors.initials: E
authors.lastname: Balocchini
authors.forename: M E
authors.initials: ME
authors.lastname: Tosti
authors.forename: R
authors.initials: R
authors.lastname: Corona
authors.forename: A
authors.initials: A
authors.lastname: Marzolini
authors.forename: A
authors.initials: A
authors.lastname: Moiraghi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006506:Hepatitis A / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007558:Italy; D016017:Odds Ratio; D011159:Population Surveillance; D011634:Public Health; D012044:Regression Analysis; D012307:Risk Factors