title: Twenty years of universal vaccination against hepatitis B in Italy: achievements and challenges.
abstract: Viral hepatitis B is a vaccine-preventable disease. Vaccination has proved to be safe and highly effective in reducing the incidence, the carrier rate and HBV-related mortality on a global scale. In Italy, universal vaccination against hepatitis B started in 1991 in infants as well as in adolescents, providing an outstanding record of safety and effectiveness. Within a few years, over 95% coverage was consistently reported. Today, some 17 million people are immune against hepatitis B and their immunity has been shown to be long-lasting. At present, no booster is required in healthy vaccinated people to sustain protection. Surveillance data from Italy have shown a clear overall decline in hepatitis B among successfully vaccinated individuals. Furthermore, a generation of children and young people (at present cohorts ranging from 0 to 32 years) is emerging with practically no markers of HBV infection. Italy's vaccination programme has resulted in substantial progress towards the prevention and control of hepatitis B. The vaccination programme must continue. Maintaining mandatory vaccination of infants and increasing HBV vaccination coverage in high-risk groups, including households of HBsAg carriers as well as immigrants, remain a priority for the future.
  
  
  BACKGROUND
  Data reported in this paper were presented at a national Meeting, Towards the elimination of hepatitis B: celebrating 20 years of vaccination in Italy, held in Milano (19 November 2011) under the high patronage of the President of the Italian Republic. Distinguished figures from the world of Italian Public Health as well as international experts participated and paid tribute to the work of those who had contributed to the saving of lives, prevention of suffering, and the savings made to the State.
authors.affiliation: Dipartimento di Sanità Pubblica - Microbiologia - Virologia, Università di Milano , Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Romanò
authors.affiliation: Dipartimento di Sanità Pubblica - Microbiologia - Virologia, Università di Milano , Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Paladini
authors.affiliation: Dipartimento di Sanità Pubblica - Microbiologia - Virologia, Università di Milano , Italy.
authors.forename: Alessandro R
authors.initials: AR
authors.lastname: Zanetti
keywords: HBV; hepatitis B; long-term immunity; vaccination