Five Decades of HBV Infection in Italy: A Continuous Challenge

SIMPLE SUMMARY: Hepatitis B virus (HBV) is a potentially life-threatening viral infection that primarily affects the liver. Vaccination against HBV is crucial for preventing the spread of the disease and reducing its associated morbidity and mortality. The introduction of the hepatitis B vaccine has had a significant impact on public health globally, including in Italy. In the 1980s, Italy had one of the highest rates of HBV infection in Europe. The Italian government recognized the importance of vaccination and introduced the hepatitis B vaccine into the national immunization program in 1991, making it freely available. This was a significant step in the fight against HBV infection. By the early 2000s, the prevalence of chronic HBV infection in Italy had decreased to less than 1% among children and adolescents. The introduction of the hepatitis B vaccine in Italy has played a crucial role in reducing the burden of HBV infection and its associated complications. The success of the vaccination program highlights the importance of public health interventions in preventing the spread of infectious diseases. ABSTRACT: In Italy, Hepatitis B virus (HBV) infection has been characterized by several changes over the last five decades. In 2019, the incidence of acute HBV among subjects targeted by the vaccination campaign was 0 cases in the age group 0–14 years and 0.1/100,000 in the age group 15–24. Nowadays, the burden of different stages of HBV-related chronic liver diseases is minimal. Intravenous drug use is no longer a risk factor (O.R. 0.7; 95% C.I. 0.5–1.02) for acquiring acute HBV; the proportion of cases reporting this exposure fell from 29.8% to 3.3% over the last two decades. The key public health intervention has been the compulsory vaccination campaign started in 1991 for infants 3 months old and 1–2 years old (the latter group for the first 12 years of the campaign). Moreover, non-immunogenic factors and the availability of effective oral antiviral drugs have played and continue to play a prominent role. The potential availability of new oral antiviral drugs with the inherent ability to eliminate the genomic HBV reservoirs may represent a further crucial step in the elimination of the virus in people that are already infected.