Severi Ettore, Georgalis Leonidas, Pijnacker Roan, Veneti Lamprini, Turiac Iulia Adelina, Chiesa Flaminia, Rizzo Caterina, Martinelli Domenico, Vold Line, Herrador Bernardo Guzman, Martinez Carmen Varela, Sanchez Elena Vanessa Martinez, Semenza Jan C, Lopalco Pierluigi, Dahlström Lisen Arnheim, Giesecke Johan
European Centre for Disease Prevention and Control, Stockholm, Sweden; Karolinska Institutet, Medical Epidemiology and Biostatistics Department, Stockholm, Sweden.
European Programme for Intervention Epidemiology Training (EPIET), ECDC, Stockholm, Sweden; Instituto de Salud Carlos III, CIBER Epidemiologia y Salud Publica, Madrid, Spain.
Int J Infect Dis. 2022 May;118:34-43. doi: 10.1016/j.ijid.2022.01.053. Epub 2022 Feb 5.
We analysed hepatitis A (HepA) notifications and hospitalisations in Italy, the Netherlands, Norway, Spain, and Sweden for available periods between 1995 and 2014. We aimed to investigate whether decreasing HepA incidence is associated with increasing age at infection and worsening HepA presentation and to identify groups at risk of severe disease.
We performed a retrospective cohort study including 36 734 notified and 36 849 hospitalised patients. We used negative binomial regressions to identify over time: i) trends in hospitalisation and notification rates; ii) proportion of hospitalised and notified patients aged ≥40 years; iii) proportion of "severe hospitalisations"; and iv) risk factors for severe hospitalisation.
During the study period both HepA notifications and hospitalisations decreased, with notification rates decreasing faster, patients aged ≥40 years increased, however, the proportion of severe HepA hospitalisations remained stable. Older patients and patients with comorbidities, particularly liver diseases, were more likely to experience severe disease.
We used digitalised health information to confirm decreasing trends in HepA hospitalisations and notifications, and the increasing age of patients with HepA in Europe. We did not identify an increase in the severity of the clinical presentation of patients with HepA. Older patients with liver diseases are at increased risk of severe disease and should be prioritised for vaccination.
我们分析了意大利、荷兰、挪威、西班牙和瑞典在1995年至2014年期间可获取时间段内甲型肝炎（HepA）的报告病例数和住院病例数。我们旨在调查甲型肝炎发病率下降是否与感染年龄增加及甲型肝炎临床表现恶化相关，并确定重症疾病的风险人群。
我们开展了一项回顾性队列研究，纳入了36734例报告病例和36849例住院患者。我们使用负二项回归来确定随时间变化的情况：i）住院率和报告率的趋势；ii）年龄≥40岁的住院患者和报告患者的比例；iii）“重症住院”的比例；iv）重症住院的危险因素。
在研究期间，甲型肝炎的报告病例数和住院病例数均下降，报告率下降更快，年龄≥40岁的患者增加，然而，甲型肝炎重症住院的比例保持稳定。老年患者和患有合并症（尤其是肝脏疾病）的患者更易发生重症疾病。
我们利用数字化健康信息证实了欧洲甲型肝炎住院病例数和报告病例数呈下降趋势，以及甲型肝炎患者年龄增加。我们未发现甲型肝炎患者临床表现的严重程度有所增加。患有肝脏疾病的老年患者发生重症疾病的风险增加，应优先接种疫苗。
