Castelli F, Carosi G, Tebaldi A, Pizzocolo G, Pisani S, Rossitto F, Boffelli L, Crevatin D, Pettoello R, Fausti G, Messino C, Brunelli M, Costa P, Ronca E
Clinic of Infectious and Tropical Diseases, University of Brescia, Region Lombardy Reference Center for Imported Diseases, Brescia, Italy.
J Travel Med. 1996 Dec 1;3(4):214-218. doi: 10.1111/j.1708-8305.1996.tb00749.x.
Background: Hepatitis A virus (HAV) circulation in the environment is decreasing in most industrialized Western countries. This decrease has lead to low seroprevalence rates in adults. As a consequence, many nonimmune unprotected travelers from areas of low prevalence are considered at risk of acquiring HAV infection when traveling to high HAV endemic areas in developing countries. The recent HAV inactivated vaccine has proved safe and effective, and its use in different geographic areas should be guided by local age-specific HAV seroprevalence rates. The aim of this paper is to describe the age-specific sero-epidemiology of HAV infection in travelers from a highly industrialized region in Northern Italy (Lombardy). Methods: Seven hundred and forty-four consecutive travelers aged from 20 to 59 years, subdivided in 10-year age groups, gave blood samples in the collaborative Health Centers in the Lombardy region and sera were tested for HAV IgG antibodies. A questionnaire was given to travelers that investigated alimentary habits and a history of previous travel. Results: Anti-HAV seroprevalence was 18.0%, 58.0%, 75.8%, and 89.5% in the 20-29, 30-39, 40-49, and 50-59 age groups, respectively. Age was the single most important determinant of anti-HAV seroprevalence. The influence of previous travels, eating shellfish, or ingestion of self-cultivated vegetables was ruled out by multivariate analysis. Conclusions: In the Lombardy region (Northern Italy), age specific anti-HAV seroprevalence rates are much higher than those reported in other Western European countries. The cost-benefit analysis suggested that travelers born after 1960 do not need serologic screening before vaccination. Whenever possible, however, HAV serologic screening is advisable for travelers born before 1960. However, the severity of the disease in older subjects, and the proved safety of HAV vaccination in immune subjects, may advise d'emblée HAV vaccination without prior screening, when serologic investigation is unfeasible because of lack of time or the unavailability of testing facilities.
在大多数西方工业化国家，甲型肝炎病毒（HAV）在环境中的传播正在减少。这种减少导致成年人中血清阳性率较低。因此，许多来自低流行地区的未免疫、无防护措施的旅行者在前往发展中国家的高HAV流行地区旅行时，被认为有感染HAV的风险。最近的HAV灭活疫苗已被证明是安全有效的，其在不同地理区域的使用应以当地特定年龄的HAV血清阳性率为指导。本文旨在描述来自意大利北部高度工业化地区（伦巴第）的旅行者中HAV感染的年龄特异性血清流行病学。方法：744名年龄在20至59岁之间的连续旅行者，按10岁年龄组细分，在伦巴第地区的合作健康中心采集血样，并检测血清中的HAV IgG抗体。向旅行者发放了一份调查问卷，调查饮食习惯和既往旅行史。结果：20 - 29岁、30 - 39岁、40 - 49岁和50 - 59岁年龄组的抗HAV血清阳性率分别为18.0%、58.0%、75.8%和89.5%。年龄是抗HAV血清阳性率的唯一最重要决定因素。多变量分析排除了既往旅行、食用贝类或摄入自种蔬菜的影响。结论：在伦巴第地区（意大利北部），特定年龄的抗HAV血清阳性率远高于其他西欧国家报告的水平。成本效益分析表明，1960年后出生的旅行者在接种疫苗前无需进行血清学筛查。然而，只要有可能，建议对1960年前出生的旅行者进行HAV血清学筛查。但是，老年受试者疾病的严重性以及HAV疫苗在免疫受试者中已证实的安全性，可能建议在由于时间不足或检测设施不可用而无法进行血清学调查时，立即进行HAV疫苗接种而无需事先筛查。
