1. UNIVERSAL IMMUNIZATION OF HEPATITIS B IN ITALY Newborns of HBsAg + mothers at birth Infants of HBsAg - mothers at 3 months of age Children 12 years old

2. HBV vaccination is strongly recommended and offered free of charge for high risk groups such as: Households of HBsAg carriers Healthcare workers Polytransfused patients Dialysis patients Drug addicts Male homosexuals

3. HEPATITIS B VACCINATION COVERAGE AMONG HEALTHCARE WORKERS IN ITALY. 1996 Geographical areaN° of subjects Coverage studied (%) Ferrara (North) 903 77.6 a Rome (Center) 1327 67.7 b Naples (South) 927 44.3 c Total 3157 64.5 a vs cP < 0.01 b vs cP < 0.01 Stroffolini et al. Infect. Control Hosp Epidemiol. 1998

4. Characteristics associated with HB vaccination acceptance among healthcare workers in Italy. Adjusted O.R. derived by multiple logistic regression analysis CharacteristicVaccineO.R.(C.I. 95%) coverage(%) Age (years): > 50 41.9 1 36 - 50 58.81.8(1.4 - 2.3) 20 - 35 85.65.3(3.7 - 7.6) Years of employment: > 10 55.2 1 6 - 10 74.31.2(0.9 - 1.5) < 6 84.21.9(1.4 - 2.7) Stroffolini et al. Infect. Control Hosp. Epidemiol. 1998

5. Proportion of acute hepatitis B cases in Italy reporting the risk factor “ Household of HBsAg + carrier”*. 1987- 2001 % Year * 28% of these subjects were aware of the carrier condition of the cohabitant, but were not vaccinated.

6. The natural cycle of HBsAg carriage Mother HBsAg+ Newborn HBV infected Newborn HBsAg+ chronic carrier Female Male

7. IMMUNIZATION POLICY FOR NEWBORNS OF HBsAg + MOTHERS Immunoglobulins within 24 h after birth PLUS Vaccine within 7 days after birth

8. Effectiveness of hepatitis B vaccination in newborns of HBsAg positive mothers in Italy, 2001 N°% Pregnant women selected 11858 Pregnant women screened for HBsAg 10881 (91.8) Pregnant women found HBsAg+ 182 (1.7) Infants immunized 172 (95.0) Stroffolini et al, Vaccine (In Press)

9. Factors associated with not adherence to HBsAg screening among pregnant women in Italy. Adjusted Odds Ratios derived by multiple logistic regression analysis. CharacteristicO.R.(C.I. 95%) Geographic area Italy 1 Foreign2.0 (1.3 - 3.0) Age (years) 15 - 34 1 > 341.0(0.8 - 1.4) Years of schooling > 8 1 < 81.0(0.8 - 1.2) Number of subjects in the household < 4 1 > 43.5(2.7 - 4.6) Hospital Public 1 Private1.9(1.3 - 2.8)

10. Prevalence of HBsAg among pregnant women in Italy by area of birth, 2001. Area of N. positive/ birth N. screened (%) Italy 139/9929 (1.4) Eastern Europe Asia, Africa, Central and South America 35/597 (5.9) Unknown 8/355(2.3) Total182/10881 (1.7)

11. Effectiveness of hepatitis B vaccination in newborns of HBsAg positive mothers in Italy, by area of birth of the mother, 2001 ItalianForeign Percentage of women93.0 % 88.0 % screened for HBsAg Percentage of newborns of92.8 % 100 % HBsAg+ mothers immunized Overall effectiveness86.6 % 87.5 %

12. Effectiveness of hepatitis B vaccination in newborns of HBsAg positive mothers in Italy, 2000 N° % Infants vaccinated 522 Infants infected ( Anti-HBc+) 17 (3.3) Infants Anti-HBc+ alone 14* (2.7) Infants chronic carriers (HBsAg+/Anti-HBc+) 3** (0.6) Immunized children were exposed for 5-14 years to HBsAg+ mothers * None was HBV-DNA positive by PCR ** All were HBV-DNA positive by PCR Mele et al. J. Infect. Dis. 2001