Vaccination Campaign against Hepatitis B Virus in Italy: A History of Successful Achievements

Advancing hepatitis B elimination: A systematic review of global immunization progress and future directions

The World Health Organization (WHO) has set a target of eliminating viral hepatitis B and C by 2030. Vaccination against hepatitis B (HepB) remains the most effective strategy for controlling and eliminating Hepatitis B Virus (HBV) infection. The development of HepB vaccines started with plasma-derived vaccines, which have since been largely replaced by safer and more effective recombinant vaccines, now considered the gold standard for preventing HBV infections. More recently, mRNA-based vaccines have emerged as a promising platform. This study aims to review and provide an up-to-date comparative analysis of the characteristics, efficacy, effectiveness, and the impact of variants of concern across 17 HepB vaccines. It also highlights the global progress of HepB vaccination, with 191 implementing HepB vaccination for the entire country, and an estimated HBV prevalence of 0.7 % among children under 5 years in 2022. This achievement is driven by the strong safety profiles, high immunogenicity, and robust efficacy of current vaccines, which have demonstrated minimal side effects. Nevertheless, challenges persist in certain populations that do not respond adequately to vaccination. Here, we report the updated guidelines and propose strategies to improve the effectiveness of HepB vaccination for these specific populations.

HBV and HCV testing outcomes among marginalized communities in Italy, 2019-2024: a prospective study

Background

The health of the marginalized populations is crucial for public health and inequalities. The World Health Organization (WHO) Global Hepatitis Report 2024 stated that over 304 million people were living with Hepatitis B Virus (HBV)/Hepatitis C Virus (HCV) infection in 2022. We performed HBV/HCV screenings among marginalized communities to reveal hidden infections and link-to-care positive participants.

Methods

From January 2019 to May 2024, finger-prick tests were used to conduct on-site screenings at non-profit organizations in Tuscany, Italy. Positive participants were referred to the closest outpatient clinic.

Findings

Eighty/1812 (4.4%) participants were Hepatitis B surface Antigen (HBsAg)+, mostly men (p < 0.001) and non-Italian natives compared to those HBsAg- (p < 0.001). Fifty-two/1812 (2.9%) were anti-HCV+ with a higher proportion of Italians (p < 0.001) and lower education level (p < 0.01) compared to the anti-HCV-. Intravenous drug use was an independent factor for being anti-HCV+ (p < 0.0001). Among the HBsAg + individuals, 66.3% (53/80) were linked and 90.4% (48/53) retained in care (treated/monitored). Of the anti-HCV participants requiring clinical evaluation, 37.8% (14/37) were linked to care, and all the 11/14 (88.6%) viremic patients were successfully treated.

Interpretation

We found higher HBV/HCV positivity compared to national prevalences. Participation and linkage to care were successful. The young mean age (33.6 yrs) of HBsAg + individuals, primarily from regions with low vaccinal adherence, indicated geographical origin as a key risk factor. HCV positivity was associated with extreme marginality. The results stress the need to implement marginalized groups screening to target HBV/HCV hidden infections, reducing disparities in healthcare and advancing towards the WHO 2030 elimination goal.

Funding

Gilead Sciences; Fondazione Cassa di Risparmio di Pistoia e Pescia; Regione Toscana.

Current Progress in Vaccines against Merkel Cell Carcinoma: A Narrative Review and Update

Merkel cell carcinoma is a rare, aggressive skin cancer that mainly occurs in elderly and immunocompromised patients. Due to the success of immune checkpoint inhibition in MCC, the importance of immunotherapy and vaccines in MCC has increased in recent years. In this article, we aim to present the current progress and perspectives in the development of vaccines for this disease. Here, we summarize and discuss the current literature and ongoing clinical trials investigating vaccines against MCC. We identified 10 articles through a PubMed search investigating a vaccine against MCC. From the international clinical trial database Clinical.Trials.gov, we identified nine studies on vaccines for the management of MCC, of which seven are actively recruiting. Most of the identified studies investigating a vaccine against MCC are preclinical or phase 1/2 trials. The vaccine principles mainly included DNA- and (synthetic) peptide-based vaccines, but RNA-based vaccines, oncolytic viruses, and the combination of vaccines and immunotherapy are also under investigation for the treatment of MCC. Although the management of MCC is changing, when compared to times before the approval of immune checkpoint inhibitors, it will still take some time before the first MCC vaccine is ready for approval.

HBV in Italian Women's Jail: An Underestimated Problem?

BACKGROUND

There is little information regarding the hepatitis B virus (HBV), vaccination status, and hepatitis B exposure in Italian women's jails. We aimed to describe the HBV exposure and HBs antibody (anti-HBs) protection levels in female prisoners.

MATERIAL AND METHODS

A retrospective multicentric study was performed in Italian prisons from 2021 to 2023. Univariate and multivariate analyses were conducted to identify risk factors for HBc antibody (anti-HBc) seropositivity and non-protective anti-HBs titer.

RESULTS

We included 156 patients. The median age was 41.0 (IQR 34.0-48.0). Of the studied subjects, 31 (19.9%) had anti-HBc positive titer. Two women were HBsAg positive. In the multivariate analysis, older age [OR 1.06 (CI 1.01-1.11), p = 0.011], North-Eastern European [OR 11.67 (3.29-41.30), p < 0.001] and African origin [OR 6.92 (CI 1.51-31.60), p = 0.013], and drug use [OR 6.55 (CI 1.96-21.9), p = 0.002] were risk factors for HBV exposure. Thirty-seven (32%) women had no history of HBV vaccination. Forty-four (38%) had an anti-HBs non-protective titer. In the multivariate analysis, North-Eastern European origin [OR 4.55 (CI 1.19-17.50), p = 0.027] was associated with unprotective anti-HBs titer.

CONCLUSION

Our results show both the low prevalence of HBV and protection in female prisoners. Age, North-Eastern European and African origin, and drug use have a role in exposure risk to HBV.