188 Infection 29 · 2001 · No. 4 © URBAN & VOGEL Infection Clinical and Epidemiological Study Hepatitis B Virus Infection in Native versus Immigrant or Adopted Children in Italy Following the Compulsory Vaccination R. Giacchino, L. Zancan, P. Vajro, G. Verucchi, M. Resti, C. Barbera, A. Maccabruni, M. Marcellini, F. Balli, A. Cascio, G. Nebbia, C. Crivellaro, F. Bortolotti, M.G. Clemente, P. Bragetti, P. Valentini, N. Mazzoni, G. Losurdo, E. Cristina Abstract Background: Compulsory vaccination of children against hepatitis B virus (HBV) infection was introduced in Italy in 1991. Patients and Methods: To evaluate the current importance of pediatric HBV infection, we studied 359 HBsAg-positive children admitted to 16 centers in Italy from 1991 to 1998. 185 patients were natives of Italy and 174 (39 immigrants and 135 adopted) came from highly endemic countries (eastern Europe: 60.9%, Asia: 16.7%, Africa: 14.9% and Central and South America: 5.7%). Results: Transaminase levels were moderately altered in both Italian (mean 134 UI/l) and foreign children (mean 168 UI/l). In total, 77% of Italian children and 88% of foreign children tested HBeAg positive. High transaminase levels and HBeAg positivity were more frequent in adopted children. Follow-up of 317 patients showed that the incidence of HBeAg/anti-HBe serum conversion was similar in all cohorts, but in adopted children it occurred at an earlier age and was associated with HBsAg clearance in 5%. Conclusion: HBV is not frequent in Italian children today, but it is common among children coming from highly endemic areas. The vaccination of nonimmune native populations must be strongly recommended. Key Words Hepatitis B virus hepatitis · Adopted children · Immigrant · HBV vaccination Infection 2001; 29: 188–191 DOI 10.1007/s15010-001-1146-2 Introduction In Italy, hepatitis B virus (HBV) infection was a serious prob- lem in children until the 1980s. Vertical transmission and household spread were the main contagion modalities, with subsequent HBV hepatitis and chronic liver disease. On the basis of Italian epidemiological data and the natural history of hepatitis, a study was carried out in different Italian pedi- atric centers in the early 1980s which showed HBV to be the cause of over 90% of hospitalizations for chronic hepatitis [1]. Thereafter, the incidence of HBV infection in children decreased considerably. Favorable factors included the widespread use in many Italian regions of HBsAg screen- ing in pregnant women, passive prophylaxis for the off- spring of HBsAg-positive mothers with specific im- munoglobulins (since 1980), associated anti-HBV vaccina- tion for the same category of newborns (since 1983) and vaccination of families at risk. An Italian comparative sero- epidemiologic study (1979 vs 1989) showed a reduction of HBV-infected children (18% vs 1.3%; p < 0.001), especially Raffaela Giacchino (corresponding author), G. Losurdo, E. Cristina Infectious Diseases Unit, ”Giannina Gaslini”Children’s Hospital, Largo G. Gaslini 5, I-16147 Genova, Italy; Phone: (+39/010) 5636220, Fax: -3776590; e-mail: raffaellagiacchino@ospedale-gaslini.ge.it L. Zancan Clinic of Pediatrics, Padova, Italy P. Vajro Dept of Pediatrics, Napoli, Italy G. Verucchi Institute of Infectious Diseases; Bologna, Italy M. Resti Dept of Pediatrics, Firenze, Italy C. Barbera Dept of Pediatric Sciences,Torino, Italy A. Maccabruni Clinic of Infectious Diseases, Pavia, Italy M. Marcellini Hepatology, Bambin Gesù, Rome, Italy F. Balli Clinic of Pediatrics, Modena, Italy A. Cascio Infectious Pathology and Virology, Palermo, Italy G. Nebbia Clinic of Pediatrics, Milano, Italy C. Crivellaro O. Monselice, Padova, Italy F. Bortolotti Dept. of Clinical Experimental Medicine, Padova, Italy M. G. Clemente Clinic of Development Age, Cagliari, Italy P. Bragetti Clinic of Pediatrics, Perugia, Italy P. Valentini Clinic of Pediatrics, Cattolica University, Roma, Italy N. Mazzoni Clinic of Pediatrics, Ancona, Italy Received: September 20, 2000 • Revision accepted: March 26, 2001