Liver and Bile

J Hepatol. 2023;79(1):61–68

Caminada S, Mele A, Ferrigno L, Alfonsi V, Crateri S, Iantosca G, Sabato M, Tosti ME; SEIEVA Collaborating Group

Risk of parenterally transmitted hepatitis following exposure to invasive procedures in Italy: SEIEVA surveillance 2000–2021

Background and aims: Surgical interventions and invasive diagnostic/therapeutic procedures are known routes of transmission of viral hepatitis. Using data from the Italian surveillance system for acute viral hepatitis (SEIEVA), the aim of this study was to investigate the association between specific types of invasive procedures and the risk of acute hepatitis B (HBV) and hepatitis (HCV) virus infections.
Methods: Data from SEIEVA (period 2000–2021) were used. The association between acute HBV and HCV infection and potential risk factors, i.e. surgical interventions and diagnostic/therapeutic procedures (given according to the ICD-9-CM classification), was investigated in comparison to age-matched hepatitis A cases, used as controls, by conditional multiple logistic regression analysis.
Results: A total of 8176 cases with acute HBV, 2179 with acute HCV, and the respective age-matched controls with acute hepatitis A virus infection were selected for the main analysis. Most of the procedures evaluated were associated with the risk of acquiring HBV or HCV. The strongest associations for HBV infection were: gynecological surgery (odds ratio [OR] = 5.19; 95% confidence interval [CI]: 1.12–24.05), otorhinolaryngological surgery (OR = 3.78; 95% CI: 1.76–8.09), and cardiac/thoracic surgery (OR = 3.52; 95% CI: 1.34–9.23); while for HCV infection, they were: neurosurgery (OR = 11.88; 95% CI: 2.40–58.85), otorhinolaryngological surgery (OR = 11.54; 95% CI: 2.55–52.24), and vascular surgery (OR = 9.52; 95% CI: 3.25–27.87). Hepatitis C was also strongly associated with ophthalmological surgery (OR = 8.32; 95% CI: 2.24–30.92). Biopsy and/or endoscopic procedures were significantly associated with both HCV (OR = 3.84; 95% CI: 2.47–5.95) and, to a lesser extent, HBV infection (OR = 1.48; 95% CI: 1.16–1.90).

Conclusions: Despite the progress made in recent years, invasive procedures still represent a significant risk factor for acquiring parenterally transmitted hepatitis viruses, thus explaining the still numerous and unexpected cases diagnosed among the elderly population in Italy. These results underline the importance of observing universal precautions to control the iatrogenic transmission of hepatitis viruses.

M.E. Tosti, Istituto Superiore di Sanità, National Center for Global Health, Rome, Italy, E-Mail:

DOI: 10.1016/j.jhep.2023.03.002

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