Prevalence of antibodies against hepatitis C virus in the elderly: a seroepidemiological study in a nursing home and in a open population

Abstract: Background: The prevalence of antibodies against hepatitis C virus (anti-HCV) increases in the general population with advancing age. Several discrepancies exist in the epidemiology of HCV, however, when selected elderly population groups are tested. Objective: To evaluate the HCV prevalence in two groups of elderly people living in the same geopgraphical area of northeast Italy, i.e., one including residents of a nursing home, the other including subjects living at home. Methods:The overall sample included 496 subjects (mean age 79.31 +/- 8.9 years); 288 were in a nursing home, and 208 were living at home. Enrollment in the latter group was based on all subjects over 65 years old listed under the public health service in the same district. The overall rate of adhesion to the study was 90%. Each subject was administered an anonymous questionnaire testing sociodemographic data and risk factors for HCV infection. Serological tests included: anti-HCV and hepatitis B virus serum markers. Multiple logistic regression analysis was performed to evaluate risk factors for anti-HCV positivity. Results: Anti HCV positivity was found in 34 of 288 (11.8%) elderly in the nursing home and in 23 of 208 (11.1%) in the open population. When the total population was considered, females exhibited a significantly a higher prevalence of anti-HCV than males (13.4 vs. 7.5%, p < 0.05). In both males and females, the highers rate of anti-HCV prevalence was found among the 75- to 79-year-old subjects. A decline in anti-HCV prevalence was observed in the very old subjects lover 80 years of age). None of the anti-HCV-positive subjects was found to be coinfected with hepatitis B surface antigen. However, multiple logistic regression analysis identified the age group between 70 and 79 years, female gender, and positivity for antihepatitis B surface antigen and/or antihepatitis B core antigen as independent variables significantly associated with HCV prevalence. Conclusions: The prevalence of anti-HCV proved identical among elderly people living in the nursing home or at home, suggesting that nursing homes do not represent a risk factor for HCV infections; the significant association between HCV prevalence and antihepatitis B surface antigen and/or antihepatitis B core antigen positivi ty supports a common route of transmission of the two viruses; these findings would suggest that there was an epidemic of HCV infection during the Second World War and in the years immediately afterward

Prevalence of antibodies against hepatitis C virus the elderly: a seroepidemiological study in a nursing home and in an open population. T collaborative Group.

BACKGROUND: The prevalence of antibodies against hepatitis C virus (anti-HCV) increases in the general population with advancing age. Several discrepancies exist in the epidemiology of HCV, however, when selected elderly population groups are tested. OBJECTIVE: To evaluate the HCV prevalence in two groups of elderly people living in the same geopgraphical area of northeast Italy, i.e., one including residents of a nursing home, the other including subjects living at home. METHODS: The overall sample included 496 subjects (mean age 79.31 +/- 8.9 years); 288 were in a nursing home, and 208 were living at home. Enrollment in the latter group was based on all subjects over 65 years old listed under the public health service in the same district. The overall rate of adhesion to the study was 90%. Each subject was administered an anonymous questionnaire testing sociodemographic data and risk factors for HCV infection. Serological tests included: anti-HCV and hepatitis B virus serum markers. Multiple logistic regression analysis was performed to evaluate risk factors for anti-HCV positivity. RESULTS: Anti-HCV positivity was found in 34 of 288 (11.8%) elderly in the nursing home and in 23 of 208 (11.1%) in the open population. When the total population was considered, females exhibited a significantly a higher prevalence of anti-HCV than males (13.4 vs. 7.5%, p < 0.05). In both males and females, the highers rate of anti-HCV prevalence was found among the 75- to 79-year-old subjects. A decline in anti-HCV prevalence was observed in the very old subjects (over 80 years of age). None of the anti-HCV-positive subjects was found to be coinfected with hepatitis B surface antigen. However, multiple logistic regression analysis identified the age group between 70 and 79 years, female gender, and positivity for antihepatitis B surface antigen and/or antihepatitis B core antigen as independent variables significantly associated with HCV prevalence. CONCLUSIONS: The prevalence of anti-HCV proved identical among elderly people living in the nursing home or at home, suggesting that nursing homes do not represent a risk factor for HCV infections; the significant association between HCV prevalence and antihepatitis B surface antigen and/or antihepatitis B core antigen positivity supports a common route of transmission of the two viruses; these findings would suggest that there was an epidemic of HCV infection during the Second World War and in the years immediately afterwards

MF59\uae-adjuvanted influenza vaccine (Fluad\uae) in the elderly: greater immunogenicity against a heterovariant A/H3N2 strain, compared with split and virosomal vaccines

background and Aim: Influenza A/H3N2 infection emerged in 1968, causing a pandemic, and has subsequently undergone considerable antigenic and genetic variation. A/H3N2 strains have been associated with more severe epidemics than the other currently circulating influenza viruses (A/H1N1 and B), especially in vulnerable populations, such as the elderly with underlying medical conditions. MF59\u2122 adjuvant has been shown to enhance immunogenicity of subunit influenza vaccine for both homologous and heterologous influenza strains. Immunity against heterologous strains is of particular medical significance during influenza epidemics when mismatches between vaccine strains and circulating influenza viruses occur. This study aimed to confirm if the presence of MF59\u2122 in the vaccine formulation could improve immune responses against a heterovariant A/ H3N2 strain in elderly subjects with chronic conditions. methods: In a randomized, double-blind trial, elderly nursing home residents ( 6565 years of age) in North-east Italy received either an MF59\u2122 adjuvanted influenza vaccine (Sub/MF5 9 ; FLUAD\uae, Novartis Vaccines) , a split vaccine (Split; Mutagrip\uae, Pasteur Merieux MSD), or a virosomal vaccine (SVV; Inflexal-V\uae, Swiss Serum and Vaccine Institute) during the winter season of 1998/9 9 ; the majority of subjects had at least one underlying chronic disease, including a heart or lung condition or diabetes mellitus. Study vaccines contained the strains recommended by the WHO for 1998/99 Northern Hemisphere formulation (A/H3N2/Sydney/5/9 7 ; A/H1N1/ Beijing/262/95 and B/ Beijing/184/93). Blood samples were obtained pre-vaccination and at 4 weeks post-vaccination. Hemagglutination inhibition (HI) titres were measured against the A/H3N2 influenza antigen recommended for the 2006/07 vaccine formulation: A/H3N2/ Wisconsin/67/2005. Pre- and post-vaccination geometric mean antibody titres (GMTs), the post-vaccination mean-fold increase in HI antibodies (MFI), the number of subjects with protective HI titers ( 6540), and the number of subjects with a four-fold increase in post-vaccination titers were calculated. Sera from 199 subjects were available for analysis (Sub/MF59: n=7 2 ; Split: n=8 8 ; SVV: n=39). More than 80% of subjects in each vaccination group were over 75 years of age. The Split group included more healthy subjects compared with the Sub/MF59 and SVV groups (39.8%, 12.5% and 20.5%, respectively). There were no male subjects in the SVV group (vs. 6.9% in the Sub/MF59 and 27.3% in the Split group). results: No statistically significant differences in baseline GMTs were observed between vaccine groups. Post-vaccination HI antibody titres against the heterovariant A/H3N2 strain were significantly higher (p=0.02) in the Sub/MF59 group, compared with SVV and Split groups. Compared with Split and SVV vaccines, MF59\u2122 adjuvanted vaccine resulted in higher MFI (2.0, 2.0 and 3.1, respectively), and significantly greater proportions of subjects with at least a fourfold increase in antibody titers (27.3%, 23.1% and 41.7%, respectively, p=0.05). Seroprotective antibody levels were achieved by more vaccinees in the MF59\u2122 adjuvanted and split vaccine groups (79.2% and 78.4%, respectively) than in the virosomal group (56.4%). Conclusion: MF59\u2122 adjuvanted influenza vaccine induced higher HI antibody levels against a heterovariant A/H3N2 strain in this population of elderly people with chronic diseases, compared with conventional split and virosomal vaccines. These results confirm superior cross-reactive immunogenicity of MF59\u2122 adjuvanted influenza vaccines. Since A/H3N2 influenza viruses are epidemiologically highly relevant for the elderly population, the broader immunogenicity conferred by FLUAD\uae could be of particular clinical benefit in seasons where an antigenic mismatch occur