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Andani A, Bunge E, Kassianos G, Eeuwijk J, Mellou K, Van Damme P, Mukherjee P, Steffen R. Hepatitis A occurrence and outbreaks in Europe over the past two decades: A systematic review. J Viral Hepat 2023; 30:497-511. [PMID: 36825922 DOI: 10.1111/jvh.13821] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023]
Abstract
Hepatitis A (HA) is a vaccine-preventable liver disease with >170 million new cases occurring yearly. In recent outbreaks in the USA, hospitalization and case-fatality ratios were >60% and ~1%, respectively. In Europe, endemicity persists and outbreaks continue to occur. We performed a systematic literature review to understand the changes in HA occurrence in Europe over the past two decades. PubMed and Embase were systematically searched for peer-reviewed articles published between 1 January 2001 and 14 April 2021 using terms covering HA, 11 selected European countries, outbreaks, outcomes and HA virus circulation. Here, we focus on HA occurrence and outbreaks in the five countries with the largest population and the most comprehensive vaccination recommendations: France, Germany, Italy, Spain and the UK; 118 reports included data for these five European countries. Notification rates (≤9.7/100,000 population) and percentages of men among cases (≤83.0%) peaked in 2017. The number of person-to-person-transmitted cases and outbreaks decreased in children but increased in other risk groups, such as men who have sex with men (MSM). Sexually transmitted outbreaks in MSM clustered around 2017. Travel-related outbreaks were few; the proportion of travel-related cases decreased during the past two decades, while the number of domestic cases increased. Despite the existing risk-based vaccination recommendations, HA transmission shifted in proportions from travelers and children to other risk groups, such as MSM and older age groups. Because a substantial proportion of the European population is susceptible to HA, adherence to existing recommendations should be monitored more closely, and enhanced vaccination strategies should be considered.
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Affiliation(s)
| | - Eveline Bunge
- Pallas Health Research and Consultancy, Rotterdam, the Netherlands
| | | | - Jennifer Eeuwijk
- Pallas Health Research and Consultancy, Rotterdam, the Netherlands
| | | | | | | | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers' Health, University of Zurich, Zurich, Switzerland.,Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas, Houston, Texas, USA
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Akbulut UE, Arslan E. Hepatitis A Seroprevalence in Mogadishu, Somalia. J Trop Pediatr 2022; 68:6521071. [PMID: 35134249 DOI: 10.1093/tropej/fmac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The hepatitis A virus (HAV) is the most frequent global causes of vaccine-preventable viral hepatitis. Since Somalia is regarded as highly endemic for hepatitis A, the hepatitis A vaccine was not included in the World Health Organization's expanded immunization program. The purpose of this study was to determine the prevalence of hepatitis A infection in the Somalia capital, Mogadishu. METHODS The serological results of 1153 individuals presenting to the Mogadishu Training and Research Hospital between January 2019 and January 2021 were examined retrospectively to evaluate the presence of anti-HAV IgG and IgM. The seroprevalence of anti-HAV IgG and IgM was analyzed on the basis of age and sex. The seroprevalence of anti-HAV IgG was also compared among the 11-year age group. FINDINGS The seroprevalence of anti-HAV IgG and IgM did not vary significantly between the sexes. Overall, the seroprevalence of anti-HAV IgG was 67.6%. The percentage of seropositivity for anti-HAV IgG was highest in adults aged ≥41 years (88.9%) and lowest in children aged 1-2 years (29.4%). Estimated age at midpoint of population immunity was 5 years which is compatible high endemicity. In addition, a significant rate of hepatitis A infection was also observed in the adolescent age group. CONCLUSIONS This study confirms the high HAV endemicity in Mogadishu. These data will be useful towards planning preventive and control measures by improving the sanitation programs in Mogadishu. Furthermore, prospective studies are needed to confirm these findings and evaluate urban-rural heterogeneity.
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Affiliation(s)
- Ulas Emre Akbulut
- Department of Pediatrics, Somalia-Turkey Training and Research Hospital, Mogadishu, Somalia
| | - Ebubekir Arslan
- Department of Emergency, Somalia-Turkey Training and Research Hospital, Mogadishu, Somalia
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Affiliation(s)
- Ghaith Habboub
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
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Domínguez A, Forns X. ¿Es posible el control de los brotes de hepatitis A en hombres que tienen sexo con hombres? Rev Clin Esp 2020; 220:434-436. [DOI: 10.1016/j.rce.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 11/22/2022]
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Domínguez A, Forns X. Can hepatitis A outbreaks in men who have sex with men be controlled? Rev Clin Esp 2020; 220:434-6. [DOI: 10.1016/j.rceng.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Godoy P, Broner S, Manzanares-Laya S, Martínez A, Parrón I, Planas C, Sala-Farré MR, Minguell S, de Olalla PG, Jané M, Dominguez A. Outbreaks of hepatitis A associated with immigrants travelling to visit friends and relatives. J Infect 2015; 72:112-5. [PMID: 26404744 DOI: 10.1016/j.jinf.2015.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/08/2015] [Accepted: 09/13/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Pere Godoy
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Sonia Broner
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sandra Manzanares-Laya
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agencia de Salut Pública de Barcelona, Barcelona, Spain
| | - Ana Martínez
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ignasi Parrón
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Caritat Planas
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | | | - Sofia Minguell
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Patricia Garcia de Olalla
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agencia de Salut Pública de Barcelona, Barcelona, Spain
| | - Mireia Jané
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Angela Dominguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departamento de Salud Pública, Universidad de Barcelona, Barcelona, Spain
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Abstract
Vaccination directly protects vaccinated individuals, but it also has the potential for indirectly protecting the unvaccinated in a population (herd protection). Unintended negative consequences such as the re-manifestation of infection, mainly expressed as age shifts, result from vaccination programs as well. We discuss the necessary conditions for achieving optimal herd protection (i.e., high quality vaccine-induced immunity, substantial effect on the force of infection, and appropriate vaccine coverage and distribution), as well as the conditions under which age shifts are likely to occur. We show examples to illustrate these effects. Substantial ambiguity in observing and quantifying these indirect vaccine effects makes accurate evaluation troublesome even though the nature of these outcomes may be critical for accurate assessment of the economic value when decision makers are evaluating a novel vaccine for introduction into a particular region or population group. More investigation is needed to identify and develop successful assessment methodologies for precisely analyzing these outcomes.
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D'Andrea L, Pérez-Rodríguez FJ, de Castellarnau M, Manzanares S, Lite J, Guix S, Bosch A, Pintó RM. Hepatitis A virus genotype distribution during a decade of universal vaccination of preadolescents. Int J Mol Sci 2015; 16:6842-54. [PMID: 25815599 DOI: 10.3390/ijms16046842] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/23/2015] [Indexed: 12/12/2022] Open
Abstract
A universal vaccination program among preadolescents was implemented in Catalonia, Spain, during the period of 1999-2013 and its effectiveness has been clearly demonstrated by an overall significant attack rate reduction. However, reductions were not constant over time, and increases were again observed in 2002-2009 due to the occurrence of huge outbreaks. In the following years, in the absence of large outbreaks, the attack rate decreased again to very low levels. However, an increase of symptomatic cases in the <5 age group has recently been observed. This is an unexpected observation since children younger than 6 are mostly asymptomatic. Such a long vaccination campaign offers the opportunity to analyze not only the effectiveness of vaccination, but also the influence of the circulating genotypes on the incidence of hepatitis A among the different age groups. This study has revealed the emergence of genotype IC during a foodborne outbreak, the short-lived circulation of vaccine-escape variants isolated during an outbreak among the men-having-sex-with-men group, and the association of genotype IIIA with the increase of symptomatic cases among the very young. From a public health perspective, two conclusions may be drawn: vaccination is better at an early age, and the vaccination schedule must be complete and include all recommended vaccine doses.
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Martínez A, Broner S, Sala MR, Manzanares-Laya S, Godoy P, Planas C, Minguell S, Torner N, Jané M, Domínguez A, For The Study Of The Immune Status In Health Care TWG, Hepatitis A In Catalonia FTSO. Changes in the epidemiology of hepatitis A outbreaks 13 years after the introduction of a mass vaccination program. Hum Vaccin Immunother 2014; 11:192-7. [PMID: 25483535 DOI: 10.4161/hv.35861] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A hepatitis A+B vaccine vaccination program of 12-year-olds was introduced in Catalonia in 1998. The aim of this study was to investigate the evolution of hepatitis A outbreaks in Catalonia and estimate the preventable fraction of cases associated with outbreaks as a measure of the impact of the vaccination program. Hepatitis A outbreaks reported to the Health Department between 1991 and 2012 were analyzed. The incidence rates of outbreaks, outbreak-associated cases and hospitalizations were calculated. The preventable fraction (PF) and 95% confidence intervals (CI) were estimated for the whole study period (pre-vaccination and post-vaccination) and the post-vaccination period. One-hundred-eight (108) outbreaks (rate of 2.21 per 10(6) persons-year) were reported in the pre-vaccination period and 258 outbreaks (rate of 2.82 per 10(6) persons-year) in the post-vaccination period. The rate of cases associated with outbreaks was 1.52 per 10(5) persons-year in the pre-vaccination period and 1.28 per 10(5) persons-year in the post-vaccination period. Hospitalization rates were 0.08 and 0.75 per 10(6) persons-year, respectively. The number of person-to-person outbreaks whose index case was a school contact decreased in the post-vaccination period (aOR 2.72; 95%CI 1.35-5.48), but outbreaks whose index case was a man who has sex with men (MSM) or an immigrant increased. The PF of all outbreak-associated cases was 6.46% (95%CI 3.11-9.82) and the highest PF was in the 15-24 years age group (42.53%; 95%CI 29.30-55.75). In the 0-4 years age group, the PF was 18.35% (95%CI 9.59-27.11), suggesting a protective herd effect in unvaccinated subjects. Vaccination of immigrants traveling to endemic countries and MSM should be reinforced.
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Affiliation(s)
- Ana Martínez
- a Public Health Agency of Catalonia; Generalitat of Catalonia, Spain
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Vizzotti C, González J, Gentile A, Rearte A, Ramonet M, Cañero-Velasco MC, Pérez Carrega ME, Urueña A, Diosque M. Impact of the single-dose immunization strategy against hepatitis A in Argentina. Pediatr Infect Dis J 2014; 33:84-8. [PMID: 24352191 DOI: 10.1097/inf.0000000000000042] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND After a country wide outbreak occurred during 2003-2004, 1 dose of hepatitis A vaccine was introduced into Argentinian regular immunization schedule for all children aged 12 months in June 2005. The aim of this study was to assess the impact of this novel intervention. METHODS A longitudinal analysis was done of hepatitis A virus (HAV) infection rates reported to the National Epidemiological Surveillance System from 2000 to 2011. Occurrence of fulminant hepatic failure (FHF) and liver transplantation cases up to 2011 were also assessed. Incidence rates and clinical impact were compared between pre- and postvaccination periods (2000-2002 vs. 2006-2011). Notification rates were also compared by age groups and geographical regions. RESULTS Since 2006, an abrupt decline was observed in HAV infection rates, as well as in FHF and liver transplantation cases. The mean incidence rate of 7.9/100,000 in the postvaccination period represents a reduction of 88.1% (P < 0.001) when compared with the prevaccination period. Neither FHF nor liver transplantation due to HAV infection were observed since March 2007. Decline in incidence rates was evident in all geographical regions and all age groups but was higher in the prevaccination most affected areas and in young children. Although an absolute decrease was observed for cases and rates in all age groups, since 2006, a higher proportion of cases was observed in people >14 years of age. CONCLUSIONS The single-dose vaccination strategy has been highly effective for controlling HAV infection in all age groups till now in Argentina. Long-term surveillance will be critical to document the sustained success of this unique intervention.
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Affiliation(s)
- Carla Vizzotti
- From the *Ministerio de Salud de la Nación, Av. de 9 de Julio 1925 (C1073ABA); †INEI-ANLIS "Dr. Carlos Malbrán", Av. Vélez Sarsfield 563 (1281); and ‡Sociedad Argentina de Pediatría, C.A.B.A., Argentina
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Moreno-Pérez D, Álvarez García F, Arístegui Fernández J, Cilleruelo Ortega M, Corretger Rauet J, García Sánchez N, Hernández Merino A, Hernández-Sampelayo Matos T, Merino Moína M, Ortigosa del Castillo L, Ruiz-Contreras J. Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2014. An Pediatr (Barc) 2014; 80:55.e1-55.e37. [DOI: 10.1016/j.anpedi.2013.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 01/29/2023] Open
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Poovorawan K, Chattakul P, Chattakul S, Thongmee T, Theamboonlers A, Komolmit P, Poovorawan Y. The important role of early diagnosis and preventive management during a large-scale outbreak of hepatitis A in Thailand. Pathog Glob Health 2013; 107:367-72. [PMID: 24392680 DOI: 10.1179/2047773213y.0000000116] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Acute hepatitis A is a worldwide public health problem especially in developing countries. Recently, a large, community-wide outbreak of hepatitis A occurred in the northeast part of Thailand. METHODS Demographic and clinical data as well as blood samples were collected and analyzed from patients with acute hepatitis who attended the Buengkan Provincial Hospital from June to September 2012. About 1619 patients with clinical symptoms of hepatitis A visited the hospital during the outbreak which manifested in three waves. Blood samples were collected from 205 patients. RESULTS One hundred and seventy eight patients had hepatitis A confirmed by the presence of anti-hepatitis A virus (HAV) IgM and/or HAV-RNA. The sensitivities for anti-HAV IgM and HAV-RNA were 95·5% (170/178) and 61·8% (110/178), respectively. When HAV-RNA was combined with anti-HAV IgM test, this increased the diagnostic yield by 7·2% (8/111) in the early phase of the acute infection (less than 5 days). Investigation of the molecular structure of the detected viruses indicated that all of the infections were caused by HAV genotype IA. There were no fatalities from this outbreak. Rapid detection, health education, sanitation campaigns, and vaccination offered on a voluntary basis have steadily reduced the number of infected patients and stopped the outbreak. CONCLUSION Occasionally a large-scale outbreak of HAV genotype IA can occur. A combination of HAV-RNA and anti-HAV IgM tests can increase the diagnostic yield during the early phase of the acute infection. Early diagnosis and preventive management campaigns can slow down and stop the outbreak.
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Lazcano-Ponce E, Conde-Gonzalez C, Rojas R, DeAntonio R, Romano-Mazzotti L, Cervantes Y, Ortega-Barria E. Seroprevalence of hepatitis A virus in a cross-sectional study in Mexico: Implications for hepatitis A vaccination. Hum Vaccin Immunother 2013; 9:375-81. [PMID: 23291940 DOI: 10.4161/hv.22774] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Hepatitis A virus (HAV) remains a public health concern worldwide contributing to significant morbidity in developed and developing countries. This cross-sectional database study estimated the overall HAV seroprevalence and the seroprevalence by gender, age, region and socioeconomic status in Mexico. Between January and October 2010, serum samples collected during the National Health and Nutrition survey (ENSANUT 2006) were obtained from subjects aged 1-95 y. Subjects' gender, age, geographical region and socioeconomic status were extracted from the survey and compiled into a subset database by the Mexican National Institute of Public Health. Anti-HAV antibodies were measured using a chemiluminescent immunoassay. A total of 3658 subjects were included in the according-to-protocol cohort. Overall, the HAV seroprevalence was 84.2%. The HAV seroprevalence rates were similar between females (86.1%) and males (82.2%). The percentage of subjects seropositive for anti-HAV antibodies was highest in adults aged ≥ 20 y (96.9%), followed by adolescents aged 10-19 y (80.1%) and lowest in children aged 1-9 y (45.0%) (p < 0.0001). Regionally, the highest HAV seroprevalence rate was observed in the South (88.8%) followed by Central and Northern Mexico and Mexico City (p = 0.02). The HAV seroprevalence was similar between subjects of high socioeconomic (90.1%) status and of low socioeconomic status (86.6%). This study confirms the intermediate HAV endemicity in Mexico. Cost-effectiveness studies are necessary to evaluate the inclusion of an effective hepatitis A vaccine from a population-based perspective in addition to continuous efforts to improve hygiene and sanitation that have a substantial impact on the disease burden.
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Moreno-Pérez D, Álvarez García F, Arístegui Fernández J, Barrio Corrales F, Cilleruelo Ortega M, Corretger Rauet J, González-Hachero J, Hernández-Sampelayo Matos T, Merino Moína M, Ortigosa del Castillo L, Ruiz-Contreras J. Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2013. An Pediatr (Barc) 2013; 78:59.e1-27. [DOI: 10.1016/j.anpedi.2012.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/01/2012] [Indexed: 01/03/2023] Open
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Erhart LM, Ernst KC. The changing epidemiology of hepatitis A in Arizona following intensive immunization programs (1988-2007). Vaccine 2012; 30:6103-10. [PMID: 22835739 DOI: 10.1016/j.vaccine.2012.07.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/09/2012] [Accepted: 07/10/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Arizona had the highest hepatitis A incidence of any U.S. state during 1987-1997. In 1995, the first hepatitis A vaccines became available in the U.S. A series of hepatitis A vaccination policies and recommendations were implemented in 1996-2006. Our objective was to examine the shifting epidemiologic patterns in hepatitis A in Arizona from 1988 to 2007. METHODS Passive surveillance reports to the Arizona Department of Health Services were used to compare hepatitis A rates by age, race/ethnicity and geographic area, before and after widespread vaccination. Reported risk factors and possible sources of infection were compared for two time periods. Age-adjusted incidence during three periods was mapped. RESULTS Overall hepatitis A incidence in Arizona fell from 58 cases per 100,000 in 1988 to 2 per 100,000 in 2007. The proportion of reported cases among children dropped from 62% in 1994-1995 to 32% in 2006-2007. Racial/ethnic disparities between American Indians and non-Hispanic White populations have been eliminated. The geographic distribution of cases within the state has shifted. Earlier cases were likely to report contact with another hepatitis A case or childcare facilities, while later cases indicated recent international travel. CONCLUSION A major shift in the overall burden of hepatitis A and hepatitis A transmission has occurred in Arizona since the widespread implementation of immunization policies and the concomitant rise in vaccination rates in the state. Current transmission has shifted to older age groups and disparities by race/ethnicity are now highest in Hispanic populations. Future strategies to further reduce hepatitis A transmission may require broadening recommendations to include general adult populations without previous vaccination history.
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Affiliation(s)
- Laura M Erhart
- Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, AZ, USA
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Pintó RM, D'Andrea L, Pérez-Rodriguez FJ, Costafreda MI, Ribes E, Guix S, Bosch A. Hepatitis A virus evolution and the potential emergence of new variants escaping the presently available vaccines. Future Microbiol 2012; 7:331-46. [PMID: 22393888 DOI: 10.2217/fmb.12.5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hepatitis A is the most common infection of the liver worldwide and is fecal-orally transmitted. Its incidence tends to decrease with improvements in hygiene conditions but at the same time its severity increases. Hepatitis A virus is the causative agent of acute hepatitis in humans and belongs to the Hepatovirus genus in the Picornaviridae family, and it has very unique characteristics. This article reviews some molecular and biological properties that allow the virus to live in a very quiescent way and to build an extremely stable capsid that is able to persist in and out of the body. Additionally, the relationship between the genomic composition and the structural and antigenic properties of the capsid is discussed, and the potential emergence of antigenic variants is evaluated from an evolutionary perspective.
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Affiliation(s)
- Rosa M Pintó
- Enteric Virus Laboratory, School of Biology, University of Barcelona, Barcelona, Spain.
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Torner N, Broner S, Martinez A, Tortajada C, Garcia de Olalla P, Barrabeig I, Sala M, Camps N, Minguell S, Alvarez J, Ferrús G, Torra R, Godoy P, Dominguez A. Factors associated to duration of hepatitis a outbreaks: implications for control. PLoS One 2012; 7:e31339. [PMID: 22355358 PMCID: PMC3280286 DOI: 10.1371/journal.pone.0031339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 01/06/2012] [Indexed: 11/24/2022] Open
Abstract
Even though hepatitis A mass vaccination effectiveness is high, outbreaks continue to occur. The aim of this study was to investigate the association between duration and characteristics of hepatitis A outbreaks. Hepatitis A (HA) outbreaks reported between 1991 and 2007 were studied. An outbreak was defined as ≥2 epidemiologically-linked cases with ≥1 case laboratory-confirmed by detection of HA immunoglobulin M (IgM) antibodies. Relationships between explanatory variables and outbreak duration were assessed by logistic regression. During the study period, 268 outbreaks (rate 2.45 per million persons-year) and 1396 cases (rate 1.28 per 10(5) persons-year) were reported. Factors associated with shorter duration were time to intervention (OR = 0.96; 95% CI: 0.94-0.98) and school setting (OR = 0.39; 95% CI: 0.16-0.92). In person-to-person transmission outbreaks only time to intervention was associated with shorter outbreak duration (OR = 0.96; 95% CI: 0.95-0.98). The only variables associated with shorter outbreak duration were early administration of IG or vaccine and a school setting. Timely reporting HA outbreaks was associated with outbreak duration. Making confirmed HA infections statutory reportable for clinical laboratories could diminish outbreak duration.
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Affiliation(s)
- Nuria Torner
- Department of Health. Generalitat of Catalonia. Barcelona, Spain.
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Ciaccia MCC, Moreira RC, Ferraro AA, Lemos MF, Oba IT, Porta G. Epidemiological and serological aspects of hepatitis A among children and teenagers in the city of Santos: a cross-sectional study. SAO PAULO MED J 2012; 130:230-5. [PMID: 22965363 PMCID: PMC10619950 DOI: 10.1590/s1516-31802012000400005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 07/02/2011] [Accepted: 12/15/2011] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Viral hepatitis A is still a concern at public health level in Brazil and around the world, due both to the number of affected subjects and the possibility of complications in the acute forms. The Brazilian Ministry of Health estimates that at least 70% of this country's population has already had contact with the hepatitis A virus (HAV). The aim here was to discover the prevalence of serological markers for the hepatitis A virus among children and teenagers at daycare facilities, kindergartens and elementary schools in the city of Santos. DESIGN AND SETTING Cross-sectional study in kindergartens and elementary schools within the municipal education network in several regions of the city of Santos. METHOD Students' family members were surveyed using a questionnaire and 4,680 finger-prick blood samples were taken and assayed by means of the ELISA technique. RESULTS The general prevalence of anti-HAV IgG was 9.72% and, of these cases, 74.6% were reactive to anti-HAV IgM. There was higher prevalence of anti-HAV IgG among older children, females, children who played in streams, those whose homes were not connected to the sewage system, those whose parents had low education levels, those with low household income and those who did not live along the seashore. The prevalence of anti-HAV IgM peaked in the early years and subsequently fell, and it was lower on the hills and in the Northwestern Zone. CONCLUSION The general prevalence of serological markers for hepatitis A was low in Santos.
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Affiliation(s)
- Maria Célia Cunha Ciaccia
- Department of Pediatrics, Instituto da Criança, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Moreno-Pérez D, Álvarez García F, Arístegui Fernández J, Barrio Corrales F, Cilleruelo Ortega M, Corretger Rauet J, González-Hachero J, Hernández-Sampelayo Matos T, Merino Moína M, Ortigosa del Castillo L, Ruiz-Contreras J. Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2012. An Pediatr (Barc) 2012. [DOI: 10.1016/j.anpedi.2011.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Moreno-Pérez D, Álvarez García F, Aristegui Fernández J, Barrio Corrales F, Cilleruelo Ortega M, Corretger Rauet J, González-Hachero J, Hernández-Sampelayo Matos T, Merino Moína M, Ortigosa del Castillo L, Ruiz-Contreras J. Immunization schedule of the Spanish Association of Pediatrics: 2012 recommendations. An Pediatr (Barc) 2012; 76:43.e1-23. [DOI: 10.1016/j.anpedi.2011.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/14/2011] [Indexed: 12/23/2022] Open
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Pérez-Sautu U, Costafreda MI, Lite J, Sala R, Barrabeig I, Bosch A, Pintó RM. Molecular epidemiology of hepatitis A virus infections in Catalonia, Spain, 2005–2009: Circulation of newly emerging strains. J Clin Virol 2011; 52:98-102. [DOI: 10.1016/j.jcv.2011.06.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/10/2011] [Accepted: 06/24/2011] [Indexed: 01/16/2023]
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EFSA Panel on Biological Hazards (BIOHAZ). Scientific Opinion on an update on the present knowledge on the occurrence and control of foodborne viruses. EFSA J 2011; 9:2190. [PMID: 32313582 DOI: 10.2903/j.efsa.2011.2190] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
A review of the biology, epidemiology, diagnosis and public health importance of foodborne viruses was performed. Data needs to support a risk assessment were also identified. In addition possible control options and their anticipated impact to prevent or reduce the number of foodborne viral human infections were identified, including the scientific reasons for and against the establishment of food safety criteria and process hygiene criteria for viruses for certain food categories. Food may be contaminated by virus during all stages of the food supply chain, and transmission can occur by consumption of food contaminated during the production process (primary production, or during further processing), or contaminated by infected food handlers. Transmission of zoonotic viruses (e.g. HEV) can also occur by consumption of products of animal origin. Viruses do not multiply in foods, but may persist for extended periods of time as infectious particles in the environment, or in foods. At the EU-level it is unknown how much viral disease can be attributed to foodborne spread. The relative contribution of different sources (shellfish, fresh produce, food handler including asymptomatic shedders, food handling environment) to foodborne illness has not been determined. The Panel recommends focusing controls on preventive measures to avoid viral contamination rather than trying to remove/inactivate these viruses from food. Also, it is recommended to introduce a microbiological criteria for viruses in bivalve molluscs, unless they are labelled "to be cooked before consumption". The criteria could be used by food business operators to validate their control options. Furthermore, it is recommended to refine the regulatory standards and monitoring approaches in order to improve public health protection. Introduction of virus microbiological criteria for classification of bivalve molluscs production areas should be considered. A virus monitoring programme for compliance with these criteria should be risk based according to the findings of a sanitary survey.
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Tsou TP, Liu CC, Huang JJ, Tsai KJ, Chang HF. Change in hepatitis A epidemiology after vaccinating high risk children in Taiwan, 1995–2008. Vaccine 2011; 29:2956-61. [DOI: 10.1016/j.vaccine.2011.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/31/2011] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
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Abstract
A Hepatitis A vaccination programme of people belonging to risk groups begun in Catalonia in 1995 and a universal vaccination programme of pre-adolescents 12 years of age with the hepatitis A + B vaccine was added in 1998. The aim of the study was to investigate the characteristics of hepatitis A outbreaks occurring in Catalonia between 1991 and 2007 to determine the associated risk factors and optimize the use of vaccination. Incidence rates of outbreaks, cases and hospitalizations associated with outbreaks and the rate ratios (RR) of person-to-person transmission outbreaks between the periods before and after mass vaccination and their 95% confidence intervals (CI) were calculated. A rate of 2.45 outbreaks per million persons per year was found. The rate of cases affected in these outbreaks was 1.28 per 10(5) persons per year and the rate of hospitalizations was 0.45 per million persons per year. In person-to-person outbreaks, the highest incidence rate (5.26 and 6.33 per million persons per year) of outbreaks according to the age of the index case was in the 5 to 14 year age group in both periods (RR:0.83; 95% CI:0.48-1.43). A significant increase was observed in the 25 to 44 year age group (RR: 0.35; 95% CI 0.14-0.77). Hepatitis A vaccination has made an important impact on burden and characteristics of outbreaks and could provide greater benefits to the community if the vaccine was administrated to children during their first years of life.
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Affiliation(s)
- N Torner
- Department of Health, Generalitat of Catalonia, Catalonia.
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26
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Abstract
BACKGROUND The purpose of this study was to review documented outbreaks of gastrointestinal illness in schools, published in the last 10 years, to identify etiology, mode of transmission, the number of children affected, morbidity and mortality patterns, and interventions for control and prevention. METHODS Searches of electronic databases, public health publications, and federal, state, and provincial public health Web sites were completed. RESULTS Of the 121 outbreaks that met the inclusion criteria, 51% were bacterial, 40% viral, 7% were from Cryptosporidium, and 2% from multiple organisms. Transmission routes recorded in 101 reports included foodborne (45%), person-to-person (16%), waterborne (12%), and animal contact (11%). Actions to control outbreaks included alerting medical and public health authorities or the community to the outbreak (13%), treating cases (12%), enhancing hand washing (11%), and increased vigilance during food preparation (8%). Recommendations to prevent future outbreaks were compared with previously published studies that demonstrated effectiveness. CONCLUSIONS The risk of foodborne illness was reduced when food handlers practiced effective hand washing technique and received food safety training and certification. Student training programs on hand hygiene, enhanced cleaning and disinfection of the school, and hepatitis A vaccination were found effective. Children should be supervised on farm visits, hand washing strictly enforced, and food eaten in an area separated from the animals. Staff and students should have a positive, continuous communication with public health authorities including educational sessions and immediate reporting of possible outbreaks.
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Affiliation(s)
- Marilyn B Lee
- School of Occupational and Public Health, Ryerson University, 350 Victoria St., Toronto, Ontario, Canada N1E 3Y5.
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Singleton RJ, Hess S, Bulkow LR, Castrodale L, Provo G, McMahon BJ. Impact of a statewide childhood vaccine program in controlling hepatitis A virus infections in Alaska. Vaccine 2010; 28:6298-304. [PMID: 20637769 DOI: 10.1016/j.vaccine.2010.06.113] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 06/11/2010] [Accepted: 06/30/2010] [Indexed: 11/21/2022]
Abstract
Historically, Alaska experienced cyclic hepatitis A virus (HAV) epidemics, and the HAV rate among Alaska Native people was significantly higher than among other racial/ethnic groups. We evaluated the impact of universal childhood vaccination, initiated in 1996, on HAV epidemiology in Alaska by analyzing HAV cases reported to the State of Alaska. HAV incidence in all age groups declined 98.6% from 60.0/100,000 in 1972-1995 to 0.9/100,000 in 2002-2007. The largest decrease (99.9%) was in Alaska Native people, whose incidence (0.3) in 2002-2007 was lower than the overall U.S. 2007 rate (1.0). Among age groups, the decrease (99.8%) among children aged 0-14 years was the largest. Routine childhood vaccination has nearly eliminated HAV infection in Alaska.
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Abstract
Human communities defend themselves against specific infectious agents in a way that extends beyond the simple sum of the immune status of its individuals. By analogy with individual immunity to specific agents, the community level of immunity may vary from complete susceptibility to full protection. Herd immunity has been used to name this community property, which is the result of evolution through natural selection, leading to relationships between two species, typical of prey-predator systems. Varying uses of the term herd immunity led to the use of other expressions, such as herd protection, herd effect and community immunity. Knowledge derived from observational studies and models on herd immunity has supported decisions on the choice of vaccines and vaccination strategies for the benefit of populations. This knowledge is most likely to be extended in the future, with far-reaching effects.
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Affiliation(s)
- Guilherme Gonçalves
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University Porto, Largo Prof. Abel Salazar, n2, 4099-003 Porto, Portugal.
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Affiliation(s)
- Sang Hoon Park
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hallym University College of Medicine, Korea.
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31
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Bernaola Iturbe E, Giménez Sánchez F, Baca Cots M, De Juan Martín F, Diez Domingo J, Garcés Sánchez M, Gómez-Campderá A, Martinón-Torres F, Picazo J, Pineda Solás V. Calendario vacunal de la Asociación Española de Pediatría: Recomendaciones 2009. An Pediatr (Barc) 2009; 70:72-82. [DOI: 10.1016/j.anpedi.2008.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 10/08/2008] [Indexed: 10/20/2022] Open
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Abstract
Over the last few decades, different types of inactivated hepatitis A virus (HAV) vaccines have been developed: several aluminum-adjuvanted vaccines and an aluminum-free, virosome-formulated vaccine. Both types of vaccines are whole-virus preparations that are produced by growth of HAV strains in human diploid cell cultures and are subsequently inactivated with formaldehyde. This review summarizes all published papers on a virosome-formulated vaccine, Epaxal, based on formalin inactivated HAV (strain RG-SB) adsorbed to the surface of special liposomes (virosomes), that replace aluminum hydroxide as the adjuvant principle. A single injection of virosomal HAV vaccine is well tolerated and highly immunogenic, with 88-97% of seroprotection 2 weeks after a first dose. HAV virosomal vaccine can be administered concomitantly with other vaccines, without inducing antigenic competition. Direct comparison with aluminum-adsorbed vaccine has shown that the immunogenicity was similar, but fewer local reactions were reported with Epaxal. Recent studies in children have demonstrated that Epaxal Junior is also an excellent HAV vaccine for mass vaccination programs.
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Affiliation(s)
- Patrick A Bovier
- Department of Community and Primary Care Medicine, Geneva University Hospitals, Switzerland.
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Domínguez A, Oviedo M, Carmona G, Jansá JM, Borrás E, Salleras L, Plasència A. Epidemiology of hepatitis A before and after the introduction of a universal vaccination programme in Catalonia, Spain. J Viral Hepat 2008; 15 Suppl 2:51-6. [PMID: 18837835 DOI: 10.1111/j.1365-2893.2008.01030.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A universal vaccination program for preadolescents, aged 12 years, with the hepatitis A + B vaccine was introduced in 1998 in Catalonia (Spain) with the aim of protecting the whole population against hepatitis A. The hepatitis A + B vaccine program replaced the hepatitis B vaccination program for preadolescent started in 1991. The impact of the hepatitis A + B vaccination program was studied by assessment of the trend of reported cases of hepatitis A. All cases of viral hepatitis reported from 1992 to 2006 were included in the study. To evaluate changes in the epidemiology of hepatitis A, two periods were considered: a prevaccination period (1992-1998) and a post-vaccination period (2001-2006). The ratios of the rates were calculated according to age and sex. The comparison of rates and proportions was made by calculation of the normal z statistic. A total of 7536 cases of viral hepatitis were reported, of which 4109 (54.52%) were hepatitis A. The incidence rate of hepatitis A fell from 5.44 per 100 000 person-years in the prevaccination period to 3.02 in the post-vaccination period. In males, the rate fell from 6.85 to 3.89 and in females from 4.10 to 2.18. The male-female ratio of incidence rates was lower in the post-vaccination period. In males the global decline of incidence rate was 43.26% and in females 46.96%. The greatest decline occurred in the 15 to 19 years age group in both sexes (79.1% in men and 78.34% in women) but declines in the 10-14 years age group were also very important (69.21% and 67.88%, respectively). In conclusion, hepatitis A incidence fell in Catalonia in the post-vaccination period in vaccinated adolescents and also in other unvaccinated groups who have benefited from the indirect effects of the vaccination program.
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Affiliation(s)
- A Domínguez
- Department of Public Health, University of Barcelona, Barcelona, Spain.
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Oviedo M, Pilar Muñoz M, Domínguez A, Borras E, Carmona G. A statistical model to estimate the impact of a hepatitis A vaccination programme. Vaccine 2008; 26:6157-64. [PMID: 18804511 DOI: 10.1016/j.vaccine.2008.08.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 07/18/2008] [Accepted: 08/30/2008] [Indexed: 01/22/2023]
Abstract
A program of routine hepatitis A+B vaccination in preadolescents was introduced in 1998 in Catalonia, a region situated in the northeast of Spain. The objective of this study was to quantify the reduction in the incidence of hepatitis A in order to differentiate the natural reduction of the incidence of hepatitis A from that produced due to the vaccination programme and to predict the evolution of the disease in forthcoming years. A generalized linear model (GLM) using negative binomial regression was used to estimate the incidence rates of hepatitis A in Catalonia by year, age group and vaccination. Introduction of the vaccine reduced cases by 5.5 by year (p-value<0.001), but there was a significant interaction between the year of report and vaccination that smoothed this reduction (p-value<0.001). The reduction was not equal in all age groups, being greater in the 12-18 years age group, which fell from a mean rate of 8.15 per 100,000 person/years in the pre-vaccination period (1992-1998) to 1.4 in the vaccination period (1999-2005). The model predicts the evolution accurately for the group of vaccinated subjects. Negative binomial regression is more appropriate than Poisson regression when observed variance exceeds the observed mean (overdispersed count data), can cause a variable apparently contribute more on the model of what really makes it.
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Affiliation(s)
- Manuel Oviedo
- CIBER Epidemiología y Salud Pública (CIBERESP), Parc de Recerca Biomèdica de Barcelona, c/Dr. Aiguadé 88, Barcelona, Spain.
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Stein-Zamir C, Shoob H, Nubani N, Zentner G. Hepatitis A in Jerusalem—The exception that proves the rule? Vaccine 2008; 26:5241-3. [DOI: 10.1016/j.vaccine.2008.07.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 07/18/2008] [Indexed: 11/26/2022]
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