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Medić S, Anastassopoulou C, Pustahija T, Petrović V, Dragnić N, Boufidou F, Tsakris A, Šaponjić V. Epidemiological Transition and Strategies for the Control of Hepatitis A in Serbia. Viruses 2023; 15:v15030753. [PMID: 36992462 PMCID: PMC10056894 DOI: 10.3390/v15030753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/27/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Improvements in socioeconomic and hygienic conditions during the past decades led to declining hepatitis A (HA) seroprevalence in many countries. Aiming at informing HA vaccination policy, we assessed current epidemiological trends in Serbia by analyzing surveillance data for 2002–2021. Methods: Data on cases and outbreaks were obtained from the Serbian national surveillance database and descriptively analyzed. HA incidence was calculated in relation to time, patients’ residence, and demographics. Results: Overall, 13,679 HA cases and 419 outbreaks were recorded with the highest incidence in the southeast. Downward HA trends were observed, while infant mortality was halved, and gross domestic product based on purchasing power parity (GDP PP) per capita, tripled. The average incidence dropped from 14.8 (95% CI 14.4–15.2)/100,000) in 2002–2006 to 1 (95% CI 0.9–1.1)/100,000)/100,000 in 2017–2021, while the number of outbreaks decreased (from 174 to 14). Sporadic cases and family clusters living in poor sanitary conditions occurred in recent years. The contact route of transmission was dominant (410/419, 97.9%). The highest average age-specific HA incidence shifted from 5–9 years in 2002–2006 to 10–19 years in 2017–2021.Serbia is transitioning towards very low HA endemicity. Enhanced surveillance and vaccination of high-risk groups are recommended as future public health priorities.
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Affiliation(s)
- Snežana Medić
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Futoška 121, 21000 Novi Sad, Serbia
- Correspondence: ; Tel.: +381-21-4897-800
| | - Cleo Anastassopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Tatjana Pustahija
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Futoška 121, 21000 Novi Sad, Serbia
| | - Vladimir Petrović
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Futoška 121, 21000 Novi Sad, Serbia
| | - Nataša Dragnić
- Department of Social Medicine and Health Statistics with Informatics, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
- Center for Informatics and Biostatistics, Institute of Public Health of Vojvodina, Futoška 121, 21000 Novi Sad, Serbia
| | - Fotini Boufidou
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vladan Šaponjić
- Institute of Public Health of Serbia, “Dr Milan Jovanović Batut”, Belgrade, Dr Subotića 5, 11000 Belgrade, Serbia
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Seroprevalence Trends and Molecular Epidemiology of Viral Hepatitis in Croatia. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010224. [PMID: 36676173 PMCID: PMC9865277 DOI: 10.3390/life13010224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/26/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
Viral hepatitis is a significant cause of morbidity and mortality worldwide. In Croatia, hepatitis B virus (HBV) and hepatitis C virus (HCV) are widely distributed, especially in some high-risk groups such as people who inject drugs (PWID), prisoners, and highly promiscuous groups. The seroprevalence of HBV ranges from 7.0% in the general population to 38.8% in PWID, depending on the region. The seroprevalence of HCV is highest among PWID (29-75.5%) as compared to 0.9% in the general population. Analyzing the distribution of HCV genotypes, no substantial changes in the molecular epidemiology of the two most frequent HCV genotypes (1 and 3) in the past 20 years were observed. However, the predominance of subtype 1b compared to subtype 1a as detected in 1996-2005 was not confirmed in 2008-2015. Hepatitis A virus (HAV) incidence was high in the past with a decreasing trend since the 2000s, except for an outbreak in 2017-2018 as part of the large European outbreak, which was mainly among men who have sex with men. Hepatitis E virus (HEV) is an emerging virus detected for the first time in Croatia in 2012. The seroprevalence of HEV is high among hemodialysis patients (27.9%) and liver transplant recipients (19.3-24.4%). In addition, higher seroprevalence rates were observed in animal-related professions (e.g., veterinarians, 15.2%; hunters, 14.9%). All detected HEV strains belonged to genotype 3.
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Badur S, Öztürk S, AbdelGhany M, Khalaf M, Lagoubi Y, Ozudogru O, Hanif K, Saha D. Hepatitis A in the Eastern Mediterranean Region: a comprehensive review. Hum Vaccin Immunother 2022; 18:2073146. [PMID: 35617508 PMCID: PMC9621081 DOI: 10.1080/21645515.2022.2073146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction With 583 million inhabitants, the Eastern Mediterranean Region (EMR) is a worldwide hub for travel, migration, and food trade. However, there is a scarcity of data on the epidemiology of the hepatitis A virus (HAV). Methods The MEDLINE and grey literature were systematically searched for HAV epidemiological data relevant to the EMR region published between 1980 and 2020 in English, French, or Arabic. Results Overall, 123 publications were extracted. The proportion of HAV cases among acute viral hepatitis cases was high. HAV seroprevalence rate ranged from 5.7% to 100.0% and it was decreasing over time while the average age at infection increased. Conclusion In the EMR, HAV remains a significant cause of acute viral hepatitis. The observed endemicity shift will likely increase disease burden as the population ages. Vaccinating children and adopting sanitary measures are still essential to disease prevention; vaccinating at-risk groups might reduce disease burden even further.
What is the context?
Hepatitis A is a viral liver disease caused by the hepatitis A virus. It is generally transmitted by ingestion of contaminated food or water or through contact with an infected person. Disease severity increases with age. Children under 6 years of age are usually asymptomatic, while adults are the most affected. Limited information exists on the number of cases and transmission of hepatitis A in the Eastern Mediterranean region, which includes 21 countries and Palestine, as defined by the World Health Organization.
What is new?
We performed a literature review to summarize data on hepatitis A disease in the Eastern Mediterranean region over the last 40 years (1980-2020). As information for many countries is scarce or outdated, most of the data is from Egypt, Iran and Saudi Arabia. We found that:
Hepatitis A virus is the most common cause of acute viral hepatitis. Hepatitis A exposure varied according to the country’s income level. Low- and middle-income countries showed a universal immunity to hepatitis A virus, although this is not the case anymore.
What is the impact?
Hepatitis A infections have decreased worldwide. Lower exposure to the virus has led to an increase in the susceptible population (including adolescent and adults). Hepatitis A vaccination for children and high-risk groups such travelers should be considered in the Eastern Mediterranean region.
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Hernandez-Suarez G, Saha D, Lodroño K, Boonmahittisut P, Taniwijaya S, Saha A, Badur S, Poovorawan Y. Seroprevalence and incidence of hepatitis A in Southeast Asia: A systematic review. PLoS One 2021; 16:e0258659. [PMID: 34851983 PMCID: PMC8635355 DOI: 10.1371/journal.pone.0258659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A previous review on hepatitis A virus (HAV) seroprevalence in 2005 categorized Southeast Asia as a low HAV endemicity region. In 2010, the World Health Organization modified this from low to low/medium endemicity, pointing out that these estimates were based on limited evidence. Since then, there has been no attempt to review HAV epidemiology from this region. We conducted a systematic review of literature to collect information on HAV incidence and seroprevalence in select countries in the Southeast Asian region, specifically, The Association of Southeast Asian Nations over the last 20 years. METHODOLOGY This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. From the relevant articles, we extracted data and conducted a risk of bias assessment of individual studies. RESULTS The search yielded 22 and 13 publications on HAV seroprevalence and incidence, respectively. Overall, our findings point to a very low HAV endemicity profile in Thailand and Singapore and evidence of a shift towards low HAV endemicity in Indonesia, Lao People's Democratic Republic, Malaysia, the Philippines, and Vietnam. Only Singapore, Thailand, Malaysia, and the Philippines have existing HAV disease surveillance and reported incidence rates below 1 per 100,000. Several outbreaks with varying magnitude documented in the region provide insights into the evolving epidemiology of HAV in the region. Risk of bias assessment of studies revealed that the individual studies were of low to medium risk. CONCLUSIONS/SIGNIFICANCE The available HAV endemicity profiles in Southeast Asian countries, aside from Thailand, are limited and outdated, but suggest an endemicity shift in the region that is not fully documented yet. These findings highlight the need to update information on HAV epidemiology through strengthening of disease surveillance mechanisms to confirm the shift in HAV endemicity in the region.
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Affiliation(s)
| | - Debasish Saha
- GSK, Medical & Clinical Emerging Markets, Wavre, Belgium
| | - Kris Lodroño
- GSK, Medical Affairs Philippines, Manila, The Philippines
| | | | | | | | - Selim Badur
- GSK, Medical & Clinical Emerging Markets, Istanbul, Turkey
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Prevalence of Anti-Hav IgG Antibodies in the Population of the Łódź Macroregion by Age Group. POLISH HYPERBARIC RESEARCH 2021. [DOI: 10.2478/phr-2021-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Over the last several decades, a gradual decrease in the incidence of hepatitis A and an increase in the population of non-immune people, especially in the group of young people have been observed in Poland. The aim of this study was to assess of the presence of specific anti-hepatitis A virus IgG class antibodies (anti-HAV IgG) in relation to age among non-vaccinated hepatitis A patients. There were statistically significantly more patients up to 45 years of age with anti-HAV IgG negative results than those over 45 years of age, and the Fi-square correlation coefficient (Φ2) was 0.263 between the analyzed variables. The data analysis shows that the number of people with specific IgG antibodies against hepatitis A increases with age. The risk of hepatitis A infection in people under 45 is high due to widespread seronegativity in this age group.
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Kareem N, Al-Salahat K, Bakri FG, Rayyan Y, Mahafzah A, Sallam M. Tracking the Epidemiologic Shifts in Hepatitis A Sero-Prevalence Using Age Stratification: A Cross-Sectional Study at Jordan University Hospital. Pathogens 2021; 10:pathogens10091081. [PMID: 34578114 PMCID: PMC8468970 DOI: 10.3390/pathogens10091081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
The study of hepatitis A virus (HAV) epidemiology and sero-prevalence has important public health implications. Changes in the epidemiology of hepatitis A can result in a larger pool of susceptible persons in countries with improved sanitation and hygienic conditions if vaccination is not provided. The aim of this study was to investigate the prevalence of HAV immunoglobulin G (IgG) in Jordan. In addition, we aimed to identify the potential differences in HAV sero-prevalence based on age, among other variables. We recruited the study participants at Jordan University Hospital in Amman, Jordan, during October 2020-June 2021. Assessment of participants' socio-demographic variables was done using a paper-based questionnaire. Testing for HAV IgG was based on a competitive enzyme linked immunosorbent assay (ELISA). The study population comprised 360 individuals with a median age of 18 years. The overall sero-prevalence of HAV in our study sample was 38.3%. Divided by age, the sero-prevalence of HAV was 8.2%, 12.3%, and 20.8% among individuals aged 10 years or less, 15 years or less, and 30 years or less, respectively. The estimated age at mid-population immunity was between 21 and 30 years. Besides age, individuals residing outside the Central region of Jordan had a significantly higher HAV sero-prevalence. Additionally, the use of filtered municipal water was associated with a lower sero-prevalence of HAV compared with the use of unfiltered municipal water among individuals aged 15 years or less. The results of this study suggest an intermediate to low endemicity of HAV in Jordan. An epidemiologic shift of HAV sero-prevalence with a declining rate of positivity for HAV IgG was noticed in this study. This highlights the importance of the recently introduced HAV vaccination in Jordan. Future research to evaluate the public health benefits of HAV vaccination in Jordan is recommended.
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Affiliation(s)
- Nariman Kareem
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (N.K.); (K.A.-S.); (A.M.)
| | - Khaled Al-Salahat
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (N.K.); (K.A.-S.); (A.M.)
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Faris G. Bakri
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (F.G.B.); (Y.R.)
- Infectious Diseases and Vaccine Center, The University of Jordan, Amman 11942, Jordan
| | - Yaser Rayyan
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (F.G.B.); (Y.R.)
- Gastroenterology and Liver Division, Department of Internal Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Azmi Mahafzah
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (N.K.); (K.A.-S.); (A.M.)
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (N.K.); (K.A.-S.); (A.M.)
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Correspondence: ; Tel.: +962-79-184-5186
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Riess M, Enkirch T, Sundqvist L, Lundberg Ederth J. High impact of molecular surveillance on hepatitis A outbreak case detection in Sweden: a retrospective study, 2009 to 2018. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2021; 26. [PMID: 33663645 PMCID: PMC7934221 DOI: 10.2807/1560-7917.es.2021.26.9.1900763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundSwedish hepatitis A surveillance includes sequence-based typing, but its contribution to outbreak detection in relation to epidemiological investigations has not been fully evaluated.AimTo evaluate the role of sequence-based typing in hepatitis A outbreak detection and to describe the hepatitis A epidemiology in Sweden to improve surveillance.MethodsWe retrospectively investigated hepatitis A virus sequences of 447 cases notified in Sweden 2009-18. We performed a phylogenetic analysis of evolutionary distances to identify cases with similar virus sequences (≥ 459/460 identical nt in the VP1/P2A junction). Unique sequences, dyads and sequence-based clusters (SBCs) were identified. We linked non-sequenced cases by epidemiological information and retrospectively assessed the value of typing for outbreak identification.ResultsFifty-five percent (n = 542/990) of the notified hepatitis A cases were referred to the Public Health Agency of Sweden for typing and 447 (45%) were sequenced successfully. Subgenotypes included IA (42.5%, n = 190), IB (42.7%, n = 191) and IIIA (14.8%, n = 66). Phylogenetic analysis identified 154 unique sequences, 33 dyads (66 cases) and 34 SBCs (227 cases). The combination of molecular and epidemiological data revealed 23 potential outbreaks comprising 201 cases. Cases were linked by sequence (59%, n = 118), epidemiological data (11%, n = 23) or both (30%, n = 60). Typing was needed to identify 15 of 23 potential outbreak signals.ConclusionSequence-based typing contributed substantially to detecting clustering cases and identifying outbreaks in Sweden. The results show routine sequence-based typing detects outbreaks, promotes timely outbreak investigations and facilitates international collaboration.
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Affiliation(s)
- Maximilian Riess
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden.,Public Health Agency of Sweden, Department of Microbiology, Solna, Sweden
| | - Theresa Enkirch
- Public Health Agency of Sweden, Department of Microbiology, Solna, Sweden
| | - Lena Sundqvist
- Public Health Agency of Sweden, Department of Communicable Disease Control and Health Protection, Solna, Sweden
| | - Josefine Lundberg Ederth
- Public Health Agency of Sweden, Department of Public Health Analysis and Data Management, Solna, Sweden
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Mihai IF, Manciuc C, Hunea IM, Lacatusu GA, Leonte GE, Luca S, Harja-Alexa IA, Vata A, Luca MC. Enterically transmitted hepatitis in the third millennium in northeastern Romania. Exp Ther Med 2021; 21:274. [PMID: 33603881 DOI: 10.3892/etm.2021.9705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/27/2020] [Indexed: 11/05/2022] Open
Abstract
While the incidence of hepatitis A virus (HAV) infections has decreased in the last few years, the incidence of hepatitis E virus (HEV) is increasing in developed countries. Both infections remain a worldwide reality, strongly related to socio-economic conditions. We retrospectively analyzed the medical files of patients with viral hepatitis hospitalized in the Infectious Disease Hospital Iasi, Romania between 2018 and 2019. The serological confirmed cases of HAV and HEV infections were included in the analysis; included in our analysis were 269 HAV-infected patients. The most affected were males (53.9% cases) aged between 8 and 15 years (53.6% cases). Severe infections were recorded at admission in 2.24% cases and evolution was favorable under supportive and symptomatic treatment. Only three adult males, with no recent history of travel, were confirmed with HEV infection. Even though we have identified a small number of cases, recent studies performed in our region found a seroprevalence of 32.5% in the general population, possibly related to zoonotic transmission. While outbreaks of HAV infection are still noted in our region, a lack of hospitalized HEV-infected patients suggest that most cases are asymptomatic or underdiagnosed. HEV infection remains an underreported disease, possibly due to misdiagnosis, subclinical or dual hepatitis infection, but with a significant risk in vulnerable categories, such as pregnant women or immunosuppressed patients.
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Affiliation(s)
- Ioana Florina Mihai
- Department of Infectious Diseases, 'Sf. Parascheva' Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania.,Department of Infectious Diseases, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Carmen Manciuc
- Department of Infectious Diseases, 'Sf. Parascheva' Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania.,Department of Infectious Diseases, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioana Maria Hunea
- Department of Infectious Diseases, 'Sf. Parascheva' Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania.,Department of Infectious Diseases, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Georgiana Alexandra Lacatusu
- Department of Infectious Diseases, 'Sf. Parascheva' Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Georgiana Enache Leonte
- Department of Infectious Diseases, 'Sf. Parascheva' Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania.,Department of Infectious Diseases, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Stefana Luca
- Department of Infectious Diseases, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioana Alina Harja-Alexa
- Department of Infectious Diseases, 'Sf. Parascheva' Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania.,Department of Infectious Diseases, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andrei Vata
- Department of Infectious Diseases, 'Sf. Parascheva' Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania.,Department of Infectious Diseases, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihaela Catalina Luca
- Department of Infectious Diseases, 'Sf. Parascheva' Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania.,Department of Infectious Diseases, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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Dimitriou P, Nikolopoulos GK, Koliou M, Constantinou E, Azina C, Panayiotou M, Christaki E. An Outbreak of Hepatitis A among Young Adult Men in Cyprus. Pathogens 2020; 9:pathogens9110979. [PMID: 33238551 PMCID: PMC7700564 DOI: 10.3390/pathogens9110979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Outbreaks of acute hepatitis A (AHA) have recently been reported in Europe among men who have sex with men (MSM). The aim of this work was to evaluate, for the first time, trends in the reported cases of AHA in Cyprus over the last seven years. Methods: We retrospectively studied all people reported with AHA in Cyprus between January 2013 and December 2019. Demographic data, type of transmission, vaccination status for HAV, laboratory and clinical data were analyzed. Results: The asnalysis involved 33 AHA cases (age 32.7 ± 17.4 years, 78.8% males). An increase in AHA reports was observed between July 2017 and June 2018 when more than a third (n = 13) of the cases of the period 2013–2019 were reported. The reporting rate of AHA doubled from 0.52 cases per 100,000 population (before July 2017) to 1.12 cases per 100,000 population (July 2017–June 2018). The male/female (M/F) ratio increased from one in 2013 to eight in 2018. Conclusion: An increase in AHA reports occurred in Cyprus between July 2017 and June 2018. Many cases with AHA in that period were MSM. Enhanced surveillance and timely public health interventions, like vaccination and awareness promotion, are important for preventing future outbreaks.
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Affiliation(s)
- Panagiotis Dimitriou
- Department of Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.A.); (E.C.)
| | - Georgios K. Nikolopoulos
- Medical School, University of Cyprus, 2029 Nicosia, Cyprus;
- Correspondence: ; Tel.: +357-22-895223
| | - Maria Koliou
- Unit for Surveillance and Control of Communicable Diseases, Medical and Public Health Services, Ministry of Health, 1448 Nicosia, Cyprus; (M.K.); (E.C.)
| | - Elisavet Constantinou
- Unit for Surveillance and Control of Communicable Diseases, Medical and Public Health Services, Ministry of Health, 1448 Nicosia, Cyprus; (M.K.); (E.C.)
| | - Chara Azina
- Department of Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.A.); (E.C.)
| | | | - Eirini Christaki
- Department of Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.A.); (E.C.)
- Medical School, University of Cyprus, 2029 Nicosia, Cyprus;
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Maltezou HC, Theodora M, Lytras T, Fotiou A, Nino E, Theodoridou M, Rodolakis A. Knowledge, attitudes and practices about vaccine-preventable diseases and vaccinations of children among pregnant women in Greece. Vaccine 2020; 38:7654-7658. [PMID: 33077302 DOI: 10.1016/j.vaccine.2020.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/27/2020] [Accepted: 10/02/2020] [Indexed: 01/05/2023]
Abstract
Vaccine hesitancy has been recognized by the World Health Organization as one of ten threats to public health globally in 2019. Pregnant women constitute an extremely important group for the study of knowledge and attitudes towards pediatric vaccinations. This is a cross-sectional survey conducted in two maternity hospitals in Athens. A standardized questionnaire was used. A total of 814 pregnant women with a mean age of 33.1 years and a mean gestational age of 24.4 weeks were studied. Overall, 717 (89%) of 804 pregnant women reported that they intend to vaccinate their baby in accordance with the National Vaccination Program, 7 (1%) that they do not, while 80 (10%) reported that they have not decided yet. The women provided a mean of 11.4 correct replies out of 14 questions about vaccine-preventable diseases and vaccines (mean knowledge score: 81.5%). A pediatrician has been recognized as the source for information about vaccines in most cases (611/809, 75.5%), while in 215 (26.6%) the internet was also used. Overall, pregnant women trusted physicians about information for vaccines ("very much trusted" in 55.9% and "quite trusted" in 40% of cases). Lastly, 642 (81%) women agreed with the statement "vaccinations should be mandatory for school entry" while 70 (9%) women agreed with the statement "parents should have the right to refuse their children vaccinations". A multivariate analysis found that a gestational age of ≤20 weeks (OR = 2.33, CIs: 1.27-4.28, p-value = 0.006), having another child (OR = 4.44, CIs: 2.30-8.58, p-value < 0.001), a history of influenza vaccination (OR = 2.54, CIs = 1.37-4.71, p-value = 0.003), and a higher knowledge score about vaccine-preventable diseases and vaccines (OR = 1.33, CIs: 1.23-1.45, p-value < 0.001) were significantly associated with an increased probability to get their child vaccinated in accordance with the National Vaccination Program.
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Affiliation(s)
- Helena C Maltezou
- Directorate for Epidemiological Surveillance and Interventions of Infectious Diseases, National Public Health Organization, Athens, Greece.
| | - Marianna Theodora
- First Department of Obstetrics and Gynecology, University of Athens, Alexandra General Hospital, Athens, Greece
| | - Theodore Lytras
- Department of Database Design, Statistics and Data Management, National Public Health Organization, Athens, Greece
| | - Aikaterini Fotiou
- Neonatal Department, Elena Venizelou Maternity Hospital, Athens, Greece
| | - Emily Nino
- Neonatal Department, Elena Venizelou Maternity Hospital, Athens, Greece
| | - Maria Theodoridou
- First Department of Pediatrics, University of Athens, Aghia Sophia Children Hospital, Athens, Greece
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, University of Athens, Alexandra General Hospital, Athens, Greece
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Nicolay N, Le Bourhis-Zaimi M, Lesourd A, Martel M, Roque-Afonso AM, Erouart S, Etienne M, Ndeikoundam Ngangro N. A description of a hepatitis A outbreak in men who have sex with men and public health measures implemented in Seine-Maritime department, Normandy, France, 2017. BMC Public Health 2020; 20:1441. [PMID: 32962667 PMCID: PMC7510153 DOI: 10.1186/s12889-020-09499-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/03/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In 2016-2017, a European-wide circulation of genotype IA hepatitis A virus was responsible for hepatitis A outbreaks in men who have sex with men (MSM). This study aimed to describe the outbreak investigation in Seine-Maritime department (France) and the control measures implemented accordingly. METHODS Outbreak description used data from mandatory reporting and enhanced surveillance of male cases. Confirmed case was genotype IA isolated, possible cases had no reported genotype information. Targeted control measures included communication on sexual practices at risk of hepatitis A transmission and two vaccination campaigns in April 2017 and January 2018. Characteristics of cases and vaccinees were described. We reported the best communication channel for relaying outbreak information and control measures based on the monitoring of social network activities and feedback from vaccinees. RESULTS During the outbreak period (December 2016 to December 2017), a total of 48 confirmed outbreak cases and 30 possible outbreak cases were notified. Among them, 69 were male (88%). Two epidemic waves were observed. Cases encountered their partners through gay-dating apps (54%) and in one specific sauna (62%). In response to the outbreak, two vaccination campaigns were deployed. A total of 156 MSM were vaccinated, of whom 56 in a truck parked beside the sauna. Most of the vaccinees had been informed about the campaign through dating apps (44%). Community-based organizations involved in sexual health promotion and other gay social media were very proactive in sharing information about the outbreak and promoting the vaccination campaign through their social media account and also on site (gay venues). Vaccinees reported the same sexual practices at risk of hepatitis A transmission as cases. CONCLUSIONS In response to this massive hepatitis A outbreak that affected mostly MSM in Seine-Maritime department, vaccination campaign remained the cornerstone of prevention. Prevention officers from the community-based organization played a key role in vaccination promotion. Gay-dating apps and outdoor sessions of vaccination allowed to effectively reach MSM. Cost-effectiveness studies might analyze the interest of a continuous sexual health promotion including vaccination against hepatitis A in MSM through dating apps and social networks.
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Affiliation(s)
- Nathalie Nicolay
- Santé publique France, French national public health agency, Normandy regional office, 76100, Rouen, France. .,European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 16973, Solna, Sweden.
| | - Maggie Le Bourhis-Zaimi
- Santé publique France, French national public health agency, Normandy regional office, 76100, Rouen, France
| | - Anais Lesourd
- Infectious and Tropical Diseases Department, Rouen University Hospital, 76000, Rouen, France
| | - Mélanie Martel
- Santé publique France, French national public health agency, Normandy regional office, 76100, Rouen, France
| | | | | | - Manuel Etienne
- Infectious and Tropical Diseases Department, Rouen University Hospital, 76000, Rouen, France.,Normandie Univ, UNIROUEN, UNICAEN, GRAM 2.0, 76000, Rouen, France
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12
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Origin of HAV strains responsible for 2016-2017 outbreak among MSM: Viral phylodynamics in Lazio region. PLoS One 2020; 15:e0234010. [PMID: 32470049 PMCID: PMC7259881 DOI: 10.1371/journal.pone.0234010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/15/2020] [Indexed: 12/31/2022] Open
Abstract
In Europe HAV infection occurs mainly among specific risk groups, such as consumers of specific food. Sexual transmission of HAV has been demonstrated, particularly among Men-Who-Have-Sex-With-Men (MSM), causing MSM-specific outbreaksin Europe. Here we report a molecular epidemiologic and phylodynamic analysis on HAV sequences in Lazio (central Italy)to identify genetic background and the phylogenetic relations, and test the HAV infection dynamics during a large outbreak through phylodynamic model.Among all HAV sequences found during 2013-2018 in Lazio, low genetic diversity was observed in HAV population in 2016 and 2017, along with high frequenciesVRD_521_2016and RIVM-HAV16-090, suggesting a large expansion event of viral population. The initial expansion of both VRD_521_2016 and RIVM-HAV16-090 clusters dated back to 2012 (95% HPD:2006-2015). During the2016-2017outbreak in Lazio region, the Re peaked around mid-2016, with a value of 1.73 (95% HPD: 1.03-2.37), consistent with incidence trend of AHA cases in Lazio between 2016 and mid-2017. This study showed the magnitude of HAV outbreak in Lazio during 2016-2017, demonstrating the epidemic continuity to MSM-specific outbreak in Europe. The HAV dataset is available on interactive phylodynamic platform https://nextstrain.org to real-time update of future outbreaks.
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13
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Shah N, Faridi M, Mitra M, Bavdekar A, Karadkhele A, Puppalwar G, Jain R. Review of long term immunogenicity and tolerability of live hepatitis A vaccine. Hum Vaccin Immunother 2020; 16:2816-2821. [PMID: 32243237 DOI: 10.1080/21645515.2020.1741997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hepatitis A represents one of the major public health problems worldwide including India. Vaccination is the most effective way to prevent hepatitis A infection. Two types of hepatitis A vaccines-live attenuated (H2 strain) and inactivated (killed) are available for use in clinical practice in India with former having advantage of a single-dose compared to two-dose killed vaccine. One of the important characteristic of an ideal vaccine includes its ability to provide life-long protection. In this article we reviewed the available long-term (≥10 years follow-up) published data on live attenuated hepatitis A (H2 strain) vaccine. The data from country of origin of the vaccine (China) and India establish the long-term immunogenicity, protection, and tolerability. Based on the results of several clinical trials showing long-term protection, single dose of live attenuated hepatitis vaccine can be widely used to protect high-risk population against hepatitis A virus infection and related complications.
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Affiliation(s)
- Nitin Shah
- Pediatrics Department, PD Hinduja Hospital , Mumbai, India
| | - Mma Faridi
- Pediatrics Department, ERA's Lucknow Medical College & Hospital , Lucknow, India
| | - Monjori Mitra
- Pediatrics Department, Institute of Child Health , Kolkata, India
| | | | | | | | - Rishi Jain
- Medical Affairs Department, Wockhardt Ltd ., Mumbai, India
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14
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Vaccination Programs for Adults in Europe, 2019. Vaccines (Basel) 2020; 8:vaccines8010034. [PMID: 31968652 PMCID: PMC7157239 DOI: 10.3390/vaccines8010034] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background: While all European countries implement vaccination programs for children, there are gaps in terms of vaccination programs for adults. Methods: We studied the 2019 vaccination policies for adults in 42 European countries. Results: Vaccination programs for adults were in place in all countries. However, there were considerable differences between countries in terms of number of vaccinations, target populations and frame of implementation (recommended or mandatory vaccinations). In particular the following vaccination policies were in place: influenza (42 countries), tetanus (31), diphtheria (30), pneumococcus (29), hepatitis B (20), pertussis (18), measles (14), human papilloma virus (14), meningococcus tetravalent A,C,W,Y (14), rubella (13), hepatitis A (11), mumps (11), poliomyelitis (10), herpes zoster (9), varicella (8), tick-born encephalitis (8), meningococcus B (6), rabies (6), Haemophilus influenzae type b (5), tuberculosis (3), typhoid fever (3), meningococcus C (2), and yellow fever (1). Seventeen countries implement mandatory vaccinations, mainly against diphtheria, tetanus and hepatitis B. Conclusions: There are significant differences in vaccination programs for adults in Europe. Routine vaccination programs for adults need to be strengthened. A consensus-based vaccination program is needed.
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15
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Sun XJ, Zhang GM, Zhou RJ, Zheng H, Miao N, Yin ZD, Wang FZ. Changes in the epidemiology of hepatitis A in three socio-economic regions of China, 1990-2017. Infect Dis Poverty 2019; 8:80. [PMID: 31578150 PMCID: PMC6775660 DOI: 10.1186/s40249-019-0591-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/22/2019] [Indexed: 01/13/2023] Open
Abstract
Background Hepatitis A (HepA) vaccination and economic transitions can change the epidemiology of HepA. China’s Gross Domestic Product (GDP) per capita was known to be inversely associated with the incidence of HepA, but a deeper understanding of the epidemiology of HepA in different socio-economic regions is lacking. We compare the changing epidemiology of HepA in three socioeconomic-geographic regions of China. Methods We obtained data on all HepA cases reported through the National Notifiable Disease Reporting System and assessed trends and changes in age-specific incidence rates by age quartile and season. We categorized the country into three regions, the sequential years into five era, compared the incidence, quartile age, seasonal intensity and coverage of HepA of the three regions. Linear regression was performed to analyse trends in incidence of HepA and to analyse the association between coverage and incidence. Results The annual mean incidences of HepA in the eastern, central, and western regions decreased from 63.52/100 000, 50.57/100 000 and 46.39/100 000 in 1990–1992 to 1.18/100 000, 1.05/100 000 and 3.14/100 000 in 2012–2017, respectively. Decreases in incidence were seen in all age groups in the three regions; the incidence was highest (9.3/100 000) in the youngest age group (0–4 years) of the western region, while in the central region, the age group with the highest incidence changed from 0 to 9 years to adults ≥60 years old. In 2017, the median age of HepA cases was 43 years (Q1–Q3: 33–55), 47 years (Q1–Q3: 32–60) and 33 years (Q1–Q3: 9–52) in the eastern, central, and western provinces, respectively. Seasonal peaks became smaller or were nearly elimination nationwide, but seasonality persisted in some provinces. After the Expanded Program on Immunization (EPI) included HepA vaccine into the routine schedule in 2007, HepA coverage increased to > 80% in the three regions and was negatively association with the HepA incidence. Conclusion The incidence of HepA decreased markedly between 1990 and 2017. A socioeconomic inequity in coverage of HepA vaccine was almost eliminated after HepA vaccine was introduced into China’s EPI system, but inequity in incidence still existed in lower socio-economic developed region. Electronic supplementary material The online version of this article (10.1186/s40249-019-0591-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiao-Jin Sun
- National Immunization Programme, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Beijing, 100050, China
| | - Guo-Min Zhang
- National Immunization Programme, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Beijing, 100050, China
| | - Rong-Jun Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Hui Zheng
- National Immunization Programme, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Beijing, 100050, China
| | - Ning Miao
- National Immunization Programme, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Beijing, 100050, China
| | - Zun-Dong Yin
- National Immunization Programme, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Beijing, 100050, China
| | - Fu-Zhen Wang
- National Immunization Programme, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Beijing, 100050, China.
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16
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Beauté J, Westrell T, Schmid D, Müller L, Epstein J, Kontio M, Couturier E, Faber M, Mellou K, Borg ML, Friesema I, Vold L, Severi E. Travel-associated hepatitis A in Europe, 2009 to 2015. ACTA ACUST UNITED AC 2019; 23. [PMID: 29871720 PMCID: PMC6152172 DOI: 10.2807/1560-7917.es.2018.23.22.1700583] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Travel to countries with high or intermediate hepatitis A virus (HAV) endemicity is a risk factor for infection in residents of countries with low HAV endemicity. Aim: The objective of this study was to estimate the risk for hepatitis A among European travellers using surveillance and travel denominator data. Methods: We retrieved hepatitis A surveillance data from 13 European Union (EU)/ European Economic Area (EEA) countries with comprehensive surveillance systems and travel denominator data from the Statistical Office of the European Union. A travel-associated case of hepatitis A was defined as any case reported as imported. Results: From 2009 to 2015, the 13 countries reported 18,839 confirmed cases of hepatitis A, of which 5,233 (27.8%) were travel-associated. Of these, 39.8% were among children younger than 15 years. The overall risk associated with travel abroad decreased over the period at an annual rate of 3.7% (95% confidence interval (CI): 0.7–2.7) from 0.70 cases per million nights in 2009 to 0.51 in 2015. The highest risk was observed in travellers to Africa (2.11 cases per million nights). Cases more likely to be reported as travel-associated were male and of younger age (< 25 years). Conclusion: Travel is still a major risk factor for HAV infection in the EU/EEA, although the risk of infection may have slightly decreased in recent years. Children younger than 15 years accounted for a large proportion of cases and should be prioritised for vaccination.
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Affiliation(s)
- Julien Beauté
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Therese Westrell
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Daniela Schmid
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | | | | | - Mia Kontio
- National Institute for Health and Welfare, Helsinki, Finland
| | | | | | - Kassiani Mellou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | | | - Ingrid Friesema
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Line Vold
- Norwegian Institute of Public Health, Oslo, Norway
| | - Ettore Severi
- Karolinska Institutet, Stockholm, Sweden.,European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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17
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Alberts CJ, Boyd A, Bruisten SM, Heijman T, Hogewoning A, Rooijen MV, Siedenburg E, Sonder GJB. Hepatitis A incidence, seroprevalence, and vaccination decision among MSM in Amsterdam, the Netherlands. Vaccine 2019; 37:2849-2856. [PMID: 30992222 DOI: 10.1016/j.vaccine.2019.03.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Several outbreaks of Hepatitis A virus (HAV) were recently documented among men who have sex with men (MSM) in Europe. We investigated the HAV incidence among MSM in Amsterdam, the Netherlands; and HAV seroprevalence and HAV vaccination decision among MSM visiting the Sexually Transmitted Infection (STI) clinic in Amsterdam. METHODS Using surveillance data from 1992 to 2017 of MSM with acute HAV in Amsterdam, we estimated the incidence by calendar year and age. We explored HAV seroprevalence by calendar year and age, determinants for HAV seropositivity, and opting-in/out for HAV vaccination using data collected among MSM that visited the STI clinic between 2006 and 2017 and were included in a nationwide Hepatitis B virus (HBV) vaccination programme. Offering HAV vaccination at the STI clinic differed over three consecutive periods: not offered, offered for free, or offered for 75 euros. Logistic regression analyses were used to explore determinants. RESULTS HAV incidence increased in 2016/17 after 4 years of absence and peaked in MSM around 35 years of age. Among MSM visiting the STI clinic, HAV seroprevalence was 37% (95%CI = 35-40%), which was constant over the period 2006-2017, and increased with age (p < 0.001). Determinants for HAV seropositivity in multivariable analysis were: older age (p < 0.001), originating from an HAV endemic country (p < 0.001), and being HBV seropositive (p = 0.001). MSM opted-in more frequently when HAV vaccination was offered for free versus paid (89% versus 11%, respectively; p < 0.001). Younger MSM were less inclined to vaccinate when payment was required (p = 0.010). Post-hoc analyses showed that 98% versus 46% of MSM visiting the Amsterdam STI clinic would be protected against HAV infection if HAV vaccination was offered for free or for 75 euros, respectively. CONCLUSIONS The MSM population of Amsterdam is vulnerable to a new HAV outbreak. We strongly recommend that MSM have access to free hepatitis A vaccination.
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Affiliation(s)
- Catharina J Alberts
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands; INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
| | - Sylvia M Bruisten
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands; Amsterdam Infection & Immunity Institute (AI&II), Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands.
| | - Titia Heijman
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands.
| | - Arjan Hogewoning
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands; Amsterdam Infection & Immunity Institute (AI&II), Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands.
| | - Martijn van Rooijen
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands.
| | - Evelien Siedenburg
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands.
| | - Gerard J B Sonder
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands; Amsterdam Infection & Immunity Institute (AI&II), Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands.
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18
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Acute hepatitis A virus infection in patients hospitalized at the Department of Infectious Diseases, Medical University of Lublin (Eastern Poland) in 2017 - a hospital-based retrospective study. Clin Exp Hepatol 2018; 4:271-274. [PMID: 30603676 PMCID: PMC6311741 DOI: 10.5114/ceh.2018.80131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/11/2018] [Indexed: 11/17/2022] Open
Abstract
The aim of our study was to analyze medical records of all adult patients with acute hepatitis A virus (HAV) infection who were hospitalized at the Department of Infectious Diseases, Medical University of Lublin, Poland in 2017. During the studied period acute HAV infection was confirmed in 33 patients. In the study group there were 30 men and 3 women. The mean time of hospitalization was 12 days. All patients recovered with no clinical sequelae.
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19
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Michaelis K, Poethko-Müller C, Kuhnert R, Stark K, Faber M. Hepatitis A virus infections, immunisations and demographic determinants in children and adolescents, Germany. Sci Rep 2018; 8:16696. [PMID: 30420608 PMCID: PMC6232152 DOI: 10.1038/s41598-018-34927-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/28/2018] [Indexed: 12/17/2022] Open
Abstract
Hepatitis A is a vaccine-preventable disease with a global distribution. It predominantly occurs in regions with inadequate living conditions, but also affects populations in industrialised countries. Children are frequently involved in the transmission of hepatitis A virus (HAV) and thus play a central role in the epidemiology of hepatitis A. Here, we investigated HAV infections, immunisations, and associated demographic determinants in a nationwide, population-based, cross-sectional survey conducted in Germany from 2003-2006. Out of 17,640 children and adolescents, complete data sets (HAV serology, demographic information and vaccination card) were available for 12,249 (69%), all aged 3-17 years. We found protective antibody levels (>=20 IU/L) in 1,755 (14%) individuals, 1,395 (11%) were vaccinated against hepatitis A, 360 (3%) individuals were HAV seropositive without prior hepatitis A vaccination, thus indicating a previous HAV infection. Antibody prevalence (attributable to vaccination or infection) increased significantly with age. Multivariate logistic regression revealed that predominantly children and adolescents with migration background-even if they were born in Germany-are affected by HAV infections. Our results provide a rationale to emphasise existing vaccination recommendations and, moreover, to consider additional groups with a higher risk of infection for targeted vaccination, especially children with a migration background.
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Affiliation(s)
- Kai Michaelis
- Department for Infectious Disease Epidemiology, Unit of Gastrointestinal Infections, Zoonoses, and Tropical Infections, Robert Koch Institute (RKI), D-13353, Berlin, Germany.
| | - Christina Poethko-Müller
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), D-12101, Berlin, Germany
| | - Ronny Kuhnert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), D-12101, Berlin, Germany
| | - Klaus Stark
- Department for Infectious Disease Epidemiology, Unit of Gastrointestinal Infections, Zoonoses, and Tropical Infections, Robert Koch Institute (RKI), D-13353, Berlin, Germany
| | - Mirko Faber
- Department for Infectious Disease Epidemiology, Unit of Gastrointestinal Infections, Zoonoses, and Tropical Infections, Robert Koch Institute (RKI), D-13353, Berlin, Germany
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20
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Abstract
Increased economic interdependence, social integration, and other aspects of globalization are contributing to significant changes in hepatitis A epidemiology. Globally, the incidence of hepatitis A virus (HAV) infection is decreasing, the age at midpoint of population immunity (AMPI) is increasing, and the proportion of symptomatic cases is increasing as the average age at infection increases. In low-income countries, HAV remains endemic but improved water and sanitation systems are reducing transmission rates among young children. In high-income countries, most adults remain susceptible to HAV and foodborne outbreaks are becoming more frequent. Middle-income countries have diverse epidemiological profiles, and they play important roles in the global spread of HAV through international trade and travel. Future changes in the epidemiology of hepatitis A will be heavily influenced by globalization processes.
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Affiliation(s)
- Kathryn H Jacobsen
- College of Health and Human Services, George Mason University, Fairfax, Virginia 22030
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21
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Godoy P, Carmona G, Manzanares S, Jane M, Borràs E, Camps N, Álvarez J, Barrabeig I, Sala MR, Rius C, Minguell S, Carol M, Ferras J, Domínguez A. Trends and risk factors of hepatitis A in Catalonia after the introduction of a hepatitis A+B vaccination programme. J Viral Hepat 2018; 25:1001-1007. [PMID: 29603832 DOI: 10.1111/jvh.12900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 01/23/2018] [Indexed: 01/26/2023]
Abstract
At the end of 1998, universal hepatitis A+B vaccination of 12 year olds was introduced in Catalonia. The aim was to examine trends in hepatitis A during 2005-2015 and assess risk factors by age group. We carried out an observational epidemiological study of the incidence and risk factors of hepatitis A reported to the surveillance system. Information on exposure was recorded for each case for the 2-6 weeks before symptom onset. Spearman's coefficient was used to evaluate the trends of rates. The chi-square test was used to compare categorical. We studied 2621 hepatitis A cases; the age mean was 26.6 years (SD=18.2), and >50% of cases were in the 20-49 years age group. The incidence decreased from 3.28/100 000 in 2005 to 1.50/100 000 in 2015. The rate for women decreased over time (P = .008), but the reduction was not significant in men (P = .234). Men consistently had higher rates than women with the biggest difference being in the 20-34 years age group (rate 8.8 vs 2.8). The greatest risk factor was travel to an endemic country (42.1%) in the 0-19 years age group and male-to-male sexual contact (18.6%) in the 20-49 years age group. The case fatality rate in adults aged >49 years was 0.4%. In conclusion, the vaccination programme of preadolescents resulted in a reduction in hepatitis A cases. However, a significant amount of cases still appear in immigrants and men who have sex with men. Hepatitis A in adults is an emerging health problem that will require new strategies.
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Affiliation(s)
- P Godoy
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Institut de Recerca Biomédica de Lleida. IRBLleida, Lleida, Spain
| | - G Carmona
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - S Manzanares
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - M Jane
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - E Borràs
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - N Camps
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - J Álvarez
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - I Barrabeig
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - M-R Sala
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - C Rius
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - S Minguell
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - M Carol
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - J Ferras
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - A Domínguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
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22
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Vaz J, Floyd C, Mason B, Shankar AG, Lewis H. Control of a community outbreak of hepatitis A in an area of low endemicity, Wales, 2016. Hum Vaccin Immunother 2018; 13:2352-2356. [PMID: 28708951 DOI: 10.1080/21645515.2017.1347242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Incidence of hepatitis A in Wales is low (average of 0.48/100,000 inhabitants from 2004-2015). We describe a community outbreak of hepatitis A involving 3 schools (primary and secondary) in South Wales between March and June 2016 and reflect on the adequacy of the control measures used. Anyone in South Wales epidemiologically linked to a serological and/or RNA positive confirmed case of hepatitis A during the 15-50 d before onset of symptoms (diarrhea, vomiting, fever, nausea, AND jaundice, or jaundice-associated symptom) was defined as a case. Case identification was based on laboratory or GP suspicion notification, changing to active surveillance toward the end. As per national guidance, household contacts were identified and offered immunisation while in schools vaccination followed evidence of transmission. We went beyond guidance by vaccinating street play mates and in secondary schools. Mass vaccination uptake was calculated. There were 17 cases, mostly in children under 16 y of age. All cases had an epidemiological link to either a school or a household case (except primary) and no travel history. Street playing was the only epidemiological link between 2 cases in different schools. A total of 139 household contacts were identified. All schools, including secondary one, had a transmission event preceding mass vaccination (overall uptake 85%, reaching 1,574 individuals) and no tertiary cases emerged after the campaigns. We recommend extending guidance to include actions taken that helped curb this outbreak: 1) vaccinating in secondary school and 2) broadening the household contact definition. Based on our learning we further suggest 3) vaccinating upon identification of a single case who attended school while infectious regardless of source and 4) active case finding by serologically testing contacts.
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Affiliation(s)
- J Vaz
- a European Programme for Intervention Epidemiology Training , European Centre for Disease Prevention, Stockholm, Sweden and Control and Public Health Wales , Cardiff , UK
| | - C Floyd
- b Public Health Specialty Registrar , Public Health Wales , Cardiff , UK
| | - B Mason
- c Consultant in Communicable Disease Control , Public Health Wales , Cardiff , UK
| | - A G Shankar
- d Professional Lead Consultant for Health Protection , Public Health Wales , Cardiff , UK
| | - H Lewis
- e Consultant in Health Protection , Public Health Wales , Cardiff , UK
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Suffredini E, Proroga YTR, Di Pasquale S, Di Maro O, Losardo M, Cozzi L, Capuano F, De Medici D. Occurrence and Trend of Hepatitis A Virus in Bivalve Molluscs Production Areas Following a Contamination Event. FOOD AND ENVIRONMENTAL VIROLOGY 2017; 9:423-433. [PMID: 28452010 DOI: 10.1007/s12560-017-9302-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/25/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to assess the trend of hepatitis A virus (HAV) in a coastal zone impacted by a contamination event, providing data for the development of management strategies. A total of 352 samples, including four bivalve mollusc species (Mytilus galloprovincialis, Solen vagina, Venus gallina and Donax trunculus), were taken over a period of 6 months from 27 production areas of the coast and analysis were performed according to ISO/TS 15216-1:2013. HAV presence was detected in 77 samples from 11 production areas and all positive results were related to samples collected in the first 3 months of the surveillance, during which HAV prevalence was 39.9% and values as high as 5096 genome copies/g were detected. A progressive reduction of viral contamination was evident during the first trimester of the monitoring, with prevalence decreasing from 78.8% in the first month, to 37.8% in the second and 3.9% in the third and quantitative levels reduced from an average value of 672 genome copies/g to 255 genome copies/g over a period of 4 weeks (virus half-life: 21.5 days). A regression analysis showed that, during the decreasing phase of the contamination, the data fitted a reciprocal quadratic model (Ra2 = 0.921) and, based on the model, a residual presence of HAV could be estimated after negativization of the production areas. The statistical analysis of the results per shellfish species and per production area showed that there were limited differences in contamination prevalence and levels among diverse bivalve species, while a statistically significant difference was present in quantitative levels of one production area. These data could be useful for the development of both risk assessment models and code of practice for the management of viral contamination in primary production.
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Affiliation(s)
- Elisabetta Suffredini
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Yolande Thérèse Rose Proroga
- Department of Food Inspection, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Via Salute 2, Portici, 80055, Naples, Italy
| | - Simona Di Pasquale
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Orlandina Di Maro
- Department of Food Inspection, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Via Salute 2, Portici, 80055, Naples, Italy
| | - Maria Losardo
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Loredana Cozzi
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Federico Capuano
- Department of Food Inspection, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Via Salute 2, Portici, 80055, Naples, Italy
| | - Dario De Medici
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
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Lanini S, Minosse C, Vairo F, Garbuglia A, Di Bari V, Agresta A, Rezza G, Puro V, Pendenza A, Loffredo MR, Scognamiglio P, Zumla A, Panella V, Ippolito G, Capobianchi MR. A large ongoing outbreak of hepatitis A predominantly affecting young males in Lazio, Italy; August 2016 - March 2017. PLoS One 2017; 12:e0185428. [PMID: 29125835 PMCID: PMC5695276 DOI: 10.1371/journal.pone.0185428] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/12/2017] [Indexed: 11/18/2022] Open
Abstract
The hepatitis A virus (HAV) is mainly transmitted through the faecal-oral route. In industrialized countries HAV infection generally occurs as either sporadic cases in travelers from endemic areas, local outbreak within closed/semi-closed population and as foodborne community outbreak. Recently, an increasing number of HAV infection clusters have been reported among young men-who-have-sex-with-men (MSM). The Lazio Regional Service for the epidemiology and control for infectious diseases (SeRESMI) has noticed an increase of acute hepatitis A (AHA) since September 2016. Temporal analysis carried out with a discrete Poisson model using surveillance data between January 2016 and March 2017 evidenced an ongoing outbreak of AHA that started at the end of August. Molecular investigation carried out on 130 out of 513 cases AHA reported until March 2017 suggests that this outbreak is mainly supported by an HAV variant which is currently spreading within MSM communities across Europe (VRD_521_2016). The report confirms that AHA is an emerging issue among MSM. In addition through the integration of standard (case based) surveillance with molecular investigation we could discriminate, temporally concomitant but epidemiologically unrelated, clusters due to different HAV variants. As suggested by the WHO, in countries with low HAV circulation, vaccination programmes should be tailored on the local epidemiological patterns to prevent outbreaks among high risk groups and eventual spillover of the infection in the general population.
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Affiliation(s)
- Simone Lanini
- Dipartimento di Epidemiologia Ricerca Pre-Clinica e Diagnostica Avanzata, National Institute for Infectious diseases Lazzaro Spallanzani, Rome, Italy
| | - Claudia Minosse
- Dipartimento di Epidemiologia Ricerca Pre-Clinica e Diagnostica Avanzata, National Institute for Infectious diseases Lazzaro Spallanzani, Rome, Italy
| | - Francesco Vairo
- Dipartimento di Epidemiologia Ricerca Pre-Clinica e Diagnostica Avanzata, National Institute for Infectious diseases Lazzaro Spallanzani, Rome, Italy
| | - Annarosa Garbuglia
- Dipartimento di Epidemiologia Ricerca Pre-Clinica e Diagnostica Avanzata, National Institute for Infectious diseases Lazzaro Spallanzani, Rome, Italy
| | - Virginia Di Bari
- Dipartimento di Epidemiologia Ricerca Pre-Clinica e Diagnostica Avanzata, National Institute for Infectious diseases Lazzaro Spallanzani, Rome, Italy
| | - Alessandro Agresta
- Dipartimento di Epidemiologia Ricerca Pre-Clinica e Diagnostica Avanzata, National Institute for Infectious diseases Lazzaro Spallanzani, Rome, Italy
| | - Giovanni Rezza
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Vincenzo Puro
- Dipartimento di Epidemiologia Ricerca Pre-Clinica e Diagnostica Avanzata, National Institute for Infectious diseases Lazzaro Spallanzani, Rome, Italy
| | - Alessio Pendenza
- Azienda Sanitaria Locale Roma 1 Dipartimento di Prevenzione—U.O.S. Controllo Malattie e Gestione Flussi Informativi, Rome, Italy
| | - Maria Rosaria Loffredo
- Azienda Sanitaria Locale Roma 3 Servizio di Igiene e Sanità Pubblica Profilassi delle malattie infettive e parassitarie, Rome, Italy
| | - Paola Scognamiglio
- Dipartimento di Epidemiologia Ricerca Pre-Clinica e Diagnostica Avanzata, National Institute for Infectious diseases Lazzaro Spallanzani, Rome, Italy
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom
| | - Vincenzo Panella
- Direzione Regionale Salute e Politiche Sociali, Regione Lazio, Rome, Italy
| | - Giuseppe Ippolito
- Dipartimento di Epidemiologia Ricerca Pre-Clinica e Diagnostica Avanzata, National Institute for Infectious diseases Lazzaro Spallanzani, Rome, Italy
- * E-mail:
| | - Maria Rosaria Capobianchi
- Dipartimento di Epidemiologia Ricerca Pre-Clinica e Diagnostica Avanzata, National Institute for Infectious diseases Lazzaro Spallanzani, Rome, Italy
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Seroprevalence of Hepatitis A Twelve Years After the Implementation of Toddlers' Vaccination: A Population-Based Study in Israel. Pediatr Infect Dis J 2017; 36:e248-e251. [PMID: 28498301 DOI: 10.1097/inf.0000000000001640] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 1999, Israel became the first country to introduce an inactivated hepatitis A vaccine into its national childhood vaccination program. The objective of the present study was to evaluate the seroprevalence of hepatitis A virus antibodies in the Israeli population before and after the introduction of the program. METHODS A cross-sectional serosurvey using the National Serum Bank was conducted on 1883 and 2027 serum samples collected before and after introduction of the vaccine, respectively. Serologic tests for the presence of hepatitis A IgG antibodies were performed using an automated enzyme-linked fluorescent assay. RESULTS The age-adjusted seroprevalence rates of hepatitis A virus antibodies before implementation of hepatitis A vaccination program were 47.1% [95% confidence interval (CI): 44.7%-49.5%] among Jews and 82.8% (95% CI: 79.6%-85.9%) among Arabs, increasing 12 years after to 67.4% (95% CI: 64.7%-70.0%) and 88.2% (95% CI: 86.1%-90.2%), respectively. CONCLUSIONS The seropositivity rate among Jews and Arabs increased significantly among the cohorts included in the program. However, among Jews, a significant increase in seropositivity was also detected among age groups not included in the vaccination program. The decrease in the incidence of hepatitis A in Israel is a consequence of high vaccine uptake, persistent seropositivity rates after vaccination and the considerable number of people vaccinated beyond the program.
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Lemon SM, Ott JJ, Van Damme P, Shouval D. Type A viral hepatitis: A summary and update on the molecular virology, epidemiology, pathogenesis and prevention. J Hepatol 2017; 68:S0168-8278(17)32278-X. [PMID: 28887164 DOI: 10.1016/j.jhep.2017.08.034] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 02/08/2023]
Abstract
Although epidemic jaundice was well known to physicians of antiquity, it is only in recent years that medical science has begun to unravel the origins of hepatitis A virus (HAV) and the unique pathobiology underlying acute hepatitis A in humans. Improvements in sanitation and the successful development of highly efficacious vaccines have markedly reduced the worldwide prevalence and incidence of this enterically-transmitted infection over the past quarter century, yet the virus persists in vulnerable populations and remains a common cause of food-borne disease outbreaks in economically-advantaged societies. Reductions in the prevalence of HAV have led to increases in the median age at which infection occurs, often resulting in more severe disease in affected persons and paradoxical increases in disease burden in some developing nations. Here, we summarize recent advances in the molecular virology of HAV, an atypical member of the Picornaviridae family, survey what is known of the pathogenesis of hepatitis A in humans and the host-pathogen interactions that typify the infection, and review medical and public health aspects of immunisation and disease prevention.
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Affiliation(s)
- Stanley M Lemon
- Lineberger Comprehensive Cancer Center, and the Departments of Medicine and Microbiology & Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7292, USA.
| | - Jördis J Ott
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany.
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, Antwerp University, Antwerp, Belgium
| | - Daniel Shouval
- Liver Unit, Institute for Gastroenterology and Hepatology, Hadassah-Hebrew University Hospital, P.O.Box 12000, Jerusalem 91120, Israel
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Messens W, Fernandez-Escamez PS, Lees D, Lindqvist R, O’Mahony M, Suffredini E, Cortiñas Abrahantes J, Chantzis E, Koutsoumanis K. Thermal processing of live bivalve molluscs for controlling viruses: On the need for a risk-based design. Crit Rev Food Sci Nutr 2017; 58:2854-2865. [DOI: 10.1080/10408398.2017.1338246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Winy Messens
- Unit on Biological Hazards and Contaminants (BIOCONTAM), European Food Safety Authority (EFSA), Parma, Italy
| | | | - David Lees
- European Community Reference Laboratory, Centre for Environment, Fisheries and Aquaculture Science (CEFAS), The Nothe, Weymouth, UK
| | - Roland Lindqvist
- Department of Risk and Benefit Assessment, Swedish National Food Agency, Sweden
| | | | - Elisabetta Suffredini
- Istituto Superiore di Sanità, Department of Food Safety, Nutrition and Veterinary Public Health, Rome, Italy
| | | | - Emmanouil Chantzis
- Unit on Biological Hazards and Contaminants (BIOCONTAM), European Food Safety Authority (EFSA), Parma, Italy
| | - Kostas Koutsoumanis
- Department of Food Science and Technology, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Gullón P, Varela C, Martínez EV, Gómez-Barroso D. Association between meteorological factors and hepatitis A in Spain 2010-2014. ENVIRONMENT INTERNATIONAL 2017; 102:230-235. [PMID: 28325534 DOI: 10.1016/j.envint.2017.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/08/2017] [Accepted: 03/13/2017] [Indexed: 05/05/2023]
Abstract
BACKGROUND There is growing concern of how climate change could affect public health, due to the increase number of extreme climate events. Hence, the study of the role that climate events play on the distribution of waterborne diseases, like Hepatitis A, could be key for developing new prevention approaches. OBJECTIVE To investigate the association between climate factors and Hepatitis A in Spain between 2010 and 2014. METHODS Weekly Hepatitis A cases between 2010 and 2014 were obtained from the Spanish Epidemiology Surveillance Network. Climate variables (weekly cumulative rainfall, rainy days, storm days and snow days) were obtained from National Climatic Data Center (NOAA satellite and information Service of USA). Each municipality was assigned to the nearest weather station (N=73). A Mixed-Effects Poisson regression was performed to estimate Incidence Rate Ratios (IRR), including a time lag of 2, 3 and 4weeks (most probable incubation period for Hepatitis A). RESULTS Rainfall higher than 90th percentile (extreme precipitation) was associated with increased number of Hepatitis A cases 2weeks (IRR=1.24 CI 95%=1.09-1.40) and 4weeks after the event (IRR=1.15 CI 95%=1.01-1.30). An extra rainy day increased the risk of Hepatitis A two weeks after (IRR=1.03 CI 95%=1.01-1.05). We found higher risk of Hepatitis A two weeks after each extra storm day (IRR=1.06 CI 95%=1.00-1.12), and lower risk with 3 and 4weeks' lag (IRR=0.93 CI 95%=0.88-0.99 for lag3; IRR=0.94 CI 95%=0.88-0.99 for lag 4). CONCLUSIONS There is an increased risk of Hepatitis A 2weeks after water-related climate events. Including meteorological information in surveillance systems might improve to develop early prevention strategies for waterborne diseases.
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Affiliation(s)
- Pedro Gullón
- National School of Public Health, Carlos III Institute of Health. Madrid, Spain; Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain.
| | - Carmen Varela
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Elena Vanessa Martínez
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Diana Gómez-Barroso
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
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Hepatitis A virus infections and outbreaks in asylum seekers arriving to Germany, September 2015 to March 2016. Emerg Microbes Infect 2017; 6:e26. [PMID: 28442750 PMCID: PMC5457677 DOI: 10.1038/emi.2017.11] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/16/2016] [Accepted: 01/17/2017] [Indexed: 12/17/2022]
Abstract
From September 2015 to March 2016, hepatitis A notifications in Germany increased by 45% to 699 cases compared to 482 cases in the same period of the previous year. Children aged five to nine years were predominantly affected (22% of all cases in this period). We hypothesized that this increase could be explained by the marked influx of asylum seekers in this time period. We analysed national surveillance data and estimated the number of imported and autochthonous hepatitis A cases in asylum seekers. We also investigated molecular signatures of hepatitis A viruses sampled from asylum seekers to identify chains of transmission. We found that 40% (278 cases) of all 699 hepatitis A cases notified between September 2015 and March 2016 in Germany concerned asylum seekers. Most infections were acquired abroad, but at least 24% accounted for autochthonous infections. Among asylum seekers, children aged five to nine years were overrepresented with 97 of 278 (35%) notified cases. The analysed hepatitis A virus sequences were primarily subgenotype IB strains and clustered with previously isolated samples from the Middle East, Turkey, Pakistan and East Africa. Except one transmission from an asymptomatic child to a nursery nurse working in a mass accommodation, we are not aware of infection chains involving asylum seekers and German residents. We conclude that asylum-seeking children and adolescents are susceptible to hepatitis A virus infections, particularly children aged five to nine years. Measures to prevent secondary infections in asylum seekers such as extended hygiene measures and post-exposure prophylaxis seem advisable.
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Scavia G, Alfonsi V, Taffon S, Escher M, Bruni R, Medici DD, Pasquale SD, Guizzardi S, Cappelletti B, Iannazzo S, Losio NM, Pavoni E, Decastelli L, Ciccaglione AR, Equestre M, Tosti ME, Rizzo C, National Italian Task Force On Hepatitis A. A large prolonged outbreak of hepatitis A associated with consumption of frozen berries, Italy, 2013-14. J Med Microbiol 2017; 66:342-349. [PMID: 28086079 DOI: 10.1099/jmm.0.000433] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE In 2013/2014, Italy experienced one of the largest community-wide prolonged outbreaks of hepatitis A virus (HAV) throughout the country. The article provides a comprehensive description of the outbreak and the investigation carried out by a multidisciplinary National Task Force, in collaboration with regional and local public health authorities. Control strategies of food-borne HAV infection in both the human and food sectors are also described. METHODOLOGY Enhanced human epidemiological and microbiological surveillance together with microbiological monitoring of HAV in food and trace-back investigation were conducted. RESULTS A total of 1803 HAV cases were identified from 1 January 2013 to 31 August 2014, in Italy. Sequencing was possible for 368 cases (20.4 %), mostly collected between 1 January 2013 and 28 February 2014, and 246 cases (66.8 %) harboured an HAV outbreak strain. Imported frozen berries contaminated with HAV were identified as the vehicle of the outbreak which also involved many other European countries in 2013 and 2014. Epidemiological evidence obtained through a case-control study was supported by the finding of a 100 % nucleotide similarity of the VP1/2A sequences of HAVs detected in human and food samples. Trace-back investigation revealed an extremely complex supplying network with no possibility for a point source potentially explaining the vast contamination of berries found in Italy. CONCLUSION The investigation benefited from an excellent collaboration among different sectors who shared proactively the available information. Our findings highlight the importance of considering frozen berries among the highest risk factors for HAV.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Nadia Marina Losio
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna, Brescia, Italy
| | - Enrico Pavoni
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna, Brescia, Italy
| | - Lucia Decastelli
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Turin, Italy
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López-Vélez R, Norman FF, Pérez-Molina JA. Migration and the geography of disease. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department; Ramón y Cajal University Hospital; Madrid Spain
| | - Francesca F. Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department; Ramón y Cajal University Hospital; Madrid Spain
| | - José-Antonio Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department; Ramón y Cajal University Hospital; Madrid Spain
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Thompson C, Dey A, Fearnley E, Polkinghorne B, Beard F. Impact of the national targeted Hepatitis A immunisation program in Australia: 2000-2014. Vaccine 2016; 35:170-176. [PMID: 27876203 DOI: 10.1016/j.vaccine.2016.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022]
Abstract
In November 2005, hepatitis A vaccine was funded under the Australian National Immunisation Program for Aboriginal and Torres Strait Islander (Indigenous) children aged 12-24months in the targeted jurisdictions of Queensland, South Australia, Western Australia and the Northern Territory. We reviewed the epidemiology of hepatitis A from 2000 to 2014 using data from the Australian National Notifiable Diseases Surveillance System, the National Hospital Morbidity Database, and Australian Bureau of Statistics causes-of-death data. The impact of the national hepatitis A immunisation program was assessed by comparison of pre-vaccine (2000-2005) and post-vaccine time periods (2006-2014), by age group, Indigenous status and jurisdiction using incidence rate ratios (IRR) per 100,000 population and 95% confidence intervals (CI). The national pre-vaccine notification rate in Indigenous people was four times higher than the non-Indigenous rate, and declined from 8.41 per 100,000 (95% CI 5.03-11.79) pre-vaccine to 0.85 per 100,000 (95% CI 0.00-1.99) post-vaccine, becoming similar to the non-Indigenous rate. Notification and hospitalisation rates in Indigenous children aged <5years from targeted jurisdictions declined in the post-vaccine period when compared to the pre-vaccine period (notifications: IRR=0.07; 95% CI 0.04-0.13; hospitalisations: IRR=0.04; 95% CI 0.01-0.16). As did notification rates in Indigenous people aged 5-19 (IRR=0.08; 95% CI 0.05-0.13) and 20-49years (IRR=0.06; 95% CI 0.02-0.15) in targeted jurisdictions. For non-Indigenous people from targeted jurisdictions, notification rates decreased significantly in children aged <5years (IRR 0.47; 95% CI 0.31-0.71), and significantly more overall (IRR=0.43; 95% CI 0.39-0.47) compared to non-Indigenous people from non-targeted jurisdictions (IRR=0.60; 95% CI 0.56-0.64). The national hepatitis A immunisation program has had a significant impact in the targeted population with relatively modest vaccine coverage, with evidence suggestive of substantial herd protection effects.
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Affiliation(s)
- Craig Thompson
- National Centre for Immunisation Research and Surveillance, Sydney Children's Hospital Network, Westmead, NSW 2145, Australia; National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, ACT 2601, Australia.
| | - Aditi Dey
- National Centre for Immunisation Research and Surveillance, Sydney Children's Hospital Network, Westmead, NSW 2145, Australia; University of Sydney, NSW 2006, Australia
| | - Emily Fearnley
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, ACT 2601, Australia
| | | | - Frank Beard
- National Centre for Immunisation Research and Surveillance, Sydney Children's Hospital Network, Westmead, NSW 2145, Australia; University of Sydney, NSW 2006, Australia
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Melhem N, Kreidieh K, Ramia S. The Syrian refugees crisis brings challenges to the health authorities in Europe: hepatitis A virus is a case in point. Eur J Epidemiol 2016; 31:711-4. [PMID: 27194123 PMCID: PMC7088383 DOI: 10.1007/s10654-016-0163-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/12/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Nada Melhem
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, P.O Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Khalil Kreidieh
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, P.O Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Sami Ramia
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, P.O Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
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Wang Z, Chen Y, Xie S, Lv H. Changing Epidemiological Characteristics of Hepatitis A in Zhejiang Province, China: Increased Susceptibility in Adults. PLoS One 2016; 11:e0153804. [PMID: 27093614 PMCID: PMC4836706 DOI: 10.1371/journal.pone.0153804] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/04/2016] [Indexed: 11/19/2022] Open
Abstract
Background Hepatitis A is a common acute hepatitis caused by hepatitis A virus (HAV). Annually, it affects 1.4 million people worldwide. Between 1991 and 1994, HAV infections were highly endemic in Zhejiang Province (China), with 78,720 reported HAV infections per year. Hepatitis A vaccine came on the market in 1995 and was implemented for voluntary immunization. Since 2008, hepatitis A vaccine has been integrated into the national childhood routine immunization program. Objective To understand the current epidemiological profile of hepatitis A in Zhejiang Province since hepatitis A vaccine has been available for nearly two decades. Methods This study used the 2005–2014 National Notifiable Diseases Reporting System data to evaluate the incidence rate of notified hepatitis A cases in Zhejiang Province. Results The overall trend of incidence rate of notified hepatitis A cases significantly decreased from 2005 to 2014 (P< 0.001). During the study period, the reported incidence rate in individuals aged ≤19 years declined to the historically lowest record in 2014. Compared with individuals aged ≤19 years, those aged ≥20 years showed the highest incidence rate (P< 0.001). Majority of HAV infected cases were Laborers, accounting for approximately 70% of reported cases. Conclusions Childhood immunization strategy with hepatitis A vaccine seemed to be effective in decreasing notified hepatitis A incidence rate in individuals aged ≤19 years. Those aged ≥20 years were observed to be the most susceptible population. The vast majority of hepatitis A cases were notified among Laborers. Therefore, we strongly suggest that future preventive and control measures should focus more on adults, particularly Laborers, in addition to the current childhood hepatitis A vaccination programme.
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Affiliation(s)
- Zhifang Wang
- Department of Immunization Programme, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, PR China
| | - Yaping Chen
- Department of Immunization Programme, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, PR China
| | - Shuyun Xie
- Department of Immunization Programme, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, PR China
| | - Huakun Lv
- Department of Immunization Programme, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, PR China
- * E-mail:
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Alidjinou E, Lazrek M, Libier L, Bocket L, Dewilde A, Engelmann I, Hober D. A patient with fever, abdominal pain and bicytopenia: Trouble once again with these IgM antibodies! J Clin Virol 2016; 75:60-3. [DOI: 10.1016/j.jcv.2015.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/15/2015] [Accepted: 11/17/2015] [Indexed: 01/10/2023]
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Immunisation schedule of the Spanish Association of Paediatrics: 2016 recommendations. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.anpede.2015.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Evaluation of heat treatments, different from those currently established in the EU legislation, that could be applied to live bivalve molluscs from B and C production areas, that have not been submitted to purification or relaying, in order to eliminate pathogenic microorganisms. EFSA J 2015. [DOI: 10.2903/j.efsa.2015.4332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Moreno-Pérez D, Álvarez García FJ, Arístegui Fernández J, Cilleruelo Ortega MJ, Corretger Rauet JM, García Sánchez N, Hernández Merino A, Hernández-Sampelayo Matos T, Merino Moína M, Ortigosa del Castillo L, Ruiz-Contreras J. [Immunisation schedule of the Spanish Association of Paediatrics: 2016 recommendations]. An Pediatr (Barc) 2015; 84:60.e1-13. [PMID: 26589473 DOI: 10.1016/j.anpedi.2015.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/08/2015] [Indexed: 11/29/2022] Open
Abstract
The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) annually publishes the immunisation schedule which, in our opinion, estimates optimal for children resident in Spain, considering available evidence on current vaccines. We acknowledge the effort of the Ministry of Health during the last year in order to optimize the funded unified Spanish vaccination schedule, with the recent inclusion of pneumococcal and varicella vaccination in early infancy. Regarding the funded vaccines included in the official unified immunization schedule, taking into account available data, CAV-AEP recommends 2+1 strategy (2, 4 and 12 months) with hexavalent (DTPa-IPV-Hib-HB) vaccines and 13-valent pneumococcal conjugate vaccine. Administration of Tdap and poliomyelitis booster dose at the age of 6 is recommended, as well as Tdap vaccine for adolescents and pregnant women, between 27-36 weeks gestation. The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years). Coverage of human papillomavirus vaccination in girls aged 11-12 with a two dose scheme (0, 6 months) should be improved. Information for male adolescents about potential beneficial effects of this immunisation should be provided as well. Regarding recommended unfunded immunisations, CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish communitary pharmacies, with a 3+1 scheme (3, 5, 7 and 13-15 months). CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants. Annual influenza immunisation and vaccination against hepatitis A are indicated in population groups considered at risk.
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Sánchez G. Processing Strategies to Inactivate Hepatitis A Virus in Food Products: A Critical Review. Compr Rev Food Sci Food Saf 2015. [DOI: 10.1111/1541-4337.12154] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Gloria Sánchez
- Dept. of Microbiology and Ecology; Univ. of Valencia, Dr. Moliner; 50. Burjassot Valencia Spain
- Inst. of Agrochemistry and Food Technology (IATA); Spanish Council for Scientific Research (CSIC); Agustín Escardino, 7. Paterna Valencia Spain
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