title: Recognising and responding to outbreaks of hepatitis A associated with child day-care centres.
abstract: OBJECTIVE
  To assess the appropriateness of a protocol for recognising and responding to outbreaks of hepatitis A in child day-care centres and to determine if measles-mumps-rubella (MMR) vaccine was given too soon following the administration of normal human immunoglobulin (NIGH) to young children to control the outbreaks.
  
  
  METHODS
  Prospective surveillance to recognise cases of hepatitis A associated with, and outbreaks of hepatitis A in, day-care centres.
  
  
  METHODS
  The percentage of initial ('sentinel') cases of hepatitis A associated with day-care centres that were subsequently recognised as also being 'index' cases of outbreaks of hepatitis A in the centres, and the number of children 9-13 months of age when given NIGH who were subsequently given MMR less than three months later.
  
  
  RESULTS
  Only 18 (16%) of the 114 sentinel day-care associated cases of hepatitis A were also index cases of outbreaks of hepatitis A in their respective centres. A total of 105 cases of hepatitis A were associated with the 18 outbreak centres; NIGH was administered to 928 (78%) of the attendee children, and to 105 (82%) of the susceptible staff, at the 18 centres. Three of the five children 9-13 months of age when given NIGH were given MMR less that three months later.
  
  
  CONCLUSIONS
  Although outbreaks of hepatitis A were common events in day-care centres in north Queensland during the two-year study period, a single case of hepatitis A associated with a centre was a poor predictor of an outbreak within that centre. Precautions must be taken to ensure that live vaccines are not administered to young children too soon after NIGH.
authors.affiliation: Tropical Public Health Unit, Queensland Health, Cairns. jeffrey_hanna@health.qld.gov.au
authors.forename: J N
authors.initials: JN
authors.lastname: Hanna
authors.forename: J L
authors.initials: JL
authors.lastname: Humphreys
authors.forename: S L
authors.initials: SL
authors.lastname: Hills
authors.forename: A R
authors.initials: AR
authors.lastname: Richards
authors.forename: D L
authors.initials: DL
authors.lastname: Brookes
mesh_terms: D000328:Adult; D002656:Child Day Care Centers; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control*; D005191:Family Characteristics; D006506:Hepatitis A / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007115:Immunization Schedule; D007136:Immunoglobulins / Q000008:administration & dosage; D007223:Infant; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage; D011446:Prospective Studies; D011793:Queensland / Q000453:epidemiology; D018571:Sentinel Surveillance
chemical_list: D007136:Immunoglobulins; D022542:Measles-Mumps-Rubella Vaccine