title: Vaccination against hepatitis A during outbreaks starting in schools: what can we learn from experiences in central Italy?
abstract: Two outbreaks of hepatitis A started almost simultaneously in a maternal school and in a day care centre located at opposite sides of Florence, Italy, at the end of 2002. Both of them originated from immigrant children, and in both cases, hepatitis A was initially not recognised due to aspecific symptoms. While vaccination of contacts started with delay in the first outbreak, the same intervention was organised and performed in 3 days in the other. The outbreak starting in the maternal school caused 30 notified cases, plus 7 cases diagnosed retrospectively. Nine of them were in a secondary school, where vaccination (in accordance with the Italian national guidelines on hepatitis A (HA) vaccination) had been started only after a secondary case occurred. Only three cases occurred overall in the other outbreak starting in the day care centre, where >80% of infants, children and personnel were immunised. Although few asymptomatic infections probably occurred, no source of contagion existed any longer 2 months after immunisation. A rapid vaccination of school and family contacts of hepatitis A cases after the first case (irrespective of school grade) seems to play an important role to shorten outbreak duration.
authors.affiliation: Public Health Department, University of Florence, Viale G.B. Morgagni 48-50134 Florence, Italy. paolo.bonanni@unifi.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Bonanni
authors.forename: Anita
authors.initials: A
authors.lastname: Franzin
authors.forename: Chiara
authors.initials: C
authors.lastname: Staderini
authors.forename: Maria
authors.initials: M
authors.lastname: Pitta
authors.forename: Giorgio
authors.initials: G
authors.lastname: Garofalo
authors.forename: Rossella
authors.initials: R
authors.lastname: Cecconi
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Santini
authors.forename: Piero
authors.initials: P
authors.lastname: Lai
authors.forename: Barbara
authors.initials: B
authors.lastname: Innocenti
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006506:Hepatitis A / Q000453:epidemiology* / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000494:pharmacology*; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D012574:Schools; D013997:Time Factors
chemical_list: D022362:Hepatitis A Vaccines