title: The shifting epidemiology of hepatitis A following routine childhood immunization program in Israel.
abstract: OBJECTIVE
  In 1999 Israel became the first country to introduce immunization against hepatitis A to its national childhood vaccination program. The study objectives were to assess the uptake of hepatitis A vaccine following the new policy and to examine the incidence of hepatitis A and the number of prevented cases.
  
  
  METHODS
  Data on incidence of hepatitis A and vaccination rates were obtained from a large health maintenance organization in Israel covering 1.6 million members. We identified all members that were diagnosed by a primary care physician as suffering from hepatitis A, had a positive hepatitis A virus-IgM test result, or were hospitalized due to hepatitis A between 1998 and 2004.
  
  
  RESULTS
  The results indicate that 5 years following its inclusion in the national childhood immunization program, vaccination coverage levels with at least one dose of hepatitis A vaccine for children aged under 5 years and 5-14 years were 87% and 51%, respectively. During this period the annual incidence rates declined by 88% from 142.4 to 17.3 per 100,000. The most significant reduction in morbidity was observed among children.
  
  
  CONCLUSIONS
  In endemic areas, vaccination of infants and children against hepatitis A may be efficient to greatly reduce the total burden of the disease.
authors.affiliation: Medical Informatics Department, Maccabi Healthcare Services, Tel Aviv, Israel. Hodik_g@mac.org.il
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chodick
authors.forename: Manfred S
authors.initials: MS
authors.lastname: Green
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Heymann
authors.forename: Lena
authors.initials: L
authors.lastname: Rosenmann
authors.forename: Varda
authors.initials: V
authors.lastname: Shalev
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D019353:Endemic Diseases / Q000517:prevention & control*; D006291:Health Policy; D006506:Hepatitis A / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000627:therapeutic use*; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007223:Infant; D007557:Israel / Q000453:epidemiology; D032541:Mass Vaccination / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D008875:Middle Aged
chemical_list: D022362:Hepatitis A Vaccines