title: Hepatitis A disease following the implementation of universal vaccination: who is at risk?
abstract: The incidence of acute hepatitis A in Israel has decreased 25 folds in less than a decade, following the introduction of a two-dose universal toddler's hepatitis A immunization in July 1999. This retrospective study describes demographic data and behavioural determinants of hepatitis A patients following the implementation of a vaccination programme. All records of hepatitis A patients reported to the Ministry of Health during the years 2003 through 2005 were reviewed, and an epidemiological investigation was conducted. During the study period, 420 hepatitis A patients were reported, representing an average annual incidence of two per 100,000 population. Case fatality rate was 0.5%. The majority of the patients were younger than 15 years of age, males and non-Jewish. The highest incidence was recorded in east Jerusalem, where vaccine coverage is relatively low. After exclusion of 165 east Jerusalem patients, 133 (52.2%) patients were available for an interview. Of those, 16 (6%) had possible occupational exposure, 37 (27.8%) travelled to endemic areas, 44 (17%) were contacts of hepatitis A cases, and 3 male patients had sex with men. No known risk determinant was identified in 33 (24.8%) patients. Four patients (3%) were previously immunized with one dose, and none had two doses. The introduction of universal toddler hepatitis A vaccination decreased morbidity. Most of the patients who were detected 4-6 years after the implementation of the vaccination programme could be classified into one of the known risk groups for hepatitis A infection or living in a partly vaccinated community.
authors.affiliation: Ramla Sub-District Health Office, Ministry of Health, Ramla, Israel. zohar.mor@rml.health.gov.il
authors.forename: Z
authors.initials: Z
authors.lastname: Mor
authors.forename: S
authors.initials: S
authors.lastname: Srur
authors.forename: R
authors.initials: R
authors.lastname: Dagan
authors.forename: S
authors.initials: S
authors.lastname: Rishpon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006506:Hepatitis A / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000276:immunology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012307:Risk Factors; D055815:Young Adult
chemical_list: D022362:Hepatitis A Vaccines