title: Time trends in pediatric hospitalizations for hepatitis A in Greece (1999-2013): Assessment of the impact of universal infant immunization in 2008.
abstract: Hepatitis A vaccine was introduced in the Greek National Immunization Program in 2008. To estimate possible impact of the universal vaccination implementation, time trends of hospitalizations for hepatitis A at the Infectious Diseases Unit of a Tertiary Pediatric Hospital in Athens during 1999-2013 were analyzed. Hepatitis A hospitalizations were recorded from the discharge database and were expressed as frequencies and rate of annual departmental hospitalizations. Time series analysis (ARIMA) was used to explore trends and the impact of the vaccination. Moreover, changes in patient age, population group distribution and the duration of hospitalization were also examined. Hepatitis A hospitalizations rate significantly decreased between pre-vaccination (1999-2008) and post-vaccination (2009-2013) era from 50.5 to 20.8/1000 hospitalizations (p = 0.005). A 3-year periodicity and a trend of reduction on hepatitis A hospitalizations rates across years were noted. Roma children had significant higher rates of hepatitis A hospitalization, followed by immigrant children. Importantly, possibly due to preceding vaccine availability with considerable uptake in private market and unvaccinated group/pockets of children (Roma), overall vaccination effect was less apparent when compared to data from other countries that implemented universal vaccination. No significant change in patient age, population group distribution, or duration of hospitalization was observed. High risk groups such as Roma children should be targeted for vaccination to reduce future outbreaks.
authors.affiliation: a Third Department of Pediatrics , National and Kapodistrian University of Athens School of Medicine , Athens , Greece.
authors.forename: V
authors.initials: V
authors.lastname: Papaevangelou
authors.affiliation: b First Department of Pediatrics , National and Kapodistrian University of Athens School of Medicine , Athens , Greece.
authors.forename: Z
authors.initials: Z
authors.lastname: Alexopoulou
authors.affiliation: c Regional Public Health Laboratory of Thessaly, Medical Faculty , University of Thessaly , Larissa , Athens , Greece.
authors.forename: C
authors.initials: C
authors.lastname: Hadjichristodoulou
authors.affiliation: d Center for Clinical Epidemiology and Outcomes Research (CLEO), National and Kapodistrian University of Athens School of Medicine , Athens , Greece.
authors.forename: G
authors.initials: G
authors.lastname: Kourlamba
authors.affiliation: c Regional Public Health Laboratory of Thessaly, Medical Faculty , University of Thessaly , Larissa , Athens , Greece.
authors.forename: A
authors.initials: A
authors.lastname: Katsioulis
authors.affiliation: b First Department of Pediatrics , National and Kapodistrian University of Athens School of Medicine , Athens , Greece.
authors.forename: K
authors.initials: K
authors.lastname: Theodoridou
authors.affiliation: b First Department of Pediatrics , National and Kapodistrian University of Athens School of Medicine , Athens , Greece.
authors.forename: V
authors.initials: V
authors.lastname: Spoulou
authors.affiliation: b First Department of Pediatrics , National and Kapodistrian University of Athens School of Medicine , Athens , Greece.
authors.forename: M
authors.initials: M
authors.lastname: Theodoridou
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006115:Greece / Q000453:epidemiology; D006291:Health Policy; D006506:Hepatitis A / Q000453:epidemiology*; D022362:Hepatitis A Vaccines / Q000008:administration & dosage*; D006760:Hospitalization; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D022362:Hepatitis A Vaccines
keywords: Roma; hepatitis A; hospitalization; time trends; universal vaccination