Hepatitis B virus transmission in pre-adolescent schoolchildren in four multi-ethnic areas of England.

The aim of this study was to estimate the amount of childhood hepatitis B virus transmission in children born in the UK, a very low-prevalence country, that is preventable only by universal hepatitis B immunization of infants. Oral fluid specimens were collected from schoolchildren aged 7-11 years in four inner city multi-ethnic areas and tested for the presence of antibody to hepatitis B core antigen (anti-HBc). Those found positive or indeterminate were followed up with testing on serum to confirm their hepatitis B status. The overall prevalence of anti-HBc in children was low [0.26%, 95% confidence interval (CI) 0.14-0.44]. The estimated average annual incidence of hepatitis B was estimated to be 29.26/100 000 children (95% CI 16.00-49.08). The total incidence that is preventable only by a universal infant immunization programme in the UK was estimated to be between 5.00 and 12.49/100 000. The study demonstrates that the extent of horizontal childhood hepatitis B virus transmission is low in children born in the UK and suggests that schools in the UK are an uncommon setting for the transmission of the virus. Targeted hepatitis B testing and immunization of migrants from intermediate- and high-prevalence countries is likely to be a more effective measure to reduce childhood transmission than a universal infant immunization programme.

Hepatitis A virus infection in people of South Asian origin in England and Wales: analysis of laboratory reports between 1992 and 2004.

The aim of the study was to determine whether rates of hepatitis A infection are higher in people of South Asian origin compared to the general population, to look for evidence of spread to the general population, and to identify ways to improve preventive strategies. Routine laboratory reports of hepatitis A infection in England and Wales in 1992-2004 were analysed. Study participants were patients with confirmed hepatitis A infection reported to the Health Protection Agency by the diagnosing laboratory. Nam Pehchan software was used to identify patients of South Asian ethnicity. Main outcome measures were comparison of incidence of hepatitis A in South Asian and non-South Asian groups, by age and region. Rates of infection were significantly higher in the South Asian group compared to the non-South Asian group (rate ratio 2.68, 95% confidence interval 2.07-3.47). Patients in the South Asian group had a younger age distribution. Travel was an important risk factor with 85% of those of South Asian origin acquiring their infection abroad, most frequently in the Indian subcontinent, compared to less than one third of those in other groups. Health-care professionals should ensure that all travellers to high-risk countries are protected by hepatitis A vaccination. Targeted information campaigns may be indicated in regions of the United Kingdom for people in South Asian minority ethnic groups.

Hepatitis C virus: laboratory surveillance in England and Wales, 1992-2004.

Between 1992 and 2004, a total of 49,819 confirmed hepatitis C infections have been reported to the Health Protection Agency (HPA) by laboratories in England and Wales; the annual number of reports increased from 241 in 1991 to 8149 in 2004. Most reports with a known risk factor were in injecting drug users (87%, 12,438/14,221), but 71% (35,598/49,819) of the total had no reported identified risk. The age-sex distribution of the latter cases was similar to that in injecting drug users. Using names to assign ethnicity, individuals with South Asian names had an older age distribution and a different risk factor profile from non-South Asians. Using published age-specific prevalence data from 1996, it was estimated that around 28,1764 cases of hepatitis C infection exist in England and Wales, and that only 17% of these cases have been reported to the HPA. Surveillance reports continue to provide important information regarding trends in hepatitis C infection in specific risk groups.

Guidelines for the control of hepatitis A virus infection.

The PHLS Advisory Committee on Vaccination and Immunisation, following a review of the evidence on control measures for preventing hepatitis A virus (HAV) infection and widespread consultation, has prepared the following guidelines. They include a description of the current epidemiology of HAV infection in England and Wales, where most individuals are now susceptible to HAV. HAV infection is uncommon, with around 1000 infections notified per year in England and Wales. Clusters occur in families and in settings where potential for faecal/oral spread is high, e.g. day care centres, nurseries, primary schools. Larger outbreaks have been recorded in men who have sex with men and injecting drug users. Personal hygiene remains the cornerstone of measures for preventing HAV infection and its spread. Those with haemophilia, hepatitis B or C virus infection or liver cirrhosis, intravenous drug users and men who have sex with men should be offered HAV vaccination as a preventive measure. HAV vaccine should be used for preventing secondary cases and outbreaks provided that patients are informed that the latest date the vaccine is most likely to be effective in preventing disease in contacts is probably 7 days from onset of illness in the primary case. Human normal immunoglobulin (HNIG) should be offered in addition or in preference to vaccine for contacts who are more than 7 days from onset of illness in the primary case, and for those at risk of adverse outcome of HAV infection. Individuals at particular risk of an adverse outcome to infection include those more than 50 years old, with liver cirrhosis of any cause, or with pre-existing hepatitis B or C virus infection. HAV vaccine should be used to prevent infection for travellers to countries where HAV infection is a risk. HNIG is no longer indicated for travellers. Children travelling to such countries should be offered vaccine from 5 years and consideration should be given to vaccinating those aged 1-4 years.

Estimating the burden of serogroup C meningococcal disease in England and Wales.

In 1999 a new conjugate vaccine for serogroup C meningococcal disease was licensed for use in the UK. In order for an appropriate vaccination strategy to be developed the burden of serogroup C disease in England and Wales needed to be established. This was done using data from an enhanced surveillance scheme alongside routine laboratory reports and a total of 5,052 cases of serogroup C disease in England and Wales between 1993 and 1998 were estimated. Among these, an estimated 398 died and 1,767 were admitted to intensive care units (ITUs). The greatest burden of disease was in young children and teenagers. The current literature identified four studies reporting sequelae following serogroup C meningococcal disease. These provided estimates of sequelae in the range of 6.5% and 45% and presented some evidence of higher levels than occur following serogroup B meningococcal disease. This information was provided to the Joint Committee on Vaccination and Immunisation to inform policy to implement a serogroup C conjugate vaccination programme in the UK. The vaccination programme has since been justified by the dramatic reduction in serogroup C meningococcal cases.