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1.
Epidemiol Health ; 41: e2019038, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31715685

RESUMEN

The 2019 hepatitis A outbreak has become increasingly prevalent among adults in Korea and is the largest outbreak since that in 2009-2010. The incidence in the current outbreak is highest among adults aged 35-44 years, corresponding to the peak incidence among those aged 25-34 years 10 years ago. This may indicate a cohort effect in the corresponding age group. Causes of these repeated outbreaks of hepatitis A in Korea are low level of immunity among adults, Korean food culture that consumes raw seafood such as salted clam and inadequate public health system. Among countermeasures, along with general infectious disease control measures including control of the infectious agent, infection spread, and host, urgent actions are needed to review the vaccination policy and establish an adequate public health system.


Asunto(s)
Brotes de Enfermedades , Hepatitis A/epidemiología , Hepatitis A/prevención & control , Adulto , Brotes de Enfermedades/prevención & control , Política de Salud , Vacunas contra la Hepatitis A/administración & dosificación , Humanos , Salud Pública , República de Corea/epidemiología , Factores de Riesgo
2.
Infect Dis Poverty ; 8(1): 80, 2019 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-31578150

RESUMEN

BACKGROUND: Hepatitis A (HepA) vaccination and economic transitions can change the epidemiology of HepA. China's Gross Domestic Product (GDP) per capita was known to be inversely associated with the incidence of HepA, but a deeper understanding of the epidemiology of HepA in different socio-economic regions is lacking. We compare the changing epidemiology of HepA in three socioeconomic-geographic regions of China. METHODS: We obtained data on all HepA cases reported through the National Notifiable Disease Reporting System and assessed trends and changes in age-specific incidence rates by age quartile and season. We categorized the country into three regions, the sequential years into five era, compared the incidence, quartile age, seasonal intensity and coverage of HepA of the three regions. Linear regression was performed to analyse trends in incidence of HepA and to analyse the association between coverage and incidence. RESULTS: The annual mean incidences of HepA in the eastern, central, and western regions decreased from 63.52/100 000, 50.57/100 000 and 46.39/100 000 in 1990-1992 to 1.18/100 000, 1.05/100 000 and 3.14/100 000 in 2012-2017, respectively. Decreases in incidence were seen in all age groups in the three regions; the incidence was highest (9.3/100 000) in the youngest age group (0-4 years) of the western region, while in the central region, the age group with the highest incidence changed from 0 to 9 years to adults ≥60 years old. In 2017, the median age of HepA cases was 43 years (Q1-Q3: 33-55), 47 years (Q1-Q3: 32-60) and 33 years (Q1-Q3: 9-52) in the eastern, central, and western provinces, respectively. Seasonal peaks became smaller or were nearly elimination nationwide, but seasonality persisted in some provinces. After the Expanded Program on Immunization (EPI) included HepA vaccine into the routine schedule in 2007, HepA coverage increased to > 80% in the three regions and was negatively association with the HepA incidence. CONCLUSION: The incidence of HepA decreased markedly between 1990 and 2017. A socioeconomic inequity in coverage of HepA vaccine was almost eliminated after HepA vaccine was introduced into China's EPI system, but inequity in incidence still existed in lower socio-economic developed region.


Asunto(s)
Vacunas contra la Hepatitis A/administración & dosificación , Hepatitis A/epidemiología , Programas de Inmunización/estadística & datos numéricos , Factores Socioeconómicos , Vacunación/estadística & datos numéricos , China/epidemiología , Geografía , Hepatitis A/virología , Incidencia , Estudios Longitudinales , Estaciones del Año , Factores de Tiempo
3.
MMWR Morb Mortal Wkly Rep ; 68(35): 766-770, 2019 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-31487277

RESUMEN

Hepatitis A virus (HAV) is an RNA virus primarily transmitted via the fecal-oral route and, in rare cases, causes liver failure and death in infected persons. Although drinking water-associated hepatitis A outbreaks in the United States are rarely reported (1), HAV was the most commonly reported etiology for outbreaks associated with untreated ground water during 1971-2008 (2), and HAV can remain infectious in water for months (3). This report analyzes drinking water-associated hepatitis A outbreaks reported to the Waterborne Disease and Outbreak Surveillance System (WBDOSS) during 1971-2017. During that period, 32 outbreaks resulting in 857 cases were reported, all before 2010. Untreated ground water was associated with 23 (72%) outbreaks, resulting in 585 (68.3%) reported cases. Reported outbreaks significantly decreased after introduction of Advisory Committee on Immunization Practices (ACIP) hepatitis A vaccination recommendations* and U.S. Environmental Protection Agency's (USEPA) public ground water system regulations.† Individual water systems, which are not required to meet national drinking water standards,§ were the only contaminated drinking water systems to cause the last four reported hepatitis A outbreaks during 1995-2009. No waterborne outbreaks were reported during 2009-2017. Water testing and treatment are important considerations to protect persons who use these unregulated systems from HAV infection.


Asunto(s)
Brotes de Enfermedades/prevención & control , Agua Potable/virología , Hepatitis A/epidemiología , Hepatitis A/prevención & control , Práctica de Salud Pública , Regulación Gubernamental , Vacunas contra la Hepatitis A/administración & dosificación , Humanos , Evaluación de Programas y Proyectos de Salud , Estados Unidos/epidemiología , United States Environmental Protection Agency , Abastecimiento de Agua/legislación & jurisprudencia
5.
BMC Public Health ; 19(1): 404, 2019 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-30987613

RESUMEN

BACKGROUND: Timely and complete vaccination with multi-dose schedules is of public health importance, because an incomplete vaccination series may yield suboptimal disease protection. However, data on adherence of adults to multi-dose vaccines are limited. We sought to estimate adherence to multi-dose hepatitis vaccination schedules among adults in the United Kingdom (UK). METHODS: This retrospective cohort study was conducted using anonymized electronic health record (EHR) data from the Clinical Practice Research Datalink (CPRD). Individuals aged 19 years and older at their first identified dose of hepatitis vaccine (2009-2016) were included if they had continuous EHR data for 12 months before the first identified hepatitis A dose or for 6 months before the first identified hepatitis B or combination hepatitis A/B dose. We estimated dose and series completion for each vaccine and adherence to recommended vaccination schedules, as well as adherence within additional prespecified time periods after the first vaccine dose, with sensitivity analyses restricted to adults who had available data for up to 24 months after the first dose. Median time to series completion was estimated using Kaplan-Meier methods. RESULTS: Mean (SD) age at initiation was 42 (16) years for hepatitis A (n = 374,881), 40 (16) years for hepatitis B (n = 71,634), and 38 (15) years for hepatitis A/B (n = 10,335). Women comprised 52 to 55% of each vaccine cohort. Overall, 42,294 adults (11%) completed the two-dose hepatitis A vaccine series within the recommended 12 months; and 15,564 (22%) and 1076 (10%) completed the three-dose hepatitis B and hepatitis A/B series, respectively, within the recommended 6 months. These percentages rose to only 23, 35, and 33%, respectively, when the follow-up periods were extended to 36 months for hepatitis A and to 30 months for hepatitis B and A/B vaccines. Median times to series completion within recommended schedules were not reached in any cohort. Sensitivity analyses supported the primary findings for the full cohorts. CONCLUSIONS: Adherence and series completion rates for hepatitis A and B vaccines in the UK are low. Identifying, understanding, and addressing barriers to series completion for multi-dose vaccines for adults in real-world settings are needed.


Asunto(s)
Vacunas contra la Hepatitis A/administración & dosificación , Hepatitis A/prevención & control , Vacunas contra Hepatitis B/administración & dosificación , Hepatitis B/prevención & control , Vacunación/estadística & datos numéricos , Adulto , Actitud Frente a la Salud , Análisis por Conglomerados , Registros Electrónicos de Salud , Femenino , Humanos , Esquemas de Inmunización , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Reino Unido , Adulto Joven
6.
J Acquir Immune Defic Syndr ; 81(1): e1-e5, 2019 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-30865187

RESUMEN

BACKGROUND: Various recent outbreaks of hepatitis A virus (HAV) have been described in men who have sex with men despite the availability of an effective vaccine. This study aimed to determine the current rates of seroconversion after receiving HAV vaccine (HAV-V) in HIV-infected patients under real-life conditions. SETTING: Patients were selected from a Southern Spanish multicentric cohort of HIV-infected subjects. METHODS: Retrospective analysis of all patients who received 2 doses (standard scheme) from April 2008 to May 2016 or from June 2016 to February 2018 facing an HAV outbreak with shortage of HAV-V, 1 single dose of HAV-V. Response to HAV-V was defined as positive anti-HAV IgG between 1 and 12 months after the last vaccination dose. RESULTS: A total of 522 patients were included, mainly men who have sex with men (86.2%). In the standard-dose group, 303/343 [88.3%; 95% confidence interval (CI): 84.5 to 91.5] patients showed seroconversion as compared with 149/179 (83.2%; 95% CI: 76.9 to 88.4) of the single-dose group (P = 0.107). Undetectable baseline HIV-RNA (adjusted odds ratio: 4.86; 95% CI: 1.86 to 12.75; P = 0.001) and a CD4 T-cell count ≥350/µL (adjusted odds ratio, 3.96; 95% CI: 1.26 to 12.49; P = 0.019) were independently associated with response to both regimens. A higher CD4/CD8 ratio was also associated with response after a single dose. CONCLUSIONS: HIV-infected patients should be encouraged to undergo HAV-V with 2 standard doses 6 months apart; a single dose achieves a high rate of seroconversion in those patients with favorable response factors and may be enough to limit future outbreaks in case of HAV-V shortage until supply is reestablished.


Asunto(s)
Coinfección/prevención & control , Infecciones por VIH/complicaciones , Vacunas contra la Hepatitis A/uso terapéutico , Hepatitis A/prevención & control , Adolescente , Adulto , Anciano , Brotes de Enfermedades/prevención & control , Femenino , Infecciones por VIH/virología , Vacunas contra la Hepatitis A/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología , Adulto Joven
7.
J Fam Pract ; 68(2): 94; 96; 98, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30870535

RESUMEN

Immunization rates for hepatitis B are still suboptimal; a new 2-dose vaccine may help turn that around. HepA vaccine is now preferred as post-exposure prophylaxis for adults >40 years.


Asunto(s)
Medicina Familiar y Comunitaria , Vacunas contra la Hepatitis A/administración & dosificación , Hepatitis A/prevención & control , Vacunas contra Hepatitis B/administración & dosificación , Hepatitis B/prevención & control , Inmunización/normas , Humanos , Esquemas de Inmunización , Profilaxis Posexposición , Profilaxis Pre-Exposición , Estados Unidos
8.
Medicine (Baltimore) ; 98(6): e14364, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30732169

RESUMEN

Several approved inactivated hepatitis A (HA) vaccines are available in Korea. These have been shown to be immunogenic and safe in European children; however, their immunogenicity and safety have not been investigated among Korean children. We aimed to compare the immunogenicity and safety of the most commonly used HA vaccines in ethnic Korean children aged 12 to 18 months.In this open-label, randomized, prospective, multicenter study, 108 children were enrolled and randomized to receive a pediatric form of Avaxim, Epaxal, or Havrix. The 2nd dose was administered after an interval of 6 months. Anti-HA virus (HAV) immunoglobulin (Ig) G was measured to assess geometric mean concentrations (GMCs) and seropositvity rates (≥20 mIU/mL anti-HAV IgG). To assess safety, local solicited adverse events (AEs), systemic solicited AEs, unsolicited AEs, and serious AEs (SAEs) were graded.Among the 108 participants enrolled, 37, 34, and 37 received Avaxim, Epaxal, and Havrix, respectively. After administration of 2 doses, the seropositivity rates in the Avaxim, Epaxal, and Havrix groups were all 100% (95% confidence intervals [CIs]: 99.0-100, 98.9-100, and 99.0-100, respectively; P < .001). The anti-HAV GMCs in the Avaxim, Epaxal, and Havrix groups were 5868.4 (95% CI: 4237.2-8126.6), 1962.1 (95% CI: 1298.0-2965.9), and 2232.9 mIU/mL (95% CI: 1428.4-3490.4), respectively, after administration of 2 doses (P < .001). There were no significant differences in the proportions of participants reporting local solicited AEs, systemic solicited AEs, unsolicited AEs, and SAEs among the 3 vaccine groups after the 1st and 2nd doses. All local solicited and unsolicited AEs were grade 1 or 2. Grade 3 systemic solicited AE occurred in 5.4% and 2.9% of the participants in the Havrix group after the 1st and 2nd doses, respectively. SAEs after the 1st and 2nd doses were reported in 2 participants and 1 participant, respectively, but none was assessed as being related to vaccination.The results indicate that these vaccines were safe and immunogenic in ethnic Korean children. The results have contributed to the establishing of an HA vaccination policy in Korea and will be informative to countries that plan to initiate vaccination programs against HAV.


Asunto(s)
Vacunas contra la Hepatitis A/efectos adversos , Vacunas contra la Hepatitis A/inmunología , Vacunas de Productos Inactivados/efectos adversos , Vacunas de Productos Inactivados/inmunología , Femenino , Vacunas contra la Hepatitis A/administración & dosificación , Humanos , Lactante , Masculino , Estudios Prospectivos , República de Corea , Vacunas de Productos Inactivados/administración & dosificación
9.
MMWR Morb Mortal Wkly Rep ; 68(6): 153-156, 2019 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-30763295

RESUMEN

Hepatitis A (HepA) vaccination is recommended routinely for children at age 12-23 months, for persons who are at increased risk for hepatitis A virus (HAV) infection, and for any person wishing to obtain immunity. Persons at increased risk for HAV infection include international travelers to areas with high or intermediate hepatitis A endemicity, men who have sex with men, users of injection and noninjection drugs, persons with chronic liver disease, person with clotting factor disorders, persons who work with HAV-infected primates or with HAV in a research laboratory setting, and persons who anticipate close contact with an international adoptee from a country of high or interme-diate endemicity (1-3). Persons experiencing homelessness are also at higher risk for HAV infection and severe infection-associated outcomes. On October 24, 2018, the Advisory Committee on Immunization Practices (ACIP)* recommended that all persons aged 1 year and older experiencing homelessness be routinely immunized against HAV. The ACIP Hepatitis Vaccines Work Group conducted a systematic review of the evidence for administering vaccine to persons experiencing homelessness, which included a set of criteria assessing the benefits and adverse events associated with vaccination. HepA vaccines are highly immunogenic, and >95% of immunocompetent adults develop protective antibody within 4 weeks of receipt of 1 dose of the vaccine (1). HAV infections are acquired primarily by the fecal-oral route by either person-to-person transmission or via ingestion of contaminated food or water. Among persons experiencing homelessness, effective implementation of alternative strategies to prevent exposure to HAV, such as strict hand hygiene, is difficult because of living conditions among persons in this population. Integrating routine HepA vaccination into health care services for persons experiencing homelessness can reduce the size of the at-risk population over time and thereby reduce the risk for large-scale outbreaks.


Asunto(s)
Vacunas contra la Hepatitis A/administración & dosificación , Hepatitis A/prevención & control , Personas sin Hogar , Inmunización/normas , Comités Consultivos , Humanos , Estados Unidos
10.
Expert Rev Vaccines ; 18(3): 209-223, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30806110

RESUMEN

INTRODUCTION: Hepatitis A, caused by hepatitis A virus (HAV), is primarily transmitted via the fecal/oral route either through ingestion of contaminated food and water or through direct contact with an infectious person. Prevalence of hepatitis A is strongly correlated with socioeconomic factors, decreasing with increased socio-economic development, access to clean water and sanitation. Vaccination against HAV should be part of a comprehensive plan for the prevention and control of viral hepatitis, either as part of regular childhood immunization programs or with other recommended vaccines for travelers. Areas covered: We present here evidence for the immunogenicity and safety of an inactivated HAV pediatric vaccine (Avaxim® 80U Pediatric, Sanofi Pasteur), indicated for use in children aged 12 months to 15 years. Data evaluated are from trials undertaken during the clinical development of this vaccine, a systematic literature review and post-market pharmacovigilance. Expert opinion: The pediatric HAV vaccine is highly immunogenic and generates long-lasting protection against hepatitis A disease in children. The safety and immunogenicity data presented in this review suggest that the pediatric HAV vaccine is a valuable option in the prevention of HAV infection in children in many areas of the world where the disease remains a healthcare issue.


Asunto(s)
Vacunas contra la Hepatitis A/administración & dosificación , Hepatitis A/prevención & control , Vacunación/métodos , Adolescente , Niño , Preescolar , Vacunas contra la Hepatitis A/efectos adversos , Vacunas contra la Hepatitis A/inmunología , Humanos , Programas de Inmunización , Inmunogenicidad Vacunal , Lactante , Factores Socioeconómicos , Vacunas de Productos Inactivados
11.
Top Antivir Med ; 26(4): 117-121, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30641485

RESUMEN

The recent hepatitis A virus (HAV) outbreak in San Diego was driven by homelessness, associated sanitation conditions, and illicit drug use. As with an outbreak in Michigan, fueled by similar factors, morbidity and mortality were higher than what has been observed with post-vaccine era foodborne HAV outbreaks. Control of the outbreak in San Diego was accomplished with vaccine, sanitation, and education initiatives that targeted those at highest risk. Mass vaccination events and mobile foot teams and vans brought education and vaccine to high-risk individuals in affected areas. The homelessness crisis in San Diego and in many locales throughout the United States poses risk of increasing numbers of outbreaks of HAV and other infectious illnesses. This article summarizes an IAS-USA continuing education webinar given by Darcy A. Wooten, MD, on July 19, 2018.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Brotes de Enfermedades , Transmisión de Enfermedad Infecciosa/prevención & control , Hepatitis A/epidemiología , Terapia Conductista , California/epidemiología , Educación en Salud , Hepatitis A/mortalidad , Hepatitis A/transmisión , Vacunas contra la Hepatitis A/administración & dosificación , Humanos
12.
Public Health ; 168: 150-156, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30442468

RESUMEN

OBJECTIVES: A routine review of hepatitis A travel vaccination recommendations was brought forward in June 2017 due to hepatitis A vaccine shortages and a concurrent outbreak in men who have sex with men (MSM). There were three objectives: first, to document the review process for changing the recommendations for the UK travellers in June 2017. Second, to study the impact of these changes on prescribing in general practice in 2017 compared with the previous 5 years. Third, to study any changes in hepatitis A notifications in June-October 2017 compared with the previous 5 years. STUDY DESIGN: This is an observational study. METHODS: Travel vaccination recommendations for countries with either low-risk (<20%) or high-risk (>90%) status according to child hepatitis A seroprevalence were not changed. A total of 67 intermediate-risk countries with existing recommendations for most travellers and with new data on rural sanitation levels were shortlisted for the analysis. Data on child hepatitis A seroprevalence, country income status, access to sanitation in rural areas and traveller volumes were obtained. Information about the vaccine supply was obtained from Public Health England. Changes to the existing classification were made through expert consensus, based on countries' hepatitis A seroprevalence, sanitation levels, level of income, volume of travel and hepatitis A traveller cases. Data on the number of combined and monovalent hepatitis A-containing vaccines prescribed in England, 2012-2017, were obtained from the National Health Service Business Service Authorities. The number of monthly prescriptions for January-September 2017 was compared with the mean number of prescriptions for the same month in the previous 5 years (t-test, α = 5%, df = 4). The number of hepatitis A cases notified in June-October 2017 not related to the MSM outbreak was compared with the number of notifications in the same months in previous years. RESULTS: A total of 36 countries were downgraded based on good access (80+% of population) to sanitation in rural areas and the intermediate-risk status in terms of child hepatitis A seroprevalence. For these countries, vaccination would only be recommended to travellers staying long term, visiting friends and relatives or staying in areas without good sanitation. There was a significant decline in hepatitis A vaccine prescriptions in June-September 2017, and there was no increase in the number of notifications. CONCLUSIONS: Hepatitis A vaccination recommendations for travel were revised in 2017 following a systematic approach to maintain continuity of supply after a hepatitis A vaccine shortage and increased hepatitis A vaccine demand related to a large outbreak. Improved access to good sanitation in rural areas and low seroprevalence estimates among children have led to 36 countries to no longer require vaccination for most travellers. These changes do not seem to have impacted on hepatitis A notifications in England, although further research will be needed to quantify the impact more precisely.


Asunto(s)
Política de Salud , Vacunas contra la Hepatitis A/administración & dosificación , Vacunas contra la Hepatitis A/provisión & distribución , Hepatitis A/prevención & control , Viaje , Brotes de Enfermedades/prevención & control , Hepatitis A/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Reino Unido/epidemiología
13.
Lupus ; 28(2): 234-240, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30551721

RESUMEN

OBJECTIVES: Vaccination of systemic lupus erythematosus patients with non-live vaccines may decrease vaccine-preventable infections and mortalities. In the present study, we aimed to compare the immunogenicity and safety of inactivated hepatitis A vaccination in childhood-onset systemic lupus erythematosus and healthy subjects. METHODS: A total of 30 childhood-onset systemic lupus erythematosus and 39 healthy participants who were seronegative for hepatitis A received two doses of the hepatitis A vaccine in a 0- and 6-month schedule. Hepatitis A virus (HAV) IgG antibodies were measured before vaccination and 7 months after the vaccination. RESULTS: Although anti-HAV IgG antibody titers after vaccination were found to be somewhat lower in children with systemic lupus erythematosus than that of the healthy subjects ( p < 0.05), the difference in seroconversion rate was insignificant between childhood-onset systemic lupus erythematosus patients ( n = 24/30, 80%) and healthy controls ( n = 33/39, 84.6%). There was no increase in median Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K scores and anti-ds DNA levels after the vaccination procedure. Seroconversion rates in childhood-onset systemic lupus erythematosus patients were not affected by medication, high disease activity (SLEDAI-2K >6) and anti-ds DNA positivity. None of the patients experienced any flare or adverse reaction throughout the study. CONCLUSIONS: According to these results, we conclude that inactivated hepatitis A vaccine is safe and well tolerated in childhood-onset systemic lupus erythematosus patients, with no adverse events or increase in activity. Immunogenicity to the hepatitis A vaccine was adequate, with a seropositivity rate of 80%.


Asunto(s)
Anticuerpos de Hepatitis A/sangre , Vacunas contra la Hepatitis A/administración & dosificación , Hepatitis A/prevención & control , Lupus Eritematoso Sistémico/complicaciones , Adolescente , Estudios de Casos y Controles , Niño , Femenino , Humanos , Inmunogenicidad Vacunal , Lupus Eritematoso Sistémico/fisiopatología , Masculino , Vacunación/métodos , Adulto Joven
14.
MMWR Morb Mortal Wkly Rep ; 67(43): 1216-1220, 2018 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-30383742

RESUMEN

Postexposure prophylaxis (PEP) with hepatitis A (HepA) vaccine or immune globulin (IG) effectively prevents infection with hepatitis A virus (HAV) when administered within 2 weeks of exposure. Preexposure prophylaxis against HAV infection through the administration of HepA vaccine or IG provides protection for unvaccinated persons traveling to or working in countries that have high or intermediate HAV endemicity. The Advisory Committee on Immunization Practices (ACIP) Hepatitis Vaccines Work Group conducted a systematic review of the evidence for administering vaccine for PEP to persons aged >40 years and reviewed the HepA vaccine efficacy and safety in infants and the benefits of protection against HAV before international travel. The February 21, 2018, ACIP recommendations update and supersede previous ACIP recommendations for HepA vaccine for PEP and for international travel. Current recommendations include that HepA vaccine should be administered to all persons aged ≥12 months for PEP. In addition to HepA vaccine, IG may be administered to persons aged >40 years depending on the provider's risk assessment. ACIP also recommended that HepA vaccine be administered to infants aged 6-11 months traveling outside the United States when protection against HAV is recommended. The travel-related dose for infants aged 6-11 months should not be counted toward the routine 2-dose series. The dosage of IG has been updated where applicable (0.1 mL/kg). HepA vaccine for PEP provides advantages over IG, including induction of active immunity, longer duration of protection, ease of administration, and greater acceptability and availability.


Asunto(s)
Vacunas contra la Hepatitis A/administración & dosificación , Hepatitis A/prevención & control , Inmunización/normas , Profilaxis Posexposición , Profilaxis Pre-Exposición , Viaje , Adolescente , Adulto , Comités Consultivos , Niño , Preescolar , Humanos , Esquemas de Inmunización , Inmunoglobulinas/uso terapéutico , Lactante , Estados Unidos , Vacunas de Productos Inactivados/administración & dosificación , Adulto Joven
15.
Zhonghua Liu Xing Bing Xue Za Zhi ; 39(10): 1351-1355, 2018 Oct 10.
Artículo en Chino | MEDLINE | ID: mdl-30453436

RESUMEN

Objective: Through analyzing the epidemiological characteristics of hepatitis A and E and the situation of vaccination, to promote the recommendation profile on Hepatitis E vaccination program, in China. Methods: Three phases of time span were divided as 2004-2007, 2008-2011 and 2012-2015, with age groups divided as <20, 20-29, 30-39 and ≥40. Incidence rates in both different phases and age groups were compared. Numbers of Hepatitis A and E vaccines released and used, were described. Results: Between 2004 and 2015, a declining trend in the reported incidence of hepatitis A (t=-12.15, P<0.001), but an increasing trend in hepatitis E (t=6.63, P<0.001) were noticed. The mean number of hepatitis A cases declined from 6 515 to 1 986 between 2004 and 2007 while the number of hepatitis E cases increased from 1 491 to 2 277 between 2012 and 2015. The peaks of hepatitis E appeared persistent annually, in March. The incidence of hepatitis A declined in three regions, with the western region (3.46/100 000) much higher than the eastern (1.13/100 000) or central regions (1.14/100 000) (χ(2)=32 630, P<0.01). The incidence of hepatitis E increased both in the central (1.74/100 000) and western regions (1.58/100 000), but more in the eastern region (2.66/100 000) (χ(2)=6 009, P<0.01). Incidence of hepatitis A declined in all age groups and declined by 84.36% among the 0-19 group. However, the incidence of hepatitis E showed an increasing trend among the ≥20 group. Incidence rates appeared higher in the older age groups. The coverage of hepatitis A vaccine increased from 62.05% to 93.54%, but with a negative association seen between the coverage of Hepatitis A vaccine and the incidence (F=10.69, χ(2)<0.05). Conclusion: The incidence of Hepatitis A declined sharply in China while hepatitis E was still increasing from 2004 to 2015, calling for the expansion on the coverage of Hepatitis E vaccine in the whole population.


Asunto(s)
Vacunas contra la Hepatitis A/administración & dosificación , Hepatitis A/epidemiología , Hepatitis E/epidemiología , Inmunización/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Anciano , China/epidemiología , Encuestas de Atención de la Salud , Humanos , Programas de Inmunización , Incidencia , Persona de Mediana Edad , Vigilancia de la Población , Adulto Joven
16.
J Emerg Med ; 55(6): 764-768, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30316620

RESUMEN

BACKGROUND: While the overall incidence of hepatitis A has declined markedly since the introduction of a vaccine, sporadic cases and outbreaks of the disease continue to occur. OBJECTIVE: Our aim was to evaluate the effectiveness of an electronic health record (EHR) provider alert as part of an outbreak-control vaccination program implemented in the emergency department (ED). METHODS: We conducted a retrospective study assessing the impact of a Best Practice Alert (BPA) built into an EHR to prompt providers when a patient was homeless to consider hepatitis A vaccination in the ED. Data were collected over three 6-month time periods: a historical control period, a pre-intervention period, and an intervention period. RESULTS: There were no vaccinations given in the ED in the historical period, which increased to 465 after the implementation of the BPA. During the implementation period, there were 1,482 visits identified among 1,131 patients that met the inclusion criteria. Of these, there were 1,147 (77.5%) visits where the patient either received the vaccine in the ED, had already received the vaccine, or it was not indicated due to the current medical issue. There were also 333 (22.5%) visits where the BPA was active for potential vaccination eligibility, but did not receive it in the ED. CONCLUSIONS: We leveraged an informatics tool developed within our EHR to identify high-risk patients and remind providers of the availability of vaccination in the ED. Using these tools enabled providers to increase vaccination efforts within our ED to help control the community-wide outbreak.


Asunto(s)
Brotes de Enfermedades , Registros Electrónicos de Salud , Servicio de Urgencia en Hospital , Vacunas contra la Hepatitis A/administración & dosificación , Hepatitis A/prevención & control , Personas sin Hogar , Adulto , California/epidemiología , Femenino , Hepatitis A/epidemiología , Humanos , Masculino , Estudios Retrospectivos
17.
Ig Sanita Pubbl ; 74(3): 295-304, 2018.
Artículo en Italiano | MEDLINE | ID: mdl-30235469

RESUMEN

Hepatitis A is an infectious disease caused by a virus (HAV), which is highly contagious and widespread all over the world. In industrialized countries, Hepatitis A is commonly considered a disease with an important socio-economic impact, as the clinical disease affects mostly young adults. After the development of a specific anti-HAV vaccine, a reduction in the incidence of Hepatitis A was observed, with a subsequent change in the prevalence of HAV. HAV spreads mainly in children and risk categories, whose work or activities or medical conditions lead to a close contact with the virus. In particular, in Men who have sex with Men (MSM) many outbreaks have been reported in the last five years. Aim of this paper is an evaluation of the recent literature about HAV infection in MSM in order to update the current guidelines on HAV procedures for MSM.


Asunto(s)
Vacunas contra la Hepatitis A/administración & dosificación , Virus de la Hepatitis A/inmunología , Hepatitis A , Homosexualidad Masculina , Adulto , Hepatitis A/epidemiología , Hepatitis A/prevención & control , Humanos , Masculino
19.
Rev. esp. enferm. dig ; 110(6): 380-385, jun. 2018. tab, graf
Artículo en Español | IBECS | ID: ibc-177692

RESUMEN

En el año 2016 se detectó en la provincia de Málaga un brote de hepatitis A en pacientes con características epidemiológicas especiales, con un predominio de sujetos del sexo masculino. Presentamos 51 casos de hepatitis A aguda con una media de edad de 35,7 años, el 90% varones, con un 55% de casos que reconocían haber mantenido relaciones sexuales con otros hombres en los últimos dos meses. La mitad de ellos requirieron ingreso hospitalario por coagulopatía significativa en el momento del diagnóstico, sin evolución a fallo fulminante, ni encefalopatía en ningún caso. Cuatro casos presentaban ascitis al diagnóstico. Este brote se suma a otros dos publicados en Reino Unido y Holanda con un número de casos similar y epidemiológicamente muy parecidos, lo cual refuerza la importancia de la vigilancia epidemiológica y la necesidad de vacunación en esta población de riesgo, así como de campañas informativas a la población para prevenir la enfermedad


In 2016, an outbreak of hepatitis A was identified in the Malaga province among patients with specific epidemiological characteristics, which were predominantly males. This is a report of 51 subjects with acute hepatitis A and a mean age of 35.7 years, 90% were male and 55% of cases were men who had had sex with other men within the last two months. Half of them required hospitalization for significant coagulopathy at diagnosis and no cases progressed to fulminant failure or encephalopathy. Four patients had ascites at the time of diagnosis. This outbreak adds to those reported in the United Kingdom and the Netherlands with a similar number of cases and epidemiology. These studies highlight the importance of epidemiological surveillance, the need for vaccination in this particular at risk population and the need for informative campaigns in order to prevent this disease


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Brotes de Enfermedades/estadística & datos numéricos , Control de Enfermedades Transmisibles/métodos , Hepatitis A/epidemiología , Enfermedad Aguda/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Vacunas contra la Hepatitis A/administración & dosificación , Estudios Retrospectivos , Factores de Riesgo
20.
Int J STD AIDS ; 29(10): 1007-1010, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29743003

RESUMEN

BASHH guidelines recommend that 'the hepatitis A virus total antibody test can be offered to at-risk patients whose immune status is unknown … depending on local funding arrangements'. We sought to measure the local prevalence of anti-hepatitis A (HAV) IgG in HIV-negative men who have sex with men (MSM), to inform the utility of pre-vaccination screening. We assessed the prevalence of anti-HAV IgG in HIV-negative MSM who attended sexual health services in County Durham and Darlington, UK, from March to August 2017. Data were extracted from electronic patient records and analysed in Excel. Our study was granted local Caldicott approval. Seventy four per cent of 244 HIV-negative MSM who attended for review were screened. Anti-HAV IgG was detected in 42% who did not report definite previous infection or vaccination; not detected in 57.4%; and was equivocal in 0.6%. Vaccine was administered to 48% of eligible patients. The estimated financial costs of universal vaccination of MSM (£4235.40) and pre-vaccination screening with vaccination of susceptible patients (£4188.13) are similar. Pre-vaccination screening and vaccination of susceptible patients does not save resources compared to a policy of universal vaccination of MSM in our setting. Universal vaccination of MSM attending genitourinary medicine clinics may improve vaccine uptake.


Asunto(s)
Seronegatividad para VIH , Anticuerpos de Hepatitis A/sangre , Vacunas contra la Hepatitis A/economía , Hepatitis A/prevención & control , Homosexualidad Masculina/estadística & datos numéricos , Inmunoglobulina G/sangre , Adulto , Costos y Análisis de Costo , Vacunas contra la Hepatitis A/administración & dosificación , Humanos , Inmunoglobulina G/inmunología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Seroepidemiológicos , Reino Unido/epidemiología , Adulto Joven
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