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1.
Nat Commun ; 12(1): 1439, 2021 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-33664251

RESUMO

Treatment of advanced melanoma with combined PD-1/CTLA-4 blockade commonly causes serious immune-mediated complications. Here, we identify a subset of patients predisposed to immune checkpoint blockade-related hepatitis who are distinguished by chronic expansion of effector memory CD4+ T cells (TEM cells). Pre-therapy CD4+ TEM cell expansion occurs primarily during autumn or winter in patients with metastatic disease and high cytomegalovirus (CMV)-specific serum antibody titres. These clinical features implicate metastasis-dependent, compartmentalised CMV reactivation as the cause of CD4+ TEM expansion. Pre-therapy CD4+ TEM expansion predicts hepatitis in CMV-seropositive patients, opening possibilities for avoidance or prevention. 3 of 4 patients with pre-treatment CD4+ TEM expansion who received αPD-1 monotherapy instead of αPD-1/αCTLA-4 therapy remained hepatitis-free. 4 of 4 patients with baseline CD4+ TEM expansion given prophylactic valganciclovir and αPD-1/αCTLA-4 therapy remained hepatitis-free. Our findings exemplify how pathogen exposure can shape clinical reactions after cancer therapy and how this insight leads to therapeutic innovations.


Assuntos
Linfócitos T CD4-Positivos/imunologia , Antígeno CTLA-4/antagonistas & inibidores , Infecções por Citomegalovirus/tratamento farmacológico , Hepatite A/prevenção & controle , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Antivirais/uso terapêutico , Linfócitos T CD4-Positivos/transplante , Linfócitos T CD8-Positivos/imunologia , Citomegalovirus/efeitos dos fármacos , Citomegalovirus/imunologia , Hepatite A/imunologia , Hepatite A/virologia , Humanos , Memória Imunológica/imunologia , Melanoma/tratamento farmacológico , Valganciclovir/uso terapêutico , Carga Viral
2.
BMC Infect Dis ; 20(1): 627, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32842988

RESUMO

BACKGROUND: The epidemiological pattern of hepatitis A infection has shown dynamic changes in many parts of the world due to improved socio-economic conditions and the accumulation of seronegative subjects, which leads to possible outbreaks and increased morbidity rate. In Tunisia, the epidemiological status of hepatits A virus is currently unknown. However, over the past years higher numbers of symptomatic hepatitis A virus infection in school attendants and several outbreaks were reported to the Ministry of Health, especially from regions with the lowest socio-economic levels in the country. The aim of this study was to investigate the current seroprevalence of hepatitis A virus antibodies in central-west Tunisia and assess the impact of hepatitis A virus vaccination on hepatitis A epidemiology. METHODS: Serum samples from 1379 individuals, aged 5-75 years, were screened for hepatitis A virus antibodies. Adjusted seroprevalence, incidence and force of infection parameters were estimated by a linear age structured SEIR (Susceptible-Exposed-Infectious-Recovered) compartmental model. A vaccine model was then constructed to assess the impact on hepatitis A virus epidemiology of 3 scenarios of vaccination strategies: one dose at 12-months of age, one dose at 6-years and one dose at 12-months and another at 6-years of age during 6 years. RESULTS: A rapid increase in anti-hepatitis A virus seroprevalence was noted during infancy and adolescence: 47% of subjects under 10-years-old are infected; the prevalence increases to 77% at 15-years and reaches 97% in subjects aged 30-years. The force of infection is highest between 10 and 30-years of age and the incidence declines with increasing age. The vaccine model showed that the 3-scenarios lead to a significant reduction of the fraction of susceptibles. The two doses scenario gives the best results. Single-dose vaccination at 6-years of age provides more rapid decrease of disease burden in school-aged children, as compared to single-dose vaccination at 12-months, but keeps with a non-negligible fraction of susceptibles among children < 6-years. CONCLUSIONS: Our study confirms the epidemiological switch from high to intermediate endemicity of hepatitis A virus in Tunisia and provides models that may help undertake best decisions in terms of vaccinations strategies.


Assuntos
Vírus da Hepatite A/imunologia , Hepatite A/epidemiologia , Hepatite A/transmissão , Modelos Teóricos , Vacinação/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Feminino , Hepatite A/sangue , Hepatite A/prevenção & controle , Anticorpos Anti-Hepatite A/sangue , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Soroepidemiológicos , Tunísia/epidemiologia , Adulto Jovem
3.
Rev Bras Epidemiol ; 23: e200073, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32638856

RESUMO

INTRODUCTION: In 2014, Brazil introduced a universal immunization program against the hepatitis A virus (HAV) for children in the second year of life, using a single dose of inactivated virus vaccine. The objective of this study was to evaluate the vaccination coverage (VC) against HAV in Brazil, against the incidence of cases reported five years after the implementation of the program. METHODOLOGY: Secondary data were obtained by searching free access electronic sites of the Ministry of Health, Department of Informatics of the Unified Health System (Departamento de Informática do Sistema Único de Saúde - DATASUS), for incidence analysis and VC from 2014 to 2018. RESULTS: VC ranged from 60.13 to 97.07%. The homogeneity of VC against hepatitis A did not reach the established goal throughout all states but for a few exceptions. After 2015, CV decreased in all regions of the country. Despite insufficient coverage, a concomitant reduction in the incidence of Hepatitis A took place throughout the country. The incidence rate fell from 3.29 to 0.80/100,000 between 2014 and 2018. However, there was an interruption in the pace of incidence fall between 2017 and 2018, which may be a consequence of insufficient VC. This phenomenon seems to be part of a widespread downward trend in vaccination effort across the country, also verified for other vaccines, such as poliomyelitis and measles, mumps and rubella vaccine. CONCLUSION: These figures suggest the need for implementing efforts to improve hepatitis A VC rates in the country.


Assuntos
Vacinas contra Hepatite A/administração & dosagem , Hepatite A/epidemiologia , Hepatite A/prevenção & controle , Programas de Imunização/organização & administração , Cobertura Vacinal/estatística & dados numéricos , Brasil/epidemiologia , Pré-Escolar , Humanos , Incidência , Avaliação de Programas e Projetos de Saúde
4.
MMWR Recomm Rep ; 69(5): 1-38, 2020 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-32614811

RESUMO

HEPATITIS A IS A VACCINE-PREVENTABLE, COMMUNICABLE DISEASE OF THE LIVER CAUSED BY THE HEPATITIS A VIRUS (HAV). THE INFECTION IS TRANSMITTED VIA THE FECAL-ORAL ROUTE, USUALLY FROM DIRECT PERSON-TO-PERSON CONTACT OR CONSUMPTION OF CONTAMINATED FOOD OR WATER. HEPATITIS A IS AN ACUTE, SELF-LIMITED DISEASE THAT DOES NOT RESULT IN CHRONIC INFECTION. HAV ANTIBODIES (IMMUNOGLOBULIN G [IGG] ANTI-HAV) PRODUCED IN RESPONSE TO HAV INFECTION PERSIST FOR LIFE AND PROTECT AGAINST REINFECTION; IGG ANTI-HAV PRODUCED AFTER VACCINATION CONFER LONG-TERM IMMUNITY. THIS REPORT SUPPLANTS AND SUMMARIZES PREVIOUSLY PUBLISHED RECOMMENDATIONS FROM THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) REGARDING THE PREVENTION OF HAV INFECTION IN THE UNITED STATES. ACIP RECOMMENDS ROUTINE VACCINATION OF CHILDREN AGED 12-23 MONTHS AND CATCH-UP VACCINATION FOR CHILDREN AND ADOLESCENTS AGED 2-18 YEARS WHO HAVE NOT PREVIOUSLY RECEIVED HEPATITIS A (HEPA) VACCINE AT ANY AGE. ACIP RECOMMENDS HEPA VACCINATION FOR ADULTS AT RISK FOR HAV INFECTION OR SEVERE DISEASE FROM HAV INFECTION AND FOR ADULTS REQUESTING PROTECTION AGAINST HAV WITHOUT ACKNOWLEDGMENT OF A RISK FACTOR. THESE RECOMMENDATIONS ALSO PROVIDE GUIDANCE FOR VACCINATION BEFORE TRAVEL, FOR POSTEXPOSURE PROPHYLAXIS, IN SETTINGS PROVIDING SERVICES TO ADULTS, AND DURING OUTBREAKS.


Assuntos
Vacinas contra Hepatite A/administração & dosagem , Hepatite A/prevenção & controle , Adolescente , Adulto , Comitês Consultivos , Criança , Pré-Escolar , Humanos , Imunização , Lactente , Guias de Prática Clínica como Assunto , Estados Unidos
5.
MMWR Morb Mortal Wkly Rep ; 69(26): 820-824, 2020 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-32614812

RESUMO

Los Angeles County comprises 4,058 square miles and is home to approximately 10 million residents (1), an estimated 59,000 (0.6%) of whom experience homelessness on a given night (2). In late 2018, Los Angeles County Department of Public Health (LAC DPH) was notified of a case of hepatitis A virus (HAV) infection in a person experiencing homelessness. LAC DPH conducted an investigation to determine the source of infection, identify additional cases, and identify contacts for postexposure prophylaxis (PEP). Over the next week, LAC DPH identified two additional hepatitis A cases in persons experiencing homelessness who knew one another socially and were known to congregate at a specific street intersection. To identify and respond rapidly to additional outbreak-associated cases, LAC DPH implemented enhanced surveillance procedures, including immediately obtaining specimens for molecular testing from all patients with suspected hepatitis A in the same geographic area. Enhanced surveillance identified four additional cases in persons linked to a senior living campus within two blocks of the intersection where the initial three patients reported congregating. These four cases were linked to the cluster in persons experiencing homelessness through HAV genotyping. Overall, DPH identified seven outbreak-associated hepatitis A cases during October 2018-January 2019. The DPH response to this community hepatitis A outbreak included conducting vaccination outreach to persons at risk, conducting environmental health outreach to restaurants in the outbreak area, and issuing health care provider alerts about the increased occurrence of hepatitis A. Implementation of near real-time molecular testing can improve hepatitis A outbreak responses by confirming HAV infections, linking additional cases to the outbreak, and informing the targeting of prevention efforts.


Assuntos
Surtos de Doenças/prevenção & controle , Hepatite A/epidemiologia , Hepatite A/prevenção & controle , Adolescente , Adulto , Idoso , Genótipo , Hepatite A/genética , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Los Angeles/epidemiologia , Pessoa de Meia-Idade , Epidemiologia Molecular , Vigilância em Saúde Pública , Adulto Jovem
7.
Gastroenterol Clin North Am ; 49(2): 191-199, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32389358

RESUMO

Hepatitis A virus (HAV) is a positive-strand RNA virus that is transmitted feco-orally through person-to-person contact. Outbreaks are often linked to poor sanitation, overcrowding, or food and water contamination. Infection is often asymptomatic in children, but adults present with jaundice, abdominal pain, hepatitis, and hyperbilirubinemia. Diagnosis is through detection of immunoglobulin M antibodies against HAV, and treatment is supportive. Vaccination is the mainstay of prevention and should be given before exposure whenever possible.


Assuntos
Hepatite A/epidemiologia , Hepatite A/prevenção & controle , Dor Abdominal/etiologia , Alanina Transaminase/sangue , Anorexia/etiologia , Biomarcadores/sangue , Hepatite A/complicações , Hepatite A/diagnóstico , Vacinas contra Hepatite A , Humanos , Icterícia/etiologia , Risco , Testes Sorológicos/métodos , Viagem
8.
Artigo em Inglês | MEDLINE | ID: mdl-32305985

RESUMO

People who travel to countries where they are at risk of contracting specific infections often need specific vaccines. To make correct recommendations in this respect several points have to be considered. The state of health of the traveler should be known as well as his or her destination and travel style. Very important, however, is the age of the traveler. As advancing age leads to changes in the immune system, in older individuals many infections are more severe. On the other hand, most vaccines are less immunogenic in the elderly. In this chapter, we will discuss which vaccines are necessary for older travelers visiting (mainly) tropical and subtropical countries, how these vaccines have to be used, and if perhaps their use has to be altered in older individuals. First, standard vaccinations will be addressed. When the immunization state of the individual is incomplete because certain vaccinations are expired or missing, it has to be updated. Vaccinations against tetanus, diphtheria, influenza, pneumococcal diseases, measles, and poliomyelitis have to be considered in this respect, because the risk of getting infected with these diseases in tropical and subtropical regions or in regions with poor hygienic conditions is often higher or at least the same as in industrialized countries. The second and main part of this chapter contains the typical travel vaccines. We will deal with vaccinations against cholera, hepatitis A and B, Japanese encephalitis, invasive meningococcal diseases, rabies, typhoid fever, and yellow fever. Clinical courses and epidemiology of the different infections are presented. The respective vaccines are discussed in detail, especially their efficiency in older individuals as far as data are available in this respect. Finally, recommendations for their use in older travelers will be given.


Assuntos
Fatores Imunológicos/uso terapêutico , Viagem , Vacinas/uso terapêutico , Idoso , Cólera/prevenção & controle , Difteria/prevenção & controle , Encefalite Japonesa/prevenção & controle , Encefalite Transmitida por Carrapatos/prevenção & controle , Hepatite A/prevenção & controle , Hepatite B/prevenção & controle , Humanos , Influenza Humana/prevenção & controle , Infecções Meningocócicas/prevenção & controle , Poliomielite/prevenção & controle , Raiva/prevenção & controle , Tétano/prevenção & controle , Febre Tifoide , Vacinação , Febre Amarela/prevenção & controle
9.
J Infect Public Health ; 13(4): 480-484, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32113699

RESUMO

BACKGROUND: Health care workers (HCWs) and students are at increased risk for blood borne infections and vaccine preventable diseases (VPDs). The aim of this study was to determine the seroprevalence of antibodies against measles, rubella, mumps, varicella zoster virus (VZV), hepatitis A and B viruses among HCWs and students and to determine whether there are differences according to gender and age group. METHODS: Information about characteristics of the 1053 participants, history of disease and vaccination status were collected using a structured questionnaire. Serum samples were tested for antibodies by commercial immunoenzymatic assays. RESULTS: Seropositivity rates were 57.1% for measles, 74% for mumps, 96.3% for rubella, 93.7% for VZV, 33.9% for hepatitis A virus and 92.2% for hepatitis B virus. Susceptibility rates among participants 18-26, 27-38 and >38 years of age were statistically significant for measles (46%, 18.6% and 0%; p < 0.001) and mumps (27.1%, 12.9% and 21.4%; p < 0.05), respectively. CONCLUSION: Low seropositivity rates for measles, mumps and HAV are important findings. For other diseases other than VZV, it is thought that vaccination without pre-screening is more appropriate. Healthcare institutions should have policies for screening and vaccination of their staff and students.


Assuntos
Varicela/epidemiologia , Pessoal de Saúde , Hepatite A/epidemiologia , Hepatite B/epidemiologia , Programas de Rastreamento , Sarampo/epidemiologia , Caxumba/epidemiologia , Rubéola (Sarampo Alemão)/epidemiologia , Estudantes de Medicina , Estudantes de Enfermagem , Vacinação , Adolescente , Adulto , Varicela/prevenção & controle , Análise Custo-Benefício , Ensaio de Imunoadsorção Enzimática , Feminino , Pessoal de Saúde/estatística & dados numéricos , Hepatite A/prevenção & controle , Hepatite B/prevenção & controle , Humanos , Masculino , Programas de Rastreamento/métodos , Sarampo/prevenção & controle , Pessoa de Meia-Idade , Caxumba/prevenção & controle , Estudos Retrospectivos , Rubéola (Sarampo Alemão)/prevenção & controle , Estudos Soroepidemiológicos , Estudantes de Medicina/estatística & dados numéricos , Estudantes de Enfermagem/estatística & dados numéricos , Inquéritos e Questionários , Turquia/epidemiologia , Vacinação/métodos , Adulto Jovem
11.
Int J Infect Dis ; 93: 163-167, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32045695

RESUMO

OBJECTIVES: To analyze the effects of one dose of live attenuated hepatitis A vaccine in a developing country. METHODS: The reported cases of hepatitis A virus (HAV) infection from 2005 to 2018 in Henan province, China, were analyzed. Data of vaccinated children were assessed on the childhood immunization information management system. Questionnaire survey and blood sample collection were randomly conducted in six counties and districts of Henan province to analyze the prevalence of HAV lgG among the population aged 0-70 years. RESULTS: In 2008, Henan province began to expand its program on immunization, and children aged 18 months were given one dose of live attenuated hepatitis A vaccine (HepA-L). From 2005 to 2007, the HAV incidence remained steady at above 5000 cases per year and increased to 7489 in 2007. Since 2008, the HAV incidence decreased cumulatively from 4576 to 237 in 2018, indicating a 94.8% decrease, which was particularly pronounced among adolescents (98.2%). The proportion of hepatitis A cases in patients younger than 10 years continually decreased from 41.6% in 2012 to 3.8% in 2018. The reduction of reported cases older than 40 years was slower than that of children. In 2012, the proportion of hepatitis A cases older than 40 years was 27.6%, and continually increased to 69.2% (164/237) in 2018. The results of serological investigation showed that the 0-1.5-year age group had the lowest anti-HAV IgG prevalence (38.6%), which increased to 75.0% in the 4-6-year age group, covered by this immunization program. CONCLUSIONS: The data indicated a large decrease in HAV infections in Henan province from 2008 onward in response to the introduction of a planned immunization program of HepA-L.


Assuntos
Vacinas contra Hepatite A , Hepatite A/epidemiologia , Hepatite A/prevenção & controle , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , China/epidemiologia , Países em Desenvolvimento , Feminino , Anticorpos Anti-Hepatite A/sangue , Vírus da Hepatite A/imunologia , Humanos , Programas de Imunização , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Vacinação , Vacinas Atenuadas , Adulto Jovem
12.
Pediatr Infect Dis J ; 39(2): 164-169, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31929432

RESUMO

BACKGROUND: Hepatitis A is endemic in many countries. Swiss guidelines recommend vaccinating patients native from endemic areas. In Geneva's Children's hospital, migrant children are screened and vaccinated if seronegative. Because hepatitis A's prevalence is decreasing worldwide, more children are seronegative at arrival, highlighting the need for immunization in medical centers and refugee camps and questioning the benefits of systematic serology. Other Swiss hospitals vaccinate regardless of serostatus. This study's aim is to assess migrant children's immunity according to origin and age, and the cost-effectiveness of different immunization strategies. METHODS: We retrospectively analyzed 329 children's serostatus (1-16 years of age) between 2012 and 2015, using enzyme-linked fluorescent assay method. Serology and vaccine costs were based on local prices. Groups were compared with χ test and the age-seropositivity relationship was studied with linear regression. RESULTS: The predominant regions were the Eastern Mediterranean and European Regions with mostly negative serologies (71% and 83%) and the African Region with mostly positive serologies (79%). Immunity varied depending on birth country. Regardless of region, seropositivity increased with age (P < 0.001). The most cost-effective vaccination strategy was an individualized approach based on age and origin, reducing costs by 2% compared with serology-guided immunization and by 17% compared with systematic vaccination. CONCLUSIONS: Many migrant children >5 years old are seronegative and at risk of clinical infection. They need to be immunized. New guidelines according to age and origin should be defined to reduce immunization costs. We recommend systematic vaccination for patients <5 years old or native from low endemicity areas (≤25.7% of seropositivity). For the others, we propose serology-based vaccination.


Assuntos
Vacinas contra Hepatite A/imunologia , Hepatite A/epidemiologia , Hepatite A/prevenção & controle , Migrantes , Vacinação , Adolescente , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Hepatite A/transmissão , Vacinas contra Hepatite A/administração & dosagem , Vacinas contra Hepatite A/economia , Humanos , Programas de Imunização , Lactente , Masculino , Programas de Rastreamento , Vigilância em Saúde Pública , Estudos Retrospectivos , Suíça/epidemiologia , Vacinação/economia , Vacinação/métodos
13.
Ann Rheum Dis ; 79(1): 39-52, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31413005

RESUMO

To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. Four systematic literature reviews were performed regarding the incidence/prevalence of vaccine-preventable infections among patients with AIIRD; efficacy, immunogenicity and safety of vaccines; effect of anti-rheumatic drugs on the response to vaccines; effect of vaccination of household of AIIRDs patients. Subsequently, recommendations were formulated based on the evidence and expert opinion. The updated recommendations comprise six overarching principles and nine recommendations. The former address the need for an annual vaccination status assessment, shared decision-making and timing of vaccination, favouring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression. Non-live vaccines can be safely provided to AIIRD patients regardless of underlying therapy, whereas live-attenuated vaccines may be considered with caution. Influenza and pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. Tetanus toxoid and human papilloma virus vaccination should be provided to AIIRD patients as recommended for the general population. Hepatitis A, hepatitis B and herpes zoster vaccination should be administered to AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD.


Assuntos
Antirreumáticos/uso terapêutico , Doenças Autoimunes/tratamento farmacológico , Infecções Bacterianas/prevenção & controle , Doenças Reumáticas/tratamento farmacológico , Vacinas/uso terapêutico , Viroses/prevenção & controle , Características da Família , Hepatite A/prevenção & controle , Vacinas contra Hepatite A/uso terapêutico , Hepatite B/prevenção & controle , Vacinas contra Hepatite B/uso terapêutico , Herpes Zoster/prevenção & controle , Vacina contra Herpes Zoster/uso terapêutico , Humanos , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/uso terapêutico , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Tétano/prevenção & controle , Toxoide Tetânico/uso terapêutico , Vacinas Atenuadas/uso terapêutico
14.
Sex Transm Infect ; 96(2): 110-114, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31346067

RESUMO

OBJECTIVES: In 2017, an outbreak of hepatitis A among gay, bisexual and other men who have sex with men (MSM) was reported in Victoria, Australia. In 2018, the Victorian government implemented a free hepatitis A vaccination programme targeting all Victorian MSM. This study aimed to determine hepatitis A vaccine uptake among MSM in a sexual health clinic in Melbourne. METHODS: All MSM attending the Melbourne Sexual Health Centre (MSHC) in 2018 were included. Chart review was performed to determine the proportion of men vaccinated for at least one dose of hepatitis A and to examine why men did not receive the vaccine. Multivariable logistic regression was performed to examine the factors associated with vaccine uptake. Vaccine uptake was defined as receipt of at least one dose of hepatitis A vaccine. RESULTS: Of the 9582 MSM who attended MSHC in 2018, 61.3% (95% CI 60.3% to 62.2%) self-reported already being immune to hepatitis A. Of the 3713 remaining eligible men, 62.7% (95% CI 61.1% to 64.2%) received at least one dose of the hepatitis A vaccine on the day of attendance. Compared with MSM not living with HIV and not taking pre-exposure prophylaxis (PrEP), MSM taking PrEP (adjusted OR 1.28; 95% CI 1.01 to 1.62) were more likely to receive the vaccine. 1386 men (37.3%) did not receive the vaccine and 55.4% were not offered the vaccine by their treating clinician. 300 men (21.6%) were identified as non-immune after serological testing but did not return for vaccination. By the end of 2018, 85.5% of MSHC attendees (8196/9582) were immune to hepatitis A. CONCLUSION: The critical vaccination threshold for hepatitis A has been estimated at >70%. Continuation of the targeted hepatitis A vaccination programme will improve immunity among the MSM population to prevent ongoing transmission and the likelihood of future outbreaks.


Assuntos
Infecções por HIV/epidemiologia , Vacinas contra Hepatite A/uso terapêutico , Hepatite A/prevenção & controle , Profilaxia Pré-Exposição/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Adulto , Surtos de Doenças , Infecções por HIV/prevenção & controle , Hepatite A/epidemiologia , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Recusa de Vacinação , Vitória/epidemiologia
15.
Epidemiol Health ; 41: e2019038, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31715685

RESUMO

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.


Assuntos
Surtos de Doenças , Hepatite A/epidemiologia , Hepatite A/prevenção & controle , Adulto , Surtos de Doenças/prevenção & controle , Política de Saúde , Vacinas contra Hepatite A/administração & dosagem , Humanos , Saúde Pública , República da Coreia/epidemiologia , Fatores de Risco
16.
Indian Pediatr ; 56(9): 741-744, 2019 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-31638005

RESUMO

OBJECTIVE: To study the Hepatitis A virus (HAV) infection-related pediatric liver disease burden. METHODS: Hospital records of 431 children (age <18 y) diagnosed to be suffering from acute HAV infection during 2011 to 2018 were extracted and analyzed. Additionally, a seroprevalence study was done on 2599 participants (696 children and 1903 adults). RESULTS: HAV infection accounted for about half (48.6% of acute hepatitis and 46.5% (92/198) of acute liver failure cases) of all acute onset icteric illness, with significant morbidity and mortality. As per seroprevalence data, 16.2% of children between 10-18 years of age, and 10.3% of adults aged 18-30 years remained susceptible to HAV infection. CONCLUSIONS: HAV infection is the major contributor the overall pediatric liver disease burden. A significant proportion of subjects remain susceptible to HAV infection even after 10 years of age. Population-based studies are required to further delineate the epidemiology of HAV infection in India for deciding introduction of HAV vaccine in the national immunization schedule.


Assuntos
Hepatite A/epidemiologia , Adolescente , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Feminino , Hepatite A/diagnóstico , Hepatite A/prevenção & controle , Vacinas contra Hepatite A , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Estudos Soroepidemiológicos
17.
Vaccine ; 37(52): 7535-7538, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31611096

RESUMO

The National Travel Health Network and Centre (NaTHNaC) offers a telephone advice line for travel health practitioners in the UK. In this study we review clinical incidents concerning vaccines or malaria prophylaxis reported between 2016 and 2018. Two-hundred-and-fifty-one clinical incident calls were recorded, and commonly concerned scheduling or dosing errors. Vaccine scheduling errors accounted for 103 calls (41%), predominantly due to hepatitis A or hepatitis B vaccination either alone or in combination (65/103, 63%). Administration of yellow fever vaccine within 28 days of measles, mumps and rubella accounted for a further 15 (15%) calls. Twenty-six (10%) calls reported administration of a vaccine that was not recommended either for the destination or contraindicated in the traveller. Yellow fever was the commonest single vaccine discussed in 28.4% of vaccine clinical incidents reported. By highlighting common mistakes, we hope to raise awareness of common issues and improve practice in travel health.


Assuntos
Esquemas de Imunização , Consulta Remota/estatística & dados numéricos , Doença Relacionada a Viagens , Viagem , Vacinas/administração & dosagem , Hepatite A/prevenção & controle , Humanos , Malária/prevenção & controle , Sarampo/prevenção & controle , Caxumba/prevenção & controle , Rubéola (Sarampo Alemão)/prevenção & controle , Telefone , Reino Unido , Vacinação , Febre Amarela/prevenção & controle
18.
Int J Health Care Qual Assur ; 32(8): 1175-1199, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31566514

RESUMO

PURPOSE: Hepatitis A is a prevalent disease that is largely preventable by vaccine usage. The vaccine for this illness is highly underused in most regions. In an attempt to find the strategies that are most beneficial in regard to quality-adjusted life years (QALYs) and cost in current environments, the purpose of this paper is to conduct cost-effectiveness analyses to investigate vaccination strategies in a more economically developed country (MEDC), generally known as a "developed" area: the USA, and a less economically developed country (LEDC), generally known as a "developing" area: the state of Rio de Janeiro, Brazil. DESIGN/METHODOLOGY/APPROACH: This study used a dynamic transmission model for comparative effectiveness analyses. The model ran two different scenarios. The two regions studied have different policies and strategies for Hepatitis A vaccination currently, and also used different strategies in 2009. In the USA, a universal vaccination policy was modeled, along with a scenario in which it was removed. In Rio de Janeiro, a no vaccination policy was modeled, along with a scenario in which a universal vaccination policy was effected. FINDINGS: The comparison of resulting incremental cost-effectiveness ratio values to accepted threshold values showed universal vaccination to be cost-effective in both the USA and Rio de Janeiro as compared to no vaccination. When episode and vaccination costs and vaccination efficacy were varied, this still remained true. Universal vaccination was found to result in lower incidence of Hepatitis A in both the USA and Rio de Janeiro. Over the twenty-year time horizon, universal vaccination is projected to prevent 506,945 cases of symptomatic Hepatitis A in the USA and 42,318 cases of Hepatitis A in Rio de Janeiro. Other benefits include a projected increase in cumulative QALYs through the use of universal vaccination. ORIGINALITY/VALUE: This analysis showed universal vaccination to be cost-effective as compared to no vaccination, and portions of the study's approach had not previously been applied in tandem to investigate Hepatitis A interventions. The results may help foster higher compliance rates for Hepatitis A vaccination and even greater per-person economic benefits of universal vaccination, particularly in the USA. The purpose of this study is also to encourage elevated levels of surveillance on age of infection in developing regions and consistent reevaluation utilizing dynamic transmission models in both the USA and Brazil, as well as other rapidly developing regions, in order to prevent future epidemics and costs associated with the disease.


Assuntos
Análise Custo-Benefício , Países em Desenvolvimento , Hepatite A/prevenção & controle , Vacinação/economia , Vacinação/tendências , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Hepatite A/epidemiologia , Humanos , Lactente , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Adulto Jovem
19.
MMWR Morb Mortal Wkly Rep ; 68(35): 766-770, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31487277

RESUMO

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.


Assuntos
Surtos de Doenças/prevenção & controle , Água Potável/virologia , Hepatite A/epidemiologia , Hepatite A/prevenção & controle , Prática de Saúde Pública , Regulamentação Governamental , Vacinas contra Hepatite A/administração & dosagem , Humanos , Avaliação de Programas e Projetos de Saúde , Estados Unidos/epidemiologia , United States Environmental Protection Agency , Abastecimento de Água/legislação & jurisprudência
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