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Профилактика вирусного гепатита А в странах со средним уровнем эндемичности остается актуальным вопросом современности. Наиболее эффективным методом профилактики в мире является вакцинация в сочетании с соблюдением удовлетворительных санитарно-гигиенических условий. Доказано, что прививки против вирусного гепатита А обеспечивают длительную и эффективную защиту, хорошо переносятся и не вызывают серьезных побочных реакций. В регионах со средним уровнем эндемичности по вирусному гепатиту А должна быть рассмотрена возможность вакцинации, особенно категорий населения, относящихся к группам риска.

Hepatitis A is an important public health issue worldwide. Hepatitis A vaccine (HepA) was first licensed in 1992. Both inactivated HepA (HepA-I) and live attenuated HepA (HepA-L) are highly immunogenic and well tolerated, and immune protection postvaccination can persist for at least 20 y. HepA is effective for both preexposure and postexposure prophylaxis, especially among children and young adults. The strategy of HepA vaccination varies in different countries and mainly includes vaccination among high-risk populations, regional childhood vaccination and universal childhood vaccination. The incidence of hepatitis A has decreased greatly in many countries in the last 30 y, but hepatitis A outbreaks frequently occur among high-risk populations and those who have not been covered by universal child vaccination programs in recent years. Disease surveillance and serosurveys are suggested to clarify the shift in the epidemiology of hepatitis A. The long-term persistence of immune protection after one dose of HepA should be further studied, as well as the cost-effective evaluation of different strategies of HepA vaccination. Based on this evidence, the recommendation on HepA vaccination should be put forward scientifically and updated in a timely and well-implemented manner.

Hepatitis A virus (HAV) infections continue to represent a significant disease burden causing approximately 200 million infections, 30 million symptomatic illnesses and 30,000 deaths each year. Effective and safe hepatitis A vaccinfes have been available since the early 1990s. Initially developed for individual prophylaxis, HAV vaccines are now increasingly used to control hepatitis A in endemic areas. The human enteral HAV is eradicable in principle, however, HAV eradication is currently not being pursued. Inactivated HAV vaccines are safe and, after two doses, elicit seroprotection in healthy children, adolescents, and young adults for an estimated 30-40 years, if not lifelong, with no need for a later second booster. The long-term effects of the single-dose live-attenuated HAV vaccines are less well documented but available data suggest they are safe and provide long-lasting immunity and protection. A universal mass vaccination strategy (UMV) based on two doses of inactivated vaccine is commonly implemented in endemic countries and eliminates clinical hepatitis A disease in toddlers within a few years. Consequently, older age groups also benefit due to the herd protection effects. Single-dose UMV programs have shown promising outcomes but need to be monitored for many more years in order to document an effective immune memory persistence. In non-endemic countries, prevention efforts need to focus on 'new' risk groups, such as men having sex with men, prisoners, the homeless, and families visiting friends and relatives in endemic countries. This narrative review presents the current evidence regarding the immunological and epidemiological long-term effects of the hepatitis A vaccination and finally discusses emerging issues and areas for research.

In most countries of the Middle East and Northern African (MENA) region, a high hepatitis A virus (HAV) endemicity has been documented. Few others, such as Saudi Arabia and Turkey, are transitioning from high to intermediate endemicity. There is a paucity of recently published HAV disease burden that could be useful to inform or strengthen relevant national hepatitis A vaccination policy and other prevention strategies in the region. This review summarizes information on HAV epidemiology before and after the implementation of a childhood hepatitis A vaccination program in Saudi Arabia and Turkey. In both countries, a clear shift in the age of first HAV exposure has been documented, with more homogeneous trends across regions in Saudi Arabia compared to Turkey. Utilizing the experience of Saudi Arabia and Turkey with hepatitis A vaccination, countries in the region are encouraged to foster discussions on potential vaccination strategies suitable for their own setting.

Background: Single dose hepatitis A virus (HAV) vaccine had been proven its efficacy in immunocompetent but not immunocompromised hosts. We aim to investigate the effectiveness of one dose versus 2 doses HAV vaccine among people living with HIV (PLHIV). Method: We conducted a 1:1 single center retrospective case–control study for PLHIV in Northern Taiwan. Case patients were those who received single dose HAV vaccine and controls were those who completed standard 2 doses HAV vaccine. Nationwide campaign of single dose HAV vaccine had been practiced for high risk population including PLHIV and those who had newly diagnosed sexually transmitted diseases. Results: During February 2016 and December 2017, 90 cases received single dose HAV vaccine provided while the other 90 age-matched controls received 2 doses vaccine were enrolled. We found more injection drug users (22.22% vs. 1.11%, p

Hepatitis A and B disease burden persists in the US. We assessed hepatitis A and hepatitis B vaccination series completion rates among 350,240 commercial/Medicare and 12,599 Medicaid enrollees aged ≥19 years. A vaccination series was considered as completed provided that the minimum interval between doses, as defined by the CDC, and the minimum number of doses were reached. We stratified completion rates by vaccine type (i.e. monovalent or bivalent) at initial vaccination for each cohort. In the commercial/Medicare cohort, the series completion rate was 32.0% for hepatitis A and 39.6% for hepatitis B among those who initiated with a monovalent vaccine, and it was 36.2% for hepatitis A and 48.9% for hepatitis B among those who initiated with a bivalent vaccine. In the Medicaid cohort, the series completion rate was 21.0% for hepatitis A and 24.0% for hepatitis B among those who initiated with a monovalent vaccine, and it was 19.0% for hepatitis A and 24.6% for hepatitis B among those who initiated with a bivalent vaccine. In conclusion, hepatitis A and B vaccination series completion rates were low, and appeared to be lower among Medicaid than among commercial/Medicare enrollees. Commercial/Medicare enrollees who initiated with a bivalent vaccine had higher series completion rates than those who initiated with monovalent vaccines – an observation that was not made among Medicaid enrollees.

To evaluate the initiation and completion and timeliness of inactivated hepatitis A vaccine (HAV-I) series, to identify the missed opportunities for HAV-I series, and to examine determinants associated with the completion of HAV-I.Children born from 1 January 2005 to 31 December 2014 and registered in Zhejiang provincial immunization information system (ZJIIS), were enrolled in this study. Descriptive statistics were used to describe the initiation and completion, the timeliness and the missed opportunities for HAV-I. Logistic regression analysis was applied to explore the determinants of the completeness of HAV-I.The initiation rate of HAV-I increased from 8.1% for the 2005 birth cohort to 13.2% for the 2014 birth cohort. The completion rate of HAV-I increased from 4.2% for the 2005 birth cohort to 7.8% for the 2014 birth cohort. The timeliness rate of the 1Although the initiation and completion of HAV-I series had improved in recent years, these indicators were still lower than those for other vaccines scheduled at the similar age. It is important for providers to identify every opportunity for HAV-I vaccination and to assure that children get protection from this vaccine-preventable disease.

Background Brazil has transitioned from an intermediate to low hepatitis A virus endemic country, increasing the risk of severe Hepatitis A (HepA) disease. To control transmission, the HepA vaccine, MSD, was introduced in the National Childhood Immunization Program (NIP) in 2014 for children aged 12-24 months and extended to children under 5 years old in 2017. We evaluated the impact of the vaccination on the HepA incidence, associated healthcare resource utilization (HCRU), and costs. Methods We conducted an observational, retrospective study using Brazilian National Public Health Data (DATASUS). An interrupted time-series analysis was conducted for incidence rates (IR) of laboratory- or clinically-confirmed Hep A cases. Using a negative binomial regression model, we assessed changes in annual HepA IR between pre- (2010-2013) and post- (2015-2018) HepA vaccination periods and compared to predicted counterfactual rates without HepA vaccination. We compared HCRU and cost of Hep A-associated hospitalizations and outpatient procedures between pre- and post- HepA vaccination periods. Results Between 2010 and 2018, 32,295 Hep A cases occurred across all ages. Among the NIP target children aged 1-4 years, HepA vaccination was associated with an immediate HepA IR decrease (-52,5% of level change) and with a decrease in slope (-7.7% vs -67.6% per year for pre- and post-periods, respectively, Figure 1). We observed a similar trend in non- HepA vaccination target children aged 5-14 years with -57.1% of level change and slope change from -3.4% (pre- HepA vaccination) to -53.7% (post- HepA vaccination) per year (Table 1). Across all age groups, 14,468 Hep A cases were averted when compared to predicted counterfactual rates (Table 2). Overall, HepA-related hospitalization rate dropped 64% after NIP introduction of vaccination resulting in a cost reduction of 55%. The total number of outpatient procedures claimed among HepA-diagnosed patients reduced 18% with 42% cost reduction. Figure 1: time-series analyses of Hepatitis A incidence rate (IR) for NIP target population. Monthly number of hepatitis A cases observed over the study period (black line). Predicted trend based on the pre- HepA vaccination (red line) and post- HepA vaccination (blue line) monthly cases Table 1: Time-series analysis of the impact of the hepatitis A vaccination on the incidence rate level of change, according to age group Table 2: Number of observed, predicted counterfactual, and averted hepatitis A cases in the post- HepA vaccination period (2015-2018), according to age group. Conclusion In Brazil, the single-dose hepatitis A vaccine childhood program effectively reduced the Hepatitis A incidence, HCRU and associated-costs in vaccinated and in some non-vaccinated age groups. Disclosures Ana Luiza Bierrenbach, MD, MSc, PhD, MSD Brazil (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support) Yoonyoung Choi, PhD, MS, RPh, Merck (Employee) Paula M. Batista, BSc, MSD Brazil (Employee) Fernando Serra, MD, MSD Brazil (Employee) Cintia Parellada, MD, PhD, MSD Brazil (Employee) Guilherme Julian, BSc, MSc, IQVIA (Employee)MSD (Consultant, Research Grant or Support) Karina Nakajima, BSc, PhD, IQVIA (Employee)MSD (Consultant, Research Grant or Support) Thais Moreira, MD, MSc, MSD Brazil (Employee)

Background Widespread Hepatitis A (Hep A) outbreaks in the United States (US) have raised the importance of vaccination. Vaccination requirements for childcare and school entry could be an effective strategy to ensure compliance to recommended vaccination schedule. We assessed the association between state childcare and school entry requirements for Hep A vaccination and vaccine coverage rate among children and adolescents in the US. Methods We conducted a cross-sectional cohort study using National Immunization Survey-Child and Teen dataset between 2008 and 2017. We included children aged 19–35 months and adolescents aged 13–17 years residing in states with childcare entry requirement only (C); school entry requirement only (S); childcare AND school entry requirement (C+S); and neither of requirements in place in the survey year (Control). We developed a multivariate logistic regression model adjusting for demographics, survey year, state’s CDC vaccination recommendation status, stringency of requirement, and history of Hep A outbreak, accounting for the survey design. Results We included 150,653 children and 119,265 adolescents in the analysis. Vaccination initiation rate was 53.9% and 72.6% (C), 48.3% and 74.9% (S), 48.2% and 83.9% (C+S) in pre- and post-requirement periods, respectively. In multivariate analysis, all state requirements were associated with higher Hep A vaccination initiation compared to control states (C: odds ratio 1.51, 95% confidence interval 1.37–1.66; S: 1.82, 1.49–2.23; and C+S: 1.49, 1.38, 1.62). Predictors for high vaccination initiation included vaccine recommendation since 1999 vs 2006 (2.87, 2.63–3.13); exemption of enforcement (most restrictive vs lenient: 2.10, 1.68–2.63). In addition, non-White, Hispanic children aged between 19–35 months with insurance, >$75,000 family income household, mothers having college degree were more likely to initiate Hep A vaccination. The associations were similar for Hep A vaccination completion. Figure 1. Hep A vaccination initiation and completion rates between pre- and post-requirement periods (C=childcare entry requirement only; S=school entry requirement only; and C+S=childcare AND school entry requirement) Table 1. Multivariate association between state policy and vaccination initiation and completion rate Conclusion States with childcare and school entry requirements are more likely to initiate and complete Hep A vaccine compared to those without such policy. This interventional policy may help to control and prevent Hep A outbreaks in states where it is applied. Disclosures Yoonyoung Choi, PhD, MS, RPh, Merck (Employee) Alexandra Bhatti, JD, MPH, Merck (Employee) Zhiwen Liu, PhD, Merck & Co., Inc., (Employee) Michelle Goveia, MD, Merck & Co., Inc (Employee, Shareholder) Jakub Simon, MD, MS, Merck Sharp & Dohme Corp, a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (Employee, Shareholder)

Background The Advisory Committee on Immunization Practices recommends simultaneous administration of all age-appropriate doses of vaccines. We estimated the vaccination coverage for ≥2 doses of hepatitis A vaccine (≥2 HepA) that could have been achieved if opportunities for simultaneous administration with other recommended childhood vaccines had not been missed. Methods We analyzed National Immunization Survey-Child data for 2008–2017 in the United States. We defined potentially achievable ≥2 HepA coverage by age 24 months as the possible coverage if opportunities for simultaneous administration with other age-appropriate doses of vaccines for children by age 24 months had not been missed. We compared potentially achievable vaccination coverage to reported ≥2 HepA vaccination coverage by birth years 2007 to 2015. For children born in 2015, we stratified estimates by state and by selected socio-demographic factors. Both potentially achievable and reported ≥2 HepA coverage were evaluated using a Kaplan–Meier survival procedure to account for censoring of vaccination status. Results Compared with reported vaccination coverage, potentially achievable coverage for ≥2 HepA was at least 10 percentage points higher across birth years 2007 to 2015 and would have surpassed the 85% target of Healthy People 2020 for children born in 2015 (Figure 1). For the 2015 birth cohort, potentially achievable ≥2 HepA coverage exceeded the 85% Healthy People 2020 target in ten states (Figure 2). In addition, potentially achievable vaccination coverage was higher than reported coverage across all selected socio-demographic factors, with differences ranging from 20.1 percentage-points (private insurance only) to 31.7 percentage-points (non-Hispanic Black) (Table 1). Conclusion Potentially achievable coverage with ≥2 HepA consistently exceeded reported coverage for children from nine recent birth cohorts and across all selected socio-demographic characteristics. Coverage could increase substantially if missed opportunities were eliminated. Evidence-based interventions such as establishment of standing orders, use of provider reminders, and use of immunization information systems are recommended to increase HepA coverage among young children. Disclosures All authors: No reported disclosures.

This study tries to look into the relationship between preventive behaviors and health belief for hepatitis A and seroprevanlence rate of hepatitis A. The cross ratio of seroprevanlence rate of hepatitis A significantly increased with an increase in age [1.210(95% CI, 1.158-1.264)], and those who had hepatitis A vaccination had a significantly higher cross ratio than those who didn`t [19.591(95% CI 6.524-58.82)], and the more health motivation they had, the higher the cross ratio was [1.478(95% CI 1.053-2.075)]. To increase seroprevalence rate of hepatitis A, it is necessary to provide personal hygiene for health motivation and prevention education thoroughly and to give vaccination of hepatitis A.

Acute hepatitis A infection is largely self-limiting illness, rarely resulting in fulminant course with consequent hepatic failure and death. We present a 13-year old previously healthy Omani with fatal hepatitis A virus infection. This case highlights the critical role of hepatitis A vaccination and argues for consideration of its inclusion in national vaccination programs in order to avert similar devastating consequences of yet another vaccine preventable disease.

Hepatitis A can cause serious illness among adolescents and adults with low vaccination coverage. Even though hepatitis A vaccine is one of the strong candidates for Korean national immunization program, adolescents aged older than 12 yr would not benefit. Our purpose was to assess the willingness and analyze the correlates of Korean mothers for hepatitis A (HepA) vaccination to develop strategies for HepA vaccination. A national telephone survey on 800 mothers with children aged 7-18 yr was conducted with random-digit dialing method. Sixty-two percent and 92% of the mothers reported that they were willing to HepA vaccination at current cost and at half of the current cost, respectively. However, at current cost, only 79% wished to vaccinate their child in an epidemic and 32% wished to vaccinate promptly. Having two or more children, not having future plans to send the child overseas, and low family income were significantly associated with not willing to HepA vaccination. Low perception of the susceptibility for hepatitis A and perception of the current cost as barrier increased the odds of unwillingness to vaccination at current cost and to prompt vaccination. The mothers' willingness to HepA vaccination for the children aged 7-18 yr in Korea was not very high at current cost and associated socioeconomic status and health-belief. Targeted intervention or strategies are needed to increase the HepA vaccination rate among children in Korea. Graphical Abstract

As India is transitioning from high to intermediate hepatitis A endemicity, the need for hepatitis A vaccination programs increases. This study investigated the immunogenicity and safety of a virosomal hepatitis A vaccine (HAVpur Junior) compared with an aluminum-adsorbed hepatitis A vaccine (Havrix 720 Junior) in Indian children. Healthy children aged 18–47 months, stratified by age, were randomized to either HAVpur Junior or Havrix 720 Junior. The first dose of vaccine was administered on Day 1 and the second (booster) dose 6 months later. Antibodies against hepatitis A virus (HAV) were measured using a microparticle enzyme immunoassay. The primary objective assessed non-inferiority of HAVpur Junior to Havrix 720 Junior in terms of seroprotection rates (≥ 10 mIU/mL anti-HAV antibodies) at 1 month after the first vaccination. Non-inferiority was demonstrated if the lower limit of the 90% confidence interval of the group difference was greater than –10%. Local and systemic adverse events were recorded. The seroprotection rate at 1 month was 95.9% in the HAVpur Junior group and 96.6% in the Havrix 720 Junior group. As the lower limit of the 90% confidence interval of the group difference was greater than –10% (–4.7), non-inferiority of HAVpur Junior to Havrix 720 Junior was established. The overall incidence of adverse events (solicited and unsolicited) after each vaccination was similar in both groups. In conclusion, the aluminum-free virosomal vaccine HAVpur Junior induced a similar immune response to Havrix 720 Junior in healthy Indian children aged 18 to 47 months. Both vaccines were well tolerated. The study shows that the low-dose virosomal HAV vaccine is consistently efficacious and well tolerated in children of all age groups and is suitable for inclusion into Indian childhood vaccination schedules.

PubMedID: 25910370 BACKGROUND/AIMS: The aim of the study was to determine the epidemiological shift that may have occurred in the last 11 years of Hepatitis A virus (HAV) seroprevalence.MATERIALS AND METHODS: In 1998, we reported the anti-HAV seroprevalence in 711 children aged between 2 and 16 years children in Adana city center. Eleven years later we repeated the same study at the same locations in a similar population with the same method.RESULTS: From 1998 to 2009 anti-HAV seroprevalence declined from 33.9% to 22.2%, 29.5% to 25.3% (p>0,05), 52.2% to 30.8%, 69.7% to 35.2%, 66.9% to 37.7% and 71.4% to 47.3% (p

Hepatitis A (HAV) incidence has decreased in the United States, yet regional disparities persist. The role of international travel has become increasingly important in HAV transmission. We compared the relative burden of HAV in border and non-border regions in Arizona and examined the role of travel in sustaining HAV transmission.HAV vaccination coverage was calculated by age and region, using Arizona State Immunization Information System data. Incidence, demographics, and risk factors of cases reported through Arizona's infectious disease surveillance system between 2006 and 2011 were analyzed.Hepatitis A incidence was higher in the border region of Arizona. Compared with the rest of Arizona, one-dose coverage in children15 years was lower in the border region until 2008. Second dose coverage was lower in the border region, particularly among Spanish speakers. International travel among cases was generally high; however, in the border region cases were more likely to visit Mexico or South/Central America (94% vs. 80%, P value = 0.01) and be Hispanic (68% vs. 42%, P value = 0.0003).Rates of HAV continue to be higher in the Arizona border region; the risk appears particularly high among Hispanics with recent travel in the Americas. Border surveillance should be emphasized, along with vaccination of all travelers, to continue to decrease and control HAV.

This study was designed to identify factors associated with hepatitis A immunization status and seropositivity in Korean children. In-person interviews, reviewing their vaccination cards and testing hepatitis A antibody were conducted with 389 children aged 1-3 years and 544 children aged 6-8 years. In all age groups, earlier birth order was the only significant factor in children receiving either single or both doses of the vaccination. And completion of the second dose of vaccination was a prerequisite for increased seropositivity. Additionally, household income had a positive impact on seropositivity only in children aged 6-8 years. Our findings suggest that presence of an economic barrier is the underlying cause of the decreased hepatitis A vaccination services in Korea. Therefore, hepatitis A vaccine should be included in the essential National Immunization Program.

Objective To assess physicians': 1) knowledge and attitudes about hepatitis A disease and hepatitis A (HepA) vaccine, 2) child care and school HepA vaccine mandates, 3) practices related to HepA vaccine delivery, 4) factors associated with strongly recommending HepA vaccine to all 1- to 2-year-olds, and 5) feasibility of implementing HepA catch-up vaccination at health maintenance visits. Methods A national survey was conducted among representative networks of pediatricians and family medicine physicians (FMs) from March to June, 2014 via e-mail or mail on the basis of provider preference. Results Response rates were 81% (356 of 440) among pediatricians and 75% (348 of 464) among FMs. Less than 50% correctly identified that hepatitis A virus (HAV) infection is usually asymptomatic in young children and that morbidity from HAV disease increases with age. Ninety-two percent of pediatricians and 59% of FMs strongly recommend HepA vaccine for all 1- to 2-year-olds. In addition to practice specialty, belief that HepA vaccine is required for kindergarten enrollment was the most robust predictor of strong physician recommendation. Conclusions Gaps in knowledge regarding HAV infection and hepatitis A recommendations and lack of a strong recommendation for routine HepA vaccination of young children among FMs likely contribute to suboptimal coverage. Closing knowledge gaps and addressing barriers that prevent all physicians from strongly recommending HepA vaccine to 1- to 2-year-olds could help increase HepA vaccine coverage and ultimately improve population protection against HAV infection.

There are indications of a shift in the pattern of hepatitis A (HAV) in Mexico from high to intermediate endemicity, progressively increasing the mean age of infection and the proportion of cases which are symptomatic. This study estimated the potential impact of universal infant HAV vaccination in Mexico with two doses of Havrix™ at 12 and 18 mo of age on all HAV infections and symptomatic HAV infections. We developed a dynamic transmission model that accounts for changes in demography and HAV epidemiology. It was calibrated using Mexican age-specific seroprevalence and symptomatic HAV incidence data. With 70% first-dose coverage and 85% second-dose coverage, the calibrated model projected that HAV vaccination would reduce the incidence of all HAV infections (symptomatic and asymptomatic) after the first 25 y of vaccination by 71-76% (minimum and maximum for different transmission scenarios). The projected reduction in cumulative incidence of symptomatic HAV infections over the first 25 y of vaccination was 45-51%. With 90% first-dose coverage and 85% second-dose coverage, the projected reduction in incidence of all HAV infections was 85-93%, and the projected reduction in the cumulative incidence of symptomatic HAV infections was 61-67%, over a 25-y time frame. Sensitivity analyses indicated that second-dose coverage is important under the conservative base-case assumptions made about the duration of vaccine protection. The model indicated that universal infant HAV vaccination could substantially reduce the burden of HAV disease in Mexico.

The article describes results of the analysis of incidence rate of hepatitis A in Russia and 29 European countries over the period 2001 to 2008. The characteristic of hepatitis A outbreaks as well as molecular genetic diversity of hepatitis A virus in Russia and Europe has been compared. The authors analyze the state of herd immunity to hepatitis A virus in population of the territories of countries mentioned above. The results of seroprevalence study of hepatitis A virus among different age groups in Moscow are presented. The critical role of hepatitis A vaccination in the system of prevention and disease control measures is emphasized.

Background: Autoimmune mechanisms and drugs used in treatment increase the risk of liver disease in patients with juvenile idiopathic arthritis (JIA) and hepatitis A virus (HAV) vaccination is important, especially in intermediate-endemicity areas like Turkey. In our study, we aimed to evaluate the immune response to hepatitis A vaccine and vaccine safety in children with JIA. Methods: This study was carried out in our hospital’s Pediatric Rheumatology outpatient clinic and Healthy Child clinic between the years 2003 and 2008. The study group consisted of 47 children with JIA (23 male and 24 female) diagnosed according to International League of Associations for Rheumatology diagnostic criteria. The control group consisted of 67 healthy children (31 female, 36 male) who did not have a history of hepatitis A infection or vaccination. Both groups were vaccinated with two doses of hepatitis A vaccine at 6-month intervals. Anti-HAV IgG >80 MIU was accepted as positive response. Results: There was no significant difference between the groups in terms of age and sex. None of the patients with JIA had fever, clinical worsening, or disease activation after vaccination. Anti-HAV IgG positivity rate was significantly higher in the control group (p

BACKGROUND Since the mid-1990s, hepatitis A vaccine has been recommended for US children living in historically high-incidence states and for persons with other risk factors or chronic liver disease (CLD). The incidence of hepatitis A has declined dramatically during the era of vaccination, but trends in mortality are largely unknown. METHODS US death certificates from 1990 to 2004 for which hepatitis A was listed as the underlying cause of death were analyzed. Average annual age-adjusted mortality rates during the prevaccine (1990-1995) and post-vaccination recommendation (2000-2004) periods were compared using a Mantel-Haenszel test of association. The number of deaths for which CLD was listed as a contributing cause was determined. RESULTS Overall, 1436 deaths due to hepatitis A occurred, averaging 96 annually (range, 142 in 1995 to 54 in 2003). CLD contributed to nearly half of these deaths. Mortality rates paralleled incidence rates, beginning to decline in the mid-1990s and achieving low points in 2003 and 2004. Average rates were 32% lower in the post-vaccination recommendation period than in the prevaccine period (P < .01). The decline was more dramatic for states with (45%; P < .001) than without (23%; P = .002) recommendations. CONCLUSIONS Hepatitis A mortality rates have declined over the past decade. CLD remains an important and preventable contributing cause of death due to hepatitis A.

peer-reviewed The present study examined the association between psychological stress, social support and antibody response to both thymus-dependent and thymus-independent vaccinations. Stressful life events in the previous year and customary social support were measured by standard questionnaires at baseline in 75 (41 females) healthy students. Antibody status was assessed at baseline, 4 and 18 weeks following vaccination with formaldehyde inactivated hepatitis A virus and pneumococcal polysaccharides, which induce thymus-dependent and -independent antibody responses respectively. Controlling for baseline antibody status, life event stress was negatively associated with antibody response to the hepatitis A vaccine at the 18-week follow-up; participants reporting a greater number of stressful life events had a poorer antibody response. There was no relationship between psychological stress and antibody response to pneumococcal vaccination. Social support was not associated with the antibody response to hepatitis A vaccination. However, there was a significant association between support and the antibody response to the thymus-independent pneumococcal vaccine at 4-week followup; participants with larger social networks mounted a better response. These relationships could not be accounted for by age and sex, or by variations in health behaviours. Psychosocial factors would appear to influence the response to both thymusdependent and thymus-independent vaccines, but not in the same manner.

BackgroundRural populations present an elevated risk of exposure to hepatitis A virus.ObjectiveThe objective of this study was to estimate the prevalence and risk factors associated with hepatitis A virus infection among residents of rural settlement projects of southwest Goiás, Central Brazil.MethodsA total of 466 residents were interviewed and tested for the detection of anti- hepatitis A virus antibodies by ELISA.ResultsThe global prevalence of anti- hepatitis A virus was 82.2%. In individuals aged 5-9 years and 10-19 years, the prevalence was 15% and 58.8%, respectively. Persons in the 10-19 age group, with a history of life in encampments, with more than five people per residence consuming well water, were predictors for exposure to hepatitis A virus.ConclusionOur results suggest that the hepatitis A virus endemicity in rural settlements in southwest Goiás similar to that found in the urban population of the Midwest Region, confirming the implementation of universal hepatitis A vaccination in children. ContextoPopulações rurais apresentam um risco elevado de exposição ao vírus da hepatite A.ObjetivoO objetivo deste estudo foi estimar a prevalência e fatores de risco associados à infecção pelo vírus da hepatite A em assentados da região Sudoeste de Goiás, Brasil Central.MétodosUm total de 466 assentados foi entrevistado e testado para detecção de anticorpos anti vírus da hepatite A por ELISA.ResultadosA prevalência global de anti vírus da hepatite A foi de 82,2%. Em indivíduos de 5-9 anos e 10-19 anos, a prevalência foi de 15% e 58,8%, respectivamente. Faixa etária de 10-19 anos, antecedentes de vida em acampamento, mais de cinco pessoas por domicílio e consumir água de poços foram preditores de exposição ao vírus da hepatite.ConclusãoNossos resultados sugerem que a endemicidade do vírus da hepatite em assentamentos rurais do Sudoeste de Goiás é semelhante a encontrada na população urbana da Região Centro-Oeste, ratificando a implementação da vacinação universal contra hepatite A em crianças.

Kawasaki disease (KD) after rotavirus and hepatitis A vaccination has not previously been reported in a baby in China. Herein, we describe a 20-month-old child who developed Kawasaki disease after receiving her second dose of Lanzhou lamb rotavirus vaccine (LLR) and her first dose of freeze-dried live attenuated hepatitis A vaccine. The case report was conducted by collecting and analyzing the hospital in-patient medical records and reviewing both the domestic and foreign pertinent literature. These findings will be important to note this possible side effect and to further investigate the association between the above 2 vaccines and Kawasaki disease.

A survey was carried out to assess the level of knowledge and vaccination coverage of hepatitis A and B among 753 subjects (>12 years of age) from rural areas, town areas, undergraduates and healthcare workers. The main objective of the study was to assess the relationship between the extent of hepatitis A and B knowledge and vaccination status of the participants. A questionnaire was distributed and completed by the subjects. The results showed that the overall level of knowledge among the public was low compared to healthcare workers and undergraduates. The hepatitis A vaccination coverage was very low among all the groups (

In countries with advanced economies better health and hygiene conditions, along with the introduction, in some cases, of global vaccination, have relegated most viral hepatitis to marginal social groups and, in particular, drug users (DUs). The availability of safe and effective vaccines for hepatitis A virus (HAV) and B (HBV) may play a major role in combating this phenomenon. Despite the availability of a safe and effective vaccine for over a decade and the recommendations of international health organizations, vaccinations against HAV among DUs are not as widely known and available as are HBV vaccinations. The purpose of this review article is to present the most significant data in the literature on the prevalence of HAV among DUs and the role of targeted vaccination. To our knowledge, the present article is the first to solely deal with vaccination against HAV in DUs. Immunization after the administration of anti-HAV vaccine has been demonstrated in DUs even if they have responded significantly less than either the general population or carriers of chronic liver disease. All the vaccines were well tolerated and adherence to the vaccine schedule was good. Further studies are needed to optimize the timing and doses of vaccine to be administered to DUs, especially to assess adherence and antibody persistence. Vaccination campaigns are feasible among DUs and have proven to be highly cost–effective.