Preventing hepatitis A through immunization in Uruguay
Keywords:
HEPATITIS A, VACCINES AGAINST HEPATITIS AAbstract
Introduction: Hepatitis A is a health problem in developing countries.
Objectives: To describe strategies to control Hepatitis A through immunization. To describe the evolution of the number of cases, rates and outbreaks from 2005 through 2010.
Method: Retrospective descriptive study covering the 2005-2010 period of time. The following was analysed:
- Strategies used by the Ministry of Public Health to control Hepatitis A through immunization: blocking of outbreaks; population at risk; universal immunization.
- Description: Number of cases of Hepatitis A in Uruguay, and in the department of Artigas; number of outbreaks in cities, neighborhoods, families and other; number of
cases/age.
Results: 21 outbreaks were recorded. 16.715 first doses and 11.354 second doses were applied. From 10 September, 2007 through 26 November, 2007 the Ministry of Public Health and the Ministry of Social Development conducted an immunization campaign aimed at children in the public sub-sector who were between 1 and 5 years old. Professors at the School of Medicine of the University of the Republic and medical students supported and contributed to the dissemination of the campaign. 44.716 first doses and 25.095 second doses were applied. In 2008 the two dose vaccine is included in the mandatory and free immunization plan.
The national rate dropped from 69.6 to 2.7 from 2005 through 2010 (p<0,05); and in the department of Artigas from 780.57/100.000 in 2005 to 0.66 in 2010 (p<0,05).
Between 2005 and 2008 there were 22 outbreaks in cities, in 2010 few intra-family outbreaks and in schools were registered.
The decrease in the number of cases from 2005 through 2010 was significant for all ages.
Comment: A significant and sustained decrease of Hepatitis A outbreaks and rates was evidenced in Uruguay from 2005 through 2010.
References
(2) Quian J, Ruttiman R, Matrai L. Prevalencia de anticuerpos contra hepatitis A en una población de Montevideo. Arch Pediatr Urug 2005; 76(2): 100-5.
(3) Ciocca M. Clinical course and consequences of hepatitis A infection. Vaccine 2000; 18(Suppl 1): S71-4.
(4) Ciocca M, Moreira-Silva SF, Alegría S, Galoppo MC, Ruttiman R, Porta G, et al. Hepatitis A as an etiologic agent of acute liver failure in Latin America. Pediatr Infect Dis J 2007; 26(8): 711-5.
(5) Van Der Wielen M, Vertruyen A, Froesner G, Ibáñez R, Hunt M, Herzog C, et al. Immunogenicity and safety of a pediatric dose of a virosome-adjuvanted hepatitis A vaccine: a controlled trial in children aged 1-16 years. Pediatr Infect Dis J 2007; 26(8): 705-10.
(6) Dagan R, Amir J, Livni G, Greenberg D, Abu-Abed J, Guy L, et al. Concomitant administration of a virosome-adjuvanted hepatitis a vaccine with routine childhood vaccines at age twelve to fifteen months: a randomized controlled trial. Pediatr Infect Dis J 2007; 26(9): 787-93.
(7) López EL, Del Carmen Xifró M, Torrado LE, De Rosa MF, Gómez R, Dumas R, et al. Safety and immunogenicity of a pediatric formulation of inactivated hepatitis A vaccine in Argentinean children. Pediatr Infect Dis J 2001; 20(1): 48-52.
(8) Riedemann S, Reinhardt G, Ibarra H, Frösner GG. Immunogenicity and safety of a virosomal hepatitis A vaccine (Epaxal) in healthy toddlers and children in Chile. Acta Paediatr 2004; 93(3): 412-4.
(9) Bovier PA, Bock J, Loutan L, Farinelli T, Glueck R, Herzog C. Long-term immunogenicity of an inactivated virosome hepatitis A vaccine. J Med Virol 2002; 68(4): 489-93.
(10) Lieberman JM, Word BM, Jacobs RJ, Dagan R, Marchant CD. Universal hepatitis A vaccination in the United States: a call for action. Pediatr Infect Dis J 2008; 27(4): 287-91.
(11) Wasley A, Samandari T, Bell BP. Incidence of hepatitis A in the United States in the era of vaccination. JAMA 2005; 294(2): 194-201.
(12) Dagan R, Leventhal A, Anis E, Slater P, Ashur Y, Shouval D. Incidence of Hepatitis A in Israel following universal immunization of toddlers. JAMA 2005; 294(2): 202-10.
(13) Centers for Disease Control and Prevention. Prevention of Hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006; 55(RR 07): 1-30.
(14) Belmaker I, Dukhan L, Yosef Y, Leventhal A, Dagan R. Elimination of Hepatitis A infection outbreaks in day care and school settings in southern Israel after introduction of the national universal toddler hepatitis A immunization program. Pediatr Infect Dis J 2007; 26(1): 36-40.
(15) Argentina. Ministerio de Salud y Ambiente de la Nación. Dirección de Epidemiología. Hepatitis A: documento técnico especial. Bol Epidemiol Periódico 2005; 3: 3-15. Disponible en: http://msal.gov.ar/htm/site/sala_situacion/PANELES/boletines/boletin_especial_HAV2.pdf Consulta: 12 noviembre 2010
(16) Argentina. Ministerio de Salud de la Nación. Dirección de Epidemiología. Enfermedades de declaración obligatoria en todo el país hasta la semana 40 de 2006. Bol Epidemiol Periódico 2006; p.20. Disponible en: http://msal.gov.ar/htm/site/sala_situacion/PANELES/boletines/boletin_BEP31.pdf Consulta: 12 noviembre 2010
(17) Argentina. Ministerio de Salud de la Nación. Calendario Nacional de Vacunación de la República Argentina. Disponible en: http://www.msal.gov.ar/htm/calendario vacunacion 2007.html Consulta: 18 diciembre 2009
(18) Cervio G, Trentadue J, D´Agostino D, Luque C, Saa G, Sánchez C, et al. Fulminant hepatic failure: the argentine experience over 10 years in four liver transplant center. Simposio Latinoamericano, Iberoamericano y Colombiano Gastroenterología, Hepatología y Nutrición Pediátrica, 2. Cartagena, Colombia, abril 19-21 de 2007.
(19) Chile. Ministerio de Salud. Departamento de Epidemiología. Situación de las Enfermedades de notificación obligatoria: situación de la hepatitis A en Chile, enero a junio/julio 2003. Disponible en: http://epi.minsal.cl/evigant/Numero20/evigia/html/notific/hepa/hepa1.htm Consulta: 20 enero 2011
(20) Cofré J, Abarca K. Vacuna anti hepatitis A. Rev Chil Infect 2003; 20(4): 243-52. Disponible en: http://www.scielo.cl/pdf/rci/v20n4/art04.pdf Consulta:20 enero 2011
(21) Uruguay. Ministerio de Salud Pública. Certificado esquema de vacunación año 2008: informe al cuerpo médico y personal de salud. Disponible en: http://www.msp.gub.uy/ucepidemiologia_1710_1.html Consulta: 21 enero 2011
(22) Uruguay. Ministerio de Desarrollo Social. Más de la mitad de los niños del Panes fueron vacunados contra la hepatitis A. Disponible: http://www.mides.gub.uy/noticias/lr071107. html. Noviembre 17 Consulta: 24 junio 2009
(23) Romero C, Chamorro F, Perdomo V, Assandri E, Giachetto G, Montano A, et al. Uruguay: Faculty of Medicine plays mayor role in National Vaccination Campaign. Immun Newsl 2010; 32 (3): 1, 3-4.
(24) Organización Panamericana de la Salud. El siglo de las vacunas. OPS Ahora 2004. Disponible en: http://www.paho.org/spanish/dd/pin/ahora11_jul04.htm Consulta: 12 noviembre 2010
(25) Valenzuela MT, Jacobs RJ, Arteaga O, Navarrete MS, Meyerhoff AS, Innis BL. Cost-effectiveness of universal childhood hepatitis A vaccination in Chile. Vaccine 2005; 23(32): 4110-9.
(26) López E, Debbag R, Coudeville L, Baron-Papillon F, Armoni J. The cost-effectiveness of universal vaccination of children against hepatitis A in Argentina: results of a dynamic health-economic analysis. J Gastroenterol 2007; 42(2): 152-60.
