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Considerations on the current universal vaccination policy against hepatitis A in Greece after recent outbreaks.

Mellou K, Sideroglou T, Papaevangelou V, Katsiaflaka A, Bitsolas N, Verykouki E, Triantafillou E, Baka A, Georgakopoulou T, Hadjichristodoulou C - PLoS ONE (2015)

Bottom Line: However, universal vaccination (~ 80% vaccine coverage of children) had no significant effect on the annual number of reported cases (p = 0.261) and has resulted to a progressive increase of the average age of infection in the general population.The mean age of cases before the inclusion of the vaccine to NCIP (24.1 years, SD = 1.5) was significantly lower than the mean age of cases after 2008 (31.7 years, SD = 2.1) (p<0.001).In the last decade, one third of all reported cases were Roma (a population accounting for 1.5% of the country's total population) and in 2013 three outbreaks with 16, 9 and 25 Roma cases respectively, were recorded, indicating the decreased effectiveness of the current immunization strategy in this group.

View Article: PubMed Central - PubMed

Affiliation: Hellenic Centre for Disease Control and Prevention, Athens, Greece.

ABSTRACT
Greece is the only European Union member state that in 2008 included hepatitis A (HAV) vaccine in the routine national childhood immunization program (NCIP). Given that the resources allocated to public health have dramatically decreased since 2008 and that Greece is a low endemicity country for the disease, the benefit from universal vaccination has been questioned. The aim of this paper is to summarize the available epidemiological data of the disease for 1982-2013, and discuss the effects of universal vaccination on disease morbidity. Descriptive analysis, ARIMA modeling and time series intervention analysis were conducted using surveillance data of acute HAV. A decreasing trend of HAV notification rate over the years was identified (p<0.001). However, universal vaccination (~ 80% vaccine coverage of children) had no significant effect on the annual number of reported cases (p = 0.261) and has resulted to a progressive increase of the average age of infection in the general population. The mean age of cases before the inclusion of the vaccine to NCIP (24.1 years, SD = 1.5) was significantly lower than the mean age of cases after 2008 (31.7 years, SD = 2.1) (p<0.001). In the last decade, one third of all reported cases were Roma (a population accounting for 1.5% of the country's total population) and in 2013 three outbreaks with 16, 9 and 25 Roma cases respectively, were recorded, indicating the decreased effectiveness of the current immunization strategy in this group. Data suggest that universal vaccination may need to be re-considered. Probably a more cost effective approach would be to implement a program that will include: a) vaccination of high risk groups, b) universal vaccination of Roma children and improving conditions at Roma camps, c) education of the population and travel advice, and d) enhancement of the control measures to increase safety of shellfish and other foods.

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Geographical distribution of hepatitis A reported cases, Mandatory Notification System, Greece, 1982–2012 (5-year time intervals with the exception of 1992–1997 because of the following change of the system).
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pone.0116939.g002: Geographical distribution of hepatitis A reported cases, Mandatory Notification System, Greece, 1982–2012 (5-year time intervals with the exception of 1992–1997 because of the following change of the system).

Mentions: During 2004–2012, 995 HAV cases were reported (mean annual number of cases: 111, SD: 75). Thirty-one (3.1%) had been vaccinated against HAV (data on the number of doses are not available). The notification rate of the disease was higher in Eastern Macedonia and Thrace and in particular in the regional units of Xanthi, Rodopi and Evros (Fig. 2).


Considerations on the current universal vaccination policy against hepatitis A in Greece after recent outbreaks.

Mellou K, Sideroglou T, Papaevangelou V, Katsiaflaka A, Bitsolas N, Verykouki E, Triantafillou E, Baka A, Georgakopoulou T, Hadjichristodoulou C - PLoS ONE (2015)

Geographical distribution of hepatitis A reported cases, Mandatory Notification System, Greece, 1982–2012 (5-year time intervals with the exception of 1992–1997 because of the following change of the system).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4295885&req=5

pone.0116939.g002: Geographical distribution of hepatitis A reported cases, Mandatory Notification System, Greece, 1982–2012 (5-year time intervals with the exception of 1992–1997 because of the following change of the system).
Mentions: During 2004–2012, 995 HAV cases were reported (mean annual number of cases: 111, SD: 75). Thirty-one (3.1%) had been vaccinated against HAV (data on the number of doses are not available). The notification rate of the disease was higher in Eastern Macedonia and Thrace and in particular in the regional units of Xanthi, Rodopi and Evros (Fig. 2).

Bottom Line: However, universal vaccination (~ 80% vaccine coverage of children) had no significant effect on the annual number of reported cases (p = 0.261) and has resulted to a progressive increase of the average age of infection in the general population.The mean age of cases before the inclusion of the vaccine to NCIP (24.1 years, SD = 1.5) was significantly lower than the mean age of cases after 2008 (31.7 years, SD = 2.1) (p<0.001).In the last decade, one third of all reported cases were Roma (a population accounting for 1.5% of the country's total population) and in 2013 three outbreaks with 16, 9 and 25 Roma cases respectively, were recorded, indicating the decreased effectiveness of the current immunization strategy in this group.

View Article: PubMed Central - PubMed

Affiliation: Hellenic Centre for Disease Control and Prevention, Athens, Greece.

ABSTRACT
Greece is the only European Union member state that in 2008 included hepatitis A (HAV) vaccine in the routine national childhood immunization program (NCIP). Given that the resources allocated to public health have dramatically decreased since 2008 and that Greece is a low endemicity country for the disease, the benefit from universal vaccination has been questioned. The aim of this paper is to summarize the available epidemiological data of the disease for 1982-2013, and discuss the effects of universal vaccination on disease morbidity. Descriptive analysis, ARIMA modeling and time series intervention analysis were conducted using surveillance data of acute HAV. A decreasing trend of HAV notification rate over the years was identified (p<0.001). However, universal vaccination (~ 80% vaccine coverage of children) had no significant effect on the annual number of reported cases (p = 0.261) and has resulted to a progressive increase of the average age of infection in the general population. The mean age of cases before the inclusion of the vaccine to NCIP (24.1 years, SD = 1.5) was significantly lower than the mean age of cases after 2008 (31.7 years, SD = 2.1) (p<0.001). In the last decade, one third of all reported cases were Roma (a population accounting for 1.5% of the country's total population) and in 2013 three outbreaks with 16, 9 and 25 Roma cases respectively, were recorded, indicating the decreased effectiveness of the current immunization strategy in this group. Data suggest that universal vaccination may need to be re-considered. Probably a more cost effective approach would be to implement a program that will include: a) vaccination of high risk groups, b) universal vaccination of Roma children and improving conditions at Roma camps, c) education of the population and travel advice, and d) enhancement of the control measures to increase safety of shellfish and other foods.

Show MeSH
Related in: MedlinePlus