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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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Distribution of reported outbreak and non-outbreak cases by prefecture of residence, Mandatory Notification System, Greece, 2013.
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pone.0116939.g004: Distribution of reported outbreak and non-outbreak cases by prefecture of residence, Mandatory Notification System, Greece, 2013.

Mentions: In 2013, in total 164 HAV cases were reported; 101 (61.6%) of them were Roma. For the general population, the reported number was lower than the mean annual number of reported cases for 2004–2012 (mean: 61, SD: 37.3). Among Roma, the number of reported cases was three times higher than the mean annual number of cases for 2004–2012 (mean: 33, SD: 34.2). The number of notifications increased during the first two months of 2013, as well as from July to September (Fig. 3). In the beginning of 2013 a cluster of 16 cases (median age: 7, IQR: 3–8 years) was identified in the prefecture of Korinthos in Southern Greece with the descriptive data suggesting person to person transmission. A larger outbreak with 25 Roma cases was recorded in the region of Xanthi in Drosero camp (median age 6, IQR: 3.6–7.0 years) later the same year and finally, another nine cases were recorded in the same region in a Roma camp in Iliopetra (median age: 19, IQR: 17–26 years). An epidemiological link between the two last clusters was not established. No community cases related to these outbreaks were identified. The geographical distribution of outbreak and of non-outbreak cases by prefecture of residence is given in Fig. 4. From the three faecal samples collected at Drosero, HAV viruses of genotype I, subgenotype IA were identified. The local public health authorities identified factors contributing to the occurrence of the outbreaks, such as the low vaccination coverage of the population, the low socioeconomic conditions and the poor hygiene, including inadequate sewage systems. Vaccination of the children living at the specific camps could not be performed due to lack of resources.


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)

Distribution of reported outbreak and non-outbreak cases by prefecture of residence, Mandatory Notification System, Greece, 2013.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0116939.g004: Distribution of reported outbreak and non-outbreak cases by prefecture of residence, Mandatory Notification System, Greece, 2013.
Mentions: In 2013, in total 164 HAV cases were reported; 101 (61.6%) of them were Roma. For the general population, the reported number was lower than the mean annual number of reported cases for 2004–2012 (mean: 61, SD: 37.3). Among Roma, the number of reported cases was three times higher than the mean annual number of cases for 2004–2012 (mean: 33, SD: 34.2). The number of notifications increased during the first two months of 2013, as well as from July to September (Fig. 3). In the beginning of 2013 a cluster of 16 cases (median age: 7, IQR: 3–8 years) was identified in the prefecture of Korinthos in Southern Greece with the descriptive data suggesting person to person transmission. A larger outbreak with 25 Roma cases was recorded in the region of Xanthi in Drosero camp (median age 6, IQR: 3.6–7.0 years) later the same year and finally, another nine cases were recorded in the same region in a Roma camp in Iliopetra (median age: 19, IQR: 17–26 years). An epidemiological link between the two last clusters was not established. No community cases related to these outbreaks were identified. The geographical distribution of outbreak and of non-outbreak cases by prefecture of residence is given in Fig. 4. From the three faecal samples collected at Drosero, HAV viruses of genotype I, subgenotype IA were identified. The local public health authorities identified factors contributing to the occurrence of the outbreaks, such as the low vaccination coverage of the population, the low socioeconomic conditions and the poor hygiene, including inadequate sewage systems. Vaccination of the children living at the specific camps could not be performed due to lack of resources.

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