Hepatitis A vaccine was introduced in the Greek National Immunization Program in 2008. To estimate possible impact of the universal vaccination implementation, time trends of hospitalizations for hepatitis A at the Infectious Diseases Unit of a Tertiary Pediatric Hospital in Athens during 1999-2013 were analyzed. Hepatitis A hospitalizations were recorded from the discharge database and were expressed as frequencies and rate of annual departmental hospitalizations. Time series analysis (ARIMA) was used to explore trends and the impact of the vaccination. Moreover, changes in patient age, population group distribution and the duration of hospitalization were also examined. Hepatitis A hospitalizations rate significantly decreased between pre-vaccination (1999-2008) and post-vaccination (2009-2013) era from 50.5 to 20.8/1000 hospitalizations (p D 0.005). A 3-year periodicity and a trend of reduction on hepatitis A hospitalizations rates across years were noted. Roma children had significant higher rates of hepatitis A hospitalization, followed by immigrant children. Importantly, possibly due to preceding vaccine availability with considerable uptake in private market and unvaccinated group/pockets of children (Roma), overall vaccination effect was less apparent when compared to data from other countries that implemented universal vaccination. No significant change in patient age, population group distribution, or duration of hospitalization was observed. High risk groups such as Roma children should be targeted for vaccination to reduce future outbreaks.
The intrafamilial clustering of hepatitis A virus infections (HAV) in families with an index case of sporadic hepatitis A was studied. Four hundred and three family members (84.3%) of 113 children with acute hepatitis A admitted to the Paediatric Department of the West Attica Hospital were included in the study. Epidemiological data and serum samples were collected within 1 week after the patient's admittance to the hospital. Enzyme-immunoassays were used to detect recent or past HAV infections. The attack rate of HAV infections in susceptible family members was found to be similar in susceptible fathers (16.6%, 1/6), mothers (23.5%, 4/17) and siblings (18.1%, 37/204). The infected family members belonged to 22 families. The attack rate was found to be higher in families with a lower immunity level, while the social class was not found to play an important role. The administration of ISG prevented further spread of hepatitis A among those susceptible. Our data suggest that immunoglobulin for HAV prevention should be given not only to children but also to parents and other adult family members in areas with a low prevalence of anti-HAV among adults.
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