Trends and risk factors of hepatitis A in Catalonia after the introduction of a hepatitis A+B vaccination programme

Abstract

At the end of 1998, universal hepatitis A+B vaccination of 12 year olds was introduced in Catalonia. The aim was to examine trends in hepatitis A during 2005-2015 and assess risk factors by age group. We carried out an observational epidemiological study of the incidence and risk factors of hepatitis A reported to the surveillance system. Information on exposure was recorded for each case for the 2-6 weeks before symptom onset. Spearman's coefficient was used to evaluate the trends of rates. The chi-square test was used to compare categorical. We studied 2621 hepatitis A cases; the age mean was 26.6 years (SD=18.2), and >50% of cases were in the 20-49 years age group. The incidence decreased from 3.28/100 000 in 2005 to 1.50/100 000 in 2015. The rate for women decreased over time (P = .008), but the reduction was not significant in men (P = .234). Men consistently had higher rates than women with the biggest difference being in the 20-34 years age group (rate 8.8 vs 2.8). The greatest risk factor was travel to an endemic country (42.1%) in the 0-19 years age group and male-to-male sexual contact (18.6%) in the 20-49 years age group. The case fatality rate in adults aged >49 years was 0.4%. In conclusion, the vaccination programme of preadolescents resulted in a reduction in hepatitis A cases. However, a significant amount of cases still appear in immigrants and men who have sex with men. Hepatitis A in adults is an emerging health problem that will require new strategies.

Universal Single-Dose Vaccination against Hepatitis A in Children in a Region of High Endemicity

“…The majority of universal HAV vaccination programs are focused on toddlers [2], although in some regions it may be targeted to older cohorts, depending on the epidemiology. For example, in Catalonia (Spain) universal hepatitis A + B vaccination was introduced for 12-year-olds [15]. In the case of Tuva, the vaccination program targets children aged three years and older.…”

Severity of the clinical presentation of hepatitis A in five European countries from 1995 to 2014

“…Amongst the main study limitations, we have to note that endemicity levels in Italy and Spain are less homogenous in geographical and historical terms than in the Netherlands, Norway and Sweden (European Centre for Disease Prevention and Control, 2016). In addition, Apulia (Italy) and Catalonia (Spain) offer HepA vaccination to toddlers and adolescents since 1998, and Ceuta and Melilla since 2000 (Chironna et al, 2012;Dominguez et al, 2003;Godoy et al, 2018;Lopalco et al, 2008). The study results for Italy and Spain may therefore not apply to all the regions part of the two countries.…”

Evidence for positive selection of hepatitis A virus antigenic variants in vaccinated men-having-sex-with men patients: Implications for immunization policies

“…Despite the implementation of vaccine programs since 1999 [11], the 2016–2018 outbreak has affected the MSM group in Barcelona including some vaccinated patients. However, the incidence in Barcelona has been much lower than in other parts of Spain in which no regular vaccination campaigns exist.…”