Vaccination strategies for control of community outbreaks of hepatitis A: A comparison of two outbreaks in England

Sharp, Ashley; Coles, S; Pegorie, Matthieu; Harwood, Ceryl A.; Ngui, Siew-Lin; Welfare, William; Mandal, Sema; Balogun, Koye; Gent, Mike

doi:10.1016/j.vaccine.2019.01.026

Cited by 8 publications

(6 citation statements)

References 10 publications

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“…Consistent with the basis for national guidance [ 5 ], limited (perhaps even zero) secondary transmission occurred through student-to-student spread and there were no undetected, asymptomatic cases. The findings of this investigation contribute to an evidence gap in quantifying asymptomatic transmission in secondary schools [ 7 ] that can be used to help inform guidance and risk assessments [ 10 ]. Almost certainly the route of transmission, both in the secondary school and also from a local bakery, was indirect contamination of food items.…”

Section: Discussionmentioning

confidence: 99%

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An outbreak of hepatitis A virus infection in a secondary school in England with no undetected asymptomatic transmission among students

Wensley¹,

Smout²,

Ngui³

et al. 2022

Epidemiol. Infect.

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In June 2019 the Health Protection Team in Yorkshire and Humber, England, was notified of cases of hepatitis A virus (HAV) infection in staff at a secondary school. Investigation revealed that an earlier case worked as a food handler in the school kitchen. Indirect transmission through food from the canteen was considered the most likely route of transmission. Cases were described according to setting of exposure. Oral fluid was obtained from students for serological testing. Environmental investigations were undertaken at settings where food handling was considered a potential transmission risk. Thirty-three confirmed cases were linked to the outbreak. All of those tested (n=31) shared the same sequence with a HAV IB genotype. The first three cases were a household cluster and included the index case for the school. A further 19 cases (16 students, 3 staff) were associated with the school and consistent with indirect exposure to the food handler. One late onset case could not be ruled out as a secondary case within the school and resulted in vaccination of the school population. Five cases were linked to a bakery where a case from the initial household cluster worked as a food server. No concerns about hygiene standards were noted at either the school or the bakery.Oral fluid samples taken at the time of vaccination from asymptomatic students (n=219, 11-16 yearsold) showed no evidence of recent or current infection. This outbreak included household and foodborne transmission but limited (and possibly zero) person-to-person transmission among secondary school students. Where adequate hygiene exists, secondary transmission within older students may not occur.

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Section: Discussionmentioning

confidence: 99%

“…The extent of asymptomatic endemicity regions asymptomatic transmission in secondary schools may be >50% [8,9], but no data is available for low endemicity regions, such as the UK. This data is required to inform assessment of the effectiveness of mass vaccination strategies in specific settings [10].…”

Section: Introductionmentioning

confidence: 99%

An outbreak of hepatitis A virus infection in a secondary school in England with no undetected asymptomatic transmission among students

Wensley¹,

Smout²,

Ngui³

et al. 2022

Epidemiol. Infect.

View full text Add to dashboard Cite

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“…Coordinating hepatitis A vaccination campaigns with other services, such as public communication campaigns through social media and social services, may further improve access to hepatitis A vaccination for high-risk individuals [43,44]. The detailed study of activities to detect and investigate hepatitis A outbreaks may be useful to generate evidencebased operational lessons for the future [45,46].…”

Section: Discussionmentioning

confidence: 99%

“…The detailed study of activities to detect and investigate hepatitis A outbreaks may be useful to generate evidencebased operational lessons for the future [45,46]. Sharp et al [44] compared two community outbreaks by returning travelers in England, which were managed by independent control teams. In one outbreak, mass vaccination was deployed in the residential area and two schools, while in the other, vaccination was reserved for household-type contacts of cases.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis A Outbreak Characteristics: A Comparison of Regions with Different Vaccination Strategies, Spain 2010–2018

et al. 2021

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We compared the cumulative incidence and characteristics of hepatitis A outbreaks in two groups of Spanish autonomous regions according to whether a universal or risk group vaccination strategy was followed. Outbreaks between 2010 and 2018 were analyzed. The cumulative incidence rate of outbreaks was estimated and compared by estimating the rate ratio (RR). The characteristics of the outbreaks and those of the first cases were compared. Adjusted OR (aOR) were calculated using a multivariate logistic regression model. Outbreak incidence was 16.04 per million persons in regions with universal vaccination and 20.76 in those with risk-group vaccination (RR 0.77; 95%CI 0.62–0.94). Imported outbreaks accounted for 65% in regions with universal vaccination and 28.7% in regions with risk-group vaccination (aOR 3.88; 95%CI 2.13–7.09). Adolescents and young adults aged 15–44 years and men who have sex with men were less frequently the first case of the outbreak in regions with a universal vaccination strategy (aOR 0.54; 95%CI 0.32–0.92 and 0.23; 95%CI 0.07–0.82, respectively). The cumulative incidence rate of outbreaks was lower in regions with universal vaccination. In all regions, independently of the vaccination strategy, activities to vaccinate persons belonging to high-risk groups for infection should be emphasized.

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“…The seroprevalence of HAV infection varies in different regions of the world, being strongly correlated with socioeconomic factors, access to clean water, and proper sanitation [ 51 , 52 , 53 ]. Improvements in socioeconomic condition, sanitation, and personal hygiene and vaccination play a fundamental role in the prevention of HAV infection [ 54 , 55 , 56 ].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis a Vaccine as Opportunity of Primary Prevention for Food Handlers: A Narrative Review

Fallucca,

Restivo,

Sgariglia

et al. 2023

Vaccines

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The hepatitis A virus (HAV) is still a leading cause of viral hepatitis worldwide. After a long incubation period, the clinical manifestations range from asymptomatic infection to acute liver failure. The severity of the disease increases with age and pre-existing liver disease. The transmission is mainly via person-to-person contact or ingestion of contaminated food or water. Food contamination can occur at any step of the food chain, especially when infected people handle not-heated or otherwise-treated food. HAV is endemic in low-income countries because of poor sanitary and sociodemographic conditions. The populations of developed countries are highly susceptible, and large outbreaks occur when HAV is introduced from endemic countries due to globalization, travel, and movement of foodstuffs. HAV prevention includes hygiene practices, immunoglobulins, and vaccination. Safe and effective inactivated and live attenuated vaccines are available and provide long-term protection. The vaccine targets are children and subjects at increased risk of HAV exposure or serious clinical outcomes. This review discusses the critical role of food handlers in the spread of HAV and the opportunity for food industry employers to consider food handler immunization a tool to manage both food safety in compliance with HACCP principles and food operators’ biologic risk.

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Vaccination strategies for control of community outbreaks of hepatitis A: A comparison of two outbreaks in England

Cited by 8 publications

References 10 publications

An outbreak of hepatitis A virus infection in a secondary school in England with no undetected asymptomatic transmission among students

An outbreak of hepatitis A virus infection in a secondary school in England with no undetected asymptomatic transmission among students

Hepatitis A Outbreak Characteristics: A Comparison of Regions with Different Vaccination Strategies, Spain 2010–2018

Hepatitis a Vaccine as Opportunity of Primary Prevention for Food Handlers: A Narrative Review

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