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

Angela Domínguez,Jesús Castilla,Núria Torner,Cristina Rius,Conchita Izquierdo,Carmen Varela,Pere Godoy,Ana Martínez,Núria Soldevila,María Guerrero,Eva Borràs,Ana María Avellón,Marina Peñuelas

doi:10.3390/vaccines9111214

Abstract

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.

Highlights

Hepatitis A, an acute disease caused by the hepatitis A virus, an RNA virus of the Hepatovirus genus and Picornaviridae family [1], causes tens of millions of annual infections worldwide
The cumulative incidence rate per million of person-to-person outbreaks and of outbreaks in the family/household setting was lower in regions with universal vaccination (RR 0.67; 95%confidence intervals (CI) 0.53–0.85; p = 0.001 and rate ratio (RR) 0.74; 95%CI 0.58–0.94; p = 0.01, respectively)
In person-to-person outbreaks, imported outbreaks were more frequent in regions with universal vaccination, and the median of hospitalized patients was lower (p = 0.03) in regions with universal vaccination (0; range 0–3) than in those with risk-group vaccination (1, range 0–47)

Summary

Introduction

Hepatitis A, an acute disease caused by the hepatitis A virus, an RNA virus of the Hepatovirus genus and Picornaviridae family [1], causes tens of millions of annual infections worldwide. The lowest-income developed countries have a high incidence rate but a low disease burden. The most important determinant of the likelihood of clinical expression is the age at which infection occurs: most infections in children aged

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