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Steffen R, Chen LH, Leggat PA. Travel vaccines-priorities determined by incidence and impact. J Travel Med 2023; 30:taad085. [PMID: 37341307 DOI: 10.1093/jtm/taad085] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Infectious disease epidemiology is continuously shifting. While travel has been disrupted by the COVID-19 pandemic and travel-related epidemiological research experienced a pause, further shifts in vaccine-preventable diseases (VPDs) relevant for travellers have occurred. METHODS We conducted a literature search on the epidemiology of travel-related VPD and synthesized data for each disease with a focus on symptomatic cases and on the impact of the respective infection among travellers, considering the hospitalization rate, disease sequela and case fatality rate. We present new data and revised best estimates on the burden of VPD relevant for decisions on priorities in travel vaccines. RESULTS COVID-19 has emerged to be a top travel-related risk and influenza remains high in the ranking with an estimated incidence at 1% per month of travel. Dengue is another commonly encountered infection among international travellers with estimated monthly incidence of 0.5-0.8% among non-immune exposed travellers; the hospitalized proportion was 10 and 22%, respectively, according to two recent publications. With recent yellow fever outbreaks particularly in Brazil, its estimated monthly incidence has risen to >0.1%. Meanwhile, improvements in hygiene and sanitation have led to some decrease in foodborne illnesses; however, hepatitis A monthly incidence remains substantial in most developing regions (0.001-0.01%) and typhoid remains particularly high in South Asia (>0.01%). Mpox, a newly emerged disease that demonstrated worldwide spread through mass gathering and travel, cannot be quantified regarding its travel-related risk. CONCLUSION The data summarized may provide a tool for travel health professionals to prioritize preventive strategies for their clients against VPD. Updated assessments on incidence and impact are ever more important since new vaccines with travel indications (e.g. dengue) have been licensed or are undergoing regulatory review.
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Affiliation(s)
- Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, Division of Infectious Diseases, World Health Organization Collaborating Centre for Travelers' Health, University of Zurich, Zurich 8001, Switzerland
- Division of Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX 77030, USA
| | - Lin H Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Faculty of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland 4810, Australia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
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2
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Zhao Q, Zhao R, Sun Y, Ji L, Xi Y, Wang X, Shen Q, Ji L, Wang Y, You Z, Yang S, Zhang W. Identification of Multiple Novel Viruses in Fecal Samples of Black-Necked Cranes Using Viral Metagenomic Methods. Viruses 2023; 15:2068. [PMID: 37896845 PMCID: PMC10612090 DOI: 10.3390/v15102068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/04/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
The black-necked crane is the only species of crane that lives in the high-altitude region of the Tibet Plateau. At present, there is little research on viral diseases of the black-necked crane (Grus nigricollis). In this study, a viral metagenomic approach was employed to investigate the fecal virome of black-necked cranes in Saga County, Shigatse City, Tibet, China. The identified virus families carried by black-necked cranes mainly include Genomoviridae, Parvoviridae, and Picornaviridae. The percentages of sequence reads belonging to these three virus families were 1.6%, 3.1%, and 93.7%, respectively. Among them, one genome was characterized as a novel species in the genus Grusopivirus of the family Picornaviridae, four new parvovirus genomes were obtained and classified into four different novel species within the genus Chaphamaparvovirus of the subfamily Hamaparvovirinae, and four novel genomovirus genomes were also acquired and identified as members of three different species, including Gemykroznavirus haeme1, Gemycircularvirus ptero6, and Gemycircularvirus ptero10. All of these viruses were firstly detected in fecal samples of black-necked cranes. This study provides valuable information for understanding the viral community composition in the digestive tract of black-necked cranes in Tibet, which can be used for monitoring, preventing, and treating potential viral diseases in black-necked cranes.
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Affiliation(s)
- Qifan Zhao
- Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang 212013, China; (Q.Z.); (Y.S.); (L.J.); (Y.X.); (X.W.); (Q.S.); (L.J.); (Y.W.)
| | - Ran Zhao
- Department of Prevention and Control, Xiamen Animal Disease Prevention and Control Center, Xiamen 361009, China;
| | - Yijie Sun
- Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang 212013, China; (Q.Z.); (Y.S.); (L.J.); (Y.X.); (X.W.); (Q.S.); (L.J.); (Y.W.)
| | - Li Ji
- Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang 212013, China; (Q.Z.); (Y.S.); (L.J.); (Y.X.); (X.W.); (Q.S.); (L.J.); (Y.W.)
| | - Yuan Xi
- Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang 212013, China; (Q.Z.); (Y.S.); (L.J.); (Y.X.); (X.W.); (Q.S.); (L.J.); (Y.W.)
| | - Xiaochun Wang
- Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang 212013, China; (Q.Z.); (Y.S.); (L.J.); (Y.X.); (X.W.); (Q.S.); (L.J.); (Y.W.)
| | - Quan Shen
- Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang 212013, China; (Q.Z.); (Y.S.); (L.J.); (Y.X.); (X.W.); (Q.S.); (L.J.); (Y.W.)
| | - Likai Ji
- Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang 212013, China; (Q.Z.); (Y.S.); (L.J.); (Y.X.); (X.W.); (Q.S.); (L.J.); (Y.W.)
| | - Yan Wang
- Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang 212013, China; (Q.Z.); (Y.S.); (L.J.); (Y.X.); (X.W.); (Q.S.); (L.J.); (Y.W.)
| | - Zhenqiang You
- School of Public Health, Hangzhou Medical College, Hangzhou 310013, China;
| | - Shixing Yang
- Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang 212013, China; (Q.Z.); (Y.S.); (L.J.); (Y.X.); (X.W.); (Q.S.); (L.J.); (Y.W.)
| | - Wen Zhang
- Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang 212013, China; (Q.Z.); (Y.S.); (L.J.); (Y.X.); (X.W.); (Q.S.); (L.J.); (Y.W.)
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Green MS, Schwartz N, Peer V. Sex differences in hepatitis A incidence rates-a multi-year pooled-analysis based on national data from nine high-income countries. PLoS One 2023; 18:e0287008. [PMID: 37310964 DOI: 10.1371/journal.pone.0287008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/28/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Possible sex differences in hepatitis A virus (HAV) incidence rates in different age groups are not well documented. We aimed to obtain stable pooled estimates of such differences based on data from a number of high-income countries. METHODS We obtained data on incident cases of HAV by sex and age group over a period of 6-25 years from nine countries: Australia, Canada, Czech Republic, Finland, Germany, Israel, Netherland, New Zealand and Spain. Male to female incidence rate ratios (IRR) were computed for each year, by country and age group. For each age group, we used meta-analytic methods to combine the IRRs. Meta-regression was conducted to estimate the effects of age, country, and time period on the IRR. RESULTS A male excess in incidence rates was consistently observed in all age groups, although in the youngest and oldest age groups, where the numbers tended to be lower, the lower bounds of the 95% confidence intervals for the IRRs were less than one. In the age groups <1, 1-4, 5-9, 10-14, 15-44, 45-64 and 65+, the pooled IRRs (with 95% CI) over countries and time periods were 1.18 (0.94,1.48), 1.22 (1.16,1.29), 1.07 (1.03,1.11), 1.09 (1.04,1.14), 1.46 (1.30,1.64), 1.32 (1.15,1.51) and 1.10 (0.99,1.23) respectively. CONCLUSIONS The excess HAV incidence rates in young males, pooled over a number of countries, suggest that the sex differences are likely to be due at least in part to physiological and biological differences and not just behavioral factors. At older ages, differential exposure plays an important role. These findings, seen in the context of the excess incidence rates in young males for many other infectious diseases, can provide further keys to the mechanisms of the infection.
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Affiliation(s)
| | - Naama Schwartz
- School of Public Health, University of Haifa, Haifa, Israel
| | - Victoria Peer
- School of Public Health, University of Haifa, Haifa, Israel
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Pryimenko N, Koval T, Kotelevska T, Bodnar V, Syzova L, Marchenko O. HEPATITIS A. THE FEATURES OF DISEASE COURSE IN ADULTS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:2572-2578. [PMID: 38290019 DOI: 10.36740/wlek202312104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The aim: To analyze the incidence of Hepatitis A in Ukraine and Poltava region and to study the clinical and epidemiological features of the course of Hepatitis A in adult patients. PATIENTS AND METHODS Materials and methods: The course of HA in 96 hospitalized patients was analyzed. The diagnosis of HA was established on the basis of clinical and epide¬miological data and confirmed by the results of laboratory studies (serological and molecular biological). RESULTS Results: In 2019, in the Poltava region, there was an increase in the incidence of Hepatitis A with a predominance among sick people of working age, among the urban population. This part of people aged from 60 to 75 years old constitutes 9.4%. This study showed that the waterway was the dominant way of HA transmission. The course of the disease in most hospitalized patients was typical and cyclic, with a predominance of a mixed variant of the pre-jaundice period and jaundice. One third of patients survey that they had fever, which persisted with jaundice. CONCLUSION Conclusions: The findings of this study indicates that the patients older than 40 years were more likely to have concomitant chronic pathology than younger patients, and Hepatitis A was more severe with the development of prolonged cholestasis, wave-like course and recurrence. In most patients under the age of 40, the course of Hepatitis A was mild, but splenomegaly and severe cytolytic syndrome were more common.
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Affiliation(s)
| | | | | | - Vadym Bodnar
- POLTAVA STATE MEDICAL UNIVERSITY, POLTAVA, UKRAINE
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Low mortality despite temporary liver dysfunction in severe courses of acute hepatitis E. Wien Klin Wochenschr 2023; 135:57-66. [PMID: 36547761 PMCID: PMC9938023 DOI: 10.1007/s00508-022-02126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hepatitis E virus (HEV) infection can cause severe viral hepatitis and eventually liver failure. We aim to provide novel data on the epidemiology and the course of HEV infections from Q1/2008 to Q3/2018 at the Vienna General Hospital. METHODS Of the 88,945 people tested, we identified HEV-IgM positive (+) or HEV-PCR (+) patients and retrospectively collated information on the course of infection from patient records. RESULTS Among 151 HEV-IgM or PCR (+) (median age 51 years, 45.8% female), 7 (4.6%) had non-severe acute HEV infection (ALT ≥ 2-5-fold upper limit of normal, ULN), 11 (7.3%) had severe HEV infection without liver dysfunction (LD) (ALT > 5-fold ULN), and 9 (6.0%) with LD (ikterus or bilirubin > 5 mg/dL, OR coagulopathy or INR > 1.5, OR encephalopathy or ammonia > 100 µmol/L). HEV-RNA-PCR was performed in 58/190 (30.5%) HEV-IgM (+) patients and was positive in 19 (30.6%). Rates of HEV IgM/PCR positivity remained stable over the observation period. The HEV genotype (GT) was GT‑1 in 71.4% (n = 5) and GT‑3 in 28.6% (n = 2). Travel history was recorded for 9/20 (45.0%) of severe HEV and 12/20 (60.0%) patients with severe HEV infection were hospitalized. One patient with pre-existing liver disease and concomitant EBV infection required intensive care. No patient required transplantation and the 30-day mortality was 3/151 (1.9%). Despite the increased testing rates, the absolute number of diagnosed HEV infections at Vienna General Hospital remained constant between 2008 to 2018. CONCLUSION Although approximately half of the patients with severe acute HEV infection required hospitalization, admissions to the intensive care unit (ICU) and short-term mortality were low.
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Bogdanić N, Begovac J, Močibob L, Zekan Š, Grgić I, Ujević J, Đaković Rode O, Židovec-Lepej S. Hepatitis A Outbreak in Men Who Have Sex with Men Using Pre-Exposure Prophylaxis and People Living with HIV in Croatia, January to October 2022. Viruses 2022; 15:87. [PMID: 36680127 PMCID: PMC9861653 DOI: 10.3390/v15010087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022] Open
Abstract
The hepatitis A virus (HAV) is a highly hepatotropic virus transmitted mainly via the fecal-oral route. The purpose of this study is to describe a prolonged HAV outbreak in HIV-infected men who have sex with men (MSM) and pre-exposure prophylaxis (PrEP) users in Croatia in 2022. Croatia has a centralized system of HIV care and the PrEP service is only available at the University Hospital for Infectious Diseases (UHID), Zagreb. We reviewed all MSM living with HIV and MSM PrEP users at UHID and identified those diagnosed with HAV between January and October 2022. During this period, a total of 1036 MSM living with HIV and 361 PrEP users were followed, and 45 (4.4%) and 32 (8.9%) were diagnosed with HAV, respectively. Most cases were diagnosed in mid-February. A total of 70.1% (726/1036) MSM living with HIV and 82.3% (297/361) PrEP users were susceptible to HAV. Sequencing information was available for 34 persons; in all cases the HAV subtype IA was found. Our findings indicate that both MSM living with HIV and HIV-uninfected PrEP users are vulnerable to HAV infection and might be a potential source for a more widespread HAV epidemic.
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Affiliation(s)
| | - Josip Begovac
- University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10 000 Zagreb, Croatia
| | - Loris Močibob
- University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia
| | - Šime Zekan
- University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10 000 Zagreb, Croatia
| | - Ivana Grgić
- University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia
| | - Josip Ujević
- University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia
| | - Oktavija Đaković Rode
- University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10 000 Zagreb, Croatia
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BAL T, YAQOOBİ H, ÖNLEN Y, ÇABALAK M, DOĞAN S. COVID-19 Enfeksiyonu Olan ve Olmayan Olguların Hepatit A Virüsüne Karşı Kazanılmış İmmün Yanıt Açısından Karşılaştırılması: Retrospektif Bir Çalışma. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1102741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Bu çalışma ile COVID-19 enfeksiyonu olan ve olmayan olgular arasında Hepatit A virüsüne karşı kazanılmış immün yanıt düzeyi açısından fark bulunup bulunmadığının irdelenmesi amaçlanmaktadır.
Bu retrospektif, kesitsel, tek merkez çalışmasına kliniğimizde 1 Haziran 2020-1 Eylül 2020 tarihleri arasında COVID-19 hastalığı (PCR pozitifliği ile doğrulanmış) nedeniyle takip edilmiş 50 olgu dahil edildi. Benzer demografik özelliklere sahip olan, salgın öncesindeki son iki yılda (1 Kasım 2017–1 Kasım 2019) kliniğimize başvuruları sırasında Anti HAV IgG düzeyleri belirlenmiş olgular arasından rastlantısal olarak seçilen toplam 150 olgu ise kontrol grubu olarak alındı. Bu iki grup arasında Anti-HAV IgG seropozitiflik oranları ile serum antikor titreleri karşılaştırıldı.
Çalışmaya dahil edilen toplam 200 olgunun ortanca yaşı 48.5 (IQR=43.0-59.0) yıl olup, 108’i (%54) erkek, 92’si (%46) kadındı. Olguların 142’si (%71) 60 yaş ve üzerinde idi, ancak hasta grupları içerisindeki 60 yaş ve üzeri olguların oranı benzerdi (p=0.105). COVID-19 olgularındaki Anti-HAV IgG seropozitifliği oranları kontrol grubundaki olgularla benzer olmakla birlikte (p=0.062), COVID-19 olgularındaki anti HAV IgG titrelerinin, kontrol olgularındakine göre anlamlı oranda daha düşük olduğu görüldü (p
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Monkeypox, severe hepatitis A, and syphilis in an HIV returning traveler from Spain to Romania. Travel Med Infect Dis 2022; 50:102455. [PMID: 36089283 PMCID: PMC9534093 DOI: 10.1016/j.tmaid.2022.102455] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022]
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Domínguez A, Varela C, Soldevila N, Izquierdo C, Guerrero M, Peñuelas M, Martínez A, Godoy P, Borràs E, Rius C, Torner N, Avellón AM, Castilla J. Hepatitis A Outbreak Characteristics: A Comparison of Regions with Different Vaccination Strategies, Spain 2010-2018. Vaccines (Basel) 2021; 9:1214. [PMID: 34835145 PMCID: PMC8620672 DOI: 10.3390/vaccines9111214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/08/2021] [Accepted: 10/15/2021] [Indexed: 12/25/2022] Open
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.
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Affiliation(s)
- Angela Domínguez
- Department of Medicine, Universidad de Barcelona, 08036 Barcelona, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
| | - Carmen Varela
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.G.); (M.P.)
| | - Núria Soldevila
- Department of Medicine, Universidad de Barcelona, 08036 Barcelona, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
| | | | - María Guerrero
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.G.); (M.P.)
| | - Marina Peñuelas
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.G.); (M.P.)
| | - Ana Martínez
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain;
| | - Pere Godoy
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain;
| | - Eva Borràs
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain;
| | - Cristina Rius
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | - Núria Torner
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
| | - Ana María Avellón
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28222 Madrid, Spain
| | - Jesús Castilla
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Instituto Salud Pública de Navarra-IdiSNA, 31003 Pamplona, Spain
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Reichenbach ZW, Hogan C, Piech G, Shah S, Lambrou T, Radcliffe M, Kiani A, Peng L. Characterization of a hepatitis a outbreak in underserved urban tertiary safety net hospitals. Ann Epidemiol 2021; 64:111-119. [PMID: 34563568 DOI: 10.1016/j.annepidem.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/12/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
Outbreaks of Hepatitis A, caused by the Hepatitis A Virus (HAV), remain a worldwide health concern. We conducted a retrospective chart review to characterize patients with acute HAV during an outbreak at our urban tertiary care center to better characterize patients infected with HAV. We searched our electronic records for patients with positive HAV IgM antibodies during a period of outbreak in Philadelphia, May 2017-December 2019. Characteristics of patients were recorded. We searched an equal period of time prior to the outbreak, September 2014-April 2017, to compare the two patient populations. During the outbreak we diagnosed 205 cases of acute HAV compared to just 23 during an equal time period prior to the onset of the outbreak. When compared to the results reported by the public health department for 2019, this accounted for 39.9% of patients documented in the city. A history of drug use was found in 49.4% of our patients while 19.5% of patients were homeless. Our analysis of homelessness and drug usage among documented cases of HAV during the outbreak period mirrored data reported by the city. Further, our analysis found that 7 zip codes accounted for 60% of our patients. Biochemical measures of liver function were higher in patients examined during the outbreak.
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Affiliation(s)
- Zachary Wilmer Reichenbach
- Division of Hepatology, Temple University Hospital, Philadelphia, PA; Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine, Temple University, Philadelphia, PA.
| | - Carolyn Hogan
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Gregory Piech
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Samik Shah
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Tiffany Lambrou
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Marlana Radcliffe
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Amirali Kiani
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Lee Peng
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
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Lewin BJ, Rodriguez J, Yang SJ, Tartof SY. Predictors of hepatitis A immunity in adults in California in order to better utilize hepatitis A vaccine. Vaccine 2021; 39:5484-5489. [PMID: 34454784 DOI: 10.1016/j.vaccine.2021.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hepatitis A vaccine recommendations now include homelessness, illegal drug use, and HIV, as well as traditional risk factors and travel to areas endemic for hepatitis A. We examined a large diverse population for predictors of Hepatitis A immunity in order to better utilize Hepatitis A vaccine. METHODS We performed a cross-sectional descriptive study of members of a large integrated health plan with a test for Hepatitis A Immunoglobulin G (IgG) between January 1st, 2007, and December 31st, 2017. Exclusion criteria included age <18 years, <6 months of continuous enrollment, and Hepatitis A vaccine prior to Hepatitis A test. Variables of interest were age, gender, primary language spoken, ethnicity/race, neighborhood household income, and history of travel or history of jaundice. Multivariable logistic regression was performed to evaluate the association of risk factors on Hepatitis A immunity. RESULTS Of the 318,170 persons ≥ 18 years tested for Hepatitis A immunity, 155, 842 persons had a reactive Hepatitis A IgG test (49%). The lowest prevalence was for Whites at 28.1% followed by Blacks at 35.8%. Hispanics and Asian/Pacific Islanders had prevalence rates of 63% and 68.2% respectively. In adjusted analyses, Asian/Pacific Islanders, Hispanics and Blacks were 5.17, 3.44 and 1.42 times more likely to have Hepatitis A immunity than Whites. Those that spoke Spanish or language other than English or Spanish as their primary preferred language were 6.11 and 3.27 time more likely to have immunity than English speakers. Known travel history conferred a 2.16 likelihood of Hepatitis A immunity. CONCLUSIONS Persons of Hispanic and Asian/Pacific Islander background as well as persons with a preferred spoken language other than English have a high prevalence of Hepatitis A immunity. Testing for Hepatitis A immunity prior to vaccination should be considered for these groups.
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Affiliation(s)
- Bruno J Lewin
- Kaiser Permanente Southern California, Department of Family Medicine, Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Clinical Science, United States.
| | - Janelle Rodriguez
- Kaiser Permanente Southern California, Department of Family Medicine, United States
| | - Su-Jau Yang
- Kaiser Permanente Southern California, Department of Research & Evaluation, United States
| | - Sara Y Tartof
- Kaiser Permanente Southern California, Department of Research & Evaluation, Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, United States
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