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Gloriani NG, de Paz-Silava SLM, Allison RD, Takashima Y, Avagyan T. The Shifting Epidemiology of Hepatitis A in the World Health Organization Western Pacific Region. Vaccines (Basel) 2024; 12:204. [PMID: 38400187 PMCID: PMC10891653 DOI: 10.3390/vaccines12020204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 02/25/2024] Open
Abstract
Within the past few decades, improvement in sanitation and economic growth has driven a changing epidemiology of hepatitis A in the Western Pacific Region (WPR) of the World Health Organization (WHO). In this review, we gathered available published information on hepatitis A epidemiology of the countries in the WPR and reviewed the trends reported in the literature from the years 2000 to 2021. Many countries have shifted from high endemicity to low endemicity. Moreover, the administration of the hepatitis A vaccine among children in recent years has shifted disease susceptibility to the older population. Seroprevalence among children has decreased in most countries, while nearly 100% seropositivity is seen in mid adulthood. This is contrary to the epidemiology seen in previous decades when most children achieved immunity by age ten. This also presents a paradox in that better living conditions have caused more vulnerability to the older age groups who are at higher risk for severe disease. Given these trends, we recommend vaccination of vulnerable populations such as the older age groups and inclusion of the hepatitis A vaccine in government immunization programs.
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Affiliation(s)
- Nina G. Gloriani
- Institute of Pathology, St. Luke’s Medical Center, Quezon City 1112, Philippines;
| | | | - Robert D. Allison
- Accelerated Disease Control Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;
| | - Yoshihiro Takashima
- Vaccine-Preventable Diseases and Immunization Unit, Division of Programmes for Disease Control, Western Pacific Regional Office, World Health Organization, Manila 1000, Philippines; (Y.T.); (T.A.)
| | - Tigran Avagyan
- Vaccine-Preventable Diseases and Immunization Unit, Division of Programmes for Disease Control, Western Pacific Regional Office, World Health Organization, Manila 1000, Philippines; (Y.T.); (T.A.)
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2
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Van Damme P, Pintó RM, Feng Z, Cui F, Gentile A, Shouval D. Hepatitis A virus infection. Nat Rev Dis Primers 2023; 9:51. [PMID: 37770459 DOI: 10.1038/s41572-023-00461-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
Hepatitis A is a vaccine-preventable infection caused by the hepatitis A virus (HAV). Over 150 million new infections of hepatitis A occur annually. HAV causes an acute inflammatory reaction in the liver that usually resolves spontaneously without chronic sequelae. However, up to 20% of patients experience a prolonged or relapsed course and <1% experience acute liver failure. Host factors, such as immunological status, age, pregnancy and underlying hepatic diseases, can affect the severity of disease. Anti-HAV IgG antibodies produced in response to HAV infection persist for life and protect against re-infection; vaccine-induced antibodies against hepatitis A confer long-term protection. The WHO recommends vaccination for individuals at higher risk of infection and/or severe disease in countries with very low and low hepatitis A virus endemicity, and universal childhood vaccination in intermediate endemicity countries. To date, >25 countries worldwide have implemented such programmes, resulting in a reduction in the incidence of HAV infection. Improving hygiene and sanitation, rapid identification of outbreaks and fast and accurate intervention in outbreak control are essential to reducing HAV transmission.
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Affiliation(s)
- Pierre Van Damme
- Centre for the Evaluation of Vaccination, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Rosa M Pintó
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Zongdi Feng
- Centre for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Angela Gentile
- Department of Epidemiology, Hospital de Niños Ricardo Gutierrez, University of Buenos Aires, Buenos Aires, Argentina
| | - Daniel Shouval
- Institute of Hepatology, Hadassah-Hebrew University Hospital, Jerusalem, Israel
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3
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Bhave S, Sapru A, Bavdekar A, Jain R, Debnath K, Kapatkar V. Long term Immunogenicity of Single Dose of Live Attenuated Hepatitis A Vaccine in Indian Children — Results of 15-Year Follow-up. Indian Pediatr 2021. [PMID: 33612491 PMCID: PMC8384096 DOI: 10.1007/s13312-021-2285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives Methods Results Conclusions
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Affiliation(s)
- Sheila Bhave
- Department of Pediatrics, KEM Hospital Research Centre, Pune, Maharashtra. Correspondence to: Dr Sheila Bhave, Consultant in Pediatric Research, Department of Pediatrics, KEM Hospital Research Centre, Rasta Peth, Pune 411 011, India.
| | - Amita Sapru
- Department of Pediatrics, KEM Hospital Research Centre, Pune, Maharashtra
| | - Ashish Bavdekar
- Department of Pediatrics, KEM Hospital Research Centre, Pune, Maharashtra
| | - Rishi Jain
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra
| | - Khokan Debnath
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra
| | - Vaibhavi Kapatkar
- Department of Medical Affairs, Wockhardt Limited, Mumbai; Maharashtra
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4
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Herzog C, Van Herck K, Van Damme P. Hepatitis A vaccination and its immunological and epidemiological long-term effects - a review of the evidence. Hum Vaccin Immunother 2021; 17:1496-1519. [PMID: 33325760 PMCID: PMC8078665 DOI: 10.1080/21645515.2020.1819742] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 01/11/2023] Open
Abstract
Hepatitis A virus (HAV) infections continue to represent a significant disease burden causing approximately 200 million infections, 30 million symptomatic illnesses and 30,000 deaths each year. Effective and safe hepatitis A vaccines have been available since the early 1990s. Initially developed for individual prophylaxis, HAV vaccines are now increasingly used to control hepatitis A in endemic areas. The human enteral HAV is eradicable in principle, however, HAV eradication is currently not being pursued. Inactivated HAV vaccines are safe and, after two doses, elicit seroprotection in healthy children, adolescents, and young adults for an estimated 30-40 years, if not lifelong, with no need for a later second booster. The long-term effects of the single-dose live-attenuated HAV vaccines are less well documented but available data suggest they are safe and provide long-lasting immunity and protection. A universal mass vaccination strategy (UMV) based on two doses of inactivated vaccine is commonly implemented in endemic countries and eliminates clinical hepatitis A disease in toddlers within a few years. Consequently, older age groups also benefit due to the herd protection effects. Single-dose UMV programs have shown promising outcomes but need to be monitored for many more years in order to document an effective immune memory persistence. In non-endemic countries, prevention efforts need to focus on 'new' risk groups, such as men having sex with men, prisoners, the homeless, and families visiting friends and relatives in endemic countries. This narrative review presents the current evidence regarding the immunological and epidemiological long-term effects of the hepatitis A vaccination and finally discusses emerging issues and areas for research.
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Affiliation(s)
- Christian Herzog
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Koen Van Herck
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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5
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Impact of Obesity and Being Overweight on the Immunogenicity to Live Attenuated Hepatitis A Vaccine in Children and Young Adults. Vaccines (Basel) 2021; 9:vaccines9020130. [PMID: 33562009 PMCID: PMC7915133 DOI: 10.3390/vaccines9020130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/16/2022] Open
Abstract
Prior results investigating a correlation between obesity and hepatitis A virus (HAV) vaccine response have been inconclusive, with limited data involving live attenuated HAV vaccines. The aim of this study is to evaluate the effect of overweight and obesity on the response to live attenuated HAV vaccine in children and young adults. This prospective cohort study was conducted in Thailand with subjects ranging in age from seven to twenty-five years. The subjects were administered 0.5 mL of MEVAC™-A and tested for anti-HAV antibodies before and at 8–9 weeks after vaccination. Baseline seronegative subjects (anti-HAV antibodies < 20 mIU/mL) were divided into non-obese (underweight/normal weight) and obese (overweight/obesity/severe obesity) groups. A total of 212 (117 non-obese and 95 obese) subjects completed the study (mean age (SD) = 13.95 (3.90) years). The seroprotection rates were 100%. Postvaccination geometric mean titers (95% CI) were 429.51 (401.97, 458.94) and 467.45 (424.47, 514.79) mIU/mL in the non-obese and obese groups, respectively. Females (p = 0.013) and subjects with truncal obesity (p = 0.002) had significantly higher titers than other participants. Live attenuated HAV vaccine is safe and has comparably high immunogenicity in both underweight/normal weight and overweight/obese persons.
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Shah N, Faridi M, Mitra M, Bavdekar A, Karadkhele A, Puppalwar G, Jain R. Review of long term immunogenicity and tolerability of live hepatitis A vaccine. Hum Vaccin Immunother 2020; 16:2816-2821. [PMID: 32243237 DOI: 10.1080/21645515.2020.1741997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hepatitis A represents one of the major public health problems worldwide including India. Vaccination is the most effective way to prevent hepatitis A infection. Two types of hepatitis A vaccines-live attenuated (H2 strain) and inactivated (killed) are available for use in clinical practice in India with former having advantage of a single-dose compared to two-dose killed vaccine. One of the important characteristic of an ideal vaccine includes its ability to provide life-long protection. In this article we reviewed the available long-term (≥10 years follow-up) published data on live attenuated hepatitis A (H2 strain) vaccine. The data from country of origin of the vaccine (China) and India establish the long-term immunogenicity, protection, and tolerability. Based on the results of several clinical trials showing long-term protection, single dose of live attenuated hepatitis vaccine can be widely used to protect high-risk population against hepatitis A virus infection and related complications.
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Affiliation(s)
- Nitin Shah
- Pediatrics Department, PD Hinduja Hospital , Mumbai, India
| | - Mma Faridi
- Pediatrics Department, ERA's Lucknow Medical College & Hospital , Lucknow, India
| | - Monjori Mitra
- Pediatrics Department, Institute of Child Health , Kolkata, India
| | | | | | | | - Rishi Jain
- Medical Affairs Department, Wockhardt Ltd ., Mumbai, India
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Irving GJ, Holden J, Yang R, Pope D. Hepatitis A immunisation in persons not previously exposed to hepatitis A. Cochrane Database Syst Rev 2019; 12:CD009051. [PMID: 31846062 PMCID: PMC6916710 DOI: 10.1002/14651858.cd009051.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This review is withdrawn because it is outdated. A new review is to be published by the end of 2019.
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Affiliation(s)
- Greg J Irving
- University of CambridgeDepartment of Public Health and Primary CareForvie Site, Robinson WayCambridge Biomedical CampusCambridgeCambridgeshireUKCB2 0SR
| | - John Holden
- Garswood SurgeryStation RoadGarswoodSt. HelensMerseysideUKWND 0SD
| | - Rongrong Yang
- Peking UniversityInstitute of Population ResearchYiheyuanroad 5Haidian DistrictBeijingChina100871
| | - Daniel Pope
- University of LiverpoolHealth Inequalities and the Social Determinants of HealthLiverpoolUKL69 3GB
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8
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Luo J, Wang X, Ma F, Kang G, Ding Z, Ye C, Pan Y, Zhao Y, Hong S, Chen J, Xi J, Wen S, Lin Y, Li X, Qiu L, Yang X, Li G, Yang J, Sun Q. Long-term immunogenicity and immune persistence of live attenuated and inactivated hepatitis a vaccines: a report on additional observations from a phase IV study. Clin Microbiol Infect 2018; 25:1422-1427. [PMID: 30496870 DOI: 10.1016/j.cmi.2018.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/24/2018] [Accepted: 11/03/2018] [Indexed: 12/20/2022]
Abstract
Both live attenuated (HA-L) and inactivated (HA-I) hepatitis A vaccine were licensed for routine use in China. Although phase 1, 2 and 3 clinical studies of both vaccines have been completed, further systematic evaluation of their immunogenicity and immunological persistence under phase 4 clinical studies in a wide range of conditions and involving large populations is necessary. A phase IV clinical trial (NCT02601040) was performed in 9000 participants over 18 months of age. Geometric mean concentrations (GMCs) and seroconversion rates (SRs) were compared at five time points during 3 years for 1800 individuals among them. The SRs of HA-L and HA-I were 98.08% (95% CI 95.59%-99.38%) and 99.64% (95% CI 98.93%-100.00%) respectively 28 days after administration of the first dose, and remained at 97.07% (95% CI 94.31%-98.73%) or above and 96.73% (95% CI 94.07%-98.42%) or above respectively during the following 3 years. The GMCs for both the HA-L and HA-I groups showed that both vaccines elicited high anti-HAV titres, considerably more than the threshold of protection needed against HAV infection in humans, and these titres were sustained. Hence, both HA-I and HA-L vaccines could provide an excellent long-term protective effect, and supported the routine use of both vaccines.
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Affiliation(s)
- J Luo
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China; Kunming Medical University Haiyuan College, Kunming, China
| | - X Wang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China
| | - F Ma
- Jiangsu Provincial Centre of Disease Control and Prevention, Nanjing, China
| | - G Kang
- Jiangsu Provincial Centre of Disease Control and Prevention, Nanjing, China
| | - Z Ding
- Yunnan Provincial Centre of Disease Control and Prevention, Kunming, Yunnan Province, China
| | - C Ye
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China; Kunming Medical University, Kunming, China
| | - Y Pan
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China
| | - Y Zhao
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China
| | - S Hong
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China; Kunming Medical University, Kunming, China
| | - J Chen
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China
| | - J Xi
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China
| | - S Wen
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China
| | - Y Lin
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China
| | - X Li
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, China
| | - L Qiu
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; The Affiliated Children's Hospital of Kunming Medical University, Kunming, China
| | - X Yang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China
| | - G Li
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China
| | - J Yang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China.
| | - Q Sun
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, Kunming, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Kunming, China.
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Chen Y, Zhou CL, Zhang XJ, Hao ZY, Zhang YH, Wang SM, Ma JC, Zhao G, Qiu C, Zhao YL, Wang B, Wang XY. Immune memory at 17-years of follow-up of a single dose of live attenuated hepatitis A vaccine. Vaccine 2017; 36:114-121. [PMID: 29183734 DOI: 10.1016/j.vaccine.2017.11.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 09/28/2017] [Accepted: 11/13/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND In recent years, hepatitis A virus (HAV) infection has declined considerably in China, associated with wide deployment of HAV vaccines and improvement in socio-economic indicators. Towards the elimination of HA in the country, we assessed the duration and characteristics of immunity conferred by the widely used, locally manufactured HAV vaccine. METHODS This is a longitudinal cohort study that followed recipients of a live attenuated HAV vaccine 17 years after the initial administration. Blood samples were collected from participants pre- and two-week post-booster HAV vaccine dose. Serum anti-HAV antibody was measured by ELISA method. Memory B and T cells were determined by ELISPOT and Flow Cytometry assays, respectively. RESULTS A robust anamnestic response was observed two-week post-challenge. Both HAV-specific memory B cell and T cells remained, and responded quickly when re-encountering HAV. The magnitude of recall responses was present, regardless of the status of the serum anti-HAV antibody pre-booster. CONCLUSIONS We demonstrated long-term immunity from the live attenuated HAV vaccine, including antibody persistence and immunological memory. Considering the conditions that make elimination of infectious diseases feasible, following polio, hepatitis A could be targeted for elimination in China.
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Affiliation(s)
- Ying Chen
- Key Laboratory of Medical Molecular Virology of MoE & MoH, and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Chen-Liang Zhou
- Key Laboratory of Medical Molecular Virology of MoE & MoH, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Xin-Jiang Zhang
- Zhengding County Center for Disease Control and Prevention, Zhengding, Hebei, China
| | - Zhi-Yong Hao
- Zhengding County Center for Disease Control and Prevention, Zhengding, Hebei, China
| | - Yan-Hong Zhang
- Zhengding County Center for Disease Control and Prevention, Zhengding, Hebei, China
| | - Song-Mei Wang
- Laboratory of Molecular Biology, Training Center of Medical Experiments, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Jing-Chen Ma
- Hebei Province Center for Disease Control and Prevention, Shijiazhuang, Hebei, China
| | - Gan Zhao
- Key Laboratory of Medical Molecular Virology of MoE & MoH, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Chao Qiu
- Key Laboratory of Medical Molecular Virology of MoE & MoH, and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Yu-Liang Zhao
- Hebei Province Center for Disease Control and Prevention, Shijiazhuang, Hebei, China
| | - Bin Wang
- Key Laboratory of Medical Molecular Virology of MoE & MoH, School of Basic Medical Sciences, Fudan University, Shanghai, China.
| | - Xuan-Yi Wang
- Key Laboratory of Medical Molecular Virology of MoE & MoH, and Institutes of Biomedical Sciences, Fudan University, Shanghai, China.
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Rao S, Mao JS, Motlekar S, Fangcheng Z, Kadhe G. A review of immunogenicity and tolerability of live attenuated Hepatitis A vaccine in children. Hum Vaccin Immunother 2017; 12:3160-3165. [PMID: 27532370 PMCID: PMC5215502 DOI: 10.1080/21645515.2016.1216286] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Changing epidemiology of Hepatitis A virus (HAV) has led to an increased susceptibility of adolescents and adults to the infection. Vaccination can remarkably reduce the incidence and associated morbidity of HAV infection. This review is focused on the safety and efficacy of H2 strain derived live attenuated Hepatitis A vaccine. We found the vaccine to be highly immunogenic with minimal or negligible safety issues. Moreover, a single dose of live attenuated vaccine persists a long term immune response and can be a preferred option for developing countries. In 2014, Indian Academy of Paediatrics (IAP) also updated their recommendations for H2 vaccine as a single dose as against the previous 2 dose schedule. A focused approach to include the vaccine in national immunization program should be explored.
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Affiliation(s)
- Sameer Rao
- a Medical Affairs Department , Wockhardt Ltd , Bandra (East), Mumbai , India
| | - J S Mao
- b Institute of Viral Diseases, Zhejiang Academy of Medical Sciences , Hangzhou , China
| | - Salman Motlekar
- a Medical Affairs Department , Wockhardt Ltd , Bandra (East), Mumbai , India
| | - Zhuang Fangcheng
- b Institute of Viral Diseases, Zhejiang Academy of Medical Sciences , Hangzhou , China
| | - Ganesh Kadhe
- a Medical Affairs Department , Wockhardt Ltd , Bandra (East), Mumbai , India
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11
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A Recombinant HAV Expressing a Neutralization Epitope of HEV Induces Immune Response against HAV and HEV in Mice. Viruses 2017; 9:v9090260. [PMID: 28914805 PMCID: PMC5618026 DOI: 10.3390/v9090260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 09/03/2017] [Accepted: 09/09/2017] [Indexed: 01/29/2023] Open
Abstract
Hepatitis A virus (HAV) and hepatitis E virus (HEV) are causative agents of acute viral hepatitis transmitted via the fecal–oral route. Both viruses place a heavy burden on the public health and economy of developing countries. To test the possibility that HAV could be used as an expression vector for the development of a combination vaccine against hepatitis A and E infections, recombinant HAV-HEp148 was created as a vector to express an HEV neutralization epitope (HEp148) located at aa 459–606 of the HEV capsid protein. The recombinant virus expressed the HEp148 protein in a partially dimerized state in HAV-susceptible cells. Immunization with the HAV-HEp148 virus induced a strong HAV- and HEV-specific immune response in mice. Thus, the present study demonstrates a novel approach to the development of a combined hepatitis A and E vaccine.
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12
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Zhang X, An J, Tu A, Liang X, Cui F, Zheng H, Tang Y, Liu J, Wang X, Zhang N, Li H. Comparison of immune persistence among inactivated and live attenuated hepatitis a vaccines 2 years after a single dose. Hum Vaccin Immunother 2016; 12:2322-6. [PMID: 27494260 PMCID: PMC5027719 DOI: 10.1080/21645515.2015.1134069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 12/02/2015] [Accepted: 12/16/2015] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Compare immune persistence from one dose of each of 3 different hepatitis A vaccines when given to school-age children: a domestic, live attenuated hepatitis A vaccine (H2 vaccine); a domestic inactivated hepatitis A vaccine (Healive®); and an imported, inactivated hepatitis A vaccine (Havrix®),. METHODS School-age children were randomized into 1 of 4 groups to receive a single dose of a vaccine: H2 vaccine, Healive®, Havrix®, or hepatitis B vaccine [control]. Serum samples were collected 12 and 24 months after vaccination for measurement of anti-HAV IgG using microparticle enzyme immunoassay. Seropositivity was defined as ≥ 20 mUI/ml. We compared groups on seropositivity and geometric mean concentration (GMC). RESULTS Seropositive rates for the H2, Healive®, Havrix®, and control groups were 64%, 94.4%, 73%, and 1.0%, respectively, 12-months post-vaccination; and 63%, 95.6%, 72%, and 1.0%, respectively 24-months post-vaccination. Seropositivity was greater for Healive® than for H2 and Havrix® at 12 months (p-values < 0.001) and 24 months (p-values < 0.0001). Average GMCs for the H2, Healive®, Havrix®, and control groups, in mIU/ml, were 29.7, 81.0, 36.4, and 2.9, respectively at 12 months, and 30.9, 112.2, 44.3, and 2.9, respectively, at 24 months. GMCs were greater for Healive® than for H2 and Havrix® at 12 months (p-values < 0.0001 and < 0.001, respectively) and 24 months (p-values < 0.001). No statistically significant differences in seropositivity or GMC were found within groups between 12 and 24 months. CONCLUSION Immunity persisted 24 months after a single dose of inactivated hepatitis A vaccine and live attenuated hepatitis A vaccine.
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Affiliation(s)
- Xiaoshu Zhang
- GanSu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Jing An
- GanSu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Aixia Tu
- GanSu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Xuefeng Liang
- GanSu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Fuqiang Cui
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Zheng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Tang
- GanSu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Jianfeng Liu
- GanSu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Xuxia Wang
- GanSu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Ningjing Zhang
- GanSu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Hui Li
- GanSu Provincial Center for Disease Control and Prevention, Lanzhou, China
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Yu C, Song Y, Qi Y, Li C, Jiang Z, Li C, Zhang W, Wang L, Xia J. Comparison of immunogenicity and persistence between inactivated hepatitis A vaccine Healive® and Havrix® among children: A 5-year follow-up study. Hum Vaccin Immunother 2016; 12:2595-2602. [PMID: 27385349 DOI: 10.1080/21645515.2016.1197450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Inactivated vaccines for hepatitis A virus (HAV) infection are widely used in China. Mass vaccination programs drive the need for data on long-term persistence of vaccine-induced protection. METHODS A prospective, randomized, open-label clinical trial was conducted to compare geometric mean concentrations (GMCs) and seroconversion rates (SRs) of anti-HAV antibody elicited by the inactivated vaccines Healive and Havrix for 5 y post immunization, in which 400 healthy children were randomly assigned in a 3:1 ratio to receive 2 doses of Healive or Havrix at 0 and 6 month. Anti-HAV antibody concentration was detected by microparticle enzyme immunoassay (MEIA) during the study. Furthermore, an attempt was made to predict persistence of protective immunogenicity by using a suitable statistical model. RESULTS The GMCs were significantly higher after vaccination with Healive than after Havrix as comparator vaccine at 1, 6, 7, 18, 30, 42, 54 and 66 month (P < 0.01) with the peak point at 7 month (3427.2 mIU/ml for Healive and 1441.9 mIU/ml for Comparator). Similarly significant differences of SRs were found between the 2 groups at 1 and 6 month (P < 0.01). Afterwards, the SRs of both groups reached 100% at 7 month and did not decline until 66 month(99.1% for Healive and 97.5% for Comparator). A linear mixed model with a change point at 18 month(Model 3) was found to be suitable to predict persistence of protective immunogenicity induced by vaccines. It was estimated that the duration of protection for Healive was at least 20 y with a lower limit of GMC 95% confidence interval (CI) no less than 20 mIU/mL. CONCLUSIONS Compared with Havrix, the new preservative-free inactivated hepatitis A vaccine (Healive) in 2 doses showed better persistence of antibody concentrations for 5 y after full-course immunization among children and the persistence of protective immunogenicity was estimated for at least 20 y.
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Affiliation(s)
- Chengkai Yu
- a Department of Health Statistics , School of Preventive Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China
| | | | - Yangyang Qi
- a Department of Health Statistics , School of Preventive Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Chanjuan Li
- a Department of Health Statistics , School of Preventive Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Zhiwei Jiang
- a Department of Health Statistics , School of Preventive Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Chen Li
- a Department of Health Statistics , School of Preventive Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Wei Zhang
- a Department of Health Statistics , School of Preventive Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Ling Wang
- a Department of Health Statistics , School of Preventive Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Jielai Xia
- a Department of Health Statistics , School of Preventive Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China
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Long-term immunogenicity of single dose of live attenuated hepatitis A vaccine in Indian children. Indian Pediatr 2016; 52:687-90. [PMID: 26388627 DOI: 10.1007/s13312-015-0697-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess immunogenicity of a single dose of live attenuated hepatitis A vaccine in Indian children, ten years after immunization. METHODS Of 143 children vaccinated in 2004, 121 children were evaluated in 2014, clinically and for anti-HAV antibodies. RESULTS 13 children were early vaccine failures who received two doses of HAV vaccine subsequently. 106 (98%) of 108 remaining children had seroprotective levels with a geometric mean titer of 100.5 mIU/mL. On analysis of all 121 children, the immunogenicity was 87.6%. CONCLUSION Single dose of live attenuated hepatitis A vaccine provides long-term immunity in Indian children.
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Mitra M, Shah N, Faridi MMA, Ghosh A, Sankaranarayanan VS, Aggarwal A, Chatterjee S, Bhattacharyya N, Kadhe G, Vishnoi G, Mane A. Long term follow-up study to evaluate immunogenicity and safety of a single dose of live attenuated hepatitis a vaccine in children. Hum Vaccin Immunother 2015; 11:1147-52. [PMID: 26018443 PMCID: PMC4514242 DOI: 10.4161/21645515.2014.979646] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Worldwide, viral hepatitis continues to be a cause of considerable morbidity and mortality. Mass immunization with a single dose of live attenuated HAV has been shown to significantly reduce disease burden in the community. This was a phase IV, 5-year follow up study carried out at 4 centers (Kolkata, Delhi, Mumbai and Chennai) across India. The subjects with antibody titer <20 mIU/mL at baseline were evaluated for long term immunogenicity. Of the 503 subjects enrolled, 349 subjects were baseline seronegative with an anti-HAV antibody titer <20 mIU/mL. Overall, 343 subjects could be followed up at some point of time during this 5 y post vaccination period. In the last year (60 months) of follow-up, 108 subjects (97.3%) of 111 subjects (who came for follow-up at the end of 5 y) had a protective antibody titer (anti-HAV antibody titer >20 mIU/mL). The seroconversion rates considering seroprotection levels of anti-HAV antibody titer >20 mIU/mL, following vaccination starting from 6 weeks, 6 months, 12 months, 24 months, 36 months, 48 months and 60 months were 95.1%, 97.9%, 98.3%, 96.2%, 97.8%, 92.6% and 97.3%, respectively. The geometric mean concentration (GMC) over the years increased from 64.9 mIU/mL at 6 weeks to 38.1 mIU/mL and 135.2 mIU/mL at 6 months and 12 months, respectively and was maintained at 127.1 mIU/mL at 60 months. In conclusion, the result of this 5-year follow up study showed that the single dose of live attenuated vaccine is well tolerated and provides long-term immunogenicity in healthy Indian children.
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Affiliation(s)
- Monjori Mitra
- Institute of Child Health; Kolkata, India
- Correspondence to: Monjori Mitra;
| | - Nitin Shah
- Department of Pediatrics; Lion's Tarachand Bapa Hospital; Sion West, Mumbai, India
| | - MMA Faridi
- Department of Pediatrics; University College of Medical Sciences; GTB Hospital, Dilshad Garden; Delhi, India
| | | | | | - Anju Aggarwal
- Department of Pediatrics; University College of Medical Sciences; GTB Hospital; Delhi, India
| | - Suparna Chatterjee
- Deptartment of Pharmacology; Institute of Postgraduate Medical Education & Research; Kolkata, India
| | | | - Ganesh Kadhe
- Medical Affairs; Wockhardt Limited, Wockhardt Towers; Bandra–Kurla Complex; Bandra–East, Mumbai
| | - Gaurav Vishnoi
- Medical Affairs; Wockhardt Limited, Wockhardt Towers; Bandra–Kurla Complex; Bandra–East, Mumbai
| | - Amey Mane
- Medical Affairs; Wockhardt Limited, Wockhardt Towers; Bandra–Kurla Complex; Bandra–East, Mumbai
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Waning of anti-HAV immunity in Shijiazhuang prefecture, Hebei province, China: A comparison of seroprevalence between 1992 and 2011. Vaccine 2014; 32:6227-32. [DOI: 10.1016/j.vaccine.2014.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/28/2014] [Accepted: 09/08/2014] [Indexed: 11/18/2022]
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Ernst KC, Erhart LM. The role of ethnicity and travel on Hepatitis A vaccination coverage and disease incidence in Arizona at the United States-Mexico Border. Hum Vaccin Immunother 2014; 10:1396-403. [PMID: 24603091 PMCID: PMC4896613 DOI: 10.4161/hv.28140] [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: 12/29/2013] [Revised: 01/27/2014] [Accepted: 02/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hepatitis A (HAV) incidence has decreased in the United States, yet regional disparities persist. The role of international travel has become increasingly important in HAV transmission. We compared the relative burden of HAV in border and non-border regions in Arizona and examined the role of travel in sustaining HAV transmission. METHODS HAV vaccination coverage was calculated by age and region, using Arizona State Immunization Information System data. Incidence, demographics, and risk factors of cases reported through Arizona's infectious disease surveillance system between 2006 and 2011 were analyzed. RESULTS Hepatitis A incidence was higher in the border region of Arizona. Compared with the rest of Arizona, one-dose coverage in children<15 years was lower in the border region until 2008. Second dose coverage was lower in the border region, particularly among Spanish speakers. International travel among cases was generally high; however, in the border region cases were more likely to visit Mexico or South/Central America (94% vs. 80%, P value = 0.01) and be Hispanic (68% vs. 42%, P value = 0.0003). CONCLUSIONS Rates of HAV continue to be higher in the Arizona border region; the risk appears particularly high among Hispanics with recent travel in the Americas. Border surveillance should be emphasized, along with vaccination of all travelers, to continue to decrease and control HAV.
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Affiliation(s)
- Kacey C Ernst
- University of Arizona; College of Public Health; Tucson, AZ USA
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Xu ZY, Wang XY. Live attenuated hepatitis A vaccines developed in China. Hum Vaccin Immunother 2013; 10:659-66. [PMID: 24280971 PMCID: PMC4130259 DOI: 10.4161/hv.27124] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/30/2013] [Accepted: 11/08/2013] [Indexed: 11/19/2022] Open
Abstract
Two live, attenuated hepatitis A vaccines, H 2 and LA-1 virus strains, were developed through serial passages of the viruses in cell cultures at 32 °C and 35 °C respectively. Both vaccines were safe and immunogenic, providing protection against clinical hepatitis A in 95% of the vaccinees, with a single dose by subcutaneous injection. The vaccine recipients were not protected from asymptomatic, subclinical hepatitis A virus (HAV) infection, which induced a similar antibody response as for unvaccinated subjects. A second dose caused anamnestic response and can be used for boosting. Oral immunization of human with H 2 vaccine or of marmoset with LA-1 vaccine failed, and no evidence was found for person-to-person transmission of the H 2 strain or for marmoset-to-marmoset transmission of LA-1 strain, by close contact. H 2 strain was genetically stable when passaged in marmosets, humans or cell cultures at 37 °C; 3 consecutive passages of the virus in marmosets did not cause virulence mutation. The live vaccines offer the benefits of low cost, single dose injection, long- term protection, and increased duration of immunity through subclinical infection. Improved sanitation and administration of 150 million doses of the live vaccines to children had led to a 90% reduction in the annual national incidence rate of hepatitis A in China during the 16-year period, from 1991 to 2006. Hepatitis A immunization with both live and inactivated HA vaccines was implemented in the national routine childhood immunization program in 2008 and around 92% of the 16 million annual births received the affordable live, attenuated vaccines at 18 months of age. Near elimination of the disease was achieved in China for 14 years following introduction of the H 2 live vaccine into the Expanded Immunization Program (EPI) in 1992.
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Affiliation(s)
- Zhi-Yi Xu
- Institutes of Biomedical Sciences; Shanghai Medical College; Fudan University; Shanghai, PR China
- Department of Epidemiology; School of Public Health, Shanghai Medical College; Fudan University; Shanghai, PR China
| | - Xuan-Yi Wang
- Institutes of Biomedical Sciences; Shanghai Medical College; Fudan University; Shanghai, PR China
- Key Laboratory of Medical Molecular Virology MoE/MoH; Shanghai Medical College; Fudan University; Shanghai, PR China
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Liu XE, Wushouer F, Gou A, Kuerban M, Li X, Sun Y, Zhang J, Liu Y, Li J, Zhuang H. Comparison of immunogenicity between inactivated and live attenuated hepatitis A vaccines: a single-blind, randomized, parallel-group clinical trial among children in Xinjiang Uighur Autonomous Region, China. Hum Vaccin Immunother 2013; 9:1460-5. [PMID: 23571173 DOI: 10.4161/hv.24366] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To compare immunogenicity among an inactivated hepatitis A vaccine (Healive(®)) with one-dose and two-dose regimens, and three kinds of live attenuated vaccines in children. METHODS A single-blind, randomized, parallel-group clinical trial was conducted among healthy children aged 1.5-6 y in Xinjiang Uighur Autonomous Region, China. Subjects were randomly assigned to 5 groups. Two groups were administered one-dose or two-dose inactivated vaccine and the remaining groups were immunized with one of three kinds of attenuated vaccines, respectively. Serum samples were collected at 6- and 12-mo follow-ups. Anti-HAV IgG was measured with a microparticle enzyme immunoassay. RESULTS No significant differences were observed in seroconversion rates (seroprotection rates) among the five groups at 6 or 12 mo (p>0.05). The geometric mean concentration (GMC) of anti-HAV IgG was significantly higher in the two-dose Healive(®) group than in the one-dose Healive(®) group and the attenuated vaccine groups at 12 mo (932.4 vs. 112.7, 135.8, 203.3, 212.8 mIU/ml, respectively, p<0.05). In the one-dose Healive(®) group, the GMC was significantly lower than that in the attenuated vaccine B and C groups at 6 mo (152.6 vs. 212, 204 mIU/ml, p<0.05) and at 12 mo (112.7 vs. 203.3, 212.8, p<0.05), but was similar to the attenuated vaccine A group at 12 mo (112.7 vs. 135.8 mIU/ml, p>0.05). The GMCs were significantly higher in the 1-2 y of age group than in the 3-6 y of age group for all types of vaccines except the attenuated vaccine C (p<0.05) at 12 mo. CONCLUSIONS A higher GMC of anti-HAV IgG was induced in the two-dose Healive(®) than in the one-dose and the attenuated vaccines at 12 mo. The attenuated vaccine B or C produced higher GMCs than the one-dose Healive(®) at 6-12 mo after vaccination.
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Affiliation(s)
- Xue-En Liu
- Department of Microbiology and Center of Infectious Disease; School of Basic Medicine; Peking University Health Science Center; Beijing, P.R. China
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Irving GJ, Holden J, Yang R, Pope D. Hepatitis A immunisation in persons not previously exposed to hepatitis A. Cochrane Database Syst Rev 2012; 2012:CD009051. [PMID: 22786522 PMCID: PMC6823267 DOI: 10.1002/14651858.cd009051.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND In many parts of the world, hepatitis A infection represents a significant cause of morbidity and socio-economic loss. Whilst hepatitis A vaccines have the potential to prevent disease, the degree of protection afforded against clinical outcomes and within different populations remains uncertain. There are two types of hepatitis A virus (HAV) vaccine, inactivated and live attenuated. It is important to determine the efficacy and safety for both vaccine types. OBJECTIVES To determine the clinical protective efficacy, sero-protective efficacy, and safety and harms of hepatitis A vaccination in persons not previously exposed to hepatitis A. SEARCH METHODS We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and China National Knowledge Infrastructure (CNKI) up to November 2011. SELECTION CRITERIA Randomised clinical trials comparing HAV vaccine with placebo, no intervention, or appropriate control vaccines in participants of all ages. DATA COLLECTION AND ANALYSIS Data extraction and risk of bias assessment were undertaken by two authors and verified by a third author. Where required, authors contacted investigators to obtain missing data. The primary outcome was the occurrence of clinically apparent hepatitis A (infectious hepatitis). The secondary outcomes were lack of sero-protective anti-HAV immunoglobulin G (IgG), and number and types of adverse events. Results were presented as relative risks (RR) with 95% confidence intervals (CI). Dichotomous outcomes were reported as risk ratio (RR) with 95% confidence interval (CI), using intention-to-treat analysis. We conducted assessment of risk of bias to evaluate the risk of systematic errors (bias) and trial sequential analyses to estimate the risk of random errors (the play of chance). MAIN RESULTS We included a total of 11 clinical studies, of which only three were considered to have low risk of bias; two were quasi-randomised studies in which we only addressed harms. Nine randomised trials with 732,380 participants addressed the primary outcome of clinically confirmed hepatitis A. Of these, four trials assessed the inactivated hepatitis A vaccine (41,690 participants) and five trials assessed the live attenuated hepatitis A vaccine (690,690 participants). In the three randomised trials with low risk of bias (all assessing inactivated vaccine), clinically apparent hepatitis A occurred in 9/20,684 (0.04%) versus 92/20,746 (0.44%) participants in the HAV vaccine and control groups respectively (RR 0.09, 95% CI 0.03 to 0.30). In all nine randomised trials, clinically apparent hepatitis A occurred in 31/375,726 (0.01%) versus 505/356,654 (0.18%) participants in the HAV vaccine and control groups respectively (RR 0.09, 95% CI 0.05 to 0.17). These results were supported by trial sequential analyses. Subgroup analyses confirmed the clinical effectiveness of both inactivated hepatitis A vaccines (RR 0.09, 95% CI 0.03 to 0.30) and live attenuated hepatitis A vaccines (RR 0.07, 95% CI 0.03 to 0.17) on clinically confirmed hepatitis A. Inactivated hepatitis A vaccines had a significant effect on reducing the lack of sero-protection (less than 20 mIU/L) (RR 0.01, 95% CI 0.00 to 0.03). No trial reported on a sero-protective threshold less than 10 mIU/L. The risk of both non-serious local and systemic adverse events was comparable to placebo for the inactivated HAV vaccines. There were insufficient data to draw conclusions on adverse events for the live attenuated HAV vaccine. AUTHORS' CONCLUSIONS Hepatitis A vaccines are effective for pre-exposure prophylaxis of hepatitis A in susceptible individuals. This review demonstrated significant protection for at least two years with the inactivated HAV vaccine and at least five years with the live attenuated HAV vaccine. There was evidence to support the safety of the inactivated hepatitis A vaccine. More high quality evidence is required to determine the safety of live attenuated vaccines.
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Affiliation(s)
- Greg J Irving
- Division of Primary Care, University of Liverpool, Liverpool, UK.
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Ott JJ, Irving G, Wiersma ST. Long-term protective effects of hepatitis A vaccines. A systematic review. Vaccine 2012; 31:3-11. [PMID: 22609026 DOI: 10.1016/j.vaccine.2012.04.104] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 04/26/2012] [Accepted: 04/28/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Data on duration and long-term protective effects of hepatitis A vaccines (HepA) have not been reviewed using a systematic approach. Our objective is to provide a comprehensive review of evidence on the duration of protection achieved by HepA, which is needed for revising existing vaccine policies. Limitations in data availability and implications for future research in this area are discussed. METHODS A systematic literature review was conducted including all studies published between 1997 and 2011 reporting on long-term protection of HepA. The outcomes considered were hepatitis A virus (HAV) infection and sero-protection measured by anti-HAV antibodies after follow-up times of over 5 years post-vaccination. RESULTS 299 studies were identified from MEDLINE and 51 studies from EMBASE. 13 manuscripts met our inclusion criteria. The maximum observation times and reported persistence levels of sero-protective anti-HAV antibodies was 15 years for live attenuated HepA and 14 years for inactivated HepA. All data were from observational studies and showed that higher number of doses of live attenuated vaccine led to higher seropositivity and GMT, but dosage and schedule did not significantly impact the long-term protection following inactivated vaccine. Few comparisons were made between the two vaccine types indicating highest levels of antibody titers achieved by multiple doses of live attenuated vaccines 7 years post-vaccination. CONCLUSION Available data indicate that both inactivated and live attenuated HepA are capable of providing protection up to 15 years as defined by currently accepted, conservative correlates of protection. Further investigations are needed to continue to monitor the long-term protection afforded by these vaccines. Standardized methods are required for vaccine-follow-up studies including assessment of co-variables potentially affecting long-term protection.
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Fangcheng Z, Xuanyi W, Mingding C, Liming J, Jie W, Qi J, Yuanping G, Wen Q, Yajuan X, Jiangsen M. Era of vaccination heralds a decline in incidence of hepatitis A in high-risk groups in China. HEPATITIS MONTHLY 2012; 12:100-5. [PMID: 22509186 PMCID: PMC3321316 DOI: 10.5812/hepatmon.838] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 12/21/2011] [Accepted: 01/15/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis A was ranked first among all of the different types of viral hepatitis in China, which occurred an average of 500,000 cases annually during the 1980's. A live attenuated hepatitis A vaccine was applied in preventing of the disease in 1992, large scale used in vaccination program in 1995, and incorporated in the Expanded Program of Immunization in 2008 in China. OBJECTIVE The objective of this study was to determine whether, and to what extent, the decline in the incidence of hepatitis A in China was the result of hepatitis A (HA) vaccination. MATERIALS AND METHODS Official documents and longitudinal serological follow-up studies were reviewed to compare the incidence of HA before and after the introduction of the vaccine. RESULTS National trends in the incidence of HA in China saw rates decrease by 92.7% in 2009, compared to the levels seen in 1992. A mass vaccination program was carried out in 3-18 year old children (Wuhan City, China), and its protective efficacy was 85.4%. In a mass vaccination program of an entire population (Shenshi County, China), the annual HA incidence decreased from 359.7/100,000 to 17.7/100,000 (almost 20.3 times). There was a significant relationship found between vaccine coverage and the incidence of HA, the correlation of the negative regression was significant at the 1% (Kendall rank correlation, significant level P < 0.05). CONCLUSIONS In summary, this study highlights the important role of implementing a vaccination program in decreasing the incidence of HA, and the large protective efficacy of such a strategy, as demonstrated in China.
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Affiliation(s)
- Zhuang Fangcheng
- Institute of Viral Disease, Zhejiang Academy of Medical Sciences, Hangzhou, China; Key Lab for Bio-tech Vaccine Research, Hangzhou, China.
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Era of Vaccination Heralds a Decline in Incidence of Hepatitis A in High-Risk Groups in China. HEPATITIS MONTHLY 2012. [DOI: 10.5812/hepatmon.4907] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Zheng H, Chen Y, Wang F, Gong X, Wu Z, Miao N, Zhang X, Li H, Chen C, Hou X, Cui F, Wang H. Comparing live attenuated and inactivated hepatitis A vaccines: an immunogenicity study after one single dose. Vaccine 2011; 29:9098-103. [PMID: 21875638 DOI: 10.1016/j.vaccine.2011.08.078] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 08/03/2011] [Accepted: 08/14/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION While three types of hepatitis A vaccines are available in China, little data are available to compare them in terms of early antibody response. We conducted a trial to compare antibody response at 7, 14 and 28 days. METHODS We randomized primary school children in Gansu and Jilin provinces into four groups to receive either (1) Chinese live attenuated hepatitis A vaccine (H2 strain), (2) domestic inactivated hepatitis A vaccine (Healive(®)), (3) imported inactivated hepatitis A vaccine (Havrix(®)) or (4) hepatitis B vaccine (Control group). We compared groups at 7, 14 and 28 days in terms of proportion of sero-conversions (≥10 mUI/ml), and Geometric Mean Concentration (GMC) of antibodies measured with a Microparticle Enzyme Immunoassay (MEIA). We compared rates of self-reported adverse events following immunization (AEFI) in the first three days. RESULTS 204 children received the H2 vaccine, 208 received Healive(®), 214 received Havrix(®), and 215 received hepatitis B vaccine (no differences across groups in terms of age, sex, weight and height). At seven days, sero-conversion proportions were 25%, 35%, 27% and 2% (p<0.0001) with GMC of 6 mIU/ml, 8 mIU/ml, 6 mIU/ml and 3 mIU/ml, respectively for the four groups. At 28 days, sero-conversion proportions were 98%, 100%, 93% and 3% (p<0.0001) with GMC of 47 mIU/ml, 71 mIU/ml, 67 mIU/ml and 3 mIU/ml, respectively. AEFI were benign and did not differ across groups (p=0.94). CONCLUSIONS While our study was not able to identify differences between Havrix(®), Healive(®) and H2 vaccine in terms of sero-conversion proportion and GMC between seven and 28 days, further studies should evaluate non-inferiority or equivalence of the Chinese vaccines, particularly with respect to the GMC concentration for the H2 vaccine since it could affect long-term protection.
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Affiliation(s)
- Hui Zheng
- Chinese Center for Disease Control and Prevention, Beiijng, China
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Karande S. Update on available vaccines in India: report of the APPA VU 2010: I. Indian J Pediatr 2011; 78:845-53. [PMID: 21373831 DOI: 10.1007/s12098-011-0384-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 02/02/2011] [Indexed: 11/25/2022]
Abstract
The Asia Pacific Pediatric Association Vaccinology Update 2010 was held in Mumbai on November 13-14, 2010 to discuss the latest information on burden of infectious diseases, recent developments in vaccines and their impact on immunization practices against infectious diseases occurring in Indian children. During the conference the importance of including conjugate Haemophilus influenzae type b vaccine and anti-rabies vaccines in routine immunization was stressed. Also, the need for giving a second dose of measles mumps rubella vaccine at school entry; and the need for a two-dose varicella vaccine regimen (first dose at 12-15 months of age and a second dose at age 4-6 years) was elucidated. Information related to vaccines which have become available in India in recent years, namely, inactivated poliovirus vaccine; diphtheria, tetanus, acellular pertussis (DTaP) vaccine; conjugate pneumococcal vaccine; rotavirus vaccines; H1N1 vaccines; live attenuated hepatitis A virus vaccine; oral cholera vaccine; tetanus, reduced-dose diphtheria, acellular pertussis (Tdap) vaccine; and human papillomavirus vaccines were discussed.
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Affiliation(s)
- Sunil Karande
- Department of Pediatrics, Seth Gordhandas Sunderdas Medical College & King Edward VII Memorial Hospital, Parel, Mumbai 400012, India.
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Yezli S, Otter JA. Minimum Infective Dose of the Major Human Respiratory and Enteric Viruses Transmitted Through Food and the Environment. FOOD AND ENVIRONMENTAL VIROLOGY 2011; 3:1-30. [PMID: 35255645 PMCID: PMC7090536 DOI: 10.1007/s12560-011-9056-7] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 02/26/2011] [Indexed: 05/18/2023]
Abstract
Viruses are a significant cause of morbidity and mortality around the world. Determining the minimum dose of virus particles that can initiate infection, termed the minimum infective dose (MID), is important for the development of risk assessment models in the fields of food and water treatment and the implementation of appropriate infection control strategies in healthcare settings. Both respiratory and enteric viruses can be shed at high titers from infected individuals even when the infection is asymptomatic. Presence of pre-existing antibodies has been shown to affect the infectious dose and to be protective against reinfection for many, but not all viruses. Most respiratory viruses appear to be as infective in humans as in tissue culture. Doses of <1 TCID50 of influenza virus, rhinovirus, and adenovirus were reported to infect 50% of the tested population. Similarly, low doses of the enteric viruses, norovirus, rotavirus, echovirus, poliovirus, and hepatitis A virus, caused infection in at least some of the volunteers tested. A number of factors may influence viruses' infectivity in experimentally infected human volunteers. These include host and pathogen factors as well as the experimental methodology. As a result, the reported infective doses of human viruses have to be interpreted with caution.
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Affiliation(s)
- Saber Yezli
- Bioquell UK Ltd, 52 Royce Close, West Portway, Andover, Hampshire, SP10 3TS, UK.
| | - Jonathan A Otter
- Bioquell UK Ltd, 52 Royce Close, West Portway, Andover, Hampshire, SP10 3TS, UK
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Immunogenicity of single dose live attenuated hepatitis a vaccine. Indian Pediatr 2010; 48:135-7. [PMID: 21169655 DOI: 10.1007/s13312-011-0039-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 05/24/2010] [Indexed: 10/18/2022]
Abstract
A long-term immunogenicity study of a single dose live attenuated H2 strain hepatitis A vaccine is being conducted in healthy Indian children at KEM Hospital, Pune. 131 of the original 143 children vaccinated in 2004, were evaluated for anti-HAV antibodies 30 months post vaccination (2007). Seroprotective antibody levels >20 mIU/mL were demonstrated in 87.8 % subjects with an overall GMT of 92.02 mIU/mL. No hepatitis like illness was recorded in any of the subjects since vaccination.
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Bian GL, Ma R, Dong HJ, Ni HX, Hu FJ, Chen YR, Chen JQ, Zhou SY, Lin YX, Xu GZ. Long-term clinical observation of the immunogenicity of inactivated hepatitis A vaccine in children. Vaccine 2010; 28:4798-801. [DOI: 10.1016/j.vaccine.2010.04.096] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 04/16/2010] [Accepted: 04/28/2010] [Indexed: 11/26/2022]
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Mor Z, Srur S, Dagan R, Rishpon S. Hepatitis A disease following the implementation of universal vaccination: who is at risk? J Viral Hepat 2010; 17:293-7. [PMID: 19691457 DOI: 10.1111/j.1365-2893.2009.01176.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The incidence of acute hepatitis A in Israel has decreased 25 folds in less than a decade, following the introduction of a two-dose universal toddler's hepatitis A immunization in July 1999. This retrospective study describes demographic data and behavioural determinants of hepatitis A patients following the implementation of a vaccination programme. All records of hepatitis A patients reported to the Ministry of Health during the years 2003 through 2005 were reviewed, and an epidemiological investigation was conducted. During the study period, 420 hepatitis A patients were reported, representing an average annual incidence of two per 100,000 population. Case fatality rate was 0.5%. The majority of the patients were younger than 15 years of age, males and non-Jewish. The highest incidence was recorded in east Jerusalem, where vaccine coverage is relatively low. After exclusion of 165 east Jerusalem patients, 133 (52.2%) patients were available for an interview. Of those, 16 (6%) had possible occupational exposure, 37 (27.8%) travelled to endemic areas, 44 (17%) were contacts of hepatitis A cases, and 3 male patients had sex with men. No known risk determinant was identified in 33 (24.8%) patients. Four patients (3%) were previously immunized with one dose, and none had two doses. The introduction of universal toddler hepatitis A vaccination decreased morbidity. Most of the patients who were detected 4-6 years after the implementation of the vaccination programme could be classified into one of the known risk groups for hepatitis A infection or living in a partly vaccinated community.
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Affiliation(s)
- Z Mor
- Ramla Sub-District Health Office, Ministry of Health, Ramla, Israel.
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Amanna IJ, Slifka MK. Wanted, dead or alive: new viral vaccines. Antiviral Res 2009; 84:119-30. [PMID: 19733596 PMCID: PMC2760379 DOI: 10.1016/j.antiviral.2009.08.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 08/21/2009] [Accepted: 08/30/2009] [Indexed: 12/20/2022]
Abstract
Vaccination is one of the most effective methods used for protecting the public against infectious disease. Vaccines can be segregated into two general categories: replicating vaccines (i.e., live, attenuated vaccines) and non-replicating vaccines (e.g., inactivated or subunit vaccines). It has been assumed that live attenuated vaccines are superior to non-replicating vaccines in terms of the quality of the antiviral immune response, the level of protective immunity, and the duration of protective immunity. Although this a prevalent viewpoint within the field, there are several exceptions to the rule. Here, we will explore the historical literature in which some of these conclusions have been based, including "Experiments of Nature" and describe examples of the efficacy of replicating vaccines compared to their non-replicating counterparts. By building a better understanding of how successful vaccines work, we hope to develop better "next-generation" vaccines as well as new vaccines against HIV--a pathogen of global importance for which no licensed vaccine currently exists.
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Affiliation(s)
- Ian J. Amanna
- Najít Technologies, Inc., 2611 S.W. 3 Avenue, Suite 200, Portland, OR 97201, USA, Phone: (503) 466-3895,
| | - Mark K. Slifka
- Vaccine and Gene Therapy Institute, Oregon Health & Science University, 505 NW 185 Avenue, Beaverton, OR 97006, USA
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Cui F, Hadler SC, Zheng H, Wang F, Zhenhua W, Yuansheng H, Gong X, Chen Y, Liang X. Hepatitis A surveillance and vaccine use in China from 1990 through 2007. J Epidemiol 2009; 19:189-95. [PMID: 19561383 PMCID: PMC3924108 DOI: 10.2188/jea.je20080087] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Hepatitis A vaccines have been highly effective in preventing hepatitis A. To investigate the epidemiology of hepatitis A in China after hepatitis A vaccine became available, we reviewed reported cases of hepatitis A and the use of hepatitis A vaccine in China during the period from 1990 through 2007. Methods Data from the National Notifiable Disease Reporting System from 1990 to 2007 and the Emergency Events Reporting System from 2004 to 2007 were reviewed and epidemiologic characteristics analyzed. Hepatitis A vaccine distribution between 1992 and 2007 was also reviewed. Results The incidence of hepatitis A has declined by 90% since 1990, from 56 to 5.9 per 105/year. Declines in age-specific incidence were seen in all age groups, most dramatically among children younger than 10 years. Disease incidence still varies substantially: poorer western provinces have had the highest incidences since 2000. In high-incidence provinces, children younger than 10 years continue to have a high disease incidence. Only 50% of cases were laboratory-confirmed, and only 3% occurred in reported local outbreaks. Over 156 million doses of hepatitis A vaccine have been distributed since 1992, and use has continued to increase since 2003. Conclusions Incidence of hepatitis A has decreased in all age groups, likely due to changing socioeconomic conditions and increasing hepatitis A vaccine use. Nevertheless, western populations remain at high risk, with transmission predominantly occurring among children. The epidemiology of hepatitis A transmission is not well understood. Improved surveillance with better laboratory confirmation is needed to monitor the impact of universal hepatitis A vaccination of young children; this strategy began to be implemented in 2008.
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Affiliation(s)
- Fuqiang Cui
- Chinese Center for Disease Control and Prevention, Beijing, China
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Affiliation(s)
- Sang Hoon Park
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hallym University College of Medicine, Korea.
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Xu ZY, Wang XY, Liu CQ, Li YT, Zhuang FC. Decline in the risk of hepatitis A virus infection in China, a country with booming economy and changing lifestyles. J Viral Hepat 2008; 15 Suppl 2:33-7. [PMID: 18837831 DOI: 10.1111/j.1365-2893.2008.01026.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objective of the study was to identify the protective factors for the rapid decline in the risk of hepatitis A virus (HAV) infection in China between 1990 and 2006. Results of serological follow-up and data on annual hepatitis A incidence were analysed and correlated with economic growth and HAV vaccine output during the same period. In conclusion, both HAV vaccination and changing lifestyles associated with the booming economy contributed to the rapid risk decline. Changing lifestyles played a major role in the decline especially in the areas with booming economy.
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Affiliation(s)
- Zhi-Yu Xu
- International Vaccine Institute, Seoul, Korea.
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Zhuang GH, Pan XJ, Wang XL. A cost-effectiveness analysis of universal childhood hepatitis A vaccination in China. Vaccine 2008; 26:4608-16. [DOI: 10.1016/j.vaccine.2008.05.086] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 05/03/2008] [Accepted: 05/19/2008] [Indexed: 11/16/2022]
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