Considerations on the Current Universal Vaccination Policy against Hepatitis A in Greece after Recent Outbreaks

Purpose Hepatitis A is a prevalent disease that is largely preventable by vaccine usage. The vaccine for this illness is highly underused in most regions. In an attempt to find the strategies that are most beneficial in regard to quality-adjusted life years (QALYs) and cost in current environments, the purpose of this paper is to conduct cost-effectiveness analyses to investigate vaccination strategies in a more economically developed country (MEDC), generally known as a “developed” area: the USA, and a less economically developed country (LEDC), generally known as a “developing” area: the state of Rio de Janeiro, Brazil. Design/methodology/approach This study used a dynamic transmission model for comparative effectiveness analyses. The model ran two different scenarios. The two regions studied have different policies and strategies for Hepatitis A vaccination currently, and also used different strategies in 2009. In the USA, a universal vaccination policy was modeled, along with a scenario in which it was removed. In Rio de Janeiro, a no vaccination policy was modeled, along with a scenario in which a universal vaccination policy was effected. Findings The comparison of resulting incremental cost-effectiveness ratio values to accepted threshold values showed universal vaccination to be cost-effective in both the USA and Rio de Janeiro as compared to no vaccination. When episode and vaccination costs and vaccination efficacy were varied, this still remained true. Universal vaccination was found to result in lower incidence of Hepatitis A in both the USA and Rio de Janeiro. Over the twenty-year time horizon, universal vaccination is projected to prevent 506,945 cases of symptomatic Hepatitis A in the USA and 42,318 cases of Hepatitis A in Rio de Janeiro. Other benefits include a projected increase in cumulative QALYs through the use of universal vaccination. Originality/value This analysis showed universal vaccination to be cost-effective as compared to no vaccination, and portions of the study’s approach had not previously been applied in tandem to investigate Hepatitis A interventions. The results may help foster higher compliance rates for Hepatitis A vaccination and even greater per-person economic benefits of universal vaccination, particularly in the USA. The purpose of this study is also to encourage elevated levels of surveillance on age of infection in developing regions and consistent reevaluation utilizing dynamic transmission models in both the USA and Brazil, as well as other rapidly developing regions, in order to prevent future epidemics and costs associated with the disease.

Download Full-text

Hepatitis A in the European Union: responding to challenges related to new epidemiological patterns

Eurosurveillance ◽

10.2807/ese.14.03.19101-en ◽

2009 ◽

Vol 14 (3) ◽

Author(s):

L Payne ◽

D Coulombier

Keyword(s):

European Union ◽

Czech Republic ◽

General Population ◽

Hepatitis A ◽

Universal Vaccination ◽

The European Union ◽

The Impact

In the European Union (EU), the overall incidence of hepatitis A has decreased over the last 10 years from 15.1 per 100,000 population in 1996 to 3.9 per 100,000 in 2006. However, reduction in circulation of HAV leads to decreased acquisition of immunity and, in the absence of universal vaccination, an accumulation of susceptible individuals. The impact of increasing susceptibility of the general population on the risk for outbreaks is clearly illustrated in independent outbreaks in Czech Republic, Latvia and Slovakia in 2008, described in three of the articles published in this week’s issue of Eurosurveillance.

Download Full-text

Seroepidemiology of hepatitis A among Greek children indicates that the virus is still prevalent: Implications for universal vaccination

Journal of Medical Virology ◽

10.1002/jmv.21434 ◽

2009 ◽

Vol 81 (4) ◽

pp. 582-587 ◽

Cited By ~ 17

Author(s):

A. Kyrka ◽

A. Tragiannidis ◽

D. Cassimos ◽

K. Pantelaki ◽

M. Tzoufi ◽

...

Keyword(s):

Hepatitis A ◽

Universal Vaccination

Download Full-text

Comparative hepatitis A seroepidemiology in 10 European countries

Epidemiology and Infection ◽

10.1017/s0950268812000015 ◽

2012 ◽

Vol 140 (12) ◽

pp. 2172-2181 ◽

Cited By ~ 16

Author(s):

S. KURKELA ◽

R. PEBODY ◽

G. KAFATOS ◽

N. ANDREWS ◽

C. BARBARA ◽

...

Keyword(s):

Disease Burden ◽

Hepatitis A ◽

Hepatitis A Virus ◽

Age Groups ◽

Risk Groups ◽

Vaccination Policy ◽

Laboratory Results ◽

Children And Young Adults ◽

Middle Aged Adults ◽

Local Laboratory

SUMMARYThe WHO recommends hepatitis A virus (HAV) immunization according to level of transmission and disease burden. We aimed to identify susceptible age groups by standardized serosurveys to inform HAV vaccination policy in participating countries: Belgium, Czech Republic, England, Finland, Germany, Italy, Lithuania, Malta, Romania, and Slovakia. Each country tested national serum banks (n = 1854–6748), collected during 1996–2004, for anti-HAV antibodies. Local laboratory results were standardized to common units. Forty-one per cent of those aged <30 years and 6% of those aged ⩾30 years were susceptible to HAV in Romania; compared to 70–94% and 26–71%, respectively, elsewhere. Romania reported high HAV incidence in children and young adults. Other countries reported HAV disease primarily in older risk groups. The results suggest low level of HAV transmission in most of Europe. Romania, however, appeared as an area with intermediate transmission. Vaccination of risk groups in countries with high susceptibility of young and middle-aged adults needs to be continued.

Download Full-text

Endemic circulation of hepatitis a virus in israel in spite of universal vaccination program evidenced by clinical and environmental surveillance

Journal of Clinical Virology ◽

10.1016/j.jcv.2015.07.198 ◽

2015 ◽

Vol 70 ◽

pp. S85

Author(s):

E. Mendelson ◽

Y. Manor ◽

D. Ram ◽

O. Mor ◽

M. Savion ◽

...

Keyword(s):

Hepatitis A ◽

Hepatitis A Virus ◽

Universal Vaccination ◽

Vaccination Program ◽

Environmental Surveillance

Download Full-text

High prevalence of anti-hepatitis A IgG in a cohort of UK HIV-negative men who have sex with men: implications for local hepatitis A vaccine policy

International Journal of STD & AIDS ◽

10.1177/0956462418770008 ◽

2018 ◽

Vol 29 (10) ◽

pp. 1007-1010 ◽

Cited By ~ 3

Author(s):

A Bhagey ◽

K Foster ◽

S Ralph ◽

A Wardropper ◽

C White ◽

...

Keyword(s):

Hepatitis A ◽

Hepatitis A Virus ◽

Antibody Test ◽

Universal Vaccination ◽

Vaccine Uptake ◽

Electronic Patient Records ◽

Previous Infection ◽

Risk Patients ◽

Sex With Men ◽

Hiv Negative

BASHH guidelines recommend that ‘the hepatitis A virus total antibody test can be offered to at-risk patients whose immune status is unknown … depending on local funding arrangements’. We sought to measure the local prevalence of anti-hepatitis A (HAV) IgG in HIV-negative men who have sex with men (MSM), to inform the utility of pre-vaccination screening. We assessed the prevalence of anti-HAV IgG in HIV-negative MSM who attended sexual health services in County Durham and Darlington, UK, from March to August 2017. Data were extracted from electronic patient records and analysed in Excel. Our study was granted local Caldicott approval. Seventy four per cent of 244 HIV-negative MSM who attended for review were screened. Anti-HAV IgG was detected in 42% who did not report definite previous infection or vaccination; not detected in 57.4%; and was equivocal in 0.6%. Vaccine was administered to 48% of eligible patients. The estimated financial costs of universal vaccination of MSM (£4235.40) and pre-vaccination screening with vaccination of susceptible patients (£4188.13) are similar. Pre-vaccination screening and vaccination of susceptible patients does not save resources compared to a policy of universal vaccination of MSM in our setting. Universal vaccination of MSM attending genitourinary medicine clinics may improve vaccine uptake.

Download Full-text