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Impact of hepatitis A vaccination of Indigenous children on notifications of hepatitis A in north Queensland

Jeffrey N Hanna, Susan L Hills and Jan L Humphreys
Med J Aust 2004; 181 (9): 482-485.

Summary

Objective: To describe the impact of a hepatitis A vaccination program for Indigenous children in north Queensland.

Design: Enhanced surveillance of all notified cases of hepatitis A in north Queensland from 1996 to 2003.

Setting: North Queensland; population, 596 500 people, including about 6900 Indigenous children aged under five years.

Interventions: Hepatitis A vaccine was provided to Indigenous children in north Queensland from February 1999; two doses were recommended (at 18 months and 2 years of age), as was catch-up vaccination up to the sixth birthday.

Results: In the 4 years 1996–1999, 787 cases of hepatitis A were notified in north Queensland, 237 (30%) of which were in Indigenous people. The average annual notification rates in Indigenous and non-Indigenous people during this period were 110 and 25 cases per 100 000 persons, respectively. In the first 4 years after introduction of the vaccination program (2000–2003), 66 cases of hepatitis A were notified. Only nine of the 66 (14%) were in Indigenous people. The average annual notification rates in Indigenous and non-Indigenous people in 2000–2003 were 4 and 2.5 cases per 100 000 persons, respectively.

Conclusion: Hepatitis A seems to have been eradicated from Indigenous communities in north Queensland very soon after the vaccination program began. The rapid decline in notifications in non-Indigenous as well as Indigenous people suggests the program quickly interrupted chains of transmission from Indigenous children to the broader community. To our knowledge this is the first evidence that a hepatitis A vaccination program targeting a high-risk population within a community can reduce disease in the broader community. Hepatitis A vaccine should be provided to other high-risk Indigenous children elsewhere in Australia.

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  • Jeffrey N Hanna1
  • Susan L Hills2
  • Jan L Humphreys3

  • 1 Tropical Public Health Unit Network, Queensland Health, Cairns, QLD.
  • 2 Tropical Public Health Unit Network, Queensland Health, Aitkenvale, QLD.

Correspondence: 

Acknowledgements: 

We thank all those in the Communicable Diseases Unit and the Tropical Public Health Unit Network, Queensland Health, who assisted in the planning and implementation of the program. We particularly wish to thank all the vaccine service providers in north Queensland who have supported the roll out and maintenance of the program.

Competing interests:

Dr Hanna has received funding from vaccine companies to attend conferences and workshops.

  • 1. Merritt A, Symons D, Griffiths M. The epidemiology of acute hepatitis A in North Queensland, 1996-1997. Commun Dis Intell 1999; 23: 120-124.
  • 2. Hanna J, Brookes D. Some occupational exposures to hepatitis A. Commun Dis Intell 1994; 18: 3-5.
  • 3. Hanna J. Hospital-acquired hepatitis A. Commun Dis Intell 1994; 18: 312-313.
  • 4. Hanna JN, Loewenthal MR, Negel P, Wenck DJ. An outbreak of hepatitis A in an Intensive Care Unit. Anaesth Intensive Care 1996; 24: 440-444.
  • 5. Hanna JN, Humphreys JL, Hills SL, et al. Recognising and responding to outbreaks of hepatitis A associated with child day-care centres. Aust N Z J Public Health 2001; 25: 525-528.
  • 6. Hanna JN, Warnock TH, Shepherd RW, Selvey LA. Fulminant hepatitis A in Indigenous children in north Queensland. Med J Aust 2000; 172: 19-21. <MJA full text>
  • 7. Australian Bureau of Statistics. 2001 Census of population and housing (1st release, Aboriginal and Torres Strait Islander profile by statistical local area). ABS: Canberra, 2002. Available at: http://datahub.govnet.qld.gov.au/ausstats/absATcensus (accessed Sep 2002).
  • 8. Werzberger A, Mensch B, Kuter B, et al. A controlled trial of a formalin-inactivated hepatitis A vaccine in healthy children. N Engl J Med 1992; 327: 453-457.
  • 9. Innis BL, Snitbhan R, Kunasol P, et al. Protection against hepatitis A by an inactivated vaccine. JAMA 1994; 271: 1328-1334.
  • 10. Bialek SR, Thoroughman DA, Hu D, et al. Hepatitis A incidence and hepatitis A vaccination among American Indians and Alaska Natives, 1990-2001. Am J Public Health 2004; 94: 996-1001.
  • 11. Smith PF, Grabau JC, Werzberger A, et al. The role of young children in a community-wide outbreak of hepatitis A. Epidemiol Infect 1997; 118: 243-252.
  • 12. Staes CJ, Schlenker TL, Risk I, et al. Sources of infection among persons with acute hepatitis A and no identified risk factors during a sustained community-wide outbreak. Pediatrics 2000; 106: E54.
  • 13. Venczel LV, Desai MM, Vertz D, et al. The role of child care in a community-wide outbreak of hepatitis A. Pediatrics 2001; 108: E78.
  • 14. National Health and Medical Research Council. Hepatitis A. In: The Australian immunisation handbook. 8th ed. Canberra: Commonwealth of Australia, 2003: 133-145.
  • 15. Piazza M, Safary A, Vegnente A, et al. Safety and immunogenicity of hepatitis A vaccine in infants: a candidate for inclusion in the childhood vaccination programme. Vaccine 1999; 17: 585-588.
  • 16. Dagan R, Amir J, Mijalovsky A, et al. Immunization against hepatitis A in the first year of life: priming despite the presence of maternal antibody. Pediatr Infect Dis J 2000; 19: 1045-1052.
  • 17. Abarca K, Ibanez I, Flores J, et al. Efficacy of hepatitis A vaccination in children aged 12 to 24 months [erratum published in Arch Med Res 2002; 33: 205]. Arch Med Res 2001; 32: 468-472.
  • 18. Dagan R, Leventhal A, Anis ER, et al. National hepatitis A virus (HAV) immunization program aimed exclusively at toddlers in an endemic country resulting in > 90% reduction in morbidity rates in all ages. Abstracts of the 40th Annual Meeting of the Infectious Diseases Society of America; Chicago; Oct 24-27 2002: 189. Available at: www.journals.uchicago.edu/CID/2002Abstracts (accessed Feb 2004).
  • 19. MacIntyre CR, Burgess MA, Hull B, McIntyre PB. Hepatitis A vaccination options for Australia. J Paediatr Child Health 2003; 39: 83-87.
  • 20. Welty TK, Darling K, Dye S, et al. Guidelines for prevention and control of hepatitis A in American Indian and Alaska Native communities. S D J Med 1996; 49: 317-322.
  • 21. Centers for Disease Control and Prevention. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1999; 48 (RR-12): 1-37.
  • 22. McMahon BJ, Beller M, Williams J, et al. A program to control an outbreak of hepatitis A in Alaska by using an inactivated hepatitis A vaccine. Arch Pediatr Adolesc Med 1996; 150: 733-739.
  • 23. Averhoff F, Shapiro CN, Bell BP, et al. Control of hepatitis A through routine vaccination of children. JAMA 2001; 286: 2968-2973.
  • 24. Van Damme P, Banatvala J, Fay O, et al. Hepatitis A booster vaccination: is there a need? Lancet 2003; 362: 1065-1071.
  • 25. Adams L, Johnson G. Hepatitis A virus infection, immunisation and the Kimberley. Kimberley Public Health Bull 2003; 34 (May): 13.

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