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.
- 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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