A program to control an outbreak of hepatitis A in Alaska by using an inactivated hepatitis A vaccine
B. J. McMahon, M. Beller, J. Williams, M. Schloss, H. Tanttila and L. Bulkow
Alaska Native Medical Center, Indian Health Service, Anchorage, USA.
OBJECTIVE: To stop an epidemic of hepatitis A in rural Alaska by mass
immunization of susceptible persons with 1 dose of an inactivated hepatitis
A vaccine. DESIGN: Nonrandomized, uncontrolled trial. Hepatitis A vaccine
was offered to all persons in susceptible age groups in villages with
documented cases of hepatitis A. Immune globulin was not offered at the
time of vaccination. SETTING: Twenty-five rural communities located in
interior Alaska and along the northwest coast of the Bering Sea and Arctic
Ocean. PARTICIPANTS: Persons without a history of acute hepatitis A in age
groups selected by applying results of a previous serosurvey conducted on
serum collected before the epidemic. INTERVENTION: One dose of a
formalin-inactivated hepatitis A vaccine was given to each participant.
Adults 20 years of age and older received 1440 enzyme-linked immunosorbent
assay units and persons younger than 20 years received 720 enzyme-linked
immunosorbent assay units. Prevaccination and postvaccination levels of
antibody to hepatitis A IgG were obtained from 136 participants. MAIN
OUTCOME MEASURES: An active surveillance system was established to detect
persons with symptomatic illnesses compatible with hepatitis A; persons who
met the illness criteria were tested for antibody to hepatitis A IgM. One
area (the Kotzebue region), where all communities were offered vaccine, was
selected for intensive surveillance and analysis. RESULTS: During the
12-month period before the vaccine trial, 529 cases of icteric hepatitis A
were reported, and 443 were confirmed to be positive for antibody to
hepatitis A IgM. Hepatitis A vaccine was administered to 4930 persons, 3517
of whom were younger than 20 years. After vaccination began, 237 persons
positive for antibody to hepatitis A IgM were identified during a 60-week
surveillance period; 46 were vaccines and 191 were unvaccinated susceptible
persons. In the Kotzebue region, in communities in which more than 80% of
persons considered susceptible were vaccinated, the outbreak ceased in 4 to
8 weeks, whereas in 1 large community in which less than 50% of susceptible
persons were vaccinated, the outbreak continued for more than 50 weeks.
More than 90% of seronegative persons developed antibody to hepatitis A IgG
3 to 4 weeks after vaccination. CONCLUSION: This trial suggested that by
providing both short-term and long-term protection, hepatitis A vaccine
used without immune globulin halted an established epidemic of hepatitis A
in rural Alaska.
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SACY et al.
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Dagan et al.
JAMA 2005;294:202-210.
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Bialek et al.
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Craig and Schaffner
NEJM 2004;350:476-481.
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Bardenheier et al.
Pediatrics 2003;112:e269-269.
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Averhoff et al.
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Webster et al.
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Allard et al.
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Cuthbert
Clin. Microbiol. Rev. 2001;14:38-58.
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Koff
NEJM 1999;340:644-645.
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