Posts filed under ‘Hepatitis A’
Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel
Morbidity and Mortality Weekly Report. 2018;67(43):1216-1220.
Update
Noele P. Nelson, MD, PhD1; Ruth Link-Gelles, PhD1; Megan G. Hofmeister, MD1; José R. Romero, MD2; Kelly L. Moore, MD3; John W. Ward, MD1; Sarah F. Schillie, MD1
Postexposure prophylaxis (PEP) with hepatitis A (HepA) vaccine or immune globulin (IG) effectively prevents infection with hepatitis A virus (HAV) when administered within 2 weeks of exposure. Preexposure prophylaxis against HAV infection through the administration of HepA vaccine or IG provides protection for unvaccinated persons traveling to or working in countries that have high or intermediate HAV endemicity. The Advisory Committee on Immunization Practices (ACIP) Hepatitis Vaccines Work Group conducted a systematic review of the evidence for administering vaccine for PEP to persons aged >40 years and reviewed the HepA vaccine efficacy and safety in infants and the benefits of protection against HAV before international travel….
https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6743a5-H.pdf
Hepatitis A Virus Outbreaks Associated with Drug Use and Homelessness – California, Kentucky, Michigan, and Utah, 2017.
MMWR Morb Mortal Wkly Rep. November 2, 2018 V.67 N.43 P.1208-1210.
Foster M, Ramachandran S, Myatt K, Donovan D, Bohm S, Fiedler J, Barbeau B, Collins J, Thoroughman D, McDonald E, Ballard J, Eason J, Jorgensen C.
Abstract
During 2017, CDC received 1,521 reports of acute hepatitis A virus (HAV) infections from California, Kentucky, Michigan, and Utah; the majority of infections were among persons reporting injection or noninjection drug use or homelessness.
Investigations conducted by local and state health departments indicated that direct person-to-person transmission of HAV infections was occurring, differing from other recent, large HAV outbreaks attributed to consumption of contaminated commercial food products.
Outbreaks with direct HAV transmission among persons reporting drug use or homelessness signals a shift in HAV infection epidemiology in the United States, and vaccination of these populations at high risk can prevent future outbreaks.
Globalization and the Changing Epidemiology of Hepatitis A Virus
Cold Spring Harbor Perspectives in Medicine March 2018
Kathryn H. Jacobsen
Increased economic interdependence, social integration, and other aspects of globalization are contributing to significant changes in hepatitis A epidemiology. Globally, the incidence of hepatitis A virus (HAV) infection is decreasing, the age at midpoint of population immunity (AMPI) is increasing, and the proportion of symptomatic cases is increasing as the average age at infection increases. In low-income countries, HAV remains endemic but improved water and sanitation systems are reducing transmission rates among young children. In high-income countries, most adults remain susceptible to HAV and foodborne outbreaks are becoming more frequent. Middle-income countries have diverse epidemiological profiles, and they play important roles in the global spread of HAV through international trade and travel. Future changes in the epidemiology of hepatitis A will be heavily influenced by globalization processes.
FULL TEXT
http://perspectivesinmedicine.cshlp.org/content/8/10/a031716.full
http://perspectivesinmedicine.cshlp.org/content/8/10/a031716.full.pdf+html
Revisiones – Diagnóstico microbiológico de las hepatitis virales
Enf Infecc & Microbiol. Clínica Noviembre 2015 V.33 N.9 e53-e62
Roberto Alonso, Antonio Aguilera, Juan Córdoba, Antonio Fuertes
a Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, España
b Servicio de Microbiología, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, España
c Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, Valencia, España
d LABCO QualityDiagnostics, Madrid, España
La inflamación hepática o hepatitis tiene causas diversas, tanto infecciosas como no infecciosas. Entre las primeras, cabe destacar la etiología viral que es la causa de, al menos, la mitad de todas las hepatitis en el mundo.
Se han descrito distintos virus con tropismo primario por el tejido hepático. Estos microorganismos se han ido nombrando sucesivamente con las letras del abecedario: A, B, C, D, E y G.
El objetivo de este artículo es revisar este grupo heterogéneo de virus en sus aspectos más básicos, sus implicaciones clínicas, su tratamiento, las principales medidas preventivas frente a estas infecciones y, con especial interés, las aproximaciones diagnósticas, tanto serológicas como moleculares, que se utilizan para su detección, cuantificación y caracterización
Fever of unknown origin in returning travellers.
Int Marit Health. 2015;66(2):77-83.
Korzeniewski K1, Gaweł B, Krankowska D, Wasilczuk K.
Author information
1Department of Epidemiology and Tropical Medicine in Gdynia, Military Institute of Medicine, Warsaw, Poland. kktropmed@wp.pl.
Abstract
The aim of the article is to discuss issues associated with the occurrence of febrile illnesses in leisure and business travellers, with a particular emphasis on fevers of unknown origin (FUO).
FUO, apart from diarrhoeas, respiratory tract infections and skin lesions, are one of the most common health problems in travellers to tropical and subtropical countries.
FUO are manifestations of various diseases, typically of infectious or invasive aetiology.
In one out of 3 cases, the cause of a fever in travellers returning from the hot climate zone is malaria, and therefore diagnostic tests should first aim at ruling out this specific disease entity.
Other illnesses with persistent fever include dengue, enteric fever, viral hepatitis A, bacterial diarrhoeas and rickettsioses.
Fever may also occur in travellers suffering from diseases of non-tropical origin, e.g. cosmopolitan respiratory tract or urinary tract infections, also, fever may coexist with other illnesses or injuries (skin rashes, bites, burns).
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Evaluation of Hepatitis A Vaccine in Post-Exposure Prophylaxis, The Netherlands, 2004-2012
PLOS ONE October 2013 V.8 N.10 e78914
Jane Whelan1*, Gerard J. Sonder1,2, Lian Bovée1, Arjen Speksnijder3, Anneke van den Hoek1,21 Department of Infectious Diseases, Amsterdam Public Health Service (GGD), Amsterdam, The Netherlands, 2 Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The Netherlands, 3 Laboratory of Public Health, Amsterdam Public Health Service (GGD) Amsterdam, The Netherlands
Background
The secondary attack rate of hepatitis A virus (HAV) among contacts of cases is up to 50%. Historically, contacts were offered immunoglobulin (IG, a human derived blood product) as post-exposure prophylaxis (PEP). Amid safety concerns about IG, HAV vaccine is increasingly recommended instead. Public health authorities’ recommendations differ, particularly for healthy contacts ≥40 years old, where vaccine efficacy data is limited. We evaluated routine use of HAV vaccine as an alternative to immunoglobulin in PEP, in those considered at low risk of severe infection in the Netherlands
Methods
Household contacts of acute HAV cases notified in Amsterdam (2004-2012) were invited ≤14 days post-exposure, for baseline anti-HAV testing and PEP according to national guidelines: immunoglobulin if at risk of severe infection, or hepatitis A vaccine if healthy and at low risk (aged <30, or, 30-50 years and vaccinated <8 days post-exposure). Incidence of laboratory confirmed secondary infection in susceptible contacts was assessed 4-8 weeks post-exposure. In a vaccinated subgroup, relative risk (RR) of secondary infection with estimated using Poisson regression.
Results
Of 547 contacts identified, 191 were susceptible to HAV. Per-protocol, 167 (87%) were vaccinated (mean:6.7 days post-exposure, standard deviation(sd)=3.3) and 24 (13%) were given immunoglobulin (mean:9.7 days post-exposure, sd=2.8). At follow-up testing, 8/112 (7%) had a laboratory confirmed infection of whom 7 were symptomatic. All secondary infections occurred in vaccinated contacts, and half were >40 years of age. In healthy contacts vaccinated per-protocol ≤8 days post-exposure, RRref. ≤15 years of secondary infection in those >40 years was 12.0 (95%CI:1.3-106.7).
Conclusions
Timely administration of HAV vaccine in PEP was feasible and the secondary attack rate was low in those <40 years. Internationally, upper age-limits for post-exposure vaccination vary. Pending larger studies, immunoglobulin should be considered PEP of choice in people >40 years of age and those vulnerable to severe disease.
Full Text
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0078914
