American Journal of Epidemiology Advance Access originally published online on December 7, 2005
American Journal of Epidemiology 2006 163(3):204-210; doi:10.1093/aje/kwj029
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Original Contribution |
Person-to-Person Transmission of Hepatitis A Virus in an Urban Area of Intermediate Endemicity: Implications for Vaccination Strategies
1 Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
2 Department of Epidemiology, Republican Sanitary Epidemiology Station, Kazakhstan Ministry of Health, Almaty, Kazakhstan
3 Virology Reference Laboratory, Republican Sanitary Epidemiology Station, Kazakhstan Ministry of Health, Almaty, Kazakhstan
4 Division of International Health, Coordinating Office for Global Health, Centers for Disease Control and Prevention, Atlanta, GA
5 Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
Reprint requests to Dr. Arnold S. Monto, Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109 (e-mail: asmonto{at}umich.edu).
Developing countries with an increasing hepatitis A disease burden may target vaccination to specific groups, such as young children, as an initial control strategy. To better understand transmission of hepatitis A virus in such countries, the authors prospectively studied household and day-care/school contacts of cases in Almaty, Kazakhstan. Overall, by the time of identification of symptomatic index cases, half of transmission had already occurred, having been detected retrospectively. The odds of household contacts' becoming infected were 35.4 times those for day-care/school contacts (95% confidence interval (CI): 17.5, 71.7). Within households, younger age of either index cases or susceptible contacts elevated the odds of secondary infection among susceptible contacts: The presence of a case under 6 years of age raised the odds 4.7 times (95% CI: 1.2, 18.7); and compared with contacts aged 14 years or older, the odds of infection were increased to 7.7 (95% CI: 1.5, 40.3) and 7.0 (95% CI: 1.4, 34.3) among contacts aged 0–6 years and 7–13 years, respectively. Young children are appropriate targets for sustainable hepatitis A vaccination programs in areas undergoing hepatitis A epidemiologic transition. If vaccine is determined to be highly effective postexposure and if it is feasible, vaccinating household contacts could be a useful additional control strategy.
communicable disease control; disease transmission; hepatitis A; hepatitis A vaccines; immunization; vaccination
Abbreviations: anti-HAV, antibodies to hepatitis A virus; HAV, hepatitis A virus; IgM, immunoglobulin M; SEA, Sanitary Epidemiology Authority
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