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The impact of one dose Hepatitis A vaccine in Latin America

The impact of one dose Hepatitis A vaccine in Latin America. Dr. Pablo Elmassian. Hepatitis A: Burden of disease. HAV cases: 1,5 millions annually worldwide Fulminant hepatic failure (FHF): 0,4% (Mortality rate 60%) Case fatality ratio: 0,1% < 15 years of age to 2,1% > 40 years

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The impact of one dose Hepatitis A vaccine in Latin America

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  1. Theimpact of onedose Hepatitis A vaccine in LatinAmerica Dr. Pablo Elmassian

  2. Hepatitis A: Burden of disease • HAV cases: 1,5 millions annually worldwide • Fulminant hepatic failure (FHF): 0,4% (Mortality rate 60%) • Case fatality ratio: 0,1% < 15 years of age to 2,1% > 40 years • HAV does not cause chronic liver disease

  3. HAV:Estimated prevalence High: Ab HAV >90% 10 years Very low: Ab HAV <50% 30 years Intermediate: Ab HAV > 50% 15 years and > 50% 30 years Hepatitis A virus seroprevalence by age and world region, 1990 and 2005.Jacobsen KH, Wiersma ST Vaccine. 2010 Sep 24; 28(41):6653-7.

  4. Hepatitis notified cases in Argentina 1995-2004

  5. Etiology of FHF in Argentina:1993-1999 100 patients Median age: 5.1 yrsold (1,1-15,8) Male 53/Female 47 90% < 10 yrsold Hepatitis A IndeterminateToxicAutoimmune Ciocca M,Ramonet M,et al JPediatr Gastroenterol Nutr 31:1050(A)2000

  6. Hepatitis A vaccine • Inactivated are the most commonly used • Highly effective • Long term protection • Licensed for use > 12 months of age • Schedule: 0 - 6 monts

  7. Argentina 2005: Single-dose vaccination strategy • almost 100% of vaccinated individuals seroconvert 30 days after the first dose • Experience of high efficacy of post –exposure prophylaxis for outbreak control with one dose • The expectation that the natural booster induced by wild virus circulation could ensure long lasting protection • The economic limitations in Argentina to include a 2-dose series

  8. Vaccination Coverage

  9. Hepatic Transplant in Argentina:1993-2013

  10. Hepatitis A: Argentina 2000-2016 Universal Vaccination

  11. Group A: Indirectestimation of HAV circulation in Argentina n=434 GroupB: Persistence of HAV Antibodiesafter 4 years of onedose of vaccine n=1059 Seroprevalence Ab-HAV beforevaccination Journal of thePediatricInfectiousDiseaseSociety, Vol 4, No 4 pp. e62-e67.2015

  12. GMC: 170,5mIU/mL (95% CI: 163,2-178,2mIU/mL) ThePediatricInfectiousDiseaseJournal.Vol 35,No 12,Dec 2016: 1339-1342

  13. n=1119 • Mean age: 10,7 years old • Mean post vaccination interval 9,7 years (Range 9,0-11,3 years) • 87,6% had protective antibodies against HAV • GMC 28,0 mIU/mL (95% CI: 26,8-29,3 mIU/mL) S320 OFID 2017: 4 (Supp 1) Poster ASbstracts

  14. WHO Position paper on Hepatitis A vaccines 2012 WHO recommendsArgentina’s 1 dosestrategy A comparable option in termsoneffectiveness Lessexpensive Easiertoimplement

  15. Countries with Public Vaccination Programs HAV in America 2017

  16. Thankyou pelmassian@fidec-online.com

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