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The Changing Epidemiology of Acute Hepatitis A in Texas

The Changing Epidemiology of Acute Hepatitis A in Texas. Rachel Wiseman, MPH, Lucille Palenapa, MS; Linda Gaul, PhD Emerging and Acute Infectious Disease Branch Texas Public Health Association Annual Education Conference April 22, 2010. Overview. Describe how hepatitis A virus has

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The Changing Epidemiology of Acute Hepatitis A in Texas

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  1. The Changing Epidemiology of Acute Hepatitis A in Texas Rachel Wiseman, MPH, Lucille Palenapa, MS; Linda Gaul, PhD Emerging and Acute Infectious Disease Branch Texas Public Health Association Annual Education Conference April 22, 2010

  2. Overview Describe how hepatitis A virus has decreased in Texas since the licensing of a vaccine • Vaccine requirements in Texas • Hepatitis A incidence • Hepatitis A distribution

  3. Hepatitis A Epidemiology • Reservoir Humans • Transmission Fecal-oral route; person-to-person or ingestion of contaminated food or water • Communicability 1-2 weeks before onset to week after onset • Temporal Pattern None • Incubation Period Avg 28-30 days (range 15-50 days)

  4. CDC Hepatitis A Vaccine Recommendations • 1995, introduction of vaccine and recommended targeted vaccination of high-risk individuals • 1999, recommended targeted hepatitis A vaccine programs for people two years of age and older residing in high incident states old • Children are often asymptomatic and can be unknown sources of infection • Texas identified the counties with the largest burden of hepatitis A and targeted those for vaccine requirements • 2005, recommended vaccination of all children 12-23 months of age and older

  5. Texas Counties Requiring Hepatitis A For Childcare and School Entry, 1999 32 Counties Requiring Hepatitis A Vaccination

  6. Texas Counties Requiring Hepatitis A For Childcare and School Entry, 2003 Seven counties, were added to the vaccination requirement. 39 Counties Requiring Hepatitis A Vaccination

  7. Texas Counties Requiring Hepatitis A For Childcare and School Entry, 2005 Counties requiring vaccine for childcare entry. Counties requiring vaccine for school and childcare entry (n=40).

  8. Current Hepatitis A Vaccine Requirements • Child-Care • Statewide for all children attending a child-care facility, including pre-K • After-school care not affected • School • Must have 2 doses for entering kindergarten • Statewide requirement (this is new for the 2009-10 school year!)

  9. Reported Cases of Hepatitis A in Texas 1995-2009* Hepatitis A vaccine licensed in 1995 Incidence rates per 100,000 population 9.3 1.1 16.1 *2009 data is provisional as of 4/6/2010.

  10. Percent of Hepatitis A Cases by Age Group

  11. Incidence Rates of Hepatitis A by Age Group

  12. Percent of Hepatitis A Cases by Gender

  13. Percent of Hepatitis A Cases by Race

  14. Incidence Rates of Hepatitis A Cases by Race

  15. Percentage of Cases in Age Category by Race, 2008 Hispanics Whites

  16. Summary Requiring school/childcare vaccination in specific locations has reduced incidence across the state in all age groups Racial disparities in disease incidence have been eliminated Expansion of vaccination requirements should help to continue these trends

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