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The Changing Epidemiology of Acute Hepatitis A in Texas
Rachel Wiseman, MPH,Lucille Palenapa, MS; Linda Gaul, PhDEmerging and Acute Infectious Disease Branch
Texas Public Health Association Annual Education Conference
April 22, 2010
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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
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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)
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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
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32 Counties Requiring Hepatitis A Vaccination
Texas Counties Requiring Hepatitis A For Childcare and School Entry, 1999, 1999
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Texas Counties Requiring Hepatitis A For Childcare and School Entry, 2003, 2003
39 Counties Requiring Hepatitis A Vaccination
Seven counties, were added to the vaccination requirement.
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Texas Counties Requiring Hepatitis A For Childcare and School Entry, 2005, 2005
Counties requiring vaccine for childcare entry.
Counties requiring vaccine for school and childcare entry (n=40).
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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!)
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Reported Cases of Hepatitis A in Texas 1995-2009*
0500
1,0001,5002,0002,5003,0003,5004,0004,5005,0001995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009*
Nu
mb
er
of
cases
Hepatitis A vaccine licensed in 1995
*2009 data is provisional as of 4/6/2010.
16.1
9.3
1.1
Incidence rates per 100,000 population
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0
5
10
15
20
25
30
35
<10
10-1
9
20-2
9
30-3
9
40-4
9
50-5
960
+
Unknown
Age Group (years)
Per
cen
tag
e o
f ca
ses
1995 2000 2008
Percent of Hepatitis A Cases by Age Group
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0
5
10
15
20
25
30
35
<10 10-19 20-29 30-39 40-49 50-59 60+
Rat
e p
er 1
00,0
00
1995 2000 2008
Incidence Rates of Hepatitis A by Age Group
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Percent of Hepatitis A Cases by Gender
0
10
20
30
40
50
60
Male Female Unknown
Pe
rce
nta
ge
of
Ca
se
s
1995 2000 2008
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Percent of Hepatitis A Cases by Race
010203040506070
A/PI
Black
Hispan
ic
White
Other
Unknow
n
Pe
rce
nta
ge
of
Ca
se
s
1995 2000 2008
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Incidence Rates of Hepatitis A Cases by Race
0
5
10
15
20
25
30
35
40
Black Hispanic White
Ra
te p
er
10
0,0
00
1995 2000 2008
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Percentage of Cases in Age Category by Race, 2008
<10
10-19
20-29
30-39
40-49
50-59
60+
Whites Hispanics
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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