Dagan Ron, Leventhal Alex, Anis Emilia, Slater Paul, Ashur Yaffa, Shouval Daniel
Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
JAMA. 2005 Jul 13;294(2):202-10. doi: 10.1001/jama.294.2.202.
In Israel, the mean annual incidence of hepatitis A disease was 50.4 per 100 000 during 1993-1998. A 2-dose universal hepatitis A immunization program aimed at children aged 18 and 24 months (without a catch-up campaign) was started in 1999.
To observe the impact of toddlers-only universal vaccination on hepatitis A virus disease in Israel.
Ongoing passive national surveillance of hepatitis A cases in Israel has been conducted since 1993 by the Ministry of Health. An active surveillance program in the Jerusalem district in 1999-2003 provided validation for the passive program.
Incidence of reported hepatitis A disease, 1993-2004.
Overall vaccine coverage in Israel in 2001-2002 was 90% for the first dose and 85% for the second dose. A decline in disease rates was observed before 1999 among the Jewish but not the non-Jewish population. After initiation of the program, a sharp decrease in disease rates was observed in both populations. The annual incidence of 2.2 to 2.5 per 100 000 during 2002-2004 represents a 95% or greater reduction for each year with respect to the mean incidence during 1993-1998 (P<.001). For children aged 1 through 4 years, a 98.2% reduction in disease was observed in 2002-2004, compared with the prevaccination period (P<.001). However, a sharp decline was also observed in all other age groups (84.3% [<1 year], 96.5% [5-9 years], 95.2% [10-14 years], 91.3% [15-44 years], 90.6% [45-64 years], and 77.3% [>or=65 years]). Among the Jewish population in the Jerusalem district, in whom the active surveillance program was successfully conducted, a more than 90% reduction of disease was demonstrated. Of the 433 cases reported nationwide in 2002-2004 in whom vaccination status could be ascertained, 424 (97.9%) received no vaccine and none received 2 doses.
This universal toddlers-only immunization program in Israel demonstrated not only high effectiveness of hepatitis A vaccination but also marked herd protection, challenging the need for catch-up hepatitis A vaccination programs.
在以色列，1993 - 1998年期间甲型肝炎的年平均发病率为每10万人50.4例。1999年启动了一项针对18和24个月大儿童的两剂次甲型肝炎普遍免疫计划（无补种活动）。
观察仅针对幼儿的普遍疫苗接种对以色列甲型肝炎病毒疾病的影响。
自1993年以来，以色列卫生部一直在对甲型肝炎病例进行持续的被动国家监测。1999 - 2003年在耶路撒冷地区开展的一项主动监测计划为被动监测计划提供了验证。
1993 - 2004年报告的甲型肝炎疾病发病率。
2001 - 2002年以色列的总体疫苗接种覆盖率第一剂为90%，第二剂为85%。在1999年之前，犹太人群而非非犹太人群的疾病发病率有所下降。该计划启动后，两个群体的疾病发病率均大幅下降。2002 - 2004年期间每年每10万人2.2至2.5例的发病率相较于1993 - 1998年的平均发病率每年降低了95%或更多（P <.001）。对于1至4岁的儿童，2002 - 2004年期间与疫苗接种前相比疾病发病率降低了98.2%（P <.001）。然而，在所有其他年龄组中也观察到了大幅下降（<1岁组为84.3%，5 - 9岁组为96.5%，10 - 14岁组为95.2%，15 - 44岁组为91.3%，45 - 64岁组为90.6%，≥65岁组为77.3%）。在成功开展主动监测计划的耶路撒冷地区的犹太人群中，疾病发病率降低了90%以上。在2002 - 2004年全国报告的433例可确定疫苗接种状况的病例中，424例（97.9%）未接种疫苗，无一例接种了两剂。
以色列的这项仅针对幼儿的普遍免疫计划不仅证明了甲型肝炎疫苗接种的高效性，还显示出显著的群体保护作用，对补种甲型肝炎疫苗计划的必要性提出了挑战。
