Vizzotti Carla, González Jorge, Gentile Angela, Rearte Analía, Ramonet Margarita, Cañero-Velasco María Cristina, Pérez Carrega María Eugenia, Urueña Analía, Diosque Máximo
From the *Ministerio de Salud de la Nación, Av. de 9 de Julio 1925 (C1073ABA); †INEI-ANLIS "Dr. Carlos Malbrán", Av. Vélez Sarsfield 563 (1281); and ‡Sociedad Argentina de Pediatría, C.A.B.A., Argentina.
Pediatr Infect Dis J. 2014 Jan;33(1):84-8. doi: 10.1097/INF.0000000000000042.
After a country wide outbreak occurred during 2003-2004, 1 dose of hepatitis A vaccine was introduced into Argentinian regular immunization schedule for all children aged 12 months in June 2005. The aim of this study was to assess the impact of this novel intervention.
A longitudinal analysis was done of hepatitis A virus (HAV) infection rates reported to the National Epidemiological Surveillance System from 2000 to 2011. Occurrence of fulminant hepatic failure (FHF) and liver transplantation cases up to 2011 were also assessed. Incidence rates and clinical impact were compared between pre- and postvaccination periods (2000-2002 vs. 2006-2011). Notification rates were also compared by age groups and geographical regions.
Since 2006, an abrupt decline was observed in HAV infection rates, as well as in FHF and liver transplantation cases. The mean incidence rate of 7.9/100,000 in the postvaccination period represents a reduction of 88.1% (P < 0.001) when compared with the prevaccination period. Neither FHF nor liver transplantation due to HAV infection were observed since March 2007. Decline in incidence rates was evident in all geographical regions and all age groups but was higher in the prevaccination most affected areas and in young children. Although an absolute decrease was observed for cases and rates in all age groups, since 2006, a higher proportion of cases was observed in people >14 years of age.
The single-dose vaccination strategy has been highly effective for controlling HAV infection in all age groups till now in Argentina. Long-term surveillance will be critical to document the sustained success of this unique intervention.
在2003年至2004年全国范围内爆发疫情后，2005年6月，阿根廷将一剂甲型肝炎疫苗纳入针对所有12个月大儿童的常规免疫计划。本研究的目的是评估这一新型干预措施的影响。
对2000年至2011年向国家流行病学监测系统报告的甲型肝炎病毒（HAV）感染率进行纵向分析。还评估了截至2011年暴发性肝衰竭（FHF）和肝移植病例的发生情况。比较了疫苗接种前后时期（2000 - 2002年与2006 - 2011年）的发病率和临床影响。还按年龄组和地理区域比较了报告率。
自2006年以来，观察到HAV感染率以及FHF和肝移植病例急剧下降。疫苗接种后时期的平均发病率为7.9/10万，与疫苗接种前时期相比降低了88.1%（P < 0.001）。自2007年3月以来，未观察到因HAV感染导致的FHF或肝移植病例。发病率下降在所有地理区域和所有年龄组都很明显，但在疫苗接种前受影响最严重的地区和幼儿中下降幅度更大。尽管所有年龄组的病例数和发病率都出现了绝对下降，但自2006年以来，14岁以上人群中的病例比例更高。
迄今为止，单剂量疫苗接种策略在阿根廷对控制所有年龄组的HAV感染非常有效。长期监测对于记录这一独特干预措施的持续成功至关重要。
