Manor Yosef, Lewis Matthew, Ram Daniela, Daudi Nili, Mor Orna, Savion Michal, Kra-Oz Zipi, Shemer Avni Yonat, Sheffer Rivka, Shouval Daniel, Mendelson Ella
Central Virology Laboratory, Israel Ministry of Health, Sheba Medical Center, Tel-Hashomer, Israel.
Tel-Aviv District, Israel Ministry of Health, Tel-Aviv, Israel.
J Infect Dis. 2017 Feb 15;215(4):574-580. doi: 10.1093/infdis/jiw611. Epub 2016 Dec 23.
Universal toddlers vaccination (UTV) introduced in 1999, reduced hepatitis A incidence in Israel from 50.4 to <1.0/100,000. The current Hepatitis A virus (HAV) molecular epidemiology in Israel was studied 13-14y post UTV introduction..
An outbreak in Tel-Aviv with 75 cases in 2012-2013 was investigated. Real-time RT-PCR and sequencing of the VP1-2A region (1100bp) was done on: a. serum samples from patients with acute Hepatitis A (12/ 75 in Tel-Aviv and 31 patients hospitalized in 3 other major cities in 2011-2013); b. in sewage samples (27 from metropolitan Tel-Aviv, 14 from the other 3 cities and 6 from Gaza).
The outbreak began among intravenous drug users then spread to the general population. Patients' mean age was 33.2y, 4/75(5.3%) had been vaccinated and 58/75(77.3%) were hospitalized. No common environmental source was found. HAV was detected in sewage samples: 16/27(59.2%) from Tel-Aviv; 4/14(28.6%) collected throughout Israel and 6/6 (100%) from Gaza. Genotype IB predominated (52/53 sequenced samples) and identical strains were demonstrated in the Israeli and Palestinian populations by phylogenetic analysis.
Despite the UTV success, HAV circulation in the Israeli population continues, apparently due to its close contacts with the endemic Palestinian population. Reassessment of vaccination policy is recommended.
1999年引入的幼儿普遍接种疫苗（UTV）使以色列甲型肝炎发病率从50.4/10万降至<1.0/10万。在引入UTV 13 - 14年后，对以色列当前的甲型肝炎病毒（HAV）分子流行病学进行了研究。
对2012 - 2013年在特拉维夫发生的75例病例的疫情进行了调查。对以下样本进行了VP1 - 2A区域（1100bp）的实时逆转录聚合酶链反应（RT - PCR）和测序：a. 急性甲型肝炎患者的血清样本（特拉维夫的75例中有12例，以及2011 - 2013年在其他3个主要城市住院的31例患者）；b. 污水样本（来自特拉维夫大都市的27份，来自其他3个城市的14份以及来自加沙的6份）。
疫情始于静脉吸毒者，然后传播到普通人群。患者的平均年龄为33.2岁，75例中有4例（5.3%）接种过疫苗，58例（77.3%）住院治疗。未发现共同的环境来源。在污水样本中检测到HAV：来自特拉维夫的样本中有16/27（59.2%）；在以色列各地收集的样本中有4/14（28.6%）；来自加沙的样本中有6/6（100%）。基因型IB占主导（53个测序样本中有52个），系统发育分析表明以色列和巴勒斯坦人群中存在相同的毒株。
尽管UTV取得了成功，但以色列人群中HAV仍在传播，显然是由于其与巴勒斯坦流行地区人群密切接触。建议重新评估疫苗接种政策。
