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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 decreased in Texas since the licensing of a vaccine – Vaccine requirements in Texas – Hepatitis A incidence – Hepatitis A distribution Hepatitis A Epidemiology • Reservoir • Transmission Humans 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) 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 Texas Counties Requiring Hepatitis A For Childcare and School Entry, 1999 32 Counties Requiring Hepatitis A Vaccination 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 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). 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!) Reported Cases of Hepatitis A in Texas 1995-2009* Incidence rates per 100,000 population 9.3 2009* 2008 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 *2009 data is provisional as of 4/6/2010. 2007 1.1 16.1 1996 5,000 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 0 1995 Number of cases Hepatitis A vaccine licensed in 1995 Percent of Hepatitis A Cases by Age Group 35 25 20 15 10 5 nk no w n U 60 + 59 50 - 49 40 - 39 30 - 29 20 - 10 - 19 0 <1 0 Percentage of cases 30 Age Group (years) 1995 2000 2008 Incidence Rates of Hepatitis A by Age Group 35 Rate per 100,000 30 25 20 15 10 5 0 <10 10-19 20-29 1995 30-39 2000 40-49 2008 50-59 60+ Percent of Hepatitis A Cases by Gender Percentage of Cases 60 50 40 30 20 10 0 Male Female 1995 2000 Unknown 2008 n 2008 U nk no w O th er W hi te is pa ni c 2000 H la ck B /P I 70 60 50 40 30 20 10 0 A Percentage of Cases Percent of Hepatitis A Cases by Race 1995 Incidence Rates of Hepatitis A Cases by Race 40 Rate per 100,000 35 30 25 20 15 10 5 0 Black Hispanic 1995 2000 White 2008 Percentage of Cases in Age Category by Race, 2008 <10 10-19 20-29 30-39 40-49 50-59 60+ Whites Hispanics 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