Skip to main content
Atencion Primaria logoLink to Atencion Primaria
. 2008 Sep 30;39(3):139–143. [Article in Spanish] doi: 10.1157/13099561

Brote comunitario de hepatitis A en un poblado marginal. Vacunación para su control y aceptación de la medida

Community outbreak of hepatitis a in a marginal population. Vaccination for its control and acceptance of the measure

Araceli Arce Arnáez a,, Luisa Cabello Ballesteros a, Jesús Íñigo Martínez b
PMCID: PMC7664548  PMID: 17386206

Abstract

Objective

To study a community outbreak of hepatitis A in a marginal population and the public health response in order to bring it under control.

Design

Descriptive study of the outbreak that occurred in February-June, 2004. An epidemiological survey was conducted to detect prior cases and active vigilance was set up. Case and susceptibility definitions were established.

Setting

A gypsy population in Madrid, Spain. They had basic provision of sewerage, water supply and waste disposal.

Participants

A population of 550 in census; estimated population, 800. 70% were under 40 and 55% were illiterate.

Interventions

Control measures were: a) health education activities to strengthen habits of hygiene, and b) immunisation of susceptible individuals. A total of 646 people were vaccinated, with the active help of staff from the Institute of Rehousing and Integration into Society.

Results

The outbreak affected 26 people, with an average age of 8 (95% CI, 6.2-9.8), similar distribution by sex and 3.3% attack rate. Fourteen cases were students at state schools, not all in the same classes. There were 7 pairs of siblings among the cases. The diagnosis was conformed by serology in 17 cases. Five needed hospital admission.

Conclusions

The epidemic curve suggested person-person transmission. All those affected were under 20 years old. Vaccination was seen to be effective in controlling the outbreak. Interventions were assisted by intermediaries in order to respect the gypsies’ cultural context and were well accepted.

Key words: Hepatitis A, Community outbreak, Vaccination

Bibliografía

  • 1.Grupo de trabajo de la Ponencia de Programas y Registro de Vacunaciones . Ministerio de Sanidad y Consumo; Madrid: 2004. Recomendaciones de vacunación en adultos año 2004. p. 35-8. [Google Scholar]
  • 2.Centers for Disease Control, Prevention Prevention of hepatitis A through active or passive immunization. Recommendations of the advisory committee on immunization practices (ACIP) MMWR. 1999;48(RR-12):1–37. [PubMed] [Google Scholar]
  • 3.Franco E., Vitiello G. Vaccination strategies against hepatitis A in southern Europe. Vaccine. 2003;21:696–697. doi: 10.1016/s0264-410x(02)00582-0. [DOI] [PubMed] [Google Scholar]
  • 4.Lopalco P.L., Salleras L.L., Barbuti S., Germinario C., Bruguera M., Buti M. Hepatitis A and B in children and adolescents. What can we learn from Puglia (Italy) and Catalonia (Spain)? Vaccine. 2001;19:470–474. doi: 10.1016/s0264-410x(00)00193-6. [DOI] [PubMed] [Google Scholar]
  • 5.Chin J., editor. El control de las enfermedades transmisibles. Organización Panamericana de la Salud; Washington: 2001. pp. 322–329. [Google Scholar]
  • 6.Craig A.S., Schaffner W. Prevention of hepatitis A with the hepatitis A vaccine. N Engl J Med. 2004;350:476–481. doi: 10.1056/NEJMcp031540. [DOI] [PubMed] [Google Scholar]
  • 7.National Immunization Advisory Committee of Physicians of Ireland. Hepatitis A. Immunisation Guidelines for Ireland; 2002 p. 50-5.
  • 8.Bruguera M. Vacuna de la hepatitis A en el control de los casos secundarios de hepatitis A. Vacunas. 2002;1:1–2. [Google Scholar]
  • 9.Bruguera M. Vacunación universal contra la hepatitis A. ¿Aún no? Vacunas. 2005;6:101–105. [Google Scholar]
  • 10.Sagliocca L., Amoroso P., Stroffolini T., Adamo B., Tosti M.E., Lettieri G. Efficacy of hepatitis A vaccine in prevention of secondary hepatitis A infection: a randomised trial. Lancet. 1999;353:1136–1139. doi: 10.1016/S0140-6736(98)08139-2. [DOI] [PubMed] [Google Scholar]
  • 11.Demicheli V., Tiberti The effectiveness and safety of hepatitis A vaccine: a systematic review. Vaccine. 2003;21:2242–2245. doi: 10.1016/s0264-410x(03)00135-x. [DOI] [PubMed] [Google Scholar]
  • 12.Irwin D.J., Millership S. Control of a community hepatitis A outbreak using hepatitis A vaccine. Commun Dis Public Health. 1999;2:184–187. [PubMed] [Google Scholar]
  • 13.Godoy P., Artigues A., Rufach J., Alonso T., Bach P., Miranda G. Brote comunitario de hepatitis A en un grupo de etnia gitana: control mediante la vacunación antihepatitis A. Vacunas. 2002;3:8–12. [Google Scholar]
  • 14.Zamir C., Rishpon S., Zamir D., Leventhal A., Rimon N., Ben-Porath E. Control of a community-wide outbreak of hepatitis A by mass vaccination with inactivated hepatitis A vaccine. Eur J Clin Microbiol Infect Dis. 2001;20:185–187. doi: 10.1007/s100960100461. [DOI] [PubMed] [Google Scholar]
  • 15.D’Argenio P., Adamo B., Cirrincione R., Gallo G. The role of vaccine in controlling hepatitis A epidemics. Vaccine. 2003;22:46–49. doi: 10.1016/s0264-410x(03)00140-3. [DOI] [PubMed] [Google Scholar]
  • 16.Comunidad de Madrid. Consejería de Sanidad y Consumo. Morbilidad por enfermedades de declaración obligatoria en la Comunidad de Madrid, año 2004. Boletín Epidemiológico de la Comunidad de Madrid. 2005;11:26.
  • 17.Venczel L.V., Desai M.M., Vertz P.D., England B., Hutin Y.J., Shapiro C.N. The role of child care in a community-wide outbreak of hepatitis A. Pediatrics. 2001;108:E78. doi: 10.1542/peds.108.5.e78. [DOI] [PubMed] [Google Scholar]
  • 18.Arce A., Rodero I., Íñigo J., Burgoa M., Guevara E. Brote de hepatitis A en una escuela infantil y transmisión intrafamiliar de la infección. An Pediatr (Barc) 2004;60:222–227. doi: 10.1016/s1695-4033(04)78255-7. [DOI] [PubMed] [Google Scholar]
  • 19.Comunidad de Madrid . Vol. 5. Boletín Epidemiológico de la Comunidad de Madrid; 2002. (Consejería de Sanidad. III Encuesta de serovigilancia de la Comunidad de Madrid). 3-41. [Google Scholar]
  • 20.Cilla G., Pérez-Trallero E., Marimón J.M., Erdozain S., Gutiérrez C. Prevalence of hepatitis A antibody among disavantaged gypsy children in northern Spain. Epidemiol Infect. 1995;115:157–161. doi: 10.1017/s0950268800058210. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Morales J.L., Huber L., Gallego S., Álvarez G., Díez-Delgado J., González A. A seroepidemiologic study of hepatitis A in Spanish children. Relationship of prevalence to age and socioenvironmental factors. Infection. 1992;20:194–196. doi: 10.1007/BF02033057. [DOI] [PubMed] [Google Scholar]
  • 22.Regidor E., Borrell C., Pasarín M.I., Gutiérrez-Fisac J.L., Lostao L., Galán I. Universidad de Alicante; Alicante: 2002. Desigualdades sociales en salud: situación en España en los últimos años del siglo XX. [Google Scholar]
  • 23.Ferrer F. El estado de salud del pueblo gitano en España. Una revisión bibliográfica. Gac Sanit. 2003;17(Suppl 3):2–8. [PubMed] [Google Scholar]
  • 24.Fundación Secretariado General Gitano. Salud [accedido 21 Dic 2005.] Disponible en: hptt:/www.asgg.org/salud
  • 25.Crowcroft N.S., Walsh B., Davison K.L., Gungabissoon U., On behalf of PHLS Advisory Committee on Vaccination and Immunisation Guidelines for the control of hepatitis A virus infection. Commun Dis Public Health. 2001;4:213–227. [PubMed] [Google Scholar]
  • 26.Averhoff F., Shapiro C.N., Bell B.P., Hyams I., Burd L., Deladisma A. Control of hepatitis A through routine vaccination of children. JAMA. 2001;286:2968–2973. doi: 10.1001/jama.286.23.2968. [DOI] [PubMed] [Google Scholar]
  • 27.Koff R.S. Hepatitis A. Lancet. 1998;341:1643–1649. doi: 10.1016/S0140-6736(98)01304-X. [DOI] [PubMed] [Google Scholar]
  • 28.Jacobs R.J., Greenberg D.P., Koff R.S., Saab S., Meyerhoff A.S. Regional variation in the cost effectiveness of childhood hepatitis A immunization. Pediatr Infect Dis J. 2003;22:904–914. doi: 10.1097/01.inf.0000091295.53969.6a. [DOI] [PubMed] [Google Scholar]
  • 29.Population and Public Health Branch Centre for Infectious Disease Prevention and Control . 6th Ed. National Advisory Committee on Immunization; Otawa: 2002. Hepatitis A Vaccine. Canadian Immunization Guide. p. 93-101. [Google Scholar]
  • 30.Agencia Española del Medicamento. Circular 12/1997. Vacuna contra la hepatitis A.

Articles from Atencion Primaria are provided here courtesy of Elsevier

RESOURCES