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Impact of the Single-dose Immunization Strategy Against Hepatitis A in Argentina

Vizzotti, Carla MD*; González, Jorge; Gentile, Angela MD; Rearte, Analía MD*; Ramonet, Margarita MD; Cañero-Velasco, María Cristina MD; Pérez Carrega, María Eugenia MD*; Urueña, Analía MD*; Diosque, Máximo MD*

The Pediatric Infectious Disease Journal: January 2014 - Volume 33 - Issue 1 - p 84–88
doi: 10.1097/INF.0000000000000042
Vaccine Reports

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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.

Accepted for publication August 16, 2013.

The National Program for the Control of Immune Preventable Diseases which is part of the National Ministry of Health funded the complete study.

The authors have no other funding or conflicts of interest.

Address for correspondence: Analía Urueña, MD, Programa Nacional de Control de Enfermedades Iinmunoprevenibles- Ministerio de Salud de la Nación. Av 9 de Julio 1925, 9° P (Ala Moreno). (C1073ABA), C.A.B.A., Argentina. E-mail:,

© 2014 by Lippincott Williams & Wilkins, Inc.