Hepatitis A Outbreak Characteristics: A Comparison of Regions with Different Vaccination Strategies, Spain 2010–2018
Abstract
:1. Introduction
2. Methods
2.1. Outbreak and Case Reporting
2.2. Variables
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
References
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Regions with Universal Vaccination Strategy n = 120 n (CIR) | Regions with Risk-Group Vaccination Strategy n = 330 n (CIR) | Rate Ratio (95% CI) | p-Value | |
---|---|---|---|---|
Outbreak incidence | 16.04 | 20.75 | 0.77 (0.62–0.95) | 0.01 |
Transmission mode | ||||
Common source | 14 (1.87) | 25 (1.57) | 1.19 (0.60–2.28) | 0.60 |
Person-to-person | 92 (12.30) | 290 (18.24) | 0.67 (0.53–0.85) | 0.001 |
Setting | ||||
Family/household | 93 (12.43) | 266 (16.74) | 0.74 (0.58–0.94) | 0.01 |
School | 7 (0.94) | 23 (1.45) | 0.65 (0.26–1.46) | 0.31 |
Restaurant/facility canteen | 0 (0) | 8 (0.50) | 0.12 (0.01–2.16) | 0.19 |
Leisure facility/summer camp | 1 (0.13) | 2 (0.13) | 1.06 (0.04–13.97) | 0.96 |
Community/other/various | 6 (0.80) | 26 (1.64) | 0.49 (0.18–1.14) | 0.10 |
Other closed facilities | 0 (0) | 3 (0.19) | 0.30 (0.02–5.87) | 0.63 |
Imported outbreak | 52 (6.95) | 68 (4.28) | 1.62 (1.13–2.33) | 0.01 |
Regions with Universal Vaccination Strategy n = 120 | Regions with Risk-Group Vaccination Strategy n = 330 | Crude Odds Ratio (95% CI) | p-Value | Adjusted Odds Ratio (95% CI) | p-Value | |
---|---|---|---|---|---|---|
Transmission mode | ||||||
Common source | 14 (13.2%) | 25 (7.9%) | 1.76 (0.88–3.54) | 0.11 | 1.54 (0.64–3.68) | 0.34 |
Person-to-person | 92 (86.8%) | 290 (92.1%) | Ref. | Ref. | ||
Setting | ||||||
Family/household | 93 (86.9%) | 266 (81.1%) | Ref. | Ref. | ||
School | 7 (6.5%) | 23 (7.0%) | 0.87 (0.36–2.10) | 0.76 | 1.67 (0.54–5.18) | 0.37 |
Restaurant/facility canteen | 0 (0%) | 8 (2.4%) | - | - | ||
Leisure facility/summer camp | 1 (0.9%) | 2 (0.6%) | 1.43 (0.13–15.96) | 0.77 | 2.03 (0.15–27.44) | 0.59 |
Community/other/various | 6 (5.6%) | 26 (7.9%) | 0.66 (0.26–1.65) | 0.37 | 0.73 (0.23–2.31) | 0.59 |
Other closed facilities | 0 (0%) | 3 (0.9%) | - | - | ||
Imported outbreak | ||||||
Yes | 52 (65.0%) | 68 (28.7%) | 4.62 (2.69–7.91) | <0.001 | 3.88 (2.13–7.09) | <0.001 |
No | 28 (35.0%) | 169 (71.3%) | Ref. | |||
No. of exposed people *, median (range) | 5 (2–422) | 5 (2–35240) | 0.24 | 0.77 | ||
No. of affected people, median (range) | 2 (2–218) | 2 (2–88) | 0.52 | 0.22 | ||
No. of hospitalized cases †, median (range) | 0 (0–5) | 1 (0–47) | <0.001 | 0.07 | ||
IG recommended to exposed people | ||||||
Yes | 21 (31.3%) | 16 (32.7%) | 0.94 (0.43–2.07) | 0.88 | 2.16 (0.67–6.97) | 0.20 |
No | 46 (68.7%) | 33 (67.3%) | Ref. | Ref. | ||
Vaccine recommended to exposed people | ||||||
Yes | 81 (92.0%) | 230 (95.0%) | 0.60 (0.23–1.59) | 0.31 | 0.44 (0.11–1.71) | 0.23 |
No | 7 (8.0%) | 12 (5.0%) | Ref. | Ref. | ||
No. of exposed people administered IG ‡, median (range) | 0 (0–68) | 0 (0–80) | 0.79 | 0.76 | ||
No. of exposed people administered vaccine §, median (range) | 3 (0–482) | 3 (0–672) | 0.36 | 0.11 |
Regions with Universal Vaccination Strategy n = 120 | Regions with Risk-Group Vaccination Strategy n = 330 | Crude Odds Ratio (95% CI) | p-Value | Adjusted Odds Ratio (95% CI) | p-Value | |
---|---|---|---|---|---|---|
COMMON SOURCE OUTBREAKS | ||||||
Setting | ||||||
Family/household | 12 (92.3%) | 20 (87.0%) | - | - | ||
Restaurant/facility canteen | 0 (0%) | 3 (13.0%) | - | - | ||
Community/other/various | 1 (7.7%) | 0 (0%) | - | - | ||
Imported outbreak | 7 (53.8%) | 10 (47.6%) | 1.28 (0.32–5.13) | 0.72 | 1.67 (0.33–8.47) | 0.53 |
No. of exposed people, median (range) | 5 (2–38) | 5 (2–400) | 0.92 | 0.82 | ||
No. of affected people, median (range) | 2 (2–38) | 2 (2–31) | 0.59 | 0.49 | ||
No. of hospitalized cases, median (range) | 0 (0–5) | 1 (0–16) | 0.38 | 0.65 | ||
PERSON-TO-PERSON TRANSMISSION OUTBREAKS | ||||||
Setting | ||||||
Family/household | 71 (86.6%) | 233 (80.3%) | Ref. | Ref. | ||
School | 6 (7.3%) | 22 (7.6%) | 0.90 (0.35–2.29) | 0.82 | 1.69 (0.65–6.59) | 0.22 |
Restaurant/facility canteen | 0 (0%) | 5 (1.7%) | - | - | ||
Leisure facility/summer camp | 1 (1.2%) | 2 (0.7%) | 1.64 (0.15–18.36) | 0.69 | 2.39 (0.18–32.34) | 0.51 |
Community/other/various | 4 (4.9%) | 25 (8.6%) | 0.53 (0.18–1.56) | 0.25 | 0.44 (0.10–2.04) | 0.29 |
Other closed facilities | 0 (0%) | 3 (1.0%) | - | - | ||
Imported outbreak | 36 (62.1%) | 54 (26.2%) | 4.61 (2.49–8.52) | <0.001 | 4.38 (2.29–8.35) | <0.001 |
No. of exposed people, median (range) | 5 (2–422) | 5 (2–473) | 0.44 | 0.46 | ||
No. of affected people, median (range) | 2 (2–218) | 2 (2–88) | 0.58 | 0.71 | ||
No. of hospitalized people, median (range) | 0 (0–3) | 1 (0–47) | <0.001 | 0.03 |
Regions with Universal Vaccination Strategy n = 120 | Regions with Risk-Group Vaccination Strategy n = 330 | Crude Odds Ratio (95% CI) | p-Value | Adjusted Odds Ratio (95% CI) | p-Value | |
---|---|---|---|---|---|---|
Age | ||||||
0–14 years | 68 (58.6%) | 86 (47.5%) | Ref. | Ref. | ||
15–44 years | 36 (31.0%) | 78 (43.1%) | 0.58 (0.35–0.97) | 0.04 | 0.54 (0.32–0.92) | 0.02 |
≥45 years | 12 (10.3%) | 17 (9.4%) | 0.89 (0.40–2.00) | 0.78 | 0.83 (0.36–1.89) | 0.65 |
Sex | ||||||
Male | 77 (67.5%) | 138 (72.3%) | Ref. | Ref. | ||
Female | 37 (32.5%) | 53 (27.7%) | 1.25 (0.76–2.07) | 0.38 | 1.13 (0.66–1.95) | 0.65 |
Born in Spain | ||||||
Yes | 36 (65.5%) | 51 (67.1%) | 0.93 (0.45–1.93) | 0.84 | 1.10 (0.48–2.54) | 0.81 |
No | 19 (34.5%) | 25 (32.9%) | Ref. | Ref. | ||
Occupation | ||||||
Food handler | 4 (5.1%) | 6 (6.7%) | Ref. | Ref. | ||
Healthcare worker | 0 (0%) | 2 (2.2%) | - | - | ||
Nursery/school/high school worker | 3 (3.8%) | 5 (5.6%) | 0.90 (0.13–6.08) | 0.91 | 1.02 (0.14–7.56) | 0.99 |
School/Student | 70 (88.6%) | 77 (85.6%) | 1.36 (0.37–5.03) | 0.64 | 1.34 (0.34–5.24) | 0.68 |
Other * | 2 (2.5%) | 0 (0%) | - | - | ||
Hepatitis A vaccinated | ||||||
Yes | 0 (0%) | 1 (0.9%) | - | - | ||
No | 84 (100%) | 132 (99.2%) | Ref. | Ref. | ||
Men who have sex with men † | ||||||
Yes | 5 (23.8%) | 27 (67.5%) | 0.15 (0.04–0.50) | 0.002 | 0.23 (0.07–0.82) | 0.02 |
No | 16 (76.2%) | 13 (32.5%) | Ref. | Ref. | ||
Drug user ‡ | ||||||
Yes | 1 (3.0%) | 0 (0%) | - | - | ||
No | 32 (97.0%) | 12 (100%) | Ref. | Ref. |
Regions with Universal Vaccination Strategy n = 120 | Regions with Risk-Group Vaccination Strategy n = 330 | Crude Odds Ratio (95% CI) | p-Value | Adjusted Odds Ratio (95% CI) | p-Value | |
---|---|---|---|---|---|---|
COMMON SOURCE | ||||||
Age | ||||||
0–14 years | 7 (53.8%) | 10 (58.8%) | Ref. | Ref. | ||
15–44 years | 4 (30.8%) | 6 (35.3%) | 0.95 (0.19–4.68) | 0.95 | 0.96 (0.19–4.80) | 0.96 |
≥45 years | 2 (15.4%) | 1 (5.9%) | 2.86 (0.21–37.99) | 0.43 | 2.86 (0.21–38.04) | 0.43 |
Sex | ||||||
Male | 9 (69.2%) | 12 (70.6%) | Ref. | Ref. | ||
Female | 4 (30.8%) | 5 (29.4%) | 1.07 (0.22–5.14) | 0.94 | 0.98 (0.20–4.94) | 0.98 |
Born in Spain | 7 (87.5%) | 8 (53.3%) | 6.12 (0.60–62.82) | 0.13 | 6.27 (0.47–82.57) | 0.16 |
Occupation | ||||||
Food handler | 1 (11.1%) | 0 (0%) | Ref. | Ref. | ||
School/Student | 7 (11.1%) | 3 (100%) | - | - | ||
Others * | 1 (77.8%) | 0 (0%) | - | - | ||
Hepatitis A vaccinated | 0 (0%) | 0 (0%) | - | - | ||
Men who have sex with men† | 2 (100%) | 0 (0%) | - | - | ||
Drug user ‡ | 0 (0%) | 0 (0%) | - | - | ||
PERSON-TO-PERSON TRANSMISSION OUTBREAKS | ||||||
Age | ||||||
0–14 years | 52 (56.5%) | 74 (46.5%) | Ref. | Ref. | ||
15–44 years | 31 (33.7%) | 69 (43.4%) | 0.64 (0.37–1.11) | 0.11 | 0.57 (0.32–1.01) | 0.05 |
≥45 years | 9 (9.8%) | 16 (10.1%) | 0.80 (0.33–1.95) | 0.62 | 0.73 (0.29–1.82) | 0.50 |
Sex | ||||||
Male | 61 (67.0%) | 124 (72.5%) | Ref. | Ref. | ||
Female | 30 (33.0%) | 47 (27.5%) | 1.30 (0.75–2.25) | 0.35 | 1.18 (0.65–2.13) | 0.59 |
Born in Spain | 26 (63.4%) | 43 (71.7%) | 0.68 (0.29–1.60) | 0.38 | 0.75 (0.30–1.90) | 0.54 |
Occupation | ||||||
Food handler | 2 (3.4%) | 6 (7.1%) | Ref. | Ref. | ||
Healthcare worker | 0 (0%) | 2 (2.4%) | - | - | ||
Nursery/school/high school worker | 3 (5.1%) | 5 (5.9%) | 1.80 (0.21–15.41) | 0.59 | 2.08 (0.22–19.59) | 0.52 |
School/Student | 53 (89.8%) | 72 (84.7%) | 2.21 (0.43–11.37) | 0.34 | 2.27 (0.42–12.31) | 0.34 |
Other § | 1 (1.7%) | 0 (0%) | - | - | ||
Hepatitis A vaccinated | 0 (0%) | 1 (0.9%) | - | - | ||
Men who have sex with men† | 3 (16.7%) | 27 (71.1%) | 0.08 (0.02–0.34) | 0.001 | 0.13 (0.03–0.55) | 0.006 |
Drug user ‡ | 1 (3.7%) | 0 (0%) | - | - |
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Domínguez, A.; Varela, C.; Soldevila, N.; Izquierdo, C.; Guerrero, M.; Peñuelas, M.; Martínez, A.; Godoy, P.; Borràs, E.; Rius, C.; Torner, N.; Avellón, A.M.; Castilla, J.; PREVICET Working Group on Viral Hepatitis. Hepatitis A Outbreak Characteristics: A Comparison of Regions with Different Vaccination Strategies, Spain 2010–2018. Vaccines 2021, 9, 1214. https://doi.org/10.3390/vaccines9111214
Domínguez A, Varela C, Soldevila N, Izquierdo C, Guerrero M, Peñuelas M, Martínez A, Godoy P, Borràs E, Rius C, Torner N, Avellón AM, Castilla J, PREVICET Working Group on Viral Hepatitis. Hepatitis A Outbreak Characteristics: A Comparison of Regions with Different Vaccination Strategies, Spain 2010–2018. Vaccines. 2021; 9(11):1214. https://doi.org/10.3390/vaccines9111214
Chicago/Turabian StyleDomínguez, Angela, Carmen Varela, Núria Soldevila, Conchita Izquierdo, María Guerrero, Marina Peñuelas, Ana Martínez, Pere Godoy, Eva Borràs, Cristina Rius, Núria Torner, Ana María Avellón, Jesús Castilla, and PREVICET Working Group on Viral Hepatitis. 2021. "Hepatitis A Outbreak Characteristics: A Comparison of Regions with Different Vaccination Strategies, Spain 2010–2018" Vaccines 9, no. 11: 1214. https://doi.org/10.3390/vaccines9111214