1. 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

2. 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

3. Hepatitis A Epidemiology
Reservoir Humans
Transmission 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 days
(range days)

4. 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 months of age and older

5. Texas Counties Requiring Hepatitis A
For Childcare and School Entry, 1999
32 Counties Requiring Hepatitis A Vaccination

6. 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

7. 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).

8. 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 school year!)

9. Reported Cases of Hepatitis A in Texas 1995-2009*
Hepatitis A vaccine licensed in 1995
Incidence rates per 100,000 population
9.3
1.1
16.1
*2009 data is provisional as of 4/6/2010.

10. Percent of Hepatitis A Cases by Age Group

11. Incidence Rates of Hepatitis A by Age Group

12. Percent of Hepatitis A Cases by Gender

13. Percent of Hepatitis A Cases by Race

14. Incidence Rates of Hepatitis A Cases by Race

15. Percentage of Cases in Age Category by Race, 2008
Hispanics
Whites

19. 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