1. The impact of one dose Hepatitis A vaccine in Latin America
Dr. Pablo Elmassian

2. Hepatitis A: Burden of disease
HAV cases: 1,5 millions annually worldwide
Fulminant hepatic failure (FHF): 0,4% (Mortality rate 60%)
Case fatality ratio: 0,1% < 15 years of age to 2,1% > 40 years
HAV does not cause chronic liver disease

3. HAV:Estimated prevalence
High: Ab HAV >90% 10 years
Very low: Ab HAV <50% 30 years
Intermediate: Ab HAV > 50% 15 years and > 50% 30 years
Hepatitis A virus seroprevalence by age and world region, 1990 and 2005.Jacobsen KH, Wiersma ST
Vaccine Sep 24; 28(41):

4. Hepatitis notified cases in Argentina 1995-2004

5. Etiology of FHF in Argentina:1993-1999
100 patients
Median age: 5.1 yrs old
(1,1-15,8)
Male 53/Female 47
90% < 10 yrs old
Hepatitis A Indeterminate Toxic Autoimmune
Ciocca M,Ramonet M,et al JPediatr Gastroenterol Nutr 31:1050(A)2000

6. Hepatitis A vaccine Inactivated are the most commonly used
Highly effective
Long term protection
Licensed for use > 12 months of age
Schedule: monts

7. Argentina 2005: Single-dose vaccination strategy
almost 100% of vaccinated individuals seroconvert 30 days after the first dose
Experience of high efficacy of post –exposure prophylaxis for outbreak control with one dose
The expectation that the natural booster induced by wild virus circulation could ensure long lasting protection
The economic limitations in Argentina to include a 2-dose series

8. Vaccination Coverage

9. Hepatic Transplant in Argentina:1993-2013

10. Hepatitis A: Argentina 2000-2016
Universal Vaccination

12. Group A: Indirect estimation of HAV circulation in Argentina n=434
GroupB: Persistence of HAV Antibodies after 4 years of one dose of vaccine n=1059
Seroprevalence Ab-HAV before vaccination
Journal of the Pediatric Infectious Disease Society, Vol 4, No 4 pp. e62-e

13. GMC: 170,5mIU/mL (95% CI: 163,2-178,2mIU/mL)
The Pediatric Infectious Disease Journal.Vol 35,No 12,Dec 2016:

14. S320 OFID 2017: 4 (Supp 1) Poster ASbstracts
n=1119
Mean age: 10,7 years old
Mean post vaccination interval 9,7 years (Range 9,0-11,3 years)
87,6% had protective antibodies against HAV
GMC 28,0 mIU/mL (95% CI: 26,8-29,3 mIU/mL)
S320 OFID 2017: 4 (Supp 1) Poster ASbstracts

15. WHO Position paper on Hepatitis A vaccines
2012 WHO recommends Argentina’s 1 dose strategy
A comparable option in terms on effectiveness
Less expensive
Easier to implement

16. Countries with Public Vaccination Programs HAV in America 2017

17. Thank you