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 ReservoirHumans TransmissionFecal-oral route; person-to-person or ingestion of contaminated food or water Communicability1-2 weeks before onset to week after onset Temporal PatternNone Incubation PeriodAvg 28-30 days (range 15-50 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 12-23 months of age and older

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

6. Texas Counties Requiring Hepatitis A, 2003 For Childcare and School Entry, 2003 39 Counties Requiring Hepatitis A Vaccination Seven counties, were added to the vaccination requirement.

7. Texas Counties Requiring Hepatitis A, 2005 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 2009-10 school year!)

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

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 Whites Hispanics

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