HEPATITIS A: ADDRESSING
OUTBREAKS WITH EFFECTIVE SOLUTIONS
David A1 and John TJ2,
on behalf of the Steering Committee for Prevention and Control of
Infectious Diseases in Asia
1 University of the
Philippines, Manila, the Philippines
2 Christian Medical
College, Vellore, India
Objective:
Throughout
Asia, improved socioeconomic and hygienic conditions have led to a
reduction in exposure to the hepatitis A virus in childhood. However, the
persistence of circulating virus may lead to outbreaks, particularly among
adolescents and adults.1 To prevent outbreaks, we need
further improvements in sanitation and vaccination of susceptible
population groups. In the interim, a systematic approach to outbreak
control is urgently needed. However, most Asian countries do not have a
clearly stated control plan.
Methods: We reviewed recent
hepatitis A outbreaks in Asia, and found that a plan of action, speedy
communication with broad coverage, public education and vaccinating
household contacts to prevent secondary cases, were among the most
important elements of successful outbreak control.
Results: We propose an outbreak
control program consisting of six key stages: initiation, planning, set-up,
implementation, vaccination of at risk populations, and evaluation. Outbreak
control requires the formation of an outbreak management team consisting of
health and communications experts, and a task force to implement
interventions and to develop educational materials aimed at increasing
public awareness and understanding of health issues. Vaccination of
household contacts, to prevent secondary infections, is a central element
of the program. The success of the program must be monitored by tracking
the incidence of hepatitis A in the community.
Conclusion: This model for outbreak
control is a framework for action in countries where Hepatitis A remains a
problem.
1 Lee SD Asian perspectives on viral hepatitis A. J
Gastroenterol Hepatol 2000 Oct;15 Suppl:G94-9.