A special six-year study, recently published in Jama, the
Journal of the American Medical Association, has found
that Hepatitis A infections have nearly been wiped out in
Israel. In 1999 Israel became the first country in the world
to offer vaccinations against the virus to all babies.
Hepatitis A, spread by contact with feces, food and water,
used to affect thousands of children in day care centers and
kindergartens each year.
Israel is still the only country in the world with such a
vaccination program.
Hepatitis A is a serious illness. People of all ages who are
infected suffer from tiredness, weight loss and absence from
work and school. Some suffer liver failure and need
transplants to live.
Since 2002, there has not been a single death from
complications of hepatitis A, and no one who was immunized
since the beginning of the program has needed a liver
transplant. Between 2002 and 2004 there were 433 cases of the
infection. Those infected, mostly children, had either not
received the vaccination or had not received one of the two
recommended doses.
The idea to vaccinate all infants against hepatitis A to
protect not only children but also the adults who come in
contact with them, was first raised and tested by Prof.
Daniel Shouval, head of the liver unit at Hadassah. Nearly a
decade ago he was asked by the Satmar Chassidim in Monsey,
New York, to help them respond to an epidemic of hepatitis A
in their community. The Monsey program was successful and Dr.
Shouval later recommended that Israel adopt a similar one.
Shouval was also involved in developing the hepatitis A
vaccine.
Shouval's team worked with Prof. Ron Dagan of Soroka-
University Medical Center and Ben-Gurion University of the
Negev, who ran a passive surveillance program of the virus.
They also ran an active surveillance program in Jerusalem,
checking on all cases of hepatitis A for six years. Hadassah
also participated in the project, and the Health Ministry
paid for the vaccines.
The article was written by Dagan, Shouval, as well as by
Health Ministry epidemiologists Dr. Paul Slater and Dr.
Emilie Anis and colleagues. They found that the national
vaccination program lowered the incidence of hepatitis A in
all age groups by 95 percent.
Slater noted that the US authorities offer hepatitis A
vaccine only to infants living where there have been 20 cases
per 100,000, while Israel provides it at no cost to all
infants.
Until 1999 in Israel, hepatitis A vaccinations were
recommended only for Israelis traveling to foreign countries
with a high risk of infection.
In the past, even sick children were taken to nursery schools
and day care centers since many young children are infectious
even when they show no symptoms. Care givers spread the
disease while changing diapers and serving food.
Shouval and Dagan argued that if infection were nearly
eliminated in babies and toddlers, it would prevent infection
not only in the babies, but also in other children and
adults. Eventually infections in older persons would also be
reduced as vaccinated children grow to adulthood, because
immunity to hepatitis A virus by vaccination is long-term.
Even though at NIS 175 per dose with shots required at 18
months and 24 months, the universal vaccination was found to
be very cost effective since the treatment costs were much
higher.
In related news, the Health Ministry has decided to give
booster shots against whooping cough (pertussis) to all first
graders at its own expense starting in the new school year.
It has also instructed the health funds to expand their
vaccinations against influenza among children up to the age
of two.
