Trends and risk factors of hepatitis A in Catalonia after the introduction of a hepatitis A plus B vaccination programme

At the end of 1998, universal hepatitis A+B vaccination of 12year olds was introduced in Catalonia. The aim was to examine trends in hepatitis A during 2005-2015 and assess risk factors by age group. We carried out an observational epidemiological study of the incidence and risk factors of hepatitis A reported to the surveillance system. Information on exposure was recorded for each case for the 2-6weeks before symptom onset. Spearman's coefficient was used to evaluate the trends of rates. The chi-square test was used to compare categorical. We studied 2621 hepatitis A cases; the age mean was 26.6years (SD=18.2), and >50% of cases were in the 20-49years age group. The incidence decreased from 3.28/100000 in 2005 to 1.50/100000 in 2015. The rate for women decreased over time (P=.008), but the reduction was not significant in men (P=.234). Men consistently had higher rates than women with the biggest difference being in the 20-34years age group (rate 8.8 vs 2.8). The greatest risk factor was travel to an endemic country (42.1%) in the 0-19years age group and male-to-male sexual contact (18.6%) in the 20-49years age group. The case fatality rate in adults aged >49years was 0.4%. In conclusion, the vaccination programme of preadolescents resulted in a reduction in hepatitis A cases. However, a significant amount of cases still appear in immigrants and men who have sex with men. Hepatitis A in adults is an emerging health problem that will require new strategies.