Impact of universal mass vaccination with monovalent inactivated hepatitis A vaccines – A systematic review

ABSTRACT

The WHO recommends integration of universal mass vaccination (UMV) against hepatitis A virus (HAV) in national immunization schedules for children aged ≥1 year, if justified on the basis of acute HAV incidence, declining endemicity from high to intermediate and cost-effectiveness. This recommendation has been implemented in several countries. Our aim was to assess the impact of UMV using monovalent inactivated hepatitis A vaccines on incidence and persistence of anti-HAV (IgG) antibodies in pediatric populations. We conducted a systematic review of literature published between 2000 and 2015 in PubMed, Cochrane Library, LILACS, IBECS identifying a total of 27 studies (Argentina, Belgium, China, Greece, Israel, Panama, the United States and Uruguay). All except one study showed a marked decline in the incidence of hepatitis A post introduction of UMV. The incidence in non-vaccinated age groups decreased as well, suggesting herd immunity but also rising susceptibility. Long-term anti-HAV antibody persistence was documented up to 17 y after a 2-dose primary vaccination. In conclusion, introduction of UMV in countries with intermediate endemicity for HAV infection led to a considerable decrease in the incidence of hepatitis A in vaccinated and in non-vaccinated age groups alike.

KEYWORDS:

• hepatitis A vaccine
• incidence
• long-term persistence
• systematic review
• universal vaccination

Abbreviations

UMV	=	universal mass vaccination
HAV	=	hepatitis A virus
WHO	=	world health organization
MSM	=	men having sex with men
GMC	=	geometric mean concentration

Disclosure of potential conflicts of interest

LDM and CM are employees of the GSK group of companies and hold stock options or restricted shares. EB and ALS are/were employees of Pallas Health Research and Consultancy BV company and they declare that Pallas Health Research and Consultancy BV company received a grant for the research from the GSK group of companies during the conduct of the study and also outside the submitted work. DS does not have anything to declare.

Acknowledgments

The authors would like to thank Lakshmi Hariharan (employee of the GSK group of companies) for providing editorial assistance and coordinated the development of this publication.

Funding

This systematic review was sponsored and funded by GlaxoSmithKline Biologicals S.A., Belgium. GlaxoSmithKline Biologicals S.A. was involved in all stages of the study conduct and analysis; and also took charge of all costs associated with the development and the publishing of the manuscript.

Author contributions

The manuscript was written by Anke L. Stuurman. All authors have contributed toward the conception of this research, development of this manuscript and critical review and approval of the final content.