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Beth P. Bell - One of the best experts on this subject based on the ideXlab platform.

  • HepAtitis A vAccine versus immune globulin for postexposure prophylAxis
    The New England Journal of Medicine, 2007
    Co-Authors: Tatiyana Y Surdina, Saida Z Suleimenova, John C. Victor, M. O. Favorov, Gilberto Vaughan, Harold S. Margolis, Arnold S. Monto, Omana V. Nainan, Beth P. Bell
    Abstract:

    BAckground HepAtitis A vAccine Administered to persons After exposure to the HepAtitis A virus hAs not been compAred directly with immune globulin, which is known to be highly effective in preventing HepAtitis A when given within 2 weeks After exposure to the virus. Methods We rAndomly Assigned household And dAy-cAre contActs, 2 to 40 yeArs of Age, in AlmAty, KAzAkhstAn, to receive one stAndArd Age-AppropriAte dose of HepAtitis A vAccine or immune globulin within 14 dAys After exposure to pAtients with HepAtitis A. InstAnces of lAborAtory-confirmed, symptomAtic HepAtitis A infection occurring between 15 And 56 dAys After exposure were then Assessed during Active follow-up of All susceptible contActs. Results Of 4524 contActs who underwent rAndomizAtion, 1414 (31%) were susceptible to HepAtitis A virus And 1090 were eligible for the per-protocol AnAlysis. Among these contActs, 568 received HepAtitis A vAccine And 522 received immune globulin. Most contActs were children (AverAge Age, 12 yeArs), And most re...

  • prevention of HepAtitis A through Active or pAssive immunizAtion recommendAtions of the Advisory committee on immunizAtion prActices Acip
    Morbidity and Mortality Weekly Report, 2006
    Co-Authors: Anthony E Fiore, Annemarie Wasley, Beth P. Bell
    Abstract:

    Routine vAccinAtion of children is An effective wAy to reduce HepAtitis A incidence in the United StAtes. Since licensure of HepAtitis A vAccine during 1995-1996, the HepAtitis A childhood immunizAtion strAtegy hAs been implemented incrementAlly, stArting with the recommendAtion of the Advisory Committee on ImmunizAtion PrActices (ACIP) in 1996 to vAccinAte children living in communities with the highest diseAse rAtes And continuing in 1999 with ACIP's recommendAtions for vAccinAtion of children living in stAtes, counties, And communities with consistently elevAted HepAtitis A rAtes. These updAted recommendAtions represent the finAl step in the childhood HepAtitis A immunizAtion strAtegy, routine HepAtitis A vAccinAtion of children nAtionwide. ImplementAtion of these recommendAtions will reinforce existing vAccinAtion progrAms, extend the benefits AssociAted with HepAtitis A vAccinAtion to the rest of the country, And creAte the foundAtion for eventuAl considerAtion of eliminAtion of indigenous HepAtitis A virus trAnsmission. This report updAtes ACIP's 1999 recommendAtions concerning the prevention of HepAtitis A through immunizAtion (CDC. Prevention of HepAtitis A through Active or pAssive immunizAtion: recommendAtions of the Advisory Committee on ImmunizAtion PrActices [ACIP]. MMWR 1999:48[No. RR-12]:1-37) And includes 1) new dAtA on the epidemiology of HepAtitis A in the erA of HepAtitis A vAccinAtion of children in selected U.S. AreAs, 2) results of AnAlyses of the economics of nAtionwide routine vAccinAtion of children, And 3) recommendAtions for the routine vAccinAtion of children in the United StAtes. Previous recommendAtions for vAccinAtion of persons in groups At increAsed risk for HepAtitis A or its Adverse consequences And recommendAtions regArding the use of immune globulin for protection AgAinst HepAtitis A Are unchAnged from the 1999 recommendAtions.

  • An outbreAk of HepAtitis A AssociAted with green onions
    The Journal of Infectious Diseases, 2005
    Co-Authors: Catherine M. Dentinger, William A Bower, Suzanne M Cotter, Gert Myers, Suzanne Fowler, Ellen Salehi, Omana V. Nainan, Letitia M Dubusky, Beth P. Bell
    Abstract:

    BAckground In November 2003, A lArge HepAtitis A outbreAk wAs identified Among pAtrons of A single PennsylvAniA restAurAnt. We investigAted the cAuse of the outbreAk And fActors thAt contributed to its unprecedented size. Methods DemogrAphic And clinicAl outcome dAtA were collected from pAtients with lAborAtory confirmAtion of HepAtitis A, And restAurAnt workers were tested for HepAtitis A. A cAse–control study wAs conducted Among pAtrons who dined At the restAurAnt between October 3 And October 6, 2003. Sequence AnAlysis wAs performed on A 315-nucleotide region of virAl RNA extrActed from serum specimens. Results Of 601 pAtients identified, 3 died; At leAst 124 were hospitAlized. Of 425 pAtients who recAlled A single dining dAte At the restAurAnt, 356 (84 percent) hAd dined there between October 3 And October 6. Among 240 pAtients in the cAse–control study, 218 hAd eAten mild sAlsA (91 percent), As compAred with 45 of 130 controls (35 percent) (odds rAtio, 19.6; 95 percent confidence intervAl, 11.0 to 34...

  • HepAtitis A incidence And HepAtitis A vAccinAtion Among AmericAn indiAns And AlAskA nAtives 1990 2001
    American Journal of Public Health, 2004
    Co-Authors: Stephanie R Bialek, Douglas Thoroughman, Edgar P Simard, Jody Chattin, Jim Cheek, Beth P. Bell
    Abstract:

    Objectives. We Assessed the effect on trends in HepAtitis A incidence of the 1996 recommendAtion for routine HepAtitis A vAccinAtion of AmericAn IndiAn/AlAskA NAtive (AIAN) children.Methods. We exAmined trends in HepAtitis A incidence Among AIAN peoples during 1990–2001 And vAccinAtion coverAge levels Among children on the lArgest AmericAn IndiAn reservAtion.Results. HepAtitis A rAtes Among AIANs declined 20-fold during 1997–2001. Declines in HepAtitis A incidence occurred Among AIANs in reservAtion And metropolitAn AreAs. Among 1956 children living on the NAvAjo NAtion whose medicAl records were reviewed, 1508 (77.1%) hAd received At leAst one dose of HepAtitis A vAccine, And 1020 (52.1%) hAd completed the vAccine series.Conclusions. HepAtitis A rAtes Among AIAN peoples hAve declined drAmAticAlly coincident with implementAtion of routine HepAtitis A vAccinAtion of AIAN children.

  • HepAtitis A vAccine.
    Pediatric Infectious Disease Journal, 2000
    Co-Authors: Beth P. Bell
    Abstract:

    InActivAted HepAtitis A vAccines Are highly immunogenic And efficAcious. BecAuse of their high diseAse rAtes And importAnce As A reservoir of trAnsmission to others, children should be the primAry focus of vAccinAtion. A long-term strAtegy of sustAined routine vAccinAtion of children living in AreAs with consistently elevAted HepAtitis A rAtes hAs been Adopted. UltimAtely, eliminAtion of HAV trAnsmission will require vAccinAtion of All children in the US. This effort would be fAcilitAted by the AvAilAbility of vAccine formulAtions or schedules for use in infAnts or children in the second yeAr of life, And combinAtion vAccines thAt include HepAtitis A.

Daniel A Sweeney - One of the best experts on this subject based on the ideXlab platform.

  • predictors of Acute liver fAilure in pAtients with Acute HepAtitis A An AnAlysis of the 2016 2018 sAn diego county HepAtitis A outbreAk
    Open Forum Infectious Diseases, 2019
    Co-Authors: Aiyang A Jiang, Holly S Greenwald, Lamiya Sheikh, Darcy Wooten, Atul Malhotra, Robert T Schooley, Daniel A Sweeney
    Abstract:

    Author(s): JiAng, AiyAng A; GreenwAld, Holly S; Sheikh, LAmiyA; Wooten, DArcy A; MAlhotrA, Atul; Schooley, Robert T; Sweeney, DAniel A | AbstrAct: BAckground:Between 2016 And 2018, SAn Diego County experienced A HepAtitis A outbreAk with A historicAlly high mortAlity rAte (3.4%) thAt highlighted the need for eArly recognition of those At risk of developing Acute liver fAilure (ALF). Methods:A retrospective cAse series of Adult hospitAlized pAtients with Acute HepAtitis A. Results:One hundred six pAtients with HepAtitis A were studied, of whom 11 (10.4%) developed ALF, of whom 7 (6.6%) died. A history of Alcohol Abuse, hyperbilirubinemiA, hypoAlbuminemiA, hyponAtremiA, And AnemiA were AssociAted with increAsed odds of developing ALF. InitiAl MAddrey's And Model of End-StAge Liver DiseAse Sodium (MELD-NA) scores were Also AssociAted with the development of ALF. MultivAriAble AnAlysis showed thAt A higher initiAl MELD-NA score (odds rAtio [OR], 1.205; 95% confidence intervAl [CI], 1.018-1.427) And A lower initiAl serum Albumin concentrAtion (OR, 9.35; 95% CI, 1.15-76.9) were AssociAted with increAsed odds of developing ALF. Combining serum Albumin And MELD-NA (SAM; C-stAtistic, 0.8878; 95% CI, 0.756-0.988) yielded A model thAt wAs not better thAn either serum Albumin (C-stAtistic, 0.852; 95% CI, 0.675-0.976) or MELD-NA (C-stAtistic, 0.891; 95% CI, 0.784-0.968; P = .841). FinAlly, positive blood cultures were more common Among pAtients with ALF compAred with those without ALF (63.6% vs 4.3%; P l .00001). Conclusions:HypoAlbuminemiA wAs AssociAted with An increAsed risk of ALF in pAtients with Acute HepAtitis A. Positive blood cultures And septic shock As A cAuse of deAth were common Among pAtients with ALF. Providers cAring for pAtients with Acute HepAtitis A should monitor for eArly signs of sepsis And consider empiric Antibiotics, especiAlly in pAtients presenting with hypoAlbuminemiA.

Assad Safary - One of the best experts on this subject based on the ideXlab platform.

  • inActivAted HepAtitis A vAccine immunogenicity efficAcy sAfety And review of officiAl recommendAtions for use
    Expert Review of Vaccines, 2002
    Co-Authors: Francis Andra, Assad Safary, Pierre Van Damme, Jangu Banatvala
    Abstract:

    There is 10 yeArs of mArketing experience with the HepAtitis A vAccine HAvrix™. It is highly immunogenic, provides lAsting protection in heAlthy individuAls And generAtes protective levels of Antibodies in pAtients with chronic liver diseAse or impAired immunity. PostmArketing surveillAnce dAtA hAve confirmed the outstAnding sAfety profile of the vAccine. The timing of the booster dose is not criticAl to effectiveness, which hAs AdvAntAges for the protection of trAvelers to regions of high endemicity. The vAccine is effective in curbing outbreAks of HepAtitis A And Also when Administered postexposure, due to rApid seroconversion And the long incubAtion period of the diseAse. In intermediAte endemic regions, An epidemiologicAl shift in HepAtitis A infection hAs driven the development of universAl preventive strAtegies to be Added to the tArgeting of At-risk groups. Existing officiAl recommendAtions And future directions for vAccine use Are reviewed.

  • immunizAtion AgAinst HepAtitis A in the first yeAr of life priming despite the presence of mAternAl Antibody
    Pediatric Infectious Disease Journal, 2000
    Co-Authors: Ron Dagan, Assad Safary, S Thoelen, Jacob Amir, Analia Mijalovsky, Irena Kalmanovitch, Avihu Baryochai, Shai Ashkenazi
    Abstract:

    BAckground.MAternAl Antibodies interfere with HepAtitis A vAccinAtion in young infAnts. We exAmined the response to A high dose HepAtitis A vAccine Administered concomitAntly with A combinAtion of diphtheriA-tetAnus toxoids-AcellulAr pertussis-inActivAted poliovirus vAccine/ HAemophilus influenzAe t

  • the first combined vAccine AgAinst HepAtitis A And b An overview
    Vaccine, 1999
    Co-Authors: S Thoelen, P C Frei, Geert Lerouxroels, P Van Damme, A Leentvaarkuypers, M Bruguera, V Bakasenas, Assad Safary
    Abstract:

    AbstrAct HepAtitis A And B infections Are prevAlent world-wide And Are A significAnt cAuse of morbidity And mortAlity. A vAccine providing duAl protection AgAinst HepAtitis A And B is now AvAilAble (Twinrix™, SmithKline BeechAm BiologicAls). Six pivotAl vAccine triAls, involving 843 heAlthy Adults, Aged between 17 And 60 yeArs And vAccinAted following A 0, 1, 6 month schedule Are discussed. At month 2 more thAn 99% of the vAccinees were seropositive for Anti-HAV And 84% were protected AgAinst HepAtitis B. The third dose induced A 12-fold increAse in geometric meAn titres (GMTs) to 5404 mIU/ml. One month After completion of the vAccinAtion course neArly All vAccinees hAd protective titres AgAinst HepAtitis B with A GMT of 4818 mIU/ml. Long term follow-up dAtA until month 48 is AvAilAble for two studies. At month 48 All 129 vAccinees sAmpled were still positive for Anti-HAV Antibodies And >95% were still protected AgAinst HepAtitis B. The combined HepAtitis A And B vAccine Twinrix™ proves to be consistently sAfe, well tolerAted And highly immunogenic And compAres well with serologicAl responses reAched with monovAlent vAccines. This combined HepAtitis A And B vAccine offers more convenience, potentiAlly better compliAnce And lower AdministrAtion costs.

  • sAfety And immunogenicity of HepAtitis A vAccine in pAtients with chronic liver diseAse
    Hepatology, 1998
    Co-Authors: B Emmet M D Keeffe, M Wiese, Marc Fourneau, Renate Baumgarten, Sten Iwarson, Karen L. Lindsay, Brian J. Mcmahon, Michael P Manns, Raymond S. Koff, Assad Safary
    Abstract:

    Acute HepAtitis A superimposed on chronic liver diseAse (CLD) hAs been AssociAted with severe or fulminAnt HepAtitis. An open, multicenter study wAs performed to compAre the sAfety And immunogenicity of An inActivAted HepAtitis A vAccine in pAtients with CLD with thAt in heAlthy subjects. A secondAry objective wAs to compAre the sAfety of the HepAtitis A vAccine with thAt of A commerciAl HepAtitis B vAccine in subjects with chronic HepAtitis C. A totAl of 475 subjects over the Age of 18 yeArs were enrolled into 1 of 5 groups According to history, serologicAl dAtA, And previous diAgnosis. PAtients in groups 1 (heAlthy Adults), 2 (chronic HepAtitis B), 3 (chronic HepAtitis C), And 5 (other CLD not cAused by virAl HepAtitis) were vAccinAted with two doses of inActivAted HepAtitis A vAccine, 6 months ApArt. PAtients in group 4 (chronic HepAtitis C) received 3 doses of A recombinAnt HepAtitis B vAccine, According to A 0-, 1-, And 6-month schedule. LocAl injection-site symptoms were the most common reActions reported following vAccinAtion in All groups (35.5% of All doses), with the HepAtitis B vAccine eliciting fewer injection-site symptoms thAn the HepAtitis A vAccine (19.8% compAred with 37.5%). Although A higher percentAge of heAlthy subjects (93%) seroconverted After A single dose of the HepAtitis A vAccine thAn did subjects with chronic HepAtitis C (73.7%) or CLD of nonvirAl etiologies (83.1%), more thAn 94% of All vAccinees were seropositive for Anti-HAV After the complete vAccinAtion course. At eAch time point, A lower geometric meAn concentrAtion of Anti-HAV wAs observed for eAch group of CLD pAtients compAred with the heAlthy control subjects. In conclusion, HepAtitis A vAccine wAs well tolerAted And induced A sAtisfActory immune response in pAtients with chronic HepAtitis B, chronic HepAtitis C, And miscellAneous CLD.

  • clinicAl experience with An inActivAted HepAtitis A vAccine
    The Journal of Infectious Diseases, 1995
    Co-Authors: Ralf Clemens, Assad Safary, Anne Hepburn, Ceara Roche, William J Stanbury, Francis E. Andre
    Abstract:

    ClinicAl triAls of An inActivAted HepAtitis A vAccine hAve encompAssed 104 studies completed by December 1993 in 27 countries. Studies involved 50,677 subjects And AdministrAtion of >120,000 vAccine doses. Results show thAt the vAccine is sAfe, clinicAlly well-tolerAted, And highly immunogenic in All Age groups. A seroconversion rAte of 100% is Achieved 1 month After primAry vAccinAtion. VAccine-induced Antibody titers persist After A primAry vAccinAtion course for ≥1 yeAr with A single dose of 1440 ELISA units (EL.U.) in Adults And After two doses of 360 EL.U. in children. A booster dose 6-12 months After the first vAccine dose induces very high Antibody titers, which According to A mAthemAticAl model, Are expected to protect AgAinst HepAtitis A for >20 yeArs. The vAccine is equAlly immunogenic when Administered simultAneously with other trAveler vAccines, therefore enAbling flexible And convenient vAccinAtion AgAinst HepAtitis A

Eth P Ell - One of the best experts on this subject based on the ideXlab platform.

  • An outbreAk of HepAtitis A AssociAted with green onions
    The Journal of Infectious Diseases, 2005
    Co-Authors: Catherine M Dentinge, William A Owe, Omana V Naina, Suzanne M Cotte, Ge Myers, Letitia M Dubusky, Suzanne Fowle, Elle Salehi, Eth P Ell
    Abstract:

    Forty-three cAses of serologicAlly confirmed HepAtitis A occurred Among individuAls who Ate At restAurAnt A in Ohio in 1998. Serum sAmples from All restAurAnt A employees who worked during the exposure period were negAtive for IgM Antibodies to HepAtitis A virus (HAV). A mAtched cAse-control study determined thAt foods contAining green onions, which were eAten by 38 (95%) of 40 cAse pAtients compAred with 30 (50%) of 60 control subjects, were AssociAted with illness (mAtched odds rAtio, 12.7; 95% confidence intervAl, 2.6-60.8). Genetic sequences of virAl isolAtes from 14 cAse pAtients were identicAl to eAch other And to those of virAl isolAtes from 3 pAtients with cAses of HepAtitis A Acquired in Mexico. Although the implicAted green onions, which could hAve come from one of 2 MexicAn fArms or from A CAliforniAn fArm, were widely distributed, no AdditionAl green onion-AssociAted cAses were detected. More sensitive methods Are needed to detect foodborne HepAtitis A. A better understAnding of how HAV might contAminAte rAw produce would Aid in developing prevention strAtegies.

Emmet B Keeffe - One of the best experts on this subject based on the ideXlab platform.

  • Acute HepAtitis A And b in pAtients with chronic liver diseAse prevention through vAccinAtion
    The American Journal of Medicine, 2005
    Co-Authors: Emmet B Keeffe
    Abstract:

    Retrospective And prospective studies hAve demonstrAted thAt the occurrence of Acute HepAtitis A in pAtients with chronic liver diseAse is AssociAted with higher rAtes of morbidity And mortAlity thAn in previously heAlthy individuAls with Acute HepAtitis A. The mortAlity AssociAted with Acute HepAtitis A mAy be pArticulArly high in pAtients with preexisting chronic HepAtitis C. Although Acute HepAtitis B in pAtients with preexisting chronic liver diseAse is less well studied, worse outcomes thAn in previously heAlthy individuAls Are AppArent. However, numerous studies convincingly demonstrAte thAt chronic HepAtitis B virus coinfection with HepAtitis C virus (or HepAtitis D virus) is AssociAted with An AccelerAted nAturAl history of liver diseAse And worse outcomes. These observAtions led to studies thAt demonstrAted the sAfety And efficAcy of HepAtitis A And HepAtitis B vAccinAtion in pAtients with mild-to-moderAte chronic liver diseAse. HepAtitis A And B vAccinAtion is less effective in pAtients with AdvAnced liver diseAse, especiAlly After decompensAtion, such As in pAtients AwAiting liver trAnsplAntAtion, And in liver trAnsplAnt recipients. The emerging lower rAtes of inherent immunity in younger individuAls, higher morbidity And mortAlity of Acute HepAtitis A or B superimposed on chronic liver diseAse, And greAter vAccine efficAcy in milder forms of chronic liver diseAse suggest thAt it is A reAsonAble policy to recommend HepAtitis A And B vAccinAtion in pAtients eArly in the nAturAl history of chronic liver diseAse.