Declining prevalence of hepatitis A virus antibodies among children from low socioeconomic groups reinforces the need for the implementation of hepatitis A vaccination in Brazil.
INTRODUCTION In many Asian countries, improved hygiene standards and socio-economic conditions have led to a reduction in exposure to the hepatitis A virus (HAV) in childhood. However, the persistence of circulating HAV may lead to hepatitis A outbreaks, particularly in adolescents and adults. In other countries and specific areas, where socio-economic conditions have not improved as markedly, HAV endemicity remains medium-to-high. A systematic approach to outbreak control is therefore urgently needed. METHODS The Steering Committee for Prevention and Control of Infectious Diseases reviewed reports on recent hepatitis A outbreaks in South-East Asian countries and determined that there is no systematic regional plan for the containment of such outbreaks. By contrast, on reviewing reports on outbreaks in several North American and European countries, it was found that the most important elements of successful outbreak control are a plan of action, rapid and widespread communication, public education and vaccination of household contacts to prevent secondary cases. RESULTS This investigation proposes an outbreak control programme 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, plus a task force to implement intervention and educate the public. The vaccination of family members and close contacts is a central element of the programme. CONCLUSION This model programme for hepatitis A outbreak control provides a framework for action in countries and specific areas where the disease remains a problem.