Contactos mayores 40. Parecer del Comite Consultivo sobre Inmunizaciones de la Sociedad Chilena de Infectologia en relacion a las brotes de hepatitis A en Chile

Contactos mayores 40. Parecer del Comite Consultivo sobre Inmunizaciones de la Sociedad Chilena de Infectologia en relacion a las brotes de hepatitis A en Chile

Statement of the Advisory Committee on Immunizations of Sociedad Chilena de Infectologia about outbreaks of hepatitis A in Chile

El presente documento corresponde a la opinion del Comite Consultivo de Inmunizaciones de la Sociedad Chilena de Infectologia, en contacto a los brotes de hepatitis A en Chile. Las recomendaciones emitidas se basan en antecedentes epidemiologicos, caracteristicas de la infeccion por virus hepatitis A(VHA) asi­ como en la practica mundial con las vacunas disponibles En conexion a la infeccion por virus hepatitis A, Chile ha transitado sobre una endemia elevada a la endemia intermedia, concentrandose Hoy En Dia los casos en personas mayores sobre 15 anos, con brotes frequentes, uno de ellos este anualidad causado por el genotipo 1A del VHA que se concentro en varones que deben sexo con varones (HSH). La endemia actual, la asistencia sobre brotes regulares, la repeticion sobre desastres naturales en el estado igual que terremotos e inundaciones sumado a la disponibilidad de vacunas eficaces, seguras y con estudios de coste efectividad locales, nos llevan a sugerir medidas para el control de brotes, medidas focalizadas en conjuntos de riesgo y especialmente medidas a mediano y largo plazo, que incorporan la vacunacion universal sobre ninos contra esta indisposicion.

Terminos clave: Brotes; hepatitis A; control; vacunas

Key words: Outbreaks; hepatitis A; control; vaccines

Situacion epidemiologica actual

En Chile, la hepatitis A se presenta en forma sobre endemia intermedia, con ciclos epidemicos que desde 1990 ocurren cada 3 o cinco anos de vida, desplazandolo hacia el pelo tasas sobre incidencia que han variado desde 70,9 Incluso 3,2 por 100 mil habts., dentro de los anos de vida 2002 asi­ como 2010. A partir del ano 2005, 70% de las casos se han presentado en sujetos mayores de quince anos.

La distribucion de las casos ha sido heterogenea a lo extenso del estado, encontrandose las tasas mas altas en las zonas de Tarapaca, Arica desplazandolo hacia el pelo Parinacota, que llegan a concentrar 45% sobre los casos del estado, con tasas sobre 173 por 100 mil habts. en el anualidad 2003, a pesar sobre que su poblacion solo constituye 3% sobre la colectividad nacional. La investigacion epidemiologica mostro que el factor sobre riesgo mas trascendente era el consumo de alimentos expendidos en la via publica.

Por este finalidad, se implemento un proyecto sobre vacunacion contra hepatitis A con dosis sola, en ninos dentro de 18 meses desplazandolo hacia el pelo 6 anos sobre perduracion, logrando descender la valoracion a 8,0 por 100 mil habts.

En las anos de vida 2015 y no ha transpirado 2016, la Region del Bio Bio presento la medida mas la mi?s superior del pais, con valores de 8 y 24,4 por 100 mil habts. respectivamente, encontrandose dentro de las hipoteticos causas las consecuencias del terremoto del 2010, debido a que igualmente se implemento la estrategia sobre vacunacion con monodosis sobre vacuna de hepatitis A.

A la semana epidemiologica (SE) 18 del anualidad 2017 se han presentado 706 casos en el pais, con una indice acumulada sobre 3,8 por 100 mil habts., lo que implica un desarrollo de 53% respecto del similar periodo del anualidad 2016, concentrandose 78% de los casos en el grupo etario entre 15 y 39 anos, con la conexion varones chicas de 4:1. En todas las semanas del ano 2017, las casos de hepatitis a han estado sobre lo esperado. Las partes que presentan engrandecimiento de las tasas respecto del mismo periodo sobre 2016 son, en orden geografico norte a sur, Antofagasta, Valparaiso, Region Metropolitana (RM), O’Higgins desplazandolo hacia el pelo Maule.

Este incremento sobre casos ha predominado en la RM, a donde se ha detectado un brote desde la SE 47 sobre 2016. A la semana 14 de este anualidad, se han notificado 253 casos con una tasa de 3,4 por 100 mil habts., lo que implica un desarrollo de mas sobre seis veces comparado con el ano 2016, en que a la misma data se habian notificado 40 casos, con la valoracion sobre 0,5 por 100 mil habts. La investigacion epidemiologica muestra que no existe incremento en el grupo escaso quince anos de vida sobre permanencia, y no ha transpirado que 85% de los casos pasa en varones dentro de quince y 39 anos.

Los varones han tenido casi siete veces mas peligro de enfermar que las hembras, entretanto que http://datingranking.net/es/christianconnection-review, en el grupo de de mi?s grande peligro, el de 25 a 29 anos, esta razon ha sido de casi 17 veces. No se han identificados elementos sobre peligro asociados al dispendio sobre alimentos o habitos sobre higiene; sin embargo, la exposicion oro-anal en varones que deben sexo con varones (HSH) seria uno de los principales elementos de riesgo. Los casos se concentran mayoritareamente en las comunas de Santiago nucleo, Providencia y Nunoa.

El analisis filogenetico sobre las virus circulantes en el brote sobre la RM, indica que corresponden al genotipo 1A, el que concuerda con el descrito en los brotes de hepatitis A en HSH reportados a principios sobre 2017 en Alemania, Paises Bajos asi­ como otros paises europeos y no ha transpirado que nunca habia sido identificado en muestras analizadas en periodos anteriores en nuestro pais. El SEREMI de la RM ha intensificado la vigilancia epidemiologica desplazandolo hacia el pelo amplio las medidas sobre cerco de contactos sobre casos Incluso los 40 anos de vida con vacuna anti hepatitis A.

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