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Experience of hepatitis A vaccination during an outbreak in a nursery school of Tuscany, Italy

An outbreak of hepatitis A started in late October 1996 in a nursery school in Tuscany, Italy. A programme of hepatitis A vaccination without the use of immunoglobulin started at the beginning of December 1996 and included 33 children, 21 household contacts and 6 adults working in the school. Overall, 11 cases occurred in children attending the school (attack rate 27%) and 10 among their household contacts (attack rate 9%). The latter also included parents, and, in two cases, grandmothers. The data indicate that susceptibility to HAV has increased over recent decades in central Italy. Past and recent experience shows that the usual duration of hepatitis A epidemics in the absence of immune prophylaxis is longer than that described here. The use of hepatitis A vaccine probably contributed to the early extinction of the outbreak, because no further cases were notified in the area after 7 February 1997.