Summer 1996 Volume 1, Number 2		ACIP HAV recommendations still in press At press time, the Recommendations of the Advisory Committee on Immunization Practices on prevention of hepatitis A were still awaiting printing at the Morbidity and Mortality Weekly Report (see "ACIP Guidelines Finalized" in Hepatitis Control Report, April 1996). Some of the continuing delay has been caused by the need to include information on Merck's VAQTAĈ, which was licensed recently (see story on page 5). Additional delay has been caused by a long publication queue at the MMWR. The Memphis outbreak: Second-phase vaccinations completed in older children The Memphis-Shelby County Health Department has completed a second- phase hepatitis A vaccination program targeted at children ages 10-18. Shelby County has been the site of a large communitywide outbreak of hepatitis A since mid-1994. In August 1995, the Health Department started an aggressive hepatitis A vaccination program aimed at children ages 2-9 in the city's highest incidence neighborhoods. Over 24,000 children received vaccine in the first phase (see Hepatitis Control Report, April 1996). Overall hepatitis A incidence rates in Memphis dropped significantly after the first phase program (see graph). In older children, however, rates remained high, or, in some vaccinated neighborhoods, actually increased. To address this, officials decided to expand vaccinations into children 10-18 years old in 14 schools in high-incidence neighborhoods. This second phase program, begun on April 22, required these children to receive hepatitis A vaccine as a condition of remaining in school. The program was recently completed, having vaccinated more than 10,500 additional children, for a total of almost 36,000 children. The expanded program encountered political resistance from a small group of activists, who filed a class action lawsuit and accused the Health Department of conducting a vaccination program based on racial discrimination. A federal judge, however, refused to stop the program, saying that "public health concerns override, at this point." Later, community leaders received hepatitis A vaccinations at a news conference to demonstrate their confidence in the vaccine and their support for the vaccine initiative. California considers next move With 20-25% of all the nation's hepatitis A cases reported from California, the State's strategy for hepatitis A control has great implications for the nation. The California Health Department is now formulating its next move against hepatitis A. The state reports 5,000-7,000 cases per year. California is already using hepatitis A vaccine to control communitywide outbreaks. The first control project took place in rural Butte County in 1995, which experienced a large communitywide outbreak beginning in 1994. In that project, VAQTAĈ was given to several thousand children ages 2-12. This year, HavrixĈ has been used to control communitywide outbreaks in rural Shasta and Kern Counties. In the Shasta outbreak, vaccine has been administered to children age 2-18 in community clinics. In Kern County, vaccine has been given to children age 2-18 in school-based clinics. Coverage rates have been high, but, according to Dr. Loring F. Dales, an epidemiologist with the California Division of Communicable Disease Control, it is too early to say whether the immunization programs have affected the course of the epidemics. State public health officials in Berkeley are now considering how to expand hepatitis A control programs into cities with high endemic disease burdens, such as Los Angeles and other southern counties. L.A. County reports 1,300-1,600 cases of hepatitis A each year, which is about 20% of the state's annual total. State disease control officials plan to present a long-term control proposal to county health officers in early summer. The state may also hire an epidemiologist to concentrate solely on hepatitis A control.