Control of hepatitis A by universal vaccination of children and adolescents: an achieved goal or a deferred appointment?

Temporal trends of Hepatitis A cases and vaccination coverage data against Hepatitis A Virus have been investigated to analyse the impact of the universal routine vaccination strategy more than 10 years from its introduction in Puglia (region of Southern Italy). The basic reproductive number (R(0)) before vaccination introduction and the effective reproductive number (R(e)) after introduction have been calculated. A progressive decrease in incidence has been recorded in Puglia during last 10 years. Vaccination coverage is actually 64.8% (95% CI: 52.7-76.9%) for children aged 12-24 months and of 67.6% (95% CI: 58.4-76.8%) for 12-year-old adolescents. R(0) estimated in 1996 was 2.01; actually R(e) is 0.651. Theoretical age at infection is 31.82 years. Universal routine vaccination aimed at the control of direct transmission remains the milestone in the strategy for the containment of the disease in settings at an intermediate level of endemicity.