• J N Hanna, J L Humphreys, S L Hills, A R Richards, and D L Brookes.
• Tropical Public Health Unit, Queensland Health, Cairns. jeffrey_hanna@health.qld.gov.au
• Aust N Z J Public Health. 2001 Dec 1; 25 (6): 525-8.

ObjectivesTo assess the appropriateness of a protocol for recognising and responding to outbreaks of hepatitis A in child day-care centres and to determine if measles-mumps-rubella (MMR) vaccine was given too soon following the administration of normal human immunoglobulin (NIGH) to young children to control the outbreaks.DesignProspective surveillance to recognise cases of hepatitis A associated with, and outbreaks of hepatitis A in, day-care centres.Main Outcome MeasuresThe percentage of initial ('sentinel') cases of hepatitis A associated with day-care centres that were subsequently recognised as also being 'index' cases of outbreaks of hepatitis A in the centres, and the number of children 9-13 months of age when given NIGH who were subsequently given MMR less than three months later.ResultsOnly 18 (16%) of the 114 sentinel day-care associated cases of hepatitis A were also index cases of outbreaks of hepatitis A in their respective centres. A total of 105 cases of hepatitis A were associated with the 18 outbreak centres; NIGH was administered to 928 (78%) of the attendee children, and to 105 (82%) of the susceptible staff, at the 18 centres. Three of the five children 9-13 months of age when given NIGH were given MMR less that three months later.ConclusionsAlthough outbreaks of hepatitis A were common events in day-care centres in north Queensland during the two-year study period, a single case of hepatitis A associated with a centre was a poor predictor of an outbreak within that centre. Precautions must be taken to ensure that live vaccines are not administered to young children too soon after NIGH.

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