Hepatitis A Outbreak in the Bedouin Village of Bir Hadaj in Southern Israel: Going Beyond Vaccination

Abstract Background Bedouin villages in the Negev lacks electricity, water, and sewage infrastructure, leading to poor sanitary conditions. This situation may lead to outbreaks of infectious diseases, including fecal-oral diseases. In July 2023, an outbreak of Hepatitis A began in the Bedouin village of Bir Hadaj (BH). About 200 babies are born in BH each year. These babies receive preventive health services at the local Southern District Health Office (SDHO) Maternal and Child Health Center (MCHC), including HAV vaccines, reaching only 57.5% second dose rates up to 12 years. Objectives Identifying hepatitis A cases not reported to the SDHO in BH, as well the other factors related to the high infection rates. Methods A retrospective telephone survey examined incidence rates of Hepatitis A not reported to the SDHO. Data on vaccination rates were taken from the computerized system of MCHC. 311 out of 518 parents of children who were not vaccinated at all or were vaccinated with only one dose of Hepatitis A, responded to the survey. Results 22 children were infected, of which only 18 were reported. 40.9% of the positive children were first-born (p = 0.011), 85% reported living in a shack, 65% reported having a toilet outside their home (p = 0.019) and 75% had a water tap for handwashing (p = 0.182). 50.5% of the patients were hospitalized (p < 0.001) and 40.5% of the patients reported having had previous contact with a patient (p < 0.001). Of the 192 children who received the first dose of Hepatitis A, 8 children (4.2%) became ill, compared to 119 who were not vaccinated, of whom 14 (11.6%) children became ill (RR = 3.26, P < 0.01). In a multivariate analysis a significant relationship was found between being firstborn child, poor sanitary conditions, and previous contact with a sick family member and disease incidence. Conclusions Efforts must be increased to identify unvaccinated children and vaccinate, and to conduct culturally appropriate educational programs about the disease and ways to prevent it. Key messages • Specific targeted efforts to reduce HAV rates must include both improve vaccine access and tackling social and environmental determinants of health. • While most cases were reported, disease prevalence was higher among unvaccinated children.