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To the Editor: In their study of hepatitis A immunization, Dr Dagan and colleagues¹ described a remarkable decline in the rate of hepatitis A following a universal toddlers-only immunization program in Israel in 1999. In the same issue of JAMA, Dr Wasley and colleagues² reported a reduction in the incidence of hepatitis A in the United States to historic lows after the implementation of childhood vaccination programs in several states. Both studies described a substantial reduction in hepatitis rates not only among children but also in adults. Wasley et al suggested that in the absence of transmission among children, transmission among some groups of adults (which is usually via the fecal-oral route, through close person-to-person contact, or by ingesting contaminated food or water³) may still be sustained.

Several investigators have reported the increase of enteric diseases in general⁴ and hepatitis A in particular⁵ during the summer when the . . . [Full Text of this Article]

Gabriel Chodick, PhD
hodik_g@mac.org.il

Varda Shalev, MD
Maccabi Healthcare Services
Tel Aviv, Israel

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