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Saffar F, Sellaoui F, Hechaichi A, Chelly S, Bouguerra H, Cherif A, Talmoudi K, Hadj MB, Bahrini A, Letaief H, Bahri O, Chahed MK, Ben Alaya NBÉ. Epidemiological patterns of Hepatitis A infection during the pre-vaccination Era: A population-based survey in Tunisia in 2015. Int J Infect Dis 2022; 117:162-168. [PMID: 35007750 DOI: 10.1016/j.ijid.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In the 1980s, Tunisia was considered a country of high endemicity for Hepatitis A virus (HAV). Since 2000, an epidemiological shift has led to an increased incidence of symptomatic and severe forms of HAV infection. OBJECTIVE In 2015, we conducted a cross-sectional nationwide household-based HAV seroprevalence study in the total population regardless of age, sex, or geographical origin using a stratified sampling design in order to make an overview of the HAV epidemiological situation in Tunisia before vaccine implementation. RESULTS A total of 6322 individuals were enrolled. The HAV prevalence was 78.8%. The anti-HAV IgG seropositivity rate increases from 16% for ages 5-9 years to 45% for ages 10-14, 67% for ages 15-19, 87% for ages 20-24, and >90% for older age groups, which suggests an age at midpoint of population immunity (AMPI) in late adolescence. It was significantly higher in rural areas (p<10-3) and varied significantly between and within regions (p<10-4). CONCLUSIONS In this study, although the overall AMPI suggests intermediate endemicity, the regional AMPI varies from intermediate to very high endemicity profiles attributable to different socio-economic determinants and conditions of sanitation and hygiene. Also it provides insights for the best decisions in terms of vaccinations strategies.
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Affiliation(s)
- Farah Saffar
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia; Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, 1007 Tunisia.
| | - Fatma Sellaoui
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia
| | - Aicha Hechaichi
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, 1007, Tunis, Tunisia; Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, 1007 Tunisia
| | - Souhir Chelly
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia
| | - Hind Bouguerra
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia; Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, 1007 Tunisia
| | - Amal Cherif
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia; Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, 1007 Tunisia
| | - Khouloud Talmoudi
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia; Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, 1007 Tunisia
| | - Meriem Ben Hadj
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia
| | - Asma Bahrini
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia
| | - Hejer Letaief
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia; Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, 1007 Tunisia
| | - Olfa Bahri
- Tunis El Manar University, Faculty of Medicine of Tunis, 1007, Tunis, Tunisia; Laboratory of Microbiology and Virology, Aziza Othmana Hospital, Tunis, Tunisia
| | - Mohamed Kouni Chahed
- Tunis El Manar University, Faculty of Medicine of Tunis, 1007, Tunis, Tunisia; Department of epidemiology and Statistics, Abderrahmen Mami Hospital, Ariana, Tunisia
| | - Nissaf Bouafif Ép Ben Alaya
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, 1007, Tunis, Tunisia; Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, 1007 Tunisia
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Zanella B, Boccalini S, Biamonte MA, Giorgetti D, Menicacci M, Bonito B, Ninci A, Tiscione E, Puggelli F, Mereu G, Bonanni P, Bechini A. A Study of Hepatitis A Seroprevalence in a Paediatric and Adolescent Population of the Province of Florence (Italy) in the Period 2017-2018 Confirms Tuscany a Low Endemic Area. Vaccines (Basel) 2021; 9:1194. [PMID: 34696301 PMCID: PMC8538179 DOI: 10.3390/vaccines9101194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Italy is considered an area with very low HAV (hepatitis A virus) endemicity. Currently in Italy the anti-HAV vaccine is recommended only for specific risk groups and there is no universal vaccination program. The aim of this study was to assess the level of immunity against hepatitis A in a sample of children and adolescents from the province of Florence. Methods: A total of 165 sera were collected from subjects aged 1 to 18 years, proportionally selected according to the general population size and stratified by age and sex. A qualitative evaluation of anti-HAV antibodies was performed using the enzyme-linked immunosorbent assay (ELISA). Anamnestic and vaccination status data were also collected. Results: Our study showed a hepatitis A seroprevalence of 9.1% in the enrolled population. A statistically significant difference in the prevalence of anti-HAV was found between Italian and non-Italian subjects. About half of the population having anti-HAV antibodies was reported to be vaccinated, and no cases of hepatitis A were found. Conclusions: The data from our study confirmed Tuscany as an area with low HAV endemicity and showed that hepatitis A seroprevalence is significantly higher in foreign children and adolescents. The presence of more seropositive subjects than those vaccinated was probably due to a natural immunization achieved through a subclinical infection and/or to underreporting of the surveillance systems.
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Affiliation(s)
- Beatrice Zanella
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (B.Z.); (S.B.); (B.B.); (E.T.); (P.B.)
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (B.Z.); (S.B.); (B.B.); (E.T.); (P.B.)
| | - Massimiliano Alberto Biamonte
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (M.A.B.); (D.G.); (M.M.); (A.N.)
| | - Duccio Giorgetti
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (M.A.B.); (D.G.); (M.M.); (A.N.)
| | - Marco Menicacci
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (M.A.B.); (D.G.); (M.M.); (A.N.)
| | - Benedetta Bonito
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (B.Z.); (S.B.); (B.B.); (E.T.); (P.B.)
| | - Alessandra Ninci
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (M.A.B.); (D.G.); (M.M.); (A.N.)
| | - Emilia Tiscione
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (B.Z.); (S.B.); (B.B.); (E.T.); (P.B.)
| | | | | | - Working Group DHS
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (M.A.B.); (D.G.); (M.M.); (A.N.)
| | | | | | - Paolo Bonanni
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (B.Z.); (S.B.); (B.B.); (E.T.); (P.B.)
| | - Angela Bechini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (B.Z.); (S.B.); (B.B.); (E.T.); (P.B.)
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3
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Ayouni K, Naffeti B, Ben Aribi W, Bettaieb J, Hammami W, Ben Salah A, Ammar H, Ben Miled S, Triki H. Hepatitis a virus infection in Central-West Tunisia: an age structured model of transmission and vaccination impact. BMC Infect Dis 2020; 20:627. [PMID: 32842988 PMCID: PMC7477833 DOI: 10.1186/s12879-020-05318-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The epidemiological pattern of hepatitis A infection has shown dynamic changes in many parts of the world due to improved socio-economic conditions and the accumulation of seronegative subjects, which leads to possible outbreaks and increased morbidity rate. In Tunisia, the epidemiological status of hepatits A virus is currently unknown. However, over the past years higher numbers of symptomatic hepatitis A virus infection in school attendants and several outbreaks were reported to the Ministry of Health, especially from regions with the lowest socio-economic levels in the country. The aim of this study was to investigate the current seroprevalence of hepatitis A virus antibodies in central-west Tunisia and assess the impact of hepatitis A virus vaccination on hepatitis A epidemiology. METHODS Serum samples from 1379 individuals, aged 5-75 years, were screened for hepatitis A virus antibodies. Adjusted seroprevalence, incidence and force of infection parameters were estimated by a linear age structured SEIR (Susceptible-Exposed-Infectious-Recovered) compartmental model. A vaccine model was then constructed to assess the impact on hepatitis A virus epidemiology of 3 scenarios of vaccination strategies: one dose at 12-months of age, one dose at 6-years and one dose at 12-months and another at 6-years of age during 6 years. RESULTS A rapid increase in anti-hepatitis A virus seroprevalence was noted during infancy and adolescence: 47% of subjects under 10-years-old are infected; the prevalence increases to 77% at 15-years and reaches 97% in subjects aged 30-years. The force of infection is highest between 10 and 30-years of age and the incidence declines with increasing age. The vaccine model showed that the 3-scenarios lead to a significant reduction of the fraction of susceptibles. The two doses scenario gives the best results. Single-dose vaccination at 6-years of age provides more rapid decrease of disease burden in school-aged children, as compared to single-dose vaccination at 12-months, but keeps with a non-negligible fraction of susceptibles among children < 6-years. CONCLUSIONS Our study confirms the epidemiological switch from high to intermediate endemicity of hepatitis A virus in Tunisia and provides models that may help undertake best decisions in terms of vaccinations strategies.
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Affiliation(s)
- Kaouther Ayouni
- Laboratory of Clinical Virology – Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
- Faculty of Sciences of Tunis, University of Tunis El Manar, Campus Universitaire 2092-El Manar, Tunis, Tunisia
| | - Bechir Naffeti
- Laboratory of Intelligent Networks and Nanotechnology, LARINA, University of Carthage, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Avenue de la République, P. O. Box 77-1054, Tunis, Amilcar Tunisia
| | - Walid Ben Aribi
- Laboratory of Intelligent Networks and Nanotechnology, LARINA, University of Carthage, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Avenue de la République, P. O. Box 77-1054, Tunis, Amilcar Tunisia
| | - Jihène Bettaieb
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
- Department of Epidemiology - Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15 Rue Djebel Lakhdhar. La Rabta, 1007 Tunis, Tunisia
| | - Walid Hammami
- Laboratory of Clinical Virology – Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
| | - Afif Ben Salah
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
- Department of Epidemiology - Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15 Rue Djebel Lakhdhar. La Rabta, 1007 Tunis, Tunisia
| | - Hamadi Ammar
- Laboratory of Intelligent Networks and Nanotechnology, LARINA, University of Carthage, Tunis, Tunisia
- Faculty of Economic Sciences and Management of Nabeul, University of Carthage, Avenue de la République, BP 77-1054, Tunis, Amilcar Tunisia
| | - Slimane Ben Miled
- Laboratory of Bioinformatics, Biomathématics and Biostatistics, Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology – Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15 Rue Djebel Lakhdhar. La Rabta, 1007 Tunis, Tunisia
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Carrillo-Santisteve P, Tavoschi L, Severi E, Bonfigli S, Edelstein M, Byström E, Lopalco P. Seroprevalence and susceptibility to hepatitis A in the European Union and European Economic Area: a systematic review. THE LANCET. INFECTIOUS DISEASES 2017. [PMID: 28645862 DOI: 10.1016/s1473-3099(17)30392-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Most of the European Union (EU) and European Economic Area (EEA) is considered a region of very low hepatitis A virus (HAV) endemicity; however, geographical differences exist. We did a systematic review with the aim of describing seroprevalence and susceptibility in the general population or special groups in the EU and EEA. We searched databases and public health national institutes websites for HAV seroprevalence records published between Jan 1, 1975, and June 30, 2014, with no language restrictions. An updated search was done on Aug 10, 2016. We defined seroprevalence profiles (very low, low, and intermediate) as the proportion of the population with age-specific anti-HAV antibodies at age 15 and 30 years, and susceptibility profiles (low, moderate, high, and very high) as the proportion of susceptible individuals at age 30 and 50 years. We included 228 studies from 28 of 31 EU and EEA countries. For the period 2000-14, 24 countries had a very low seroprevalence profile, compared with five in 1975-89. The susceptibility among adults ranged between low and very high and had a geographical gradient, with three countries in the low susceptibility category. Since 1975, EU and EEA countries have shown decreasing seropositivity; however, considerable regional variability exists. The main limitations of this study are that the studies retrieved for analysis might not be representative of all EU and EEA publications about HAV and might have poor national representativeness. A large proportion of EU and EEA residents are now susceptible to HAV infection. Our Review supports the need to reconsider specific prevention and control measures, to further decrease HAV circulation while providing protection against the infection in the EU and EEA, and could be used to inform susceptible travellers visiting EU and EEA countries with different HAV endemicity levels.
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Affiliation(s)
| | - Lara Tavoschi
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Ettore Severi
- European Centre for Disease Prevention and Control, Solna, Sweden; Karolinska Institutet, Stockholm, Sweden
| | - Sandro Bonfigli
- European Centre for Disease Prevention and Control, Solna, Sweden; Ministry of Health, Rome, Italy
| | - Michael Edelstein
- European Centre for Disease Prevention and Control, Solna, Sweden; Public Health Agency of Sweden, Stockholm, Sweden
| | - Emma Byström
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Pierluigi Lopalco
- European Centre for Disease Prevention and Control, Solna, Sweden; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Gallone MF, Desiante F, Gallone MS, Barbuti G, Tafuri S, Germinario C. Serosurveillance of hepatitis A in a region which adopted the universal mass vaccination. Medicine (Baltimore) 2017; 96:e5884. [PMID: 28248852 PMCID: PMC5340425 DOI: 10.1097/md.0000000000005884] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Hepatitis A is a common infectious disease worldwide that was endemic in many regions of Southern Italy, such as Apulia region. After a large hepatitis A outbreak occurred between 1996 and 1997, in Apulia an active-free immunization program that was targeted to new-borns and adolescents was started. The aim of this study is to investigate the hepatitis A seroprevalence in the adult Apulian population 18 years after the immunization program introduction, in order to evaluate the risk of new epidemics onset.The study was carried out from May 2011 to June 2012 among blood donors from Department of Transfusion Medicine and Blood Bank of Policlinico General Hospital in Bari. Participants signed a written consent and filled out a questionnaire including items on demographic characteristics, risk factors, disease memory, and raw food consumption. Serum samples, collected from each patient, were tested for anti-HAV using the chemiluminescent microparticle immunoassay. Vaccination status against hepatitis A was checked on Regional Digital Immunization Registry (GIAVA).In total 1827 donors agreed to participate (77.7% male) with a mean age of 38.4 ± 11.7 years. However, 1172 (64.1%) donors were seropositive with no difference by sex. The highest proportion of seronegative subjects was in the 27 to 35 years age group. 91.8% of 1-dose vaccinated subjects (n = 190/207; 95%CI = 87.2-95.1) and 96.1% (n = 171/178; 95%CI = 92.1-98.1) of 2-doses vaccinated subjects were immune to the disease. Sensitivity of disease memory in unvaccinated subjects was 14.4% (95%CI = 12.2-16.7), specificity was 97.8% (95%CI = 96.3-98.8), positive predictive value was 91% (95%CI = 85.3-95), and negative predictive value was 42.6% (95%CI = 40-45.2). Raw seafood consumption in unvaccinated subjects was associated with the anti-HAV IgG positivity (OR = 2.1; 95%CI = 1.7-2.7; z = 7.4; P < 0.0001).The vaccination program seems to have changed the virus circulation pattern, with a higher seronegativity rate among subjects not included in the vaccination strategy: 67% of susceptible subjects were among younger people aged 27 to 35 years. Immunization program implementation with a catch-up strategy may be needed to avoid a possible increase of hepatitis A incidence and outbreaks in Apulia. Epidemiological surveillance should be continued and vaccination should actively be offer for free to all the cases contacts, in order to prevent new outbreaks onset.
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Affiliation(s)
- Maria Filomena Gallone
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Bari, Italy
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6
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Campagna M, Maria Mereu N, Mulas L, Pilia R, Francesca Piazza M, Spada L, Lai A, Portoghese I, Galletta M, Masia G, Restivo A, Mura P, Finco G, Cristina Coppola R. Pattern of Hepatitis A Virus Epidemiology in Nursing Students and Adherence to Preventive Measures at Two Training Wards of a University Hospital. HEPATITIS MONTHLY 2016; 16:e34219. [PMID: 27195012 PMCID: PMC4867361 DOI: 10.5812/hepatmon.34219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/25/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Nursing students can be exposed to patients with hepatitis A virus (HAV) and can represent a vehicle of transmission both for health personnel, patients and relatives. OBJECTIVES The aim of this study was to assess the risk of HAV infection in nursing students during their internship. PATIENTS AND METHODS A seroprevalence survey on HAV infection was performed on nursing students at the Cagliari university-hospital, together with the assessment of the compliance to preventive measures to decrease the risk of infection during their internship. Blood specimens were obtained from 253 students. All serum samples were tested for anti-HAV antibodies (IgG) by the enzyme-linked immunosorbent assay (ELISA). Compliance to preventive measures was recorded by trained personnel. RESULTS Overall HAV seropositivity in nursing students (mean age 24, range 17 - 45 years) was 3%. Compliance to preventive measures was not uniform (6% - 76%) and extremely low in some specific measures targeted to decrease the oral-fecal transmission. CONCLUSIONS The high proportion of susceptible nursing students can contribute to an increase in the risk of nosocomial transmission, especially when specific preventive measures are not completely applied. Nursing education packages, before starting medical internship, should be implemented in order to increase their compliance to preventive measures, especially in wards at higher risk. Vaccination should be considered in wards at higher risk.
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Affiliation(s)
- Marcello Campagna
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
- Corresponding Author: Marcello Campagna, Marcello Campagna, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy. Tel: +39-0706754441, E-mail:
| | - Noemi Maria Mereu
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Lucia Mulas
- Azienda Ospedaliero-Universitaria, Policlinico Universitario, Monserrato, Cagliari, Italy
| | - Roberta Pilia
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Maria Francesca Piazza
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Laura Spada
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Alberto Lai
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Igor Portoghese
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Maura Galletta
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Giuseppina Masia
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Angelo Restivo
- Department of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, Italy
| | - Paolo Mura
- Anesthesia and Intensive Care Department, Pain Therapy Service, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Gabriele Finco
- Anesthesia and Intensive Care Department, Pain Therapy Service, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Rosa Cristina Coppola
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
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C MA, J M RT, A CR, M BN, M DG, S L MR. Prevalence of hepatitis A antibodies in Eastern Bolivia: a population-based study. J Med Virol 2013; 85:1692-7. [PMID: 23861034 DOI: 10.1002/jmv.23671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2013] [Indexed: 11/12/2022]
Abstract
The seroprevalence of hepatitis A virus (HAV) is changing from high to intermediate endemicity in several Latin American countries, but the pattern in the Andean Latin American countries is unknown. A seroepidemiological survey (n = 436) of HAV in schoolchildren living in the Cochabamba region of Bolivia was conducted in 2010. A questionnaire was completed by parents to obtain demographic, socio-economic, and housing data, and blood samples were collected. The overall prevalence of HAV IgG was 95.4% (95% CI 93.5-97.4). The prevalence was higher in children aged 5-10 years (97%) and pre-adolescents aged 10-13 years (97.9%). The prevalence was also higher in subjects whose parents had a low level of education (99.4-99.5%), who lived in rural areas (98.7%), lived in municipalities with low urban development (99.1-100%), had water delivered at home from a tanker (99.4%), and spoke Quechua at home (99.5%). The descriptive and bivariate analysis suggested that no change in HAV epidemiology has occurred in Cochabamba.
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Affiliation(s)
- Masuet-Aumatell C
- Preventive Medicine Department, Bellvitge Biomedical Research Institute (IDIBELL), International Health Centre and Travel Medicine Clinic, University Hospital of Bellvitge, Catalonia, Spain.
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8
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Garbuglia AR, Scognamiglio P, Petrosillo N, Mastroianni CM, Sordillo P, Gentile D, La Scala P, Girardi E, Capobianchi MR. Hepatitis E virus genotype 4 outbreak, Italy, 2011. Emerg Infect Dis 2013; 19:110-4. [PMID: 23260079 PMCID: PMC3558000 DOI: 10.3201/eid1901.120983] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
During 2011, 5 persons in the area of Lazio, Italy were infected with a monophyletic strain of hepatitis E virus that showed high sequence homology with isolates from swine in China. Detection of this genotype in Italy parallels findings in other countries in Europe, signaling the possible spread of strains new to Western countries.
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Affiliation(s)
- Anna R Garbuglia
- Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy
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9
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Prato R, Martinelli D, Tafuri S, Barbuti G, Quarto M, Germinario CA, Chironna M. Safety of shellfish and epidemiological pattern of enterically transmitted diseases in Italy. Int J Food Microbiol 2013; 162:125-8. [DOI: 10.1016/j.ijfoodmicro.2012.12.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 10/15/2012] [Accepted: 12/15/2012] [Indexed: 11/28/2022]
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10
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Rapicetta M, Monarca R, Kondili LA, Chionne P, Madonna E, Madeddu G, Soddu A, Candido A, Carbonara S, Mura MS, Starnini G, Babudieri S. Hepatitis E virus and hepatitis A virus exposures in an apparently healthy high-risk population in Italy. Infection 2012; 41:69-76. [DOI: 10.1007/s15010-012-0385-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 12/07/2012] [Indexed: 10/27/2022]
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Wu JY, Liu Y, Chen JT, Xia M, Zhang XM. Review of 10 years of marketing experience with Chinese domestic inactivated hepatitis A vaccine Healive®. Hum Vaccin Immunother 2012; 8:1836-44. [PMID: 23032165 PMCID: PMC3656073 DOI: 10.4161/hv.21909] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/12/2012] [Accepted: 08/21/2012] [Indexed: 11/19/2022] Open
Abstract
In 2002, the first Chinese domestic preservative-free inactivated hepatitis A vaccine, Healive®, was introduced in China. It is highly immunogenic, and provides lasting protection in healthy individuals and generates protective levels of antibodies in other at-risk individuals. Over 10 years since its first licensure, postmarketing surveillance data have confirmed the outstanding safety profile of the vaccine. Comparative clinical trials indicated that Healive® induce equal or similar immunogenicity with other currently available inactivated hepatitis A vaccines and are interchangeable for the course of HAV immunization in Chinese children. The vaccine is effective in curbing outbreaks of hepatitis A due to rapid seroconversion and the long incubation period of the disease. Additional issues surrounding the use of the vaccine are also reviewed.
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Affiliation(s)
- Jun-Yu Wu
- Clinical Research Department, Sinovac Biotech Co. Ltd.; Beijing, P.R. China
| | - Yan Liu
- Clinical Research Department, Sinovac Biotech Co. Ltd.; Beijing, P.R. China
| | - Jiang-Ting Chen
- Clinical Research Department, Sinovac Biotech Co. Ltd.; Beijing, P.R. China
| | - Ming Xia
- Sales Department, Sinovac Biotech Co. Ltd.; Beijing, P.R. China
| | - Xiao-Mei Zhang
- Production Department, Sinovac Biotech Co. Ltd.; Beijing, P.R. China
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Campagna M, Siddu A, Meloni A, Basciu C, Ferrai L, Pettinau A, Cardia C, Masia G, Coppola RC. Changing pattern of hepatitis a virus epidemiology in an area of high endemicity. HEPATITIS MONTHLY 2012; 12:382-5. [PMID: 22879827 PMCID: PMC3412554 DOI: 10.5812/hepatmon.5940] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 05/01/2012] [Accepted: 05/10/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Continuous assessment of hepatitis A virus (HAV) seroepidemiology is a useful tool to control the risk of infection. OBJECTIVES This study aimed to evaluate the changing patterns of anti-HAV seroprevalence in a population,which isgenerally considered to be anarea ofhigh endemicity. PATIENTS AND METHODS Overall, the results of 3349 sera collected during the period 2005-2008 from patients attending the University Hospital of Cagliari, Italy were studied; their mean age was 52.7 years, (s + 16.22). Patients with liver disease were excluded from the study. Age specific seroprevalence results were compared with those observed in similar previous studies carried out in the same area. RESULTS The overall prevalence of anti-HAV was 74.6% with consistently lower values in subjects younger than 40 years (17.5%; P < 0.0001) particularly in those under 30 years of age (8.9%, CI 5.8-11.9). A significant declining trend in age specific seroprevalence has been foundin people under 30 years;61% in 1988, 33% in 1995 and 8.9% in 2005-2008. CONCLUSIONS Our findings show that a significant decline inherd immunity has occurred in the last 20 years as a consequence of lower HAV circulation due to improvementsin socio-economical and hygienic conditions. Adolescents and young adults are becoming increasingly susceptible to HAV infections, as recent outbreaks of acute HAV hepatitis have occurred. Persistent environmental monitoring and the implementation of prevention measures must be considered in order to contain the risk related to this epidemiological shift.
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Affiliation(s)
- Marcello Campagna
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Andrea Siddu
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Angelo Meloni
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Claudia Basciu
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Luigi Ferrai
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | | | - Cristiana Cardia
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Giuseppina Masia
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Rosa Cristina Coppola
- Department of Public Health, University of Cagliari, Cagliari, Italy
- Corresponding author: Rosa Cristina Coppola, Department of Public Health, University of Cagliari, Cagliari, Italy. Tel.: +39-0706753104, Fax: +39-0706753760, E-mail:
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Taffon S, Bidini G, Vichi F, Corti G, Genovese D, Kondili LA, Bindi R, Armellini F, Leoncini F, Bartoloni A, Mazzotta F, Rapicetta M. A unique HAV strain circulated in patients with acute HAV infection with different risk exposures in Tuscany, Italy. J Clin Virol 2010; 50:142-7. [PMID: 21094625 DOI: 10.1016/j.jcv.2010.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 09/22/2010] [Accepted: 10/18/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Acute Hepatitis A Virus (HAV) is reported to be an emergent problem in several developed countries. OBJECTIVES AND STUDY DESIGN The aim of this study was to analyse the HAV strains circulating among individuals with acute HAV infection, apparently transmitted by different routes, in several districts of Tuscany in central Italy, during the year 2008. RESULTS An outbreak of acute HAV infection occurred from May to August 2008 in Arezzo; 32 individuals were admitted to the hospital, in 25 of them at least a linkage with an infected food handler and/or household contacts was reported and in 3 homosexuality was a possible risk factor. In Florence, from January 2008 to August 2008, 41 individuals mainly homosexual men were admitted to two hospitals with the diagnosis of acute HAV. The phylogenetic analysis of VP1/2A region of HAV was used to characterize these HAV isolates. All viral sequences were assigned to genotype IA. All clustered in the same branch (bootstrap 82%) of phylogenetic tree, thus indicating the same circulating isolate. Apart of one isolate from France and one from Germany which were similar with the "Tuscany" strain reported here, high heterogeneity with the other European HAV strains reported in the GenBank in the last years, was observed. CONCLUSION The detection of a unique HAV isolate circulating in different Tuscany districts, suggests sequential transmission of HAV infection in this geographical area through possible links among acute hepatitis cases. The application of safe food handling practices and vaccination of homosexual men may contribute to the prevention of HAV infection.
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Affiliation(s)
- Stefania Taffon
- Istituto Superiore di Sanità, Department of Infectious, Parasitic and Immune-Mediated Disease, Rome, Italy
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Ajelli M, Fumanelli L, Manfredi P, Merler S. Spatiotemporal dynamics of viral hepatitis A in Italy. Theor Popul Biol 2010; 79:1-11. [PMID: 20883708 DOI: 10.1016/j.tpb.2010.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 09/20/2010] [Accepted: 09/21/2010] [Indexed: 11/29/2022]
Abstract
Viral hepatitis A is still common in Italy, especially in Southern regions. In this study, a metapopulation model for hepatitis A virus (HAV) transmission is proposed and analyzed. Analytical results on the asymptotic and transient behaviors of the system are carried out. Based on the available Italian movement data, a national spatial contact matrix at the regional level, which could be used for new studies on the transmission dynamics of other infectious diseases, is derived for modeling fluxes of individuals. Despite the small number of fitted parameters, model simulations are in good agreement with the observed average HAV incidence in all regions. Our results suggest that the mass vaccination program introduced in one Italian region only (Puglia, the one with the highest endemicity level) could have played a role in the decline of HAV incidence in the country as a whole. The only notable exception is represented by Campania, a Southern region showing a high endemicity level, which is not substantially affected by HAV dynamics in Puglia. Finally, our results highlight that the continuation of the vaccination campaign in Puglia would have a relevant impact in decreasing long-term HAV prevalence, especially in Southern Italy.
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Affiliation(s)
- Marco Ajelli
- Predictive Models for Biomedicine & Environment, Bruno Kessler Foundation, Italy.
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Jacobsen KH, Wiersma ST. Hepatitis A virus seroprevalence by age and world region, 1990 and 2005. Vaccine 2010; 28:6653-7. [PMID: 20723630 DOI: 10.1016/j.vaccine.2010.08.037] [Citation(s) in RCA: 370] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 07/27/2010] [Accepted: 08/03/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate current age-specific rates of immunity to hepatitis A virus (HAV) in world regions by conducting a systematic review and meta-analysis of published data. The estimation of the global burden of hepatitis A and policies for public health control are dependent on an understanding of the changing epidemiology of this viral infection. METHODS Age-specific IgG anti-HAV seroprevalence data from more than 500 published articles were pooled and used to fit estimated age-seroprevalence curves in 1990 and 2005 for each of 21 world regions (as defined by the Global Burden of Disease 2010 Study). FINDINGS High-income regions (Western Europe, Australia, New Zealand, Canada, the United States, Japan, the Republic of Korea, and Singapore) have very low HAV endemicity levels and a high proportion of susceptible adults, low-income regions (sub-Saharan Africa and parts of South Asia) have high endemicity levels and almost no susceptible adolescents and adults, and most middle-income regions have a mix of intermediate and low endemicity levels. CONCLUSION Anti-HAV prevalence estimates in this analysis suggest that middle-income regions in Asia, Latin America, Eastern Europe, and the Middle East currently have an intermediate or low level of endemicity. The countries in these regions may have an increasing burden of disease from hepatitis A, and may benefit from new or expanded vaccination programs.
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Affiliation(s)
- Kathryn H Jacobsen
- Department of Global & Community Health, George Mason University, 4400 University Drive MS 5B7, Fairfax, VA 22030, USA.
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Control of hepatitis A by universal vaccination of children and adolescents: an achieved goal or a deferred appointment? Vaccine 2010; 28:6783-8. [PMID: 20688041 DOI: 10.1016/j.vaccine.2010.07.069] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/20/2010] [Accepted: 07/20/2010] [Indexed: 11/23/2022]
Abstract
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.
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Saha SK, Saha S, Shakur S, Hanif M, Habib MA, Datta SK, Bock HL. Community-based cross-sectional seroprevalence study of hepatitis A in Bangladesh. World J Gastroenterol 2009; 15:4932-7. [PMID: 19842225 PMCID: PMC2764972 DOI: 10.3748/wjg.15.4932] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 09/17/2009] [Accepted: 09/24/2009] [Indexed: 02/06/2023] Open
Abstract
AIM To elucidate the age-distribution of anti-hepatitis A virus (HAV) seroprevalence across different socioeconomic status (SES) categories in Bangladesh which, despite scarce data, is generally deemed to have high endemicity. METHODS Blood samples of 818 subjects from a stratified sample of schools and hospitals, comprising different age categories and SES were collected. They were assayed for total anti-HAV antibodies. Social and medical history data were obtained using a questionnaire. RESULTS Overall anti-HAV seroprevalence was 69.6%, increasing with age from 1-5 years (40.4%) to > 30 years (98.4%). Seroprevalence was lowest (49.8%) in the high SES group and highest (96.5%) in the rural lower-middle SES group. Among subjects aged 6-20 years, anti-HAV seroprevalence was lowest in urban private school children (43.0%), followed by urban government school children (76.2%) and rural school children (96.5%) (P < 0.01). Within the high SES group, anti-HAV seroprevalence was 32.3% in subjects < 10 years and 51.7% in those aged 11-20 years. Until now Bangladesh has been deemed to have high endemicity for HAV. CONCLUSION The transition from high to intermediate HAV endemicity may be underway; high SES adolescents and adults remain particularly at risk of symptomatic illness. Preventive measures need consideration.
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Montuori P, Negrone M, Cacace G, Triassi M. Wastewater workers and hepatitis A virus infection. Occup Med (Lond) 2009; 59:506-8. [DOI: 10.1093/occmed/kqp092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
This article summarizes the meta-analyses of interventions for viral hepatitis A, B, and C. Some of the interventions assessed are described in small trials with unclear bias control. Other interventions are supported by large, high-quality trials. Although attempts have been made to adjust for unclear bias control, analysis of publication bias and other biases is difficult when only few trials are available. It is possible that some of the meta-analyses presented in this article are biased. Furthermore, performing updated cumulative meta-analyses also may introduce random error.3,4 The extent and direction of bias may vary. On average, however, bias leads to overestimated intervention benefits.1 Accordingly, the benefit of some of the interventions suggested in this article may be exaggerated by systematic and random errors. Additional research including large, randomized trials is necessary to clarify the true intervention effects.
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Affiliation(s)
- Lise L Gluud
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Ajelli M, Merler S. An individual-based model of hepatitis A transmission. J Theor Biol 2009; 259:478-88. [PMID: 19361529 DOI: 10.1016/j.jtbi.2009.03.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 03/31/2009] [Accepted: 03/31/2009] [Indexed: 11/20/2022]
Abstract
Viral hepatitis A, as other endemic diseases, represents a public health priority worldwide. To study long-time scale human pathogens through individual-based simulations, the development of a dynamic network of contacts is required. In this work, we introduce an individual-based model accounting for the birth and death of the individuals, the generation of new households, and the educational career of the individuals, in order to investigate viral hepatitis A dynamics in the most affected Italian areas. Intervention options such as targeted vaccination, social distancing measures (e.g., closure of day care centers and kindergartens) and improvements in standards of living and hygiene are evaluated. Results show that a very low vaccination coverage is sufficient to control hepatitis A in Italy, while its elimination is not possible since new cases are continuously imported from high endemicity areas outside the country. Finally, the considered social distancing measures can be counterproductive since the fraction of recovered individuals does not decline while the age at infection increases, thus augmenting the probability of developing acute symptoms.
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Affiliation(s)
- Marco Ajelli
- Fondazione Bruno Kessler, via Sommarive 18, I-38123 Trento Povo, Italy.
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