Seroepidemiology of hepatitis A and E virus infections in Tehran, Iran: a population based study

Reverse Vaccinology and Immunoinformatic Approach for Designing a Bivalent Vaccine Candidate Against Hepatitis A and Hepatitis B Viruses

Hepatitis A and B are two crucial viral infections that still dramatically affect public health worldwide. Hepatitis A Virus (HAV) is the main cause of acute hepatitis, whereas Hepatitis B Virus (HBV) leads to the chronic form of the disease, possibly cirrhosis or liver failure. Therefore, vaccination has always been considered the most effective preventive method against pathogens. At this moment, we aimed at the immunoinformatic analysis of HAV-Viral Protein 1 (VP1) as the major capsid protein to come up with the most conserved immunogenic truncated protein to be fused by HBV surface antigen (HBs Ag) to achieve a bivalent vaccine against HAV and HBV using an AAY linker. Various computational approaches were employed to predict highly conserved regions and the most immunogenic B-cell and T-cell epitopes of HAV-VP1 capsid protein in both humans and BALB/c. Moreover, the predicted fusion protein was analyzed regarding primary and secondary structures and also homology validation. Afterward, the three-dimensional structure of vaccine constructs docked with various toll-like receptors (TLR) 2, 4 and 7. According to the bioinformatics tools, the region of 99-259 amino acids of VP1 was selected with high immunogenicity and conserved epitopes. T-cell epitope prediction showed that this region contains 32 antigenic peptides for Human leukocyte antigen (HLA) class I and 20 antigenic peptides in terms of HLA class II which are almost fully conserved in the Iranian population. The vaccine design includes 5 linear and 4 conformational B-cell lymphocyte (BCL) epitopes to induce humoral immune responses. The designed VP1-AAY-HBsAg fusion protein has the potency to be constructed and expressed to achieve a bivalent vaccine candidate, especially in the Iranian population. These findings led us to claim that the designed vaccine candidate provides potential pathways for creating an exploratory vaccine against Hepatitis A and Hepatitis B Viruses with high confidence for the identified strains.

Hepatitis A in the Eastern Mediterranean Region: a comprehensive review

INTRODUCTION

With 583 million inhabitants, the Eastern Mediterranean Region (EMR) is a worldwide hub for travel, migration, and food trade. However, there is a scarcity of data on the epidemiology of the hepatitis A virus (HAV).

METHODS

The MEDLINE and grey literature were systematically searched for HAV epidemiological data relevant to the EMR region published between 1980 and 2020 in English, French, or Arabic.

RESULTS

Overall, 123 publications were extracted. The proportion of HAV cases among acute viral hepatitis cases was high. HAV seroprevalence rate ranged from 5.7% to 100.0% and it was decreasing over time while the average age at infection increased.

CONCLUSION

In the EMR, HAV remains a significant cause of acute viral hepatitis. The observed endemicity shift will likely increase disease burden as the population ages. Vaccinating children and adopting sanitary measures are still essential to disease prevention; vaccinating at-risk groups might reduce disease burden even further.

Seroprevalence of Hepatitis E Virus Infection in Middle Eastern Countries: A Systematic Review and Meta-Analysis

Hepatitis E virus (HEV) is a hepatotropic virus that is a major public health concern worldwide. Autochthonous HEV is spread through oral feces in unsanitary environments, as well as vertical and, occasionally, blood transfusion. HEV is more common in developing countries, but it has recently become more widespread in developed countries as well. The Middle East (ME) has long been an endemic location for HEV infection. Therefore, the aim of this systematic review and meta-analysis was to assess the seroprevalence of anti-HEV antibodies in ME countries. The author systematically searched five databases, namely ScienceDirect, EMBASE, Scopus, PubMed, and Google Scholar, to identify English-language articles published on or before 25 April 2022. Comprehensive meta-analysis software was used for all statistical analyses (CMA, version 3, BioStat, Englewood, CO, USA). After quality control and exclusion of irrelevant studies, 80 studies were included in the qualitative synthesis and meta-analysis. A forest plot showed that the overall pooled seroprevalence of HEV infection in ME countries in the fixed-effect and random-effect models were 21.3% (95% CI: 0.209–0.216) and 11.8% (95% CI: 0.099–0.144), respectively. Furthermore, the findings showed a high level of heterogeneity (I2 = 98.733%) among the included studies. In both fixed-effect and random-effect models, the seroprevalence of HEV infection by country was high in Egypt as compared to other regions, at 35.0% (95% CI: 0.342–0.359), and 34.7% (95% CI: 0.153–0.611), respectively. The seroprevalence of HEV infection by country was high among pregnant women, at 47.9% (95% CI: 0.459–0.499) in the fixed-effect model, and in renal transplant recipients, at 30.8% (95% CI: 0.222–0.410) in the random-effect model. The seroprevalence of HEV infection varies by country and study population in the Middle East. More research is needed to determine the disease’s incidence, morbidity, and mortality in the region, where it is prevalent.

Seroprevalence of Hepatitis A and Hepatitis E Viruses among Pregnant Women in Northern Iran

Background

Hepatitis A (HAV) and hepatitis E viruses (HEV) are endemic in Iran and are known major causes of acute viral hepatitis. Also, during pregnancy, they are associated with severe outcomes. Therefore, it is vital to evaluate the antibody levels against HAV and HEV in pregnant women to avoid severe outcomes incidence. Study design and methods. A total of 247 pregnant women were enrolled in this prospective cross-sectional study. In addition to completing the questionnaire and interviewing all participants, the serum samples were tested for anti-HAV and anti-HEV IgG using the enzyme-linked immunosorbent assay (ELISA). The association between anti-HAV and anti-HEV antibodies status and risk factors was evaluated.

Results

The mean age of patients was 28.06 ± 5.29 years. Anti-HAV antibody was found in 111 patients (44.9%), while anti-HEV antibody was detected in only two pregnant women (0.8%). The seroprevalence of HAV was inversely related to the level of education. There was no significant correlation between HAV antibody levels and age, marital status, residence location, and pregnancy trimesters.

Conclusion

Considering many complications of these diseases in pregnancy, the detection of enteroviral hepatitis, especially HAV in pregnant women, is necessary, and therefore, proactive measures, such as promoting education, improving people awareness, and vaccination, are recommended.

Accelerating Effects of Vitamin E Supplementation on Liver Enzyme Normalization in Children with Acute Hepatitis A Infection; a Single-Blinded Clinical Trial

Background: Hepatitis A virus (HAV) infection is a widespread disease with no specific treatment. Objectives: In the present study, we investigated the effects of vitamin E in the treatment of acute HAV infection in children. Methods: This clinical trial study was conducted on 142 patients with acute HAV infection referred to Amir-Al-Momenin Hospital of Zabol during February 2016-August 2017. The patients were randomly divided into two groups of intervention (Vit E, n = 71) and control (no medication, n = 71). Liver enzymes were monitored during a six-month period. Results: The mean ages of the patients were 8.4 ± 2.5 and 9 ± 4.3 years in the control and intervention groups, respectively. Male participants constituted 36 (50.7%) and 35 (49.3%) in the control and intervention groups, respectively. In both the treatment and control groups, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) significantly decreased over six months during the study (P < 0.001). AST level (IU/L) was significantly lower in the children who received vitamin E than controls at one-month (P = 0.01), two-month (P = 0.002), three-month (P = 0.005), four-month (P < 0.001), and six-month (P = 0.002) post-treatment periods. There was no significant difference comparing ALT between the intervention and control groups except for two months post-treatment (P = 0.01). Conclusions: Our study showed that the administration of vitamin E in children with acute hepatitis A can accelerate liver enzyme normalization.

Cross-sectional Seroprevalence and Genotype of Hepatitis E Virus in Humans and Swine in a High-density Pig-farming Area in Central China

Hepatitis E virus (HEV) infection is a common public health problem in developing countries. However, the current prevalence of HEV and the relationship of HEV genotype between swine and human within high-density pig-farming areas in central China are still inadequately understood. Here, cross-sectional serological and genotypic surveys of HEV among the 1232 general population, 273 workers occupationally exposed to swine, and 276 pigs in a high-density pig-breeding area, were undertaken by ELISA and nested RT-PCR methods. Anti-HEV IgG was detected in 26.22% of general population and 48.35% of occupational workers. The prevalence of swine serum HEV-Ag was 6.52%. The prevalence of anti-HEV IgG was significantly higher among the workers occupationally exposed to swine than among the general population. An increased HEV seropositivity risk among the general population was associated with either being a peasant or male and was very strongly associated with the increase of age. Among the occupationally exposed group, the prevalence of anti-HEV IgG antibodies increased with age and working years. Among the 30 HEV-IgM-positive people, the infection rates of clerks in the public, peasants, pork retailers, and pig farmers were higher than those of others. A phylogenetic analysis revealed that all the isolates belonged to subgenotype 4_d, and four people and four pigs shared 97.04%-100% sequence homology. This study revealed a high HEV seroprevalence among the general population and workers occupationally exposed to swine in the Anlu City, and supports the notion that swine are a source of human HEV infection.

A Special Risk Group for Hepatitis E Infection: The First Record of North Cyprus

Hepatitis E virus (HEV) is transmitted by a fecal oral route from animals to humans following exposure to the body fluids of infected animals. We investigated the seroprevalence of anti-hepatitis E (anti-HEV) antibodies by monitoring IgG and IgM virus antibodies amongst employees in the animal industry in North Cyprus through a cross-sectional study. Samples were taken from individuals without occupational exposure to animals and from those who worked with animals (doing animal husbandry, veterinary work or butchery). Enzyme-linked immunoassays were used to detect anti-HEV IgG and IgM in the blood samples. The prevalence of anti-HEV IgG antibodies was 3.0% (12/400), while the prevalence of anti-HEV IgM antibodies was 0.25% (1/400). The prevalence of anti-HEV IgG amongst the samples received from females was approximately 2.5-fold higher than samples received from males (2.4%). Anti-HEV IgG was detected amongst 7% of animal husbandry workers and amongst 2% of veterinarians and butchers. The current findings represent the first records of HEV surveillance in Cyprus. We investigated the seroprevalence of anti-HEV by monitoring IgG and IgM virus antibodies amongst employees.

Prevalence of HAV Ab, HEV (IgG), HSV2 IgG, and Syphilis Among Sheltered Homeless Adults in Tehran, 2012

Background: This study investigated the prevalence for hepatitis A virus (HAV), hepatitis E virus (HEV), herpes simplex virus type 2 (HSV2) and syphilis among homeless in the city of Tehran.

Methods: In this cross-sectional study, 596 homeless were recruited in Tehran. A researcher-designed questionnaire was used to study demographic data. Using enzyme-linked immunoassay, and rapid plasma reagin (RPR) test, we evaluated the seroprevalence of HAV anti-body, HEV IgG, herpes, HSV2 IgG, and syphilis among sheltered homeless in Tehran. The associations between the participant’s characteristics and infections were evaluated using logistic regression and chi-square.

Results: A total of 569 homeless, 78 women (13.7%) and 491 men (86.3%) were enrolled into the study from June to August 2012. Their age mean was 42 years and meantime of being homeless was 24 months. Seroprevalence of syphilis, HEV IgG, HSV2 IgG and HAV Ab was 0.55%, 24.37%, 16.48%, and 94.34%, respectively. History of drug abuse was reported in 77.70%; 46.01% of them were using a drug during the study and 26.87% of them had history of intravenous drug abuse. Among people who had intravenous drug abuse, 48.25% had history of syringe sharing.

Conclusion: The prevalence of HAV, HEV and HSV2 were higher than the general population while low prevalence of syphilis was seen among homeless peoples who are at high risk of sexually transmitted infection (STD). Our findings highlighted that significant healthcare needs of sheltered homeless people in Tehran are unmet and much more attention needs to be paid for the health of homeless people.

Prevalence of hepatitis E infection in the general population of Iran: a systematic review and meta-analysis

Aim: Hepatitis E is a form of acute viral hepatitis, which is caused by hepatitis E virus (HEV). The study objective was to evaluate the prevalence of HEV to provide an overall relative frequency in Iran. Methods: In this study, databases such as PubMed and Scopus were searched using the following keywords according to MeSH, “Hepatitis E virus”, “Epidemiology”, “Enzyme-linked immunosorbent assay (ELISA)” and “Iran”. Then studies which had reported prevalence of HEV were selected. Results: We selected 36 researches out of 9246 for our study. From all the samples, the pooled estimated prevalence of HEV positive was 9.7%. It should be noted that HEV infection's relative frequency varied from 1.1% in Tehran to 46.1% in Ahvaz. Conclusion: HEV is common in Iran, although comparing to some neighboring countries, its prevalence is lower.

Seroprevalence of Hepatitis E Virus in Iran: A Systematic Review and Meta-analysis

BACKGROUND Hepatitis E virus (HEV) is one of common causes of viral hepatitis worldwide with higher prevalence in tropical and subtropical regions. Although epidemics of HEV have been reported from Iran, there are variable reports of this infection out of epidemics from different parts of Iran. This study aimed to determine the seroprevalence of HEV in Iran. METHODS In this systematic review and meta-analysis we searched PubMed, Scopus, Science direct, Google Scholar, Scientific Information Databank (SID), IranMedex, and Magiran for all relevant studies published in either English or Persian languages, up to 2015. Pooled seroprevalence estimates with a DerSimonian-Laird random-effects model were calculated. Statistical heterogeneity among the included studies was evaluated by Cochrane Q statistic and I2. RESULTS 38 studies fulfilled the inclusion criteria compromising 18461 participants. The pooled seroprevalence rate of HEV in Iran was estimated about 10% (95% CI=0.09-0.12) with maximum and minimum of 46% (95 % CI=0.42-0.50), and 0.01% (95 % CI=0.000-0.002), respectively. CONCLUSION HEV is common in Iran although the prevalence is lower than some neighbor countries.

Epidemiology of hepatitis E virus in Iran

Iran is known as an endemic country for hepatitis E virus (HEV) infection, while there are variations in the epidemiology of HEV infection throughout the country. The available epidemiological studies in different regions of Iran show HEV seroprevalence of 1.1%-14.2% among general population, 4.5% -14.3% among blood donors, 6.1%-22.8% among injecting drug users, 6.3%-28.3% among hemodialysis patients, 1.6%-11.3% among patients infected with other hepatitis viruses, 27.5% among patients with chronic liver disease, 30.8% among kidney transplant recipient patients, and 10%-16.4% among human immunodeficiency virus-infected patients. These variations reflect differences in the status of public health and hygiene, risk factors, and routes of transmission in different regions and groups. Therefore, it is necessary to review the epidemiology of HEV infection to determine the most prevalent risk factors and routes of transmission, and to evaluate the effectiveness of preventive strategies employed in the public health services of the country. Moreover, the other epidemiological aspects of HEV, including the genotypic pattern, extra hepatic manifestations, and incidence of chronic infection need to be investigated among Iranian population to expand the current knowledge on the epidemiology of HEV and to clarify the real burden of HEV infection. Therefore, this review was performed to provide a general overview regarding the epidemiology of HEV in Iran.

Hepatitis A Virus and Hepatitis E Virus Seroprevalence Among Blood Donors in Tehran, Iran

BACKGROUND

Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are both transmitted by the fecal-oral route and are known as the leading causes of acute viral hepatitis in the world, especially in developing countries. There is a lack of updated data on HAV and HEV seroprevalence in Iran.

OBJECTIVES

The aim of this study was to determine the seroprevalence of HAV and HEV among a group of blood donors in Tehran, Iran.

MATERIALS AND METHODS

A cross-sectional study was performed from July 2014 to December 2014, on a total of 559 blood donors referred to the Tehran blood transfusion center. The serum samples were tested for antibodies to HAV and HEV, using the enzyme-linked immunosorbent assay.

RESULTS

In the present study, 536 (95.9%) cases were male and 23 (4.1%) female with mean age of 38 years. Out of 559 blood donors, 107 (19.1%) were first-time donors, 163 (29.2%) lapsed donors and 289 (51.7%) regular donors. Anti-HAV was found in 395 (70.7%) and anti-HEV in 45 (8.1%) of the blood donors. The HAV and HEV seroprevalence increased by age. There was no significant difference between genders in terms of anti-HAV and anti-HEV status. The HAV and HEV seroprevalence was significantly related to the level of education, where the donors with higher level of education had lower rate of HAV and HEV seroprevalence. The HAV and HEV seroprevalence was significantly higher in regular and lapsed donors than in first-time donors.

CONCLUSIONS

The present study showed that both HAV and HEV infections are still endemic in Iran.

Hepatitis A Virus Infection, Vaccination and Iranian Healthcare Workers

CONTEXT

Hepatitis A virus (HAV) infection is an important public health problem. It is estimated that about 1.4 million cases of HAV infection occur every year worldwide. Non-immune healthcare workers (HCWs) can be at higher risk of HAV infection in comparison to general population and an appropriate preventive method should be considered for them.

EVIDENCE ACQUISITION

For finding related articles, a comprehensive search was performed in Scopus, PubMed and Google Scholar and all appropriate combinations of following keywords were considered; "healthcare provider", "healthcare personnel", "healthcare worker", "nurse" "medical students", "Iran", "Hepatitis A" and "vaccination". Also we did a search in Persian language in Google scholar and scientific information database (SID) to find related Persian literature.

RESULTS

A gradual shift in age of HAV infection has been seen from childhood toward adulthood. Data about HAV seropositivity among Iranian HCWs are very limited. However based on the recent studies, it seems that HAV seropositivity has been reduced among HCWs in comparison with the past. All recent studies have suggested HAV vaccination for HCWs.

CONCLUSIONS

Available limited studies show that Iranian healthcare personnel need HAV vaccination. However, for selecting an appropriate preventive method for this high risk group, more original studies are still needed.

Hepatitis E Virus Seroprevalence Among Blood Donors in Bushehr, South of Iran

BACKGROUND

Although so far several studies have determined the hepatitis E virus (HEV) prevalence in some parts of Iran, no data exists regarding the HEV seroprevalence in Bushehr province as the southernmost point in Iran yet.

OBJECTIVES

The aim of this study was to evaluate the seroprevalence of anti-HEV IgG among the blood donors in Bushehr.

PATIENTS AND METHODS

A total of 628 blood donor samples were collected from September to October 2013, after obtaining informed written consents, and analyzed for the presence of anti-HEV IgG using commercial HEV enzyme-linked immunosorbent assay (ELISA) kit. All the samples were tested by two ELISA kits and evaluated for liver function test.

RESULTS

Overall, 105 (16.7%) blood samples were positive for HEV-specific-IgG antibodies, while 523 (83.8%) were negative. The presence of anti-HEV IgG was not associated with gender; however, it was correlated with age. It was indicated that the anti-HEV prevalence increases by age and there was a significant difference between the age groups regarding HEV seropositivity.

CONCLUSIONS

High HEV seroprevalence (16.7%) was observed among the blood donors in Bushehr province. It appears that exposure to HEV increases with age; although, more people should be examined.

A Study on Genetic Association of Interleukin-16 Single Nucleotide Polymorphism (rs1131445) With Chronic Hepatitis B Virus Infection in Iranian Patients

BACKGROUND

Interleukin-16 (IL-16) is an immunomodulatory cytokine, which plays an important role in some inflammatory and autoimmune diseases such as hepatitis B, which is a major health concern worldwide.

OBJECTIVES

In this study, we aimed to investigate the plausible association between IL-16 polymorphism and chronic HBV susceptibility in an Iranian population.

PATIENTS AND METHODS

In a case-control study, we analyzed rs1131445 polymorphism in the microRNA binding site of the IL-16 gene in 262 patients with chronic hepatitis B and 269 healthy controls, using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and DNA sequencing technology to confirm our results.

RESULTS

Altogether, in this investigation, a significant association was observed between the IL-16 TC genotype compared with the TT genotype (OR = 0.696, 95% CI: 0.485 - 0.997, P = 0.048), after adjustments for confounders including age and gender.

CONCLUSIONS

These findings show that immunogenetic factors, such as single nucleotide polymorphism in IL-16, could be a risk factor for susceptibility to chronic HBV infection. However, further investigations are needed to verify these results.

Seroprevalence of Hepatitis A and E Virus Infections Among Healthy Population in Shiraz, Southern Iran

Background:

Enterically-transmitted acute viral hepatitis is caused predominantly by hepatitis A virus (HAV) and hepatitis E virus (HEV). The prevalence of HEV and HAV infections varies in different geographical regions.

Objectives:

This study was conducted to determine the prevalence of HEV and HAV infections among Iranian healthy individuals in southern Iran.

Patients and Methods:

Totally, 1030 samples were collected from healthy subjects in schools, those referred to tertiary outpatient clinics and health centers in Shiraz between November 2011 and May 2012. Their ages ranged between six months and 95 years. The presence of total anti-HAV and anti-HEV immunoglobulin M (IgM) in plasma was assessed by ELISA.

Results:

The results showed that 66.2% and 0.6% of the general population in this area were positive for total anti-HAV and IgM antibodies by ELISA, respectively. As seen, 13.4% and 0.9% were positive for total anti-HEV and IgM antibodies, respectively. The difference in total anti-HAV and anti-HEV antibodies was significant among the age groups (P < 0.001).

Conclusions:

This study showed that the prevalence rates of HAV and HEV antibodies were positively correlated with age. The results demonstrated that the infection with these two viruses in the region was high and some high-risk individuals including females at child-bearing age were more susceptible. HAV vaccination could be recommended for antibody-negative adults.

Hepatitis E virus in the countries of the Middle East and North Africa region: an awareness of an infectious threat to blood safety

PURPOSE

Hepatitis E virus (HEV) is mainly transmitted through contaminated water supplies which make the virus endemic in developing countries including countries of the Middle East and North Africa (MENA) region. Recent reports suggest potential risk of HEV transmission via blood transfusion.

METHODS

Related articles on HEV were collected by searching through the 25 countries of the MENA region using Pubmed and Medline within the past 14 years: January 2000-August 2014.

RESULTS

One hundred articles were extracted, of which 25 were not eligible. The articles discussed the seroprevalence of HEV and HEV markers in 12 countries. Eight articles provided data on HEV in blood donors. The seroprevalence of HEV in the general MENA population ranged from 2.0 to 37.5% and was higher in males than in females. Prevalence increased with age, but exposure seems to be in early life.

CONCLUSIONS

In the MENA region, the role of HEV as an infectious threat to blood safety is under-investigated. More data are needed to quantify the risk of transmission and to assess clinical outcomes. This requires, at least, surveillance screening of donors and recipients for HEV markers using sensitive and specific serological tests. At the present time, serious consideration should be given to selective screening for certain groups of patients (e.g., immunocompromised, pregnant women and others) who commonly require blood transfusion and are at high risk of hepatic failure or chronicity from HEV infection.

Prevalence of Hepatitis E Virus among Adults in South-West of Iran

Background. Knowledge regarding prevalence of HEV in general population can be an indicator of the public health and hygiene. Therefore, this study was conducted to evaluate the prevalence of HEV among adults in South-West of Iran. Methods. Blood samples were taken from 510 participants, 206 (40.4%) males and 304 (59.6%) females from February to July 2014. Detection of anti-HEV IgG and IgM antibodies was carried out by ELISA test. Results. The overall anti-HEV IgG and IgM prevalence rates were 46.1% and 1.4%, respectively. Anti-HEV IgG and IgM seropositivity were not statistically associated with gender and race/ethnicity. Meanwhile, there were significant differences between the age groups regarding HEV IgG and IgM seropositivity. HEV IgG seroprevalence increased with age from 14.3% in subjects aged 18-30 years to 71.4% in persons over 71 years old, and considerably individuals aged 61 to 70 years had the highest HEV prevalence (90.9%). Also, 5.7% in the age group 18-30 years and 2.2% in the age group 31-40 years were positive for anti-HEV IgM antibodies and the highest rate was observed in subjects aged 18-30 years. Conclusion. In conclusion, high HEV IgG seroprevalence of 46.1% was observed among adults in South-West of Iran.

Seroprevalence of hepatitis A in Iranian adolescents: is it time to introduce a vaccine?

Universal vaccination of children for hepatitis A virus (HAV) has emerged as a cost-effective strategy to prevent this infection in regions with high incidence of symptomatic disease. Age-specific seroprevalence surveys are practical and reliable methods to estimate the rate of susceptibility in populations, and to help the implementation of vaccination policies. We surveyed the age-specific HAV seroprevalence in a nationally representative sample of Iranian adolescent students aged 10-18 years. Serum samples (n = 2494) were tested by enzyme immunoassay for total anti-HAV antibody. The overall rate of HAV seropositivity was 64% [95% confidence interval (CI), 62-66), which increased sharply from 14·8% (95% CI 7-23) at age 10 years to 72·9% (95% CI 68-78) at age 13 years, without a significant increase up to age 18 years. No significant difference in HAV seroprevalence was observed between males and females (63% vs. 65·1%), or urban and rural areas (63·4% vs. 65·2%); the seropositivity rate was similar in four different socioeconomic regions of Iran. We conclude that the seroconversion rate of HAV is high in Iranian adolescents and therefore mass vaccination of children may be necessary and should be considered by national health authorities.

HAV Immunity in Iranian Medical Students

BACKGROUND

Hepatitis A, a fecal-oral transmitted disease, which has been considered endemic in developing countries, seems to change its pattern in developing countries because of their improved socioeconomic status.

OBJECTIVES

In the present study, we aimed to determine the need of vaccination in 270 students at AJA University of Medical Sciences.

MATERIALS AND METHODS

The serum level of anti-HAV antibody was checked in 270 students of AJA University of medical students, and effect of different factors, including age, gender, pre-university entrance exam region, familial education, familial income, clean water availability, and previous history of jaundice were tested.

RESULTS

Of total 270 students, 30 were female. Their age ranged between 18 and 30 years old with the mean age of 20.58 years and just 34% of students had positive level of anti-HAV antibody. Age and sex had no role in positive serum level of anti-HAV antibody. According to analyzed data, lack of clean water availability, pre-university entrance exam region, lower family education, and poor health status estimation increased statistically the risk of HAV infection.

CONCLUSIONS

Because 66% of students were anti-HAV antibody negative and they will work as health care workers in future, our study suggest vaccinating all students accepted at AJA University of Medical Sciences.

High Prevalence of Symptomatic Hepatitis A Infection in Rural Area of Chaharmahal VA Bakhtiari Province, Iran

INTRODUCTION

Hepatitis A virus (HAV) is the most common cause of hepatitis during childhood and is an important public health problem. Therefore, the aim of this study was to investigate an outbreak of symptomatic viral hepatitis in children and in young adults in a rural area from Chaharmahal Va Bakhtiari Province, Iran.

MATERIALS AND METHODS

Serum samples from the 70 patients with icterus, who were suspected for HAV infection, referred to a therapeutic center in a central province of Iran from February to July, 2010 were tested for IgM specific antibody to HAV, using Enzyme linked Fluorscent assay (ELFA) Kit (General Biological Corp., Hsinchu, Taiwan).

RESULTS

All of the 70 children had jaundice. The ELFA results showed that 48 out of 70 (68.6%) tested positive for anti-HAV specific antibody (IgM). The mean age of the individuals were 12.81+12.2 and 23 of them (32.8%) were females. There was significant relationship between seropositivity for IgM anti-HAV antibody and age group in the patients studied (p<0.05).

CONCLUSION

The high number of cases identified, may indicate an outbreak of hepatitis A in this region with the children as the most susceptible age group to this symptomatic infection.

Epidemiology of hepatitis E virus in China: results from the Third National Viral Hepatitis Prevalence Survey, 2005-2006

In China, hepatitis E virus (HEV) is prevalent and causes disease, but its epidemiological profile is not well understood. We used a commercial enzyme-linked immunosorbent assay to detect total antibodies to hepatitis E virus in 15,862 serum samples collected during the Third National Viral Hepatitis Prevalence Survey. The results were analyzed to calculate estimates of HEV seroprevalence and to examine the effects of some putative risk factors. The seroprevalence of HEV in the general Chinese population during the period from 2005 through 2006 was 23.46% (95% confidence interval [CI], 18.41%–28.50%). The farming population, the age group of 15–60 year olds, and those living in the Midwest or Mideast region and in Xinjiang province had the highest seroprevalence estimates. The prevalence of HEV is high in China. The seroprevalence rate of HEV shows an unbalanced distribution among areas with different geographic location and economic development levels. The characteristics of the distribution associated may be due to the route of HEV transmission (via contaminated water or animal reservoirs). Within the same region, the seroprevalence of HEV is generally increased with age.

Hepatitis A and E seroprevalence and associated risk factors: a community-based cross-sectional survey in rural Amazonia

BACKGROUND

Hepatitis A virus (HAV) and hepatitis E virus (HEV) are both transmitted by the faecal-oral route, and represent common causes of acute hepatitis in developing countries. The endemicity of HAV infection has shifted from high to moderate in Brazil. Human cases of HEV infection seem to be rare, although the virus has been detected in swine livestock and effluents of slaughterhouses. This study was to determine the epidemiology of hepatitis A and E in one of the largest agricultural settlements in the Amazon Basin of Brazil.

METHODS

Serum samples collected from 397 individuals aged between 5 and 90 years during a population-based cross-sectional survey were tested for anti-HAV and anti-HEV antibodies. Associated risk factors and spatial clustering of HAV and HEV seropositivity were also analyzed.

RESULTS

The overall rate of HAV seropositivity was 82.9% (95% confidence interval (CI), 79.2-86.6%). Multilevel logistic regression analysis identified increasing age (in years; odds ratio (OR), 1.097; 95% CI, 1.050-1.147; P < 0.001) and crowding (OR, 1.603; 95% CI, 1.054-2.440; P = 0.028) as significant risk factors for HAV seropositivity. Anti-HEV IgG was detected in 50/388 settlers (12.9%, 95% CI, 9.5-16.2%). Anti-HEV IgM was detected in 7/43 (16.3%) anti-IgG positive samples, and 4 of them had a confirmed result by immunoblot. Increasing age was the only significant determinant of HEV seropositivity (OR, 1.033; 95% CI, 1.016-1.050; P < 0.001). No significant spatial clustering of HAV and HEV seropositivity was detected in the area.

CONCLUSIONS

Both HAV and HEV are endemic, with differing rates of infection in children and adults in this rural setting of the Brazilian Amazon. Anti-HEV prevalence was considerably higher than those previously reported in Brazil. The detection of HEV- specific IgM antibodies in four asymptomatic individuals is highly suggestive of the circulation of HEV in this rural population.

Determinants of poor outcome in patients with hepatitis A infection: a four-year retrospective study in Shiraz, Southern Iran

There are 1.4 million estimated cases of hepatitis A every year worldwide. We aimed to detect the correlates of poor outcome in patients with hepatitis A virus (HAV) infection. In this four-year retrospective study, which was conducted in Shiraz, Southern Iran, data of all hospitalized HAV patients were analyzed by SPSS and STATA. Out of 110 HAV patients, 8 (7.3 %) developed hepatic encephalopathy, and 7 (6.4 %) died. The results show that 19 years of age is a cutoff level for predicting mortality, with a sensitivity of 42.9 % and specificity of 91.3 %, and with an area under the curve (AUC) of 0.595 (95 % CI, 0.309-0.881). Every one-year increase in age adds 3 % to the mortality rate from severe hepatitis A. The cutoff level of alanine aminotransferase (ALT) for predicting death is 1819.5 IU/L, with a sensitivity of 100 %, specificity of 68 %, and AUC 0.877 (95 % CI, 0.777-0.977). Every 100 IU/L increase in ALT is associated with a 0.1 % increase in the risk of death. Patients from large families (OR, 0.583, 95 % CI, 0.46-0.74) and those who are not the firstborn child of their family (OR, 0.287, 95 % CI, 0.146-0.564) have better outcome. Adult patients with hepatitis A who are first children, are from a small family, or have a very high level of ALT are more prone to a poor outcome of this infection. Public education and establishment of a national surveillance system for HAV and an HAV vaccination program for high-risk populations should be regarded among the priorities of the health system of Iran.

Hepatitis A virus in the Middle East and North Africa region: a new challenge

During the past three decades, a gradual shift in the age of infection with hepatitis A virus (HAV) from early childhood to adulthood has been observed. There is a general lack of updated data on HAV burden of disease, incidence and age-specific seroprevalence in countries of the Middle East and North Africa (MENA) region. The aim of this article is to review the published data on anti-HAV seroprevalence, an important tool to monitor infections rates, in countries of the MENA region and associated risk factors including water and socioeconomic data when available. Data on anti-HAV seroprevalence were found for 12 of 25 MENA countries. We show that MENA countries, similar to other areas in the world, have a clear shift in HAV incidence with a decline among young age groups and an increase among adults and older individuals. This would likely be associated with increased morbidity and increased risks of outbreaks among younger age groups. Consequently, the continuous surveillance of hepatitis A cases and the inclusion of hepatitis A vaccine in the expanded immunization programmes are needed in countries of the MENA.

Hepatitis A infection in patients with chronic viral liver disease: a cross-sectional study in Jahrom, Iran

Infection with hepatitis A virus (HAV) in patient with chronic liver disease (CLD; due to hepatitis B or hepatitis C) may cause severe disease and fulminant liver failure. This study aimed to determine the seroprevalence of HAV antibodies in patients infected with HCV or HBV in Iran (Jahrom city). A total of 159 patients with underlying CLD were recruited between September 2012 and February 2013. Serum samples were collected from each patient and tested for anti-HAV using enzyme-linked immunosorbent assay (ELISA). The overall seroprevalence of total anti-HAV was 79·2%. Patients aged 20-30 years had the lowest (28·3%) anti-HAV seropositivity and those aged >50 years had the highest (95%) seropositivity. The overall prevalence of anti-HAV in patients with chronic HCV and HBV infection was 93·7% and 77·1%, respectively. The anti-HAV seropositivity in liver cirrhosis patients was 100% compared to CLD patients. Because of low HAV immunity in younger CLD patients, vaccination against HAV should be considered.

Seroepidemiology of hepatitis E virus infection in an urban population in Zambia: strong association with HIV and environmental enteropathy

BACKGROUND

Hepatitis E virus (HEV) infection causes major epidemics of infectious hepatitis, with high mortality rates in pregnant women. Recent reports indicate that HEV coinfections with human immunodeficiency virus (HIV) may have a more protracted course. However, the impact of HEV infections in communities heavily affected by HIV remains poorly studied. We set out to examine age-related seroprevalence in a community where we have previously carried out studies on environmental enteropathy.

METHODS

Blood samples from 194 children and 106 adults were examined for immunoglobulin G and immunoglobulin M antibodies for HEV. HEV data were correlated with HIV status and morphometric analysis of small intestinal biopsies.

RESULTS

Seroprevalence rose throughout childhood, from 8% in children aged 1-4 years, to 36% in children aged 10-14 years. In adults, the overall prevalence was 42%, with 28% in HIV-seronegative adults and 71% in HIV-seropositive adults (odds ratio, 6.2; 95% confidence interval, 2.2-18; P = .0001). In adults, villous height and crypt depth measurements showed that HEV seropositivity was associated with worse enteropathy (P = .05 and P = .005, respectively).

CONCLUSIONS

HEV infection is common in Zambia. In adults it is strongly associated with HIV status, and also with environmental enteropathy.

Light and Darkness: Prevalence of Hepatitis E Virus Infection among the General Population

Human hepatitis E virus (HHEV) spreads early in life among the population in areas endemic for genotype 1 and infects mainly adults in areas endemic for genotype 3, where it would be responsible for about 10% of cases of suspected acute viral hepatitis of unknown etiology and for a number of subclinical, unrecognized infections. The overall prevalence of antibody to HHEV is high in most of the former areas and low in most of the later ones, but wide regional differences have been recorded in both cases. "Hot spots" of HHEV infection would exist for both types of strains in particular regions or among particular populations of the world. Studies on pork derivatives, shellfish bivalves, and vegetables for HHEV contamination at the sale point need to be extended for evaluating the impact of the agent on food safety, and the meaning of the finding of HHEV genotype 1 genomes in urban sewage from developed countries should be established through active surveillance. Consensus about technical issues in regard to anti-HEV testing would improve the knowledge of the HHEV epidemiology. Studies in particular regions and populations, and introduction of molecular diagnosis in the clinical setting as a routine tool, would also be required.

Seroprevalence of hepatitis e among pregnant women in urmia, iran

BACKGROUND

While hepatitis E virus (HEV) mostly causes self-limited disease in general population, it is more severe in pregnant women.

OBJECTIVES

This study aimed to investigate the seroprevalence of anti-HEV IgG among a population of pregnant women in West Azerbaijan of Iran .

PATIENTS AND METHODS

One hundred thirty six pregnant women referred to urban health centers of Urmia for pursuing pregnancy-related health services were enrolled in a descriptive, cross-sectional study. Anti-HEV IgG antibody was evaluated using enzyme-linked immunosorbent assay (enzyme-linked immunosorbent assay, ELISA; Dia.Pro; Diagnostic Bioprobes).

RESULTS

Only five (3.6%) of 136 cases had positive results for anti-HEV IgG. There was no significant difference between age (P=0.88), and income level (P = 0.19) of the two seropositive and seronegative groups. All seropositive cases were from urban areas.

CONCLUSIONS

The seroprevalence of anti-HEV IgG is low in the population of pregnant women in , similar to the rates reported from developed countries. Effective health services and provision of safe water supplies in Urmia may take role in this low prevalence rate.

Hepatitis E virus infection in patients infected with human immunodeficiency virus in an endemic area in Iran

Some studies have suggested that hepatitis E virus is more frequent in human immunodeficiency virus (HIV) patients and can progress to chronic infection. We aimed to determine the prevalence of hepatitis E virus antibodies and RNA in a series of 100 HIV-infected patients in Tehran, Iran, with comparison to 52 healthy HIV, hepatitis B and C-negative blood donors as controls. HIV-infected patients were also tested for hepatitis E virus-RNA. Among the HIV-infected patients, 10% had antibodies to hepatitis E virus - a finding not significantly different from the uninfected controls (11.5%). No HIV-infected patients had hepatitis E virus IgM antibodies nor did any have detectable hepatitis E virus-RNA. We found no associations between anti-hepatitis E virus IgG-seropositivity and age, sex, route of HIV acquisition, aminotransferases levels, CD4, antiretroviral therapy, hepatitis B virus and hepatitis C virus co-infection. Hepatitis E virus is relatively prevalent in our HIV-infected patients, although without evidence of chronic infection and no more common than among HIV-negative controls or the general population. For the present, we do not recommend routine screening for hepatitis E virus infection in HIV-infected patients in our moderately endemic region.