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Lopatukhina MA, Kyuregyan KK, Karlsen AA, Asadi Mobarkhan FA, Potemkin IA, Kichatova VS, Isaeva OV, Ilchenko LY, Saryglar AA, Mikhailov MI. The Immunological and Epidemiological Effectiveness of Pediatric Single-Dose Vaccination against Hepatitis A 9 to 11 Years after Its Implementation in the Tyva Republic, the Russian Federation. Vaccines (Basel) 2024; 12:907. [PMID: 39204032 PMCID: PMC11359913 DOI: 10.3390/vaccines12080907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/02/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
Since 2012, universal single-dose HAV vaccination in children aged 3 years and older has been implemented in the Tyva Republic, a region of the Russian Federation. The aim of this prospective non-interventional observational single-center study was to determine the immunological and epidemiological effectiveness of single-dose vaccination against hepatitis A 9 to 11 years after its implementation. The anti-HAV IgG antibodies were determined in two independent cohorts of children who were vaccinated with a single dose of monovalent pediatric inactivated vaccine (HAVRIX® 720 EU) in Tyva in 2012 and recruited 9 years (Year 9 Cohort) and 11 years (Year 11 Cohort) after immunization. The seroprotection rates defined as anti-HAV antibody concentrations ≥10 mIU/mL reached 99.4% (95% CI: 98.2-99.9% [501/504]) in the Year 9 Cohort, but decreased significantly to 75.4% (95% CI: 73.0-77.6% [1006/1335]) in the Year 11 Cohort (p < 0.0001). The anti-HAV geometric mean concentrations decreased from 1446.3 mIU/mL (95% CI: 1347.1-1545.4 mIU/mL) in the Year 9 Cohort to 282.6 mIU/mL (95% CI: 203.8-360.8, p < 0.0001) in the Year 11 Cohort. The HAV vaccination program resulted in zero rates of hepatitis A incidence in the Tyva Republic since 2016. However, the limited monitoring of HAV RNA in sewage and environmental samples demonstrated the ongoing circulation of both the regional epidemic strain of HAV genotype IA and another genotype IA strain imported recently from other parts of the Russian Federation, probably due to subclinical infections in non-vaccinated children under 3 years of age. Taken together, these data indicate the effectiveness of the single-dose HAV vaccination strategy but suggest the need to expand the vaccination program to include children aged 12 months and older to achieve maximum effectiveness.
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Affiliation(s)
- Maria A. Lopatukhina
- Laboratory of Viral Hepatitis, Mechnikov Research Institute of Vaccines and Sera, 105064 Moscow, Russia; (M.A.L.); (A.A.K.); (F.A.A.M.); (I.A.P.); (V.S.K.); (O.V.I.); (L.Y.I.); (M.I.M.)
- Laboratory of Molecular Epidemiology of Viral Hepatitis, Central Research Institute of Epidemiology, 111123 Moscow, Russia
| | - Karen K. Kyuregyan
- Laboratory of Viral Hepatitis, Mechnikov Research Institute of Vaccines and Sera, 105064 Moscow, Russia; (M.A.L.); (A.A.K.); (F.A.A.M.); (I.A.P.); (V.S.K.); (O.V.I.); (L.Y.I.); (M.I.M.)
- Laboratory of Molecular Epidemiology of Viral Hepatitis, Central Research Institute of Epidemiology, 111123 Moscow, Russia
| | - Anastasia A. Karlsen
- Laboratory of Viral Hepatitis, Mechnikov Research Institute of Vaccines and Sera, 105064 Moscow, Russia; (M.A.L.); (A.A.K.); (F.A.A.M.); (I.A.P.); (V.S.K.); (O.V.I.); (L.Y.I.); (M.I.M.)
- Laboratory of Molecular Epidemiology of Viral Hepatitis, Central Research Institute of Epidemiology, 111123 Moscow, Russia
| | - Fedor A. Asadi Mobarkhan
- Laboratory of Viral Hepatitis, Mechnikov Research Institute of Vaccines and Sera, 105064 Moscow, Russia; (M.A.L.); (A.A.K.); (F.A.A.M.); (I.A.P.); (V.S.K.); (O.V.I.); (L.Y.I.); (M.I.M.)
- Laboratory of Molecular Epidemiology of Viral Hepatitis, Central Research Institute of Epidemiology, 111123 Moscow, Russia
| | - Ilya A. Potemkin
- Laboratory of Viral Hepatitis, Mechnikov Research Institute of Vaccines and Sera, 105064 Moscow, Russia; (M.A.L.); (A.A.K.); (F.A.A.M.); (I.A.P.); (V.S.K.); (O.V.I.); (L.Y.I.); (M.I.M.)
- Laboratory of Molecular Epidemiology of Viral Hepatitis, Central Research Institute of Epidemiology, 111123 Moscow, Russia
| | - Vera S. Kichatova
- Laboratory of Viral Hepatitis, Mechnikov Research Institute of Vaccines and Sera, 105064 Moscow, Russia; (M.A.L.); (A.A.K.); (F.A.A.M.); (I.A.P.); (V.S.K.); (O.V.I.); (L.Y.I.); (M.I.M.)
- Laboratory of Molecular Epidemiology of Viral Hepatitis, Central Research Institute of Epidemiology, 111123 Moscow, Russia
| | - Olga V. Isaeva
- Laboratory of Viral Hepatitis, Mechnikov Research Institute of Vaccines and Sera, 105064 Moscow, Russia; (M.A.L.); (A.A.K.); (F.A.A.M.); (I.A.P.); (V.S.K.); (O.V.I.); (L.Y.I.); (M.I.M.)
- Laboratory of Molecular Epidemiology of Viral Hepatitis, Central Research Institute of Epidemiology, 111123 Moscow, Russia
| | - Lyudmila Yu. Ilchenko
- Laboratory of Viral Hepatitis, Mechnikov Research Institute of Vaccines and Sera, 105064 Moscow, Russia; (M.A.L.); (A.A.K.); (F.A.A.M.); (I.A.P.); (V.S.K.); (O.V.I.); (L.Y.I.); (M.I.M.)
- Chumakov Federal Scientific Center for Research and Development of Immunobiological Products of Russian Academy of Sciences, 108819 Moscow, Russia
| | - Anna A. Saryglar
- Kyzyl Hospital of Infectious Diseases, 667003 Kyzyl, Tyva Republic, Russia;
| | - Mikhail I. Mikhailov
- Laboratory of Viral Hepatitis, Mechnikov Research Institute of Vaccines and Sera, 105064 Moscow, Russia; (M.A.L.); (A.A.K.); (F.A.A.M.); (I.A.P.); (V.S.K.); (O.V.I.); (L.Y.I.); (M.I.M.)
- Laboratory of Molecular Epidemiology of Viral Hepatitis, Central Research Institute of Epidemiology, 111123 Moscow, Russia
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Ré VE, Ridruejo E, Fantilli AC, Moutinho BD, Pisano MB, Pessoa MG. Hepatitis A in Latin America: The current scenario. Rev Med Virol 2024; 34:e2566. [PMID: 38970225 DOI: 10.1002/rmv.2566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/29/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
This review aims to gather and disseminate updated information regarding hepatitis A virus (HAV) in Latin America (LA) in the last 11 years, including seroprevalence, post-vaccination studies, virus detection in aqueous matrices and food samples, and outbreak reports. Only 24 seroprevalence studies were published between 2012 and 2023 with 55%-100% reported prevalences of anti-HAV IgG. Among the 25 LA countries, only eight of them have introduced HAV vaccines into their immunisation programs. Outbreaks of hepatitis A occurred between 2017-2019, mainly affecting men who have sex with men in Argentina, Brazil and Chile, probably as a consequence of the abrupt decline of young adults' immunity. This could be due to that young adult have never been infected in childhood (due to socio-health improvements) and are above the cut-off ages to be included when the vaccination programs were introduced. Although scarce, studies focused on environmental and food HAV surveillance have shown viral presence in these samples. Surface waters presented HAV detections between 1.2% and 86.7%, and untreated wastewaters between 2.8% and 70.9%. Genotypes found in all cases were IA and IC. The only wastewater-based epidemiology study showed to be a useful tool as a complement of traditional epidemiological surveillance. Only four LA countries have looked for HAV in food samples, with genome detection rates between 9% and 33%. Latin American HAV circulation scenario is changing. In countries where socioeconomic and sanitary conditions have not improved, the virus persists with high endemicity and the access to the vaccine should be re-evaluated by local governments. In countries where access to clean water, better sanitary conditions and HAV immunisation programs have been implemented, the number of cases among young adults seems to be increasing, alerting health authorities.
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Affiliation(s)
- Viviana E Ré
- Facultad de Ciencias Médicas, Instituto de Virología 'Dr. J. M. Vanella', Universidad Nacional de Córdoba, Córdoba, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Ezequiel Ridruejo
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Department of Medicine. Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno 'CEMIC', Hepatology Section, Viral Hepatitits Special Interest Group, Latin American Association for the Study of the Liver (ALEH), Buenos Aires, Argentina
| | - Anabella C Fantilli
- Facultad de Ciencias Médicas, Instituto de Virología 'Dr. J. M. Vanella', Universidad Nacional de Córdoba, Córdoba, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Bruna Damásio Moutinho
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - María Belén Pisano
- Facultad de Ciencias Médicas, Instituto de Virología 'Dr. J. M. Vanella', Universidad Nacional de Córdoba, Córdoba, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Mário Guimarães Pessoa
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, University of São Paulo School of Medicine, São Paulo, Brazil
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Wu Y, Wang P, Huang Y, Chen J, Chang Y, Li J, Wang Y, Hao Y, Zhang W, Du Z. Assessing the effectiveness of the expanded hepatitis A vaccination program in China: an interrupted time series design. BMJ Glob Health 2024; 9:e013444. [PMID: 38320803 PMCID: PMC10859990 DOI: 10.1136/bmjgh-2023-013444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/06/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION China initialised the expanded hepatitis A vaccination programme (EHAP) in 2008. However, the effectiveness of the programme remains unclear. We aimed to comprehensively evaluate the effectiveness of EHAP in the country. METHODS Based on the provincial data on the incidence of hepatitis A (HepA), the population and meteorological variables in China, we developed interrupted time series (ITS) models to estimate the effectiveness of EHAP with the autocorrelation, seasonality and the meteorological confounders being controlled. Results were also stratified by economic zones, age groups and provinces. RESULTS We found a 0.9% reduction (RR=0.991, 95% CI: 0.990 to 0.991) in monthly HepA incidence after EHAP, which was 0.3% greater than the reduction rate before EHAP in China. Across the three economic regions, we found a 1.1% reduction in HepA incidence in both central and western regions after EHAP, which were 0.3% and 1.2% greater than the reduction rates before EHAP, respectively. We found a decreased reduction rate for the eastern region. In addition, we found generally increased reduction rate after EHAP for age groups of 0-4, 5-14 and 15-24 years. However, we found decreased reduction rate among the 25-64 and ≥65 years groups. We found a slight increased rate after EHAP in Shanxi Province but not elsewhere. CONCLUSION Our finding provides comprehensive evidence on the effectiveness of EHAP in China, particularly in the central and western regions, and among the population aged 0-24 years old. This study has important implications for the adjustment of vaccination strategies for other regions and populations.
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Affiliation(s)
- Yueqian Wu
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Pengyu Wang
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Yong Huang
- Department of Immunization Programme Planning, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jinwei Chen
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Yikun Chang
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Junxi Li
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Yibing Wang
- School of Medicine & Warshel Institute for Computational Biology, The Chinese University of Hong Kong, Shenzhen, Shenzhen, China
| | - Yuantao Hao
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Peking University, Beijing, China
| | - Wangjian Zhang
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Zhicheng Du
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
- Guangzhou Joint Research Center for Disease Surveillance and Risk Assessment, Sun Yat-sen University & Guangzhou Center for Disease Control and Prevention, Sun Yat-sen University, Guangzhou, China
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de Brito WI, de Oliveira RM, Silva J, Tubarão LN, Bom APDA, Melgaço JG, Pinto MA, Souto FJD. Persistence of immunity against hepatitis A in Brazilian children vaccinated with a single dose of inactivated virus vaccine. J Viral Hepat 2023; 30:615-620. [PMID: 36807662 DOI: 10.1111/jvh.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
In 2014, the Brazilian National Immunization Program implemented the universal vaccination against the hepatitis A virus (HAV) for children aged 12 months and older, applying a single dose of the inactivated virus vaccine. It is essential to carry out follow-up studies in this population, aiming to verify the longevity of HAV immunological memory. This study evaluated the humoral and cellular immune response of a cohort of children vaccinated between 2014 and 2015, and further investigated between 2015 and 2016, and who had their initial antibody response assessed after the single dose. A second evaluation took place in January 2022. We examined 109 children out of the 252 that took part in the initial cohort. Seventy (64.2%) of them had anti-HAV IgG antibodies. Cellular immune response assays were performed in 37 anti-HAV-negative and 30 anti-HAV-positive children. Production of interferon-gamma (IFN-y) stimulated with the VP1 antigen was demonstrated in 34.3% of these 67 samples. Of the 37 negative anti-HAV samples, 12 (32.4%) produced IFN-y. Among the 30 anti-HAV-positive, 11 (36.7%) produced IFN-y. In total, 82 (76.6%) children presented some type of immune response against HAV. These findings demonstrate the persistence of immunological memory against HAV in the majority of children vaccinated between 6 and 7 years with a single dose of the inactivated virus vaccine.
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Affiliation(s)
- Wagner Izidoro de Brito
- Medicine School, Postgraduate Program in Health Sciences, Federal University of Mato Grosso, Brazilian Company of Hospital Services (EBSERH), Cuiabá, Brazil
| | | | - Jane Silva
- Laboratory of Immune Technology, Institute of Immunobiological Technology, Bio-Manguinhos, Oswaldo Cruz Foundation, FIOCRUZ, Rio de Janeiro, Brazil
| | - Luciana Neves Tubarão
- Laboratory of Immune Technology, Institute of Immunobiological Technology, Bio-Manguinhos, Oswaldo Cruz Foundation, FIOCRUZ, Rio de Janeiro, Brazil
| | - Ana Paula Dinis Ano Bom
- Laboratory of Immune Technology, Institute of Immunobiological Technology, Bio-Manguinhos, Oswaldo Cruz Foundation, FIOCRUZ, Rio de Janeiro, Brazil
| | - Juliana Gil Melgaço
- Laboratory of Immune Technology, Institute of Immunobiological Technology, Bio-Manguinhos, Oswaldo Cruz Foundation, FIOCRUZ, Rio de Janeiro, Brazil
| | - Marcelo Alves Pinto
- Laboratory of Immune Technology, Institute of Immunobiological Technology, Bio-Manguinhos, Oswaldo Cruz Foundation, FIOCRUZ, Rio de Janeiro, Brazil
| | - Francisco José Dutra Souto
- Medicine School, Postgraduate Program in Health Sciences, Federal University of Mato Grosso, Brazilian Company of Hospital Services (EBSERH), Cuiabá, Brazil
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Castro LS, de Rezende GR, Puga MAM, Bandeira LM, Ortiz Tanaka TS, Weis-Torres S, Taira DL, Demarchi LHF, Croda JRH, Pinho JRR, Gomes-Gouvêa MS, Motta-Castro ARC. Hepatitis A virus infection in Brazilian correctional facilities. PLoS One 2023; 18:e0283868. [PMID: 37098017 PMCID: PMC10128929 DOI: 10.1371/journal.pone.0283868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/17/2023] [Indexed: 04/26/2023] Open
Abstract
Hepatitis A virus (HAV) infection is transmitted by the fecal-oral route, through interpersonal contact and ingestion of contaminated food or water. Prisoners are at higher risk of acquiring HAV infection mainly due to the environment of closed penal institutions and socioeconomic conditions. This study aims to determine the seroprevalence of anti-HAV and its associated risk factors among inmates from twelve prisons in Central Brazil. A cross-sectional study was conducted between March 2013 and March 2014. A total of 580 prisoners participated in the study. The participant's samples were tested for Total and IgM anti-HAV antibodies by electrochemiluminescence immunoassay (ECLIA). Risk factors associated with anti-HAV seropositivity were also analyzed. The prevalence rate of HAV exposure was 88.1% (95% CI: 85.5-90.7). No sample had a positive reaction to IgM anti-HAV. Increasing age, low level of education, and being imprisoned in Corumbá city were independently associated with HAV exposure among prisoners. To prevent the burden of the disease, vaccination strategies should be considered for susceptible prisoners in Central Brazil.
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Affiliation(s)
- Lisie Souza Castro
- Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Universidade Federal de Rondonópolis, Rondonópolis, Mato Grosso, Brazil
| | | | | | - Larissa Melo Bandeira
- Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Sabrina Weis-Torres
- Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Deborah Ledesma Taira
- Laboratório Central de Saúde Pública de Mato Grosso do Sul/SES/MS, Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Julio Rosa Henrique Croda
- Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Fiocruz Mato Grosso do Sul, Fundação Oswaldo Cruz, Campo Grande, Mato Grosso do Sul, Brazil
| | - João Renato Rebello Pinho
- LIM-07, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Michele Soares Gomes-Gouvêa
- LIM-07, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Ana Rita Coimbra Motta-Castro
- Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Fiocruz Mato Grosso do Sul, Fundação Oswaldo Cruz, Campo Grande, Mato Grosso do Sul, Brazil
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do Nascimento LG, Sarmento SK, Leonardo R, Gutierrez MB, Malta FC, de Oliveira JM, Guerra CR, Coutinho R, Miagostovich MP, Fumian TM. Detection and Molecular Characterization of Enteric Viruses in Bivalve Mollusks Collected in Arraial do Cabo, Rio de Janeiro, Brazil. Viruses 2022; 14:2359. [PMID: 36366459 PMCID: PMC9695388 DOI: 10.3390/v14112359] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 01/31/2023] Open
Abstract
Viral bivalve contamination is a recognized food safety hazard. Therefore, this study investigated the detection rates, seasonality, quantification, and genetic diversity of enteric viruses in bivalve samples (mussels and oysters). We collected 97 shellfish samples between March 2018 and February 2020. The screening of samples by qPCR or RT-qPCR revealed the detection of norovirus (42.3%), rotavirus A (RVA; 16.5%), human adenovirus (HAdV; 24.7%), and human bocavirus (HBoV; 13.4%). There was no detection of hepatitis A virus. In total, 58.8% of shellfish samples tested positive for one or more viruses, with 42.1% of positive samples contaminated with two or more viruses. Norovirus showed the highest median viral load (3.3 × 106 GC/g), followed by HAdV (median of 3.5 × 104 GC/g), RVA (median of 1.5 × 103 GC/g), and HBoV (median of 1.3 × 103 GC/g). Phylogenetic analysis revealed that norovirus strains belonged to genotype GII.12[P16], RVA to genotype I2, HAdV to types -C2, -C5, and -F40, and HBoV to genotypes -1 and -2. Our results demonstrate the viral contamination of bivalves, emphasizing the need for virological monitoring programs to ensure the quality and safety of shellfish for human consumption and as a valuable surveillance tool to monitor emerging viruses and novel variants.
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Affiliation(s)
- Lilian Gonçalves do Nascimento
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Sylvia Kahwage Sarmento
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Raphael Leonardo
- Laboratory of Viral Morphology and Morphogenesis, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Meylin Bautista Gutierrez
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Fábio Correia Malta
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Jaqueline Mendes de Oliveira
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Caroline Rezende Guerra
- Laboratory of Marine Genetics, Department of Marine Biotechnology, Sea Studies Institute Admiral Paulo Moreira (IEAPM), Arraial do Cabo 28930-000, RJ, Brazil
| | - Ricardo Coutinho
- Laboratory of Marine Genetics, Department of Marine Biotechnology, Sea Studies Institute Admiral Paulo Moreira (IEAPM), Arraial do Cabo 28930-000, RJ, Brazil
| | - Marize Pereira Miagostovich
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Tulio Machado Fumian
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, RJ, Brazil
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Mello VM, Bianchi LM, Sousa PSF, Tavares PS, Di Salvo DRG, Ginuino CF, Almeida NAA, Fernandes CAS, Mello FCA, Villar LM, Lewis-Ximenez LL, Lago BV. Increase in Hepatitis A Cases Linked to Imported Strains to Rio de Janeiro, Brazil: A Cross-Sectional Study. Viruses 2022; 14:v14020303. [PMID: 35215897 PMCID: PMC8874517 DOI: 10.3390/v14020303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims to evaluate the epidemiological and molecular features associated with HAV transmission in adults in Rio de Janeiro during a period of increased registered cases of HAV (2017–2018). Socio-epidemiological data and serum samples from anti-HAV IgM+ individuals were obtained. HAV RNA was RT-PCR amplified and sequenced for further phylogenetic and phylogeographic analyses. From fifty-two HAV IgM+ individuals, most were men (78.85%; p = 0.024), aged 20–30 years old (84.61%; p < 0.001), resided in the Rio de Janeiro north zone (31/52; 59.62%; p = 0.001), and are men who have sex with men (MSM) (57.69%; p = 0.002). Sexual practices were more frequent (96%) than others risk factors (food-borne (44%), water-borne (42.31%), and parenteral (34.62%)). Individuals who traveled to endemic regions had a 7.19-fold (1.93–36.04; p < 0.01) increased risk of HAV. Phylogenetic analysis revealed four distinct clades of subgenotype IA, three of them comprised sequences from European/Asian MSM outbreaks and one from Brazilian endemic strains. Bayesian Inference showed that the imported strains were introduced to Brazil during large mass sportive events. Sexual orientation and sexual practices may play a role in acquiring HAV infection. Public policies targeting key populations must be implemented to prevent further dissemination of HAV and other STIs.
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Affiliation(s)
- Vinicius M. Mello
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
| | - Lucas M. Bianchi
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil;
| | - Paulo Sergio F. Sousa
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
| | - Pedro S. Tavares
- Research Group on Territory and Politics, Geosciences Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941-916, Brazil;
| | - Daniel R. G. Di Salvo
- Cartography Laboratory, Geosciences Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941-916, Brazil;
| | - Cleber F. Ginuino
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
| | - Nathalia A. A. Almeida
- Molecular Virology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil;
| | - Carlos A. S. Fernandes
- Hepatitis Division, Rio de Janeiro Health State Secretariat, Rio de Janeiro 20211-110, Brazil;
| | - Francisco C. A. Mello
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
| | - Livia M. Villar
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
| | - Lia L. Lewis-Ximenez
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
| | - Barbara V. Lago
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
- Institute of Technology in Immunobiologics–Bio-Manguinhos, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil
- Correspondence: ; Tel.: +55-21-2562-1799
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8
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Chuffi S, Gomes-Gouvêa MS, Casadio LVB, Nastri ACSS, Gonzalez MP, Cotia ALF, Aranda AGD, Tenore SB, Ono SK, Malta FM, Madalosso G, Ferreira PRA, Carrilho FJ, Pinho JRR. The Molecular Characterization of Hepatitis A Virus Strains Circulating during Hepatitis A Outbreaks in São Paulo, Brazil, from September 2017 to May 2019. Viruses 2021; 14:v14010073. [PMID: 35062277 PMCID: PMC8777592 DOI: 10.3390/v14010073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Outbreaks of hepatitis A may occur in countries of medium and high socioeconomic levels in which the population generally exhibits an increased susceptibility in young adults to this infection if they are not vaccinated against the hepatitis A virus (HAV). In Europe, an outbreak involved approximately 22 European countries with 4475 cases reported from 2016 to 2018; most of them were men who have sex with men (MSM). This outbreak expanded to North and South America, including Brazil, particularly in São Paulo city with 1547 reported cases from 2016 to 2019. In the present study, we characterized the HAV strains involved in the acute hepatitis A cases identified in the reference centers of São Paulo city during this outbreak. A total of 51 cases with positive anti-HAV IgM were included, 80.4% male, 68.6% of them between 20 and 40 years old and 41.7% MSM. HAV RNA was detected in 92% (47/51) of the cases. Subgenotype IA of HAV was identified and most of the strains were closely related to that isolated in outbreaks that occurred in different European countries in 2016. These results showed the epidemiological relation between these outbreaks and reinforce the need to implement vaccination against hepatitis A for the adult population, particularly for a population with a high-risk behavior.
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Affiliation(s)
- Samira Chuffi
- Laboratório de Gastroenterologia e Hepatologia Tropical—LIM/07, Departamento de Gastroenterologia, Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 500, São Paulo 05403-000, SP, Brazil; (S.C.); (J.R.R.P.)
| | - Michele S. Gomes-Gouvêa
- Laboratório de Gastroenterologia e Hepatologia Tropical—LIM/07, Departamento de Gastroenterologia, Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 500, São Paulo 05403-000, SP, Brazil; (S.C.); (J.R.R.P.)
- Correspondence:
| | - Luciana V. B. Casadio
- Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, SP, Brazil; (L.V.B.C.); (A.C.S.S.N.)
| | - Ana Catharina S. S. Nastri
- Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, SP, Brazil; (L.V.B.C.); (A.C.S.S.N.)
| | - Mario P. Gonzalez
- Instituto de Infectologia Emilio Ribas, São Paulo 05403-000, SP, Brazil; (M.P.G.); (A.L.F.C.); (A.G.D.A.)
| | - André L. F. Cotia
- Instituto de Infectologia Emilio Ribas, São Paulo 05403-000, SP, Brazil; (M.P.G.); (A.L.F.C.); (A.G.D.A.)
| | - Amanda G. D. Aranda
- Instituto de Infectologia Emilio Ribas, São Paulo 05403-000, SP, Brazil; (M.P.G.); (A.L.F.C.); (A.G.D.A.)
| | - Simone B. Tenore
- Centro de Referência e Treinamento—CRT DST-AIDS, São Paulo 05403-000, SP, Brazil;
- Hospital São Paulo, Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 05403-000, SP, Brazil;
| | - Suzane K. Ono
- Hospital das Clínicas, Departamento de Gastroenterologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, SP, Brazil; (S.K.O.); (F.J.C.)
| | - Fernanda M. Malta
- Laboratório de Técnicas Especiais, Hospital Israelita Albert Einstein, Albert Einstein Medicina Diagnóstica, São Paulo 05403-000, SP, Brazil;
| | - Geraldine Madalosso
- Epidemiological Surveillance Center, Disease Control Coordination, State of São Paulo Department of Health, São Paulo 05403-000, SP, Brazil;
| | - Paulo R. A. Ferreira
- Hospital São Paulo, Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 05403-000, SP, Brazil;
| | - Flair J. Carrilho
- Hospital das Clínicas, Departamento de Gastroenterologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, SP, Brazil; (S.K.O.); (F.J.C.)
| | - João R. R. Pinho
- Laboratório de Gastroenterologia e Hepatologia Tropical—LIM/07, Departamento de Gastroenterologia, Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 500, São Paulo 05403-000, SP, Brazil; (S.C.); (J.R.R.P.)
- Laboratório de Técnicas Especiais, Hospital Israelita Albert Einstein, Albert Einstein Medicina Diagnóstica, São Paulo 05403-000, SP, Brazil;
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9
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Prado T, Barbosa MRF, Araújo RS, Garcia SC, Melo AJ, Galvani AT, Brandão CJ, Silva RLO, Sato MIZ. Hepatitis A Outbreaks and Environmental Circulation of Genotype IA Strains in the São Paulo City, 2017-2018. FOOD AND ENVIRONMENTAL VIROLOGY 2021; 13:520-527. [PMID: 34532781 DOI: 10.1007/s12560-021-09497-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
Hepatitis A virus (HAV) is the major cause of enterically transmitted infectious hepatitis. Between 2016 and 2017, the number of confirmed cases of hepatitis A virus (HAV) increased from 64 to 786 in São Paulo affecting mainly adults aged between 18 and 39 years (80%) and males (88%). To support epidemiological surveillance, the present study monitored the presence of HAV in urban sewage samples collected bimonthly for 1 year (November 2017-November 2018) in the central region of the city, where most of cases were detected. Sewage samples were concentrated by polyethylene glycol precipitation and HAV RNA was quantified by RT-qPCR. Nucleotide sequencing targeting the VP1/2A junction region was carried out to genotype the HAV strains. HAV was detected in 76.9% (40/52) of the samples, with a geometric mean viral load of 5.09 × 104 (± SD 4.51 × 105) genome copies (GC/L) (Mauá Street) and 5.27 × 104 (± SD 1.26 × 106) GC/L (Prestes Maia Avenue). Of the 40 positive samples, 8 were typed as HAV subgenotype IA [100% nucleotide (nt) identity with HAV strain VRD_521_2016]. Highest homology was obtained with sequences from European countries (Italy, Spain) and Israel, all of which had reported recent HAV outbreaks associated with men who have sex with men. Our results highlight that wastewater surveillance is a useful tool to support investigating HAV outbreaks in the community, including circulating genotypes.
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Affiliation(s)
- Tatiana Prado
- Division of Microbiology and Parasitology, Department of Environmental Analysis, Environmental Company of the São Paulo State (CETESB), Av. Prof. Frederico Hermann Jr., 345, São Paulo, CEP 05459-900, Brazil.
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, CEP 21040-360, Brazil.
| | - Mikaela Renata Funada Barbosa
- Division of Microbiology and Parasitology, Department of Environmental Analysis, Environmental Company of the São Paulo State (CETESB), Av. Prof. Frederico Hermann Jr., 345, São Paulo, CEP 05459-900, Brazil
| | - Ronalda Silva Araújo
- Division of Microbiology and Parasitology, Department of Environmental Analysis, Environmental Company of the São Paulo State (CETESB), Av. Prof. Frederico Hermann Jr., 345, São Paulo, CEP 05459-900, Brazil
| | - Suzi Cristina Garcia
- Division of Microbiology and Parasitology, Department of Environmental Analysis, Environmental Company of the São Paulo State (CETESB), Av. Prof. Frederico Hermann Jr., 345, São Paulo, CEP 05459-900, Brazil
| | - Adalgisa Jesus Melo
- Division of Microbiology and Parasitology, Department of Environmental Analysis, Environmental Company of the São Paulo State (CETESB), Av. Prof. Frederico Hermann Jr., 345, São Paulo, CEP 05459-900, Brazil
| | - Ana Tereza Galvani
- Division of Microbiology and Parasitology, Department of Environmental Analysis, Environmental Company of the São Paulo State (CETESB), Av. Prof. Frederico Hermann Jr., 345, São Paulo, CEP 05459-900, Brazil
| | - Carlos Jesus Brandão
- Division of Microbiology and Parasitology, Department of Environmental Analysis, Environmental Company of the São Paulo State (CETESB), Av. Prof. Frederico Hermann Jr., 345, São Paulo, CEP 05459-900, Brazil
| | - Renan Lourenço Oliveira Silva
- Division of Microbiology and Parasitology, Department of Environmental Analysis, Environmental Company of the São Paulo State (CETESB), Av. Prof. Frederico Hermann Jr., 345, São Paulo, CEP 05459-900, Brazil
| | - Maria Inês Zanoli Sato
- Division of Microbiology and Parasitology, Department of Environmental Analysis, Environmental Company of the São Paulo State (CETESB), Av. Prof. Frederico Hermann Jr., 345, São Paulo, CEP 05459-900, Brazil
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10
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Leal PR, José de Paula E Sousa Guimarães R, Kampel M. Sociodemographic and spatiotemporal profiles of hepatitis-A in the state of Pará, Brazil, based on reported notified cases. GEOSPATIAL HEALTH 2021; 16. [PMID: 34730318 DOI: 10.4081/gh.2021.981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
Hepatitis-A virus is a worldwide healthcare problem, mainly affecting countries with poor sanitary and socioeconomic conditions. This communication evaluates the spatiotemporal variability of the disease's socioepidemiological profile in one of the endemic Brazilian regions (Pará State) prior to (2008-2013) and after (2014-2017) the launch of the national public vaccination programme. Hepatitis-A epidemiological reports concerning Pará State - Brazil - were used for this study including municipalitylevel data of the disease's reported positive notification cases (PNCs). The analyses involved socioepidemiological profiling and space-time scan statistics. A total of 5500 PNCs were reported in the study period. On average, PNCs decreased over time throughout the state, with strongest drops after 2015. The PNCs were specific for gender, race/ethnic origin and age group. The predominant gender and race/ethnic groups was male and brown, respectively. While children were the most susceptible age group prior to 2015, there was a shift towards older ages (young and adults) in later years. Those found to be the most affected by the disease, as shown by space-time scan statistics, were people in densely populated municipalities with unsatisfactory sanitary conditions and also less well covered by the public vaccination programme. Despite drops in the number of hepatitis-A PNCs, thanks to the national vaccination programme, the disease still persists in Pará State and elsewhere in Brazil. The present study reinforces the need of continuous prevention and control strategies for effective control and erradication of hepatitis-A.
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Affiliation(s)
| | | | - Milton Kampel
- National Institute for Space Research, São José dos Campos, SP.
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11
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Castro LS, Rezende GRD, Pires Fernandes FR, Bandeira LM, Cesar GA, do Lago BV, Gomes Gouvêa MS, Motta-Castro ARC. HAV infection in Brazilian men who have sex with men: The importance of surveillance to avoid outbreaks. PLoS One 2021; 16:e0256818. [PMID: 34529672 PMCID: PMC8445402 DOI: 10.1371/journal.pone.0256818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background Hepatitis A is a fecal-oral infection caused by hepatitis A virus (HAV). Men who have sex with men (MSM) and transgender women (TW) have been reported as target groups for HAV infection. This study aimed to determine the seroprevalence, risk factors, and circulating strains associated with HAV infection among MSM and TW in Central Brazil. Methods A cross-sectional study was conducted from November 2011 to September 2013. Serum samples were collected from 425 individuals for anti-HAV antibody testing and HAV molecular characterization. Of them, 149 (35.1%) participants were self-identified as transgender women. Statistical analysis was performed to evaluate the risk factors of HAV seropositivity. Results The seroprevalence of HAV exposure was 69.7% (95% Confidence Interval: 65.3–74.0%). Serological evidence of HAV was significantly higher in participants who self-identified as transgender women (83.2%) than MSM (62.3%). Increasing age, non-white race, and lower monthly household income were independently associated with HAV exposure among MSM. Only lower monthly household income was independently associated with HAV exposure among TW. One anti-HAV IgM positive sample, from a transgender woman (0.2%), was detected and classified as subgenotype IA. Conclusions High HAV prevalence was observed, markedly among TW. Considering the risky sexual behaviors this population is exposed to, HAV vaccination and prevention programs targeting this population should be considered to prevent outbreaks and the burden of the disease.
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Affiliation(s)
- Lisie Souza Castro
- Federal University of Mato Grosso do Sul, Campo Grande, Brazil.,Federal University of Mato Grosso, Rondonópolis, Brazil
| | | | - Fernanda Rodas Pires Fernandes
- Federal University of Mato Grosso do Sul, Campo Grande, Brazil.,Ministry of Agriculture, Livestock and Food Supply/National Agricultural Laboratory, MAPA/LANAGRO, Minas Gerais, Brazil
| | | | | | | | | | - Ana R C Motta-Castro
- Federal University of Mato Grosso do Sul, Campo Grande, Brazil.,Oswaldo Cruz Foundation, FIOCRUZ, Rio de Janeiro, Mato Grosso do Sul, Brazil
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12
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Jaisli S, Mayorga O, Flores N, de Berti S, Frösner G, Herzog C, Zwahlen M, Herzog SA. Clinical, serological and epidemiological features of hepatitis A in León, Nicaragua. PeerJ 2021; 9:e11516. [PMID: 34221712 PMCID: PMC8223896 DOI: 10.7717/peerj.11516] [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: 01/26/2021] [Accepted: 05/04/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To monitor and document the endemicity and disease burden of acute hepatitis A in the area of an ongoing vaccine effectiveness study in León, Nicaragua. METHODS At community health centres in León, all children, adolescents and young adults presenting with jaundice and/or other clinical signs of hepatitis were offered free serologic screening (hepatitis A, B and C) and blood tests for liver enzymes and bilirubin. Clinical and socioeconomic data were collected with a structured questionnaire. Diagnosis of acute hepatitis A was confirmed by anti-HAV IgM testing. Using logistic regression we compared the characteristics and living conditions of acute hepatitis A cases with those of non-cases. RESULTS Of 557 eligible subjects enrolled between May 2006 and March 2010, 315 (56.6%) were diagnosed with hepatitis A, 80.6% of them ≤10 years and five >18 years of age. No severe cases were encountered. Apart from jaundice (95.6%) and other signs of hepatitis A (fever, pale stool, dark urine, nausea, vomiting, anorexia), two thirds of patients had moderately raised liver enzymes. Cases occurred throughout the year, with highest incidences from August to March. Poor sanitary conditions and crowding were the main risk factors. CONCLUSIONS In the study area, hepatitis A is still highly endemic in young and school age children living in low socioeconomic conditions. There are, however, first indications that the endemicity level is shifting from high to high-intermediate.
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Affiliation(s)
- Sophie Jaisli
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Orlando Mayorga
- Department of Microbiology & Parasitology, Faculty of Medical Sciences, National Autonomous University, León, Nicaragua
| | - Nadia Flores
- Department of Microbiology & Parasitology, Faculty of Medical Sciences, National Autonomous University, León, Nicaragua
| | | | - Gustav Frösner
- Institute of Virology, Technical University, Munich, Germany
| | - Christian Herzog
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Medical Department, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sereina A. Herzog
- Centre for Health Economics Research and Modelling of Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
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13
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Herzog C, Van Herck K, Van Damme P. Hepatitis A vaccination and its immunological and epidemiological long-term effects - a review of the evidence. Hum Vaccin Immunother 2021; 17:1496-1519. [PMID: 33325760 PMCID: PMC8078665 DOI: 10.1080/21645515.2020.1819742] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 01/11/2023] Open
Abstract
Hepatitis A virus (HAV) infections continue to represent a significant disease burden causing approximately 200 million infections, 30 million symptomatic illnesses and 30,000 deaths each year. Effective and safe hepatitis A vaccines have been available since the early 1990s. Initially developed for individual prophylaxis, HAV vaccines are now increasingly used to control hepatitis A in endemic areas. The human enteral HAV is eradicable in principle, however, HAV eradication is currently not being pursued. Inactivated HAV vaccines are safe and, after two doses, elicit seroprotection in healthy children, adolescents, and young adults for an estimated 30-40 years, if not lifelong, with no need for a later second booster. The long-term effects of the single-dose live-attenuated HAV vaccines are less well documented but available data suggest they are safe and provide long-lasting immunity and protection. A universal mass vaccination strategy (UMV) based on two doses of inactivated vaccine is commonly implemented in endemic countries and eliminates clinical hepatitis A disease in toddlers within a few years. Consequently, older age groups also benefit due to the herd protection effects. Single-dose UMV programs have shown promising outcomes but need to be monitored for many more years in order to document an effective immune memory persistence. In non-endemic countries, prevention efforts need to focus on 'new' risk groups, such as men having sex with men, prisoners, the homeless, and families visiting friends and relatives in endemic countries. This narrative review presents the current evidence regarding the immunological and epidemiological long-term effects of the hepatitis A vaccination and finally discusses emerging issues and areas for research.
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Affiliation(s)
- Christian Herzog
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Koen Van Herck
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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14
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Leal PR, Guimarães RJDPSE, Kampel M. Associations Between Environmental and Sociodemographic Data and Hepatitis-A Transmission in Pará State (Brazil). GEOHEALTH 2021; 5:e2020GH000327. [PMID: 34027261 PMCID: PMC8128032 DOI: 10.1029/2020gh000327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Hepatitis-A is a waterborne infectious disease transmitted by the eponymous hepatitis-A virus (HAV). Due to the disease's sociodemographic and environmental characteristics, this study applied public census and remote sensing data to assess risk factors for hepatitis-A transmission. Municipality-level data were obtained for the state of Pará, Brazil. Generalized linear and nonlinear models were evaluated as alternative predictors for hepatitis-A transmission in Pará. The Histogram Gradient Boost (HGB) regression model was deemed the best choice ( R M S E = 2.36, and higherR 2 = 0.95) among the tested models. Partial dependence analysis and permutation feature importance analysis were used to investigate the partial dependence and the relative importance values of the independent variables in the disease transmission prediction model. Results indicated a complex relationship between the disease transmission and the sociodemographic and environmental characteristics of the study area. Population size, lack of sanitation, urban clustering, year of notification, insufficient public vaccination programs, household proximity to open-air dumpsites and storm-drains, and lack of access to healthcare facilities and hospitals were sociodemographic parameters related to HAV transmission. Turbidity and precipitation were the environmental parameters closest related to disease transmission. Based on HGB model, a hepatitis-A risk map was built for Pará state. The obtained risk map can be thought of as an auxiliary tool for public health strategies. This study reinforces the need to incorporate remote sensing data in epidemiological modelling and surveillance plans for the development of early prevention strategies for hepatitis-A.
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Affiliation(s)
- Philipe Riskalla Leal
- National Institute for Space Research (INPE, Instituto Nacional de Pesquisas Espaciais)São PauloBrazil
| | | | - Milton Kampel
- National Institute for Space Research (INPE, Instituto Nacional de Pesquisas Espaciais)São PauloBrazil
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15
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Pereira LMMB, Stein AT, Figueiredo GM, Coral GP, Montarroyos UR, Cardoso MRA, Braga MC, Moreira RC, Santos AAD, Ximenes RA. Prevalence of hepatitis A in the capitals of the States of North, Southeast and South regions of Brazil: decrease in prevalence and some consequences. Rev Inst Med Trop Sao Paulo 2021; 63:e34. [PMID: 33909848 PMCID: PMC8075615 DOI: 10.1590/s1678-9946202163034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 03/26/2021] [Indexed: 12/03/2022] Open
Abstract
Hepatitis A virus (HAV) infection has been considered one of the leading causes
of acute hepatitis. The aim of the present study was to estimate the prevalence
of HAV among children and adolescents in a population-based study in the
capitals of the States of the North, Southeast and South of Brazil and identify
predictive factors for the infection. A multi-stage sampling was used to select
subjects aged between 5-9 and 10-19 years. Individual and household levels aside
from the level of variables in the areas were collected. The outcome was the
total IgG antibodies to HAV levels detected using a commercial Enzyme Immuno
Assay (EIA). The associations between HAV and the independent variables were
assessed using the odds ratio. A multilevel analysis was performed by GLLAMM
using the Stata software. The prevalence of HAV infection in the 5-9 and 10-19
age groups was 28.7% and 67.5%, respectively for the North, 20.6% and 37.7%, for
the Southeast and 18.9% and 34.5% for the South Region. The prevalence of HAV
increased according to age in all sites. Variables related to education at the
individual level (North and South), family and area level (South and Southeast)
and family income level (Southeast and South) were independently associated with
HAV infection. This emphasizes the need for individualized strategies to prevent
the infection.
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Affiliation(s)
- Leila M M B Pereira
- Universidade de Pernambuco, Instituto do Fígado de Pernambuco, Recife, Pernambuco, Brazil
| | - Airton T Stein
- Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Porto Alegre, Brazil
| | - Gerusa Maria Figueiredo
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Medicina Preventiva, São Paulo, São Paulo, Brazil
| | - Gabriela Perdomo Coral
- Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Porto Alegre, Brazil
| | - Ulisses R Montarroyos
- Universidade de Pernambuco, Instituto de Ciências Biológicas, Recife, Pernambuco, Brazil
| | - Maria Regina Alves Cardoso
- Universidade de São Paulo, Faculdade de Saúde Pública, Departamento de Epidemiologia, São Paulo, São Paulo, Brazil
| | - Maria Cynthia Braga
- Fundação Oswaldo Cruz, Centro de Pesquisas Aggeu Magalhães, Recife, Pernambuco, Brazil
| | | | | | - Ricardo Alencar Ximenes
- Universidade de Pernambuco, Faculdade de Ciências Médicas, Recife, Pernambuco, Brazil.,Universidade Federal de Pernambuco, Departamento de Medicina Tropical, Recife, Pernambuco, Brazil
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16
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Bierrenbach AL, Choi Y, Batista PDM, Serra FB, Parellada CI, Julian GS, Nakajima K, Moreira TDNF. The Impact of an Inactivated Hepatitis A Vaccine with One Dose in Brazil: A Retrospective Time-Series. Vaccines (Basel) 2021; 9:407. [PMID: 33924029 PMCID: PMC8072696 DOI: 10.3390/vaccines9040407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In 2014, a recommended one-dose of inactivated hepatitis A vaccine was included in the Brazilian National Immunization Program targeting children 12-24 months. This decision addressed the low to intermediate endemicity status of hepatitis A across Brazil and the high rate of infection in children and adolescents between 5 and 19 years old. The aim of the study was to conduct a time-series analysis on hepatitis A incidence across age groups and to assess the hepatitis A distribution throughout Brazilian geographic regions. METHODS An interrupted time-series analysis was performed to assess hepatitis A incidence rates before (2010-2013) and after (2015-2018) hepatitis A vaccine program implementation. The time-series analysis was stratified by age groups while a secondary analysis examined geographic distribution of hepatitis A cases. RESULTS Overall incidence of hepatitis A decreased from 3.19/100.000 in the pre-vaccine period to 0.87/100.000 (p = 0.022) post-vaccine introduction. Incidence rate reduction was higher among children aged 1-4 years old, with an annual reduction of 67.6% in the post-vaccination period against a 7.7% annual reduction in the pre-vaccination period (p < 0.001). Between 2015 and 2018, the vaccination program prevented 14,468 hepatitis A cases. CONCLUSION Our study highlighted the positive impact of a recommended one-dose inactivated hepatitis A vaccine for 1-4-years-old in controlling hepatitis A at national level.
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Affiliation(s)
- Ana Luiza Bierrenbach
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo 01308-050, SP, Brazil
| | | | | | - Fernando Brandão Serra
- MSD Brazil, São Paulo 04717-004, SP, Brazil; (P.d.M.B.); (F.B.S.); (C.I.P.); (T.d.N.F.M.)
| | - Cintia Irene Parellada
- MSD Brazil, São Paulo 04717-004, SP, Brazil; (P.d.M.B.); (F.B.S.); (C.I.P.); (T.d.N.F.M.)
| | | | - Karina Nakajima
- IQVIA Brazil, São Paulo 04719-002, SP, Brazil; (G.S.J.); (K.N.)
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Wang F, Sun X, Wang F, Zheng H, Jia Z, Zhang G, Bi S, Miao N, Zhang S, Cui F, Li L, Wang H, Liang X, Rodewald LE, Feng Z, Yin Z, Shen L. Changing Epidemiology of Hepatitis A in China: Evidence From Three National Serological Surveys and the National Notifiable Disease Reporting System. Hepatology 2021; 73:1251-1260. [PMID: 32592242 DOI: 10.1002/hep.31429] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/07/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS China has conducted surveillance for hepatitis A since 1990, and hepatitis A was highly-to-intermediately endemic in 1992 when a Chinese hepatitis A vaccine (HepA) was licensed and introduced as a family-pay vaccine. In 2008, HepA was introduced into the Expanded Program on Immunization as a free childhood vaccine. APPROACH AND RESULTS Three nationally representative surveys conducted in 1992, 2006, and 2014 assessed hepatitis B serology. The 1992 survey included hepatitis A virus (HAV) serology, and we tested sera from the 2006 and 2014 surveys for HAV antibodies. We used surveillance, seroprevalence, and vaccination status data to describe the changing epidemiology of hepatitis A in China from 1990 through 2014. Before HepA licensure, anti-HAV seroprevalence was 60% at 4 years of age, 70% at 10 years, and 90% at 59 years; incidence was 52/100,000 and peaked at 4 years. In 2006, after >10 years of private sector vaccination, HepA coverage was <30% among children <5 years, and incidence was 5.4/100,000 with a peak at 10 years. In 2014, coverage was >90% among children under 5 years; incidence was 1.9/100,000. Individuals born before the national introduction of HepA (1988-2004) had lower anti-HAV seroprevalence than earlier and later birth cohorts. CONCLUSIONS The incidence of hepatitis A declined markedly following HepA introduction and improvement of sanitation and hygiene. The emerging epidemiology is consistent with disease-induced immunity having been replaced by vaccine-induced immunity, resulting in a low incidence of hepatitis A. Catch-up HepA campaigns to close the immunity gap among the 1998-2004 birth cohorts should be considered.
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Affiliation(s)
- Fuzhen Wang
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaojin Sun
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Feng Wang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Zheng
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhiyuan Jia
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guomin Zhang
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shengli Bi
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ning Miao
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuang Zhang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fuqiang Cui
- School of Public Health, Peking University, Beijing, China
| | - Li Li
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huaqing Wang
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaofeng Liang
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lance E Rodewald
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zijian Feng
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liping Shen
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Andani A, van Damme P, Bunge EM, Salgado F, van Hoorn RC, Hoet B. One or two doses of hepatitis A vaccine in universal vaccination programs in children in 2020: A systematic review. Vaccine 2021; 40:196-205. [PMID: 33526283 DOI: 10.1016/j.vaccine.2021.01.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hepatitis A virus (HAV) is a global health concern as outbreaks continue to occur. Since 1999, several countries have introduced universal vaccination (UV) of children against HAV according to approved two-dose schedules. Other countries have implemented one-dose UV programs since 2005; the long-term impact of this schedule is not yet known. METHODS We conducted a systematic literature search in four electronic databases for data published between January 2000 and July 2019 to assess evidence for one-dose and two-dose UV of children with non-live HAV vaccines and describe their global impact on incidence, mortality, and severity of hepatitis A, vaccine effectiveness, vaccine efficacy, and antibody persistence. RESULTS Of 3739 records screened, 33 peer-reviewed articles and one conference abstract were included. Rapid declines in incidence of hepatitis A and related outcomes were observed in all age groups post-introduction of UV programs, which persisted for at least 14 years for two-dose and six years for one-dose programs according to respective study durations. Vaccine effectiveness was ≥95% over 3-5 years for two-dose programs. Vaccine efficacy was >98% over 0.1-7.5 years for one-dose vaccination. Antibody persistence in vaccinated individuals was documented for up to 15 years (≥90%) and ten years (≥74%) for two-dose and one-dose schedules, respectively. CONCLUSION Experience with two-dose UV of children against HAV is extensive, demonstrating an impact on the incidence of hepatitis A and antibody persistence for at least 15 years in many countries globally. Because evidence is more limited for one-dose UV, we were unable to draw conclusions on immune response persistence beyond ten years or the need for booster doses later in life. Ongoing epidemiological monitoring is essential in countries implementing one-dose UV against HAV. Based on current evidence, two doses of non-live HAV vaccines are needed to ensure long-term protection.
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Affiliation(s)
- Anar Andani
- GSK, 20 Fleming Avenue, 1300 Wavre, Belgium.
| | - Pierre van Damme
- Center for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein, 1, 2610 Wilrijk, Belgium.
| | - Eveline M Bunge
- Pallas Health Research and Consultancy, Postbus 21238, 3001 AE Rotterdam, the Netherlands.
| | | | - Rosa C van Hoorn
- Pallas Health Research and Consultancy, Postbus 21238, 3001 AE Rotterdam, the Netherlands.
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Hepatitis A virus age-specific seroprevalence after the implementation of a Toddlers' Vaccination in Turkey: Shifting susceptibility to adolescents. Turk Arch Pediatr 2021; 55:370-375. [PMID: 33414654 PMCID: PMC7750331 DOI: 10.14744/turkpediatriars.2020.06982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/23/2020] [Indexed: 11/28/2022]
Abstract
Aim: In Turkey, improvements in sanitation and the implementation of a vaccination program resulted in reduced rates of childhood exposure to hepatitis A virus. The incidence of symptoms and the complications of the disease are known to be increased in later ages. We aimed to describe changes in the seroprevalence of hepatitis A virus from the pre-vaccine era (2012) to the post-vaccine era (2018) in different age groups. Material and Methods: Levels of anti-hepatitis A virus immunoglobulin (Ig)-G of patients with no chronic disease and who were admitted to our hospital between 2013–2018 were obtained retrospectively from a single children’s hospital database system. Results: A total of 3238 subjects were enrolled in the study (2820 children, 418 adults). The overall percentage of seropositivity was 60.5% in group 1 (age ≤2 years), 57.9% in group 2 (age 2–6 years), 31.2% in group 3 (age 7–11 years), 32.7% in group 4 (age 12–18 years), 44.6% in group 5 (age 19–24 years), and 73.9% in group 6 (age >25 years). Between 2013–2018, the increase in the number of seropositive individuals in group 2 (p<0.01), and the decrease in groups 3 and 4 were statistically significant from 2013 to 2018 (p=0.028, p<0.01). Conclusion: According to the data of this single-center children’s hospital in Turkey, hepatitis A virus seropositivity increases significantly in the preschool age group, but decreases in school-age children and adolescents after vaccination.
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Universal Single-Dose Vaccination against Hepatitis A in Children in a Region of High Endemicity. Vaccines (Basel) 2020; 8:vaccines8040780. [PMID: 33419299 PMCID: PMC7766627 DOI: 10.3390/vaccines8040780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
Since August 2012, universal single-dose vaccination in children aged at least three years has been implemented in the Republic of Tuva, which was previously the region most affected by hepatitis A in Russia. The objective of this cross-sectional study was the assessment of the immunological and epidemiological effectiveness of vaccination program five years following its implementation. In the pre-vaccination period, anti-HAV antibody detection rates in Tuva was 66.0% [95% CI: 56.3-74.6%] in children aged 10-14 years and reached a plateau (>95%) by age 20-29 years. Annual incidence rates in children under 18 years of age peaked at 450-860 per 100,000 in pre-vaccination years but dropped to 7.5 per 100,000 in this age group and to 3.2 per 100,000 in the total population one year after the start of vaccination. Since 2016, no cases of hepatitis A has been reported in Tuva. Serum anti-HAV antibodies were quantified in samples from healthy children following single-dose vaccination. Protective anti-HAV antibody concentrations (≥10 mIU/mL) were detected in 98.0% (95% CI: 96.2-99.0% (442/451)) of children tested one month after single-dose immunization, in 93.5% (95% CI: 91.0-95.4% (477/510)) and in 91.1% (95% CI: 88.2-93.4% (422/463)) of children one year and five years after single-dose immunization, respectively. Anti-HAV antibody geometric mean concentrations were similar in sera collected one month, one year, and five years following single-dose vaccination: 40.24 mIU/mL, 44.96 mIU/mL, and 57.73 mIU/mL, respectively (p > 0.05). These data confirm that single-dose vaccination is an effective method of bringing hepatitis A under control in a short period of time in a highly endemic region.
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Xiaojin S, Rodewald LE, Guomin Z, Hui Z, Ning M, Fuzhen W, Zundong Y. Long-term seropositivity, safety, and impact of inactivated and live, attenuated hepatitis a vaccines in China – A cross-sectional study. Vaccine 2020; 38:8302-8309. [DOI: 10.1016/j.vaccine.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022]
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Juliao P, Abadia I, Welby S, Wéry S, Wong D, De Léon T, DeAntonio R, Naranjo L, Guignard A, Marano C. Hepatitis A antibody persistence 8 and 10 years after 1-dose and 2-dose vaccination in children from Panama. Vaccine 2020; 39:26-34. [PMID: 33239226 DOI: 10.1016/j.vaccine.2020.11.030] [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: 02/12/2020] [Revised: 08/14/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hepatitis A virus (HAV) remains a global public health concern, which is potentially growing in Latin America, due to an expected shift from high to intermediate endemicity levels. The use of HAV vaccines in pediatric national immunization programs (NIPs), either as a 2-dose or a 1-dose schedule, has been explored in Latin American countries; however, evidence demonstrating long-term protection in this population is limited in the region. We evaluated long-term antibody persistence following a 1-dose partial series and the recommended 2-dose schedule used in Panama's pediatric NIP. METHODS Two independent cross-sectional serological surveys were conducted at year 8 (Y8) and Y10 following vaccination under the NIP with 1 or 2 doses of an inactivated HAV vaccine (Havrix, GSK). Seropositivity (anti-HAV antibody concentration ≥ 15 mIU/mL) rates and antibody geometric mean concentrations (GMCs) were assessed at each serosurvey. Non-inferiority of 1 dose versus 2 doses was also explored. RESULTS This study (NCT02712359) included 600 and 599 children at Y8 and Y10 post-vaccination, respectively. Seropositivity rates were 74.3% (95% confidence interval [CI]: 69.0; 79.2) and 97.7% (95% CI: 95.3; 99.1) at Y8 and 71.9% (95% CI: 66.4; 76.9) and 96.3% (95% CI: 93.5; 98.2) at Y10, in the 1-dose and 2-dose groups, respectively. Antibody GMCs were lower in the 1-dose versus the 2-dose group in both surveys. Non-inferiority was not demonstrated since the lower limit of the 2-sided 95% CI for the between-group difference in seropositivity rates (1-dose minus 2-dose) was < -10%. CONCLUSION Anti-HAV antibody persistence was observed in lower percentages of children receiving 1 dose versus 2 doses of Havrix, at 8 and 10 years post-vaccination in Panama. Further investigations are needed to confirm antibody persistence and conclude on the protection afforded beyond 10 years in the pediatric population in Latin America.
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Affiliation(s)
| | - Ivonne Abadia
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología de Panama, Panama City, Panama.
| | | | | | - Digna Wong
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología de Panama, Panama City, Panama.
| | - Tirza De Léon
- Unidad Materno-Infantil José Domingo de Obaldia, Chiriqui, Panama.
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Andani A, van Elten TM, Bunge EM, Marano C, Salgado F, Jacobsen KH. Hepatitis A epidemiology in Latin American countries: a 2020 view from a systematic literature review. Expert Rev Vaccines 2020; 19:795-805. [PMID: 32955965 DOI: 10.1080/14760584.2020.1813575] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The World Health Organization recommends vaccination against hepatitis A virus (HAV) for children aged 1 year and older in areas where endemicity has shifted from high to intermediate. There are no recent comprehensive reviews of the epidemiology of HAV infection in Latin America, but seroprevalence and socioeconomic data suggest that, with improved clean water and sanitation systems, countries are transitioning to intermediate endemicity. AREAS COVERED We conducted a systematic literature review of the epidemiology of HAV infection in 25 countries in the Latin American region, which included gray literature. We compiled data on HAV incidence and prevalence, including the identification of epidemiological changes observed in countries that established pediatric HAV vaccination programs. EXPERT OPINION We identified 59 relevant articles, including 34 peer-reviewed seroprevalence studies (12 recent studies from Brazil), three incidence studies, and six vaccine impact studies (three from Argentina). Based on the estimated age at midpoint of population immunity in each country, most have a high-intermediate, intermediate, or low-intermediate level of HAV endemicity, suggesting that national childhood immunization may be an appropriate disease prevention strategy. However, recent data were lacking for most countries. Improved data quality and continued epidemiological surveillance are required for this region.
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Affiliation(s)
| | - Tessa M van Elten
- Pallas Health Research and Consultancy B.V ., Rotterdam, The Netherlands
| | - Eveline M Bunge
- Pallas Health Research and Consultancy B.V ., Rotterdam, The Netherlands
| | | | | | - Kathryn H Jacobsen
- Department of Global & Community Health, George Mason University , Fairfax, VA, USA
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Abstract
Hepatitis A is an important public health issue worldwide. Hepatitis A vaccine (HepA) was first licensed in 1992. Both inactivated HepA (HepA-I) and live attenuated HepA (HepA-L) are highly immunogenic and well tolerated, and immune protection postvaccination can persist for at least 20 y. HepA is effective for both preexposure and postexposure prophylaxis, especially among children and young adults. The strategy of HepA vaccination varies in different countries and mainly includes vaccination among high-risk populations, regional childhood vaccination and universal childhood vaccination. The incidence of hepatitis A has decreased greatly in many countries in the last 30 y, but hepatitis A outbreaks frequently occur among high-risk populations and those who have not been covered by universal child vaccination programs in recent years. Disease surveillance and serosurveys are suggested to clarify the shift in the epidemiology of hepatitis A. The long-term persistence of immune protection after one dose of HepA should be further studied, as well as the cost-effective evaluation of different strategies of HepA vaccination. Based on this evidence, the recommendation on HepA vaccination should be put forward scientifically and updated in a timely and well-implemented manner.
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Affiliation(s)
- Li Zhang
- Academy of Preventive Medicine, Shandong University , Jinan, China.,Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention , Jinan, China
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Brito WID, Souto FJD. Universal hepatitis A vaccination in Brazil: analysis of vaccination coverage and incidence five years after program implementation. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200073. [PMID: 32638856 DOI: 10.1590/1980-549720200073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/08/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In 2014, Brazil introduced a universal immunization program against the hepatitis A virus (HAV) for children in the second year of life, using a single dose of inactivated virus vaccine. The objective of this study was to evaluate the vaccination coverage (VC) against HAV in Brazil, against the incidence of cases reported five years after the implementation of the program. METHODOLOGY Secondary data were obtained by searching free access electronic sites of the Ministry of Health, Department of Informatics of the Unified Health System (Departamento de Informática do Sistema Único de Saúde - DATASUS), for incidence analysis and VC from 2014 to 2018. RESULTS VC ranged from 60.13 to 97.07%. The homogeneity of VC against hepatitis A did not reach the established goal throughout all states but for a few exceptions. After 2015, CV decreased in all regions of the country. Despite insufficient coverage, a concomitant reduction in the incidence of Hepatitis A took place throughout the country. The incidence rate fell from 3.29 to 0.80/100,000 between 2014 and 2018. However, there was an interruption in the pace of incidence fall between 2017 and 2018, which may be a consequence of insufficient VC. This phenomenon seems to be part of a widespread downward trend in vaccination effort across the country, also verified for other vaccines, such as poliomyelitis and measles, mumps and rubella vaccine. CONCLUSION These figures suggest the need for implementing efforts to improve hepatitis A VC rates in the country.
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Affiliation(s)
- Wagner Izidoro de Brito
- Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil
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Nelson NP, Weng MK, Hofmeister MG, Moore KL, Doshani M, Kamili S, Koneru A, Haber P, Hagan L, Romero JR, Schillie S, Harris AM. Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020; 69:1-38. [PMID: 32614811 PMCID: PMC8631741 DOI: 10.15585/mmwr.rr6905a1] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
HEPATITIS A IS A VACCINE-PREVENTABLE, COMMUNICABLE DISEASE OF THE LIVER CAUSED BY THE HEPATITIS A VIRUS (HAV). THE INFECTION IS TRANSMITTED VIA THE FECAL-ORAL ROUTE, USUALLY FROM DIRECT PERSON-TO-PERSON CONTACT OR CONSUMPTION OF CONTAMINATED FOOD OR WATER. HEPATITIS A IS AN ACUTE, SELF-LIMITED DISEASE THAT DOES NOT RESULT IN CHRONIC INFECTION. HAV ANTIBODIES (IMMUNOGLOBULIN G [IGG] ANTI-HAV) PRODUCED IN RESPONSE TO HAV INFECTION PERSIST FOR LIFE AND PROTECT AGAINST REINFECTION; IGG ANTI-HAV PRODUCED AFTER VACCINATION CONFER LONG-TERM IMMUNITY. THIS REPORT SUPPLANTS AND SUMMARIZES PREVIOUSLY PUBLISHED RECOMMENDATIONS FROM THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) REGARDING THE PREVENTION OF HAV INFECTION IN THE UNITED STATES. ACIP RECOMMENDS ROUTINE VACCINATION OF CHILDREN AGED 12-23 MONTHS AND CATCH-UP VACCINATION FOR CHILDREN AND ADOLESCENTS AGED 2-18 YEARS WHO HAVE NOT PREVIOUSLY RECEIVED HEPATITIS A (HEPA) VACCINE AT ANY AGE. ACIP RECOMMENDS HEPA VACCINATION FOR ADULTS AT RISK FOR HAV INFECTION OR SEVERE DISEASE FROM HAV INFECTION AND FOR ADULTS REQUESTING PROTECTION AGAINST HAV WITHOUT ACKNOWLEDGMENT OF A RISK FACTOR. THESE RECOMMENDATIONS ALSO PROVIDE GUIDANCE FOR VACCINATION BEFORE TRAVEL, FOR POSTEXPOSURE PROPHYLAXIS, IN SETTINGS PROVIDING SERVICES TO ADULTS, AND DURING OUTBREAKS.
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Hepatitis A: Epidemiology, Natural History, Unusual Clinical Manifestations, and Prevention. Gastroenterol Clin North Am 2020; 49:191-199. [PMID: 32389358 PMCID: PMC7883407 DOI: 10.1016/j.gtc.2020.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis A virus (HAV) is a positive-strand RNA virus that is transmitted feco-orally through person-to-person contact. Outbreaks are often linked to poor sanitation, overcrowding, or food and water contamination. Infection is often asymptomatic in children, but adults present with jaundice, abdominal pain, hepatitis, and hyperbilirubinemia. Diagnosis is through detection of immunoglobulin M antibodies against HAV, and treatment is supportive. Vaccination is the mainstay of prevention and should be given before exposure whenever possible.
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Declining trends in Hepatitis A seroprevalence over the past two decades, 1998-2017, in Pune, Western India. Epidemiol Infect 2020; 148:e121. [PMID: 32381137 PMCID: PMC7339083 DOI: 10.1017/s0950268820000953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Reduction in seroprevalence of Hepatitis A virus (HAV) is known to be associated with improvements in socioeconomic conditions of the community. National Institute of Virology, Pune has been studying seroprevalence of hepatitis viruses in Pune region over the past four decades. In total, 1438 samples were collected from urban general (UGEN), urban lower socioeconomic stratum (ULSES) and rural (RURAL) populations of the Pune district. Based on estimates in previous studies, subjects were enrolled from age groups ‘6–10’, ‘15–25’ and ‘40 + ’ years. HAV seroprevalence in younger population showed a significant decline. A significant decline in HAV seroprevalence in ‘15–25’ years age group in UGEN (from 85.9% to 73.9%; OR = 0.46, 95% CI: 0.25–0.86) and RURAL (from 98.6% to 91.4%; OR = 0.15, 95% CI: 0.05–0.45) populations suggested that the trend probably started more than a decade ago. Seroprevalence of HAV among ULSES ‘6–10’ children was found to be significantly higher (70.4%) than that among the RURAL children (44.2%; OR = 3.0, 95%CI: 1.7–5.2) and UGEN children (40.4%; OR = 3.5, 95%CI: 1.8–6.7). In view of increasing rates of urbanisation in India, ULSES population needs special consideration while designing future studies and viral hepatitis vaccination/elimination strategies. Our findings call for robust population-based studies that consider heterogeneity within populations and dynamics of socio-economic parameters in various regions of a country.
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De Oliveira TM, Vieira NSG, Sepp TDS, Souto FJD. Recent trends in hepatitis A incidence in Brazil. J Med Virol 2020; 92:1343-1349. [DOI: 10.1002/jmv.25694] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/31/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Talita M. De Oliveira
- Facimed Medicine CourseCollege of Biomedical Sciences of CacoalCacoal Rondônia Brazil
| | - Nádia S. G. Vieira
- Facimed Medicine CourseCollege of Biomedical Sciences of CacoalCacoal Rondônia Brazil
| | - Thaís D. S. Sepp
- Facimed Medicine CourseCollege of Biomedical Sciences of CacoalCacoal Rondônia Brazil
| | - Francisco J. D. Souto
- Facimed Medicine CourseCollege of Biomedical Sciences of CacoalCacoal Rondônia Brazil
- Internal Medicine DepartmentFederal University of Mato GrossoCuiabá Mato Grosso Brazil
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Guo Y, Zhang L, Feng D, Zhao S, Liu Q, Xu J, Lu M, Li J, Zhang Y, Guo W. The impact of universal live attenuated hepatitis A vaccines in Henan, China, 2005-2018. Int J Infect Dis 2020; 93:163-167. [PMID: 32045695 DOI: 10.1016/j.ijid.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To analyze the effects of one dose of live attenuated hepatitis A vaccine in a developing country. METHODS The reported cases of hepatitis A virus (HAV) infection from 2005 to 2018 in Henan province, China, were analyzed. Data of vaccinated children were assessed on the childhood immunization information management system. Questionnaire survey and blood sample collection were randomly conducted in six counties and districts of Henan province to analyze the prevalence of HAV lgG among the population aged 0-70 years. RESULTS In 2008, Henan province began to expand its program on immunization, and children aged 18 months were given one dose of live attenuated hepatitis A vaccine (HepA-L). From 2005 to 2007, the HAV incidence remained steady at above 5000 cases per year and increased to 7489 in 2007. Since 2008, the HAV incidence decreased cumulatively from 4576 to 237 in 2018, indicating a 94.8% decrease, which was particularly pronounced among adolescents (98.2%). The proportion of hepatitis A cases in patients younger than 10 years continually decreased from 41.6% in 2012 to 3.8% in 2018. The reduction of reported cases older than 40 years was slower than that of children. In 2012, the proportion of hepatitis A cases older than 40 years was 27.6%, and continually increased to 69.2% (164/237) in 2018. The results of serological investigation showed that the 0-1.5-year age group had the lowest anti-HAV IgG prevalence (38.6%), which increased to 75.0% in the 4-6-year age group, covered by this immunization program. CONCLUSIONS The data indicated a large decrease in HAV infections in Henan province from 2008 onward in response to the introduction of a planned immunization program of HepA-L.
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Affiliation(s)
- Yonghao Guo
- Henan Center for Disease Control and Prevention, No. 105, Nongye Rd., 450016, Zhengzhou, China.
| | - Lu Zhang
- Henan Center for Disease Control and Prevention, No. 105, Nongye Rd., 450016, Zhengzhou, China.
| | - Daxing Feng
- Henan Center for Disease Control and Prevention, No. 105, Nongye Rd., 450016, Zhengzhou, China.
| | - Sheng Zhao
- Henan Center for Disease Control and Prevention, No. 105, Nongye Rd., 450016, Zhengzhou, China.
| | - Qian Liu
- Henan Center for Disease Control and Prevention, No. 105, Nongye Rd., 450016, Zhengzhou, China.
| | - Jin Xu
- Henan Center for Disease Control and Prevention, No. 105, Nongye Rd., 450016, Zhengzhou, China.
| | - Mingxia Lu
- Henan Center for Disease Control and Prevention, No. 105, Nongye Rd., 450016, Zhengzhou, China.
| | - Jun Li
- Henan Center for Disease Control and Prevention, No. 105, Nongye Rd., 450016, Zhengzhou, China.
| | - Yanyang Zhang
- Henan Center for Disease Control and Prevention, No. 105, Nongye Rd., 450016, Zhengzhou, China.
| | - Wanshen Guo
- Henan Center for Disease Control and Prevention, No. 105, Nongye Rd., 450016, Zhengzhou, China
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