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Raju B, Andani A, Kolhapure S, Agrawal A. Need for hepatitis A prevention in patients with chronic liver disease in the changing epidemiological setting of India. Hum Vaccin Immunother 2021; 17:1520-1529. [PMID: 33236963 PMCID: PMC8078677 DOI: 10.1080/21645515.2020.1832408] [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] [Indexed: 12/13/2022] Open
Abstract
The burden of chronic liver disease (CLD) in India is high, particularly among middle-aged men, with nearly 220,000 deaths due to cirrhosis in 2017. CLD increases the risk of infection, severe disease (e.g. hepatitis A virus or HAV superinfection, acute-on-chronic liver failure, fulminant hepatic failure), and mortality. Hence, various countries recommend HAV vaccination for CLD patients. While historic Indian studies showed high seroprevalences of protective HAV antibodies among Indian adults with CLD, the most recent ones found that nearly 7% of CLD patients were susceptible to HAV infection. Studies in healthy individuals have shown that HAV infection in childhood is decreasing in India, resulting in an increasing population of adults susceptible to HAV infection. As patients with CLD are at increased risk of severe HAV infection, now may be the time to recommend HAV vaccination among people with CLD in India.
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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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Agrawal A, Singh S, Kolhapure S, Hoet B, Arankalle V, Mitra M. Increasing Burden of Hepatitis A in Adolescents and Adults and the Need for Long-Term Protection: A Review from the Indian Subcontinent. Infect Dis Ther 2019; 8:483-497. [PMID: 31679118 PMCID: PMC6856242 DOI: 10.1007/s40121-019-00270-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatitis A, an acute inflammatory liver disease caused by hepatitis A virus (HAV) infection from close contact with infected people, is highly endemic in the Indian subcontinent. Due to poor sanitary conditions, most of the population is exposed to the virus in childhood. At this age, the disease is asymptomatic and provides life-long protection against the disease. Due to rapid socioeconomic development in some areas, however, pockets of the population are reaching adolescence/adulthood without prior exposure to the virus and are thus susceptible to infection. At these ages, infection carries a higher risk of symptomatic disease and complications including mortality. This review of epidemiology and burden of disease studies in the Indian subcontinent, published since 2005, shows increasing evidence of a shift from high to intermediate endemicity in high-income-typically urban-populations. The prevalence of anti-HAV antibodies (previously reported at > 90%) is lower now in adolescents and young adults (e.g., around 80% in Bangladesh and 55% in 5-15 years in India). As a result, HAV is responsible for more acute viral hepatitis predominantly in this age group (e.g., > 15 years: 3.4% in 1999 to 12.3% in 2003 or high socioeconomic status 13-20 years: 27% in 1999 to 62% in 2003), with a greater clinical and economic burden. Numerous outbreaks due to HAV have been reported [e.g., Sri Lanka (2009-2010): > 13,000 affected; Kashmir (2015-2017): 12 outbreaks; Kerala (2012-2016): 84 outbreaks] from water or food contamination. Due to current shifts in endemicity, a growing proportion of the population is no longer exposed in childhood. As the disease remains highly endemic, it also provides a source for more severe disease in susceptible people at an older age and for outbreaks. Well-tolerated and effective vaccines are available and help prevent disease burden and provide long-term protection. These should now be used more widely to protect more patients from the growing disease burden of hepatitis A. FUNDING: GlaxoSmithKline Biologicals SA. Plain language summary available for this article-please see Fig. 1 and the following link: https://doi.org/10.6084/m9.figshare.9963044.Fig. 1Plain Language Summary. Highlights the context of the article, the endemicity shift and the burden of hepatitis A in adolescents and adults and steps to be taken to address the impact of this disease.
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Gallone MF, Desiante F, Gallone MS, Barbuti G, Tafuri S, Germinario C. Serosurveillance of hepatitis A in a region which adopted the universal mass vaccination. Medicine (Baltimore) 2017; 96:e5884. [PMID: 28248852 PMCID: PMC5340425 DOI: 10.1097/md.0000000000005884] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Hepatitis A is a common infectious disease worldwide that was endemic in many regions of Southern Italy, such as Apulia region. After a large hepatitis A outbreak occurred between 1996 and 1997, in Apulia an active-free immunization program that was targeted to new-borns and adolescents was started. The aim of this study is to investigate the hepatitis A seroprevalence in the adult Apulian population 18 years after the immunization program introduction, in order to evaluate the risk of new epidemics onset.The study was carried out from May 2011 to June 2012 among blood donors from Department of Transfusion Medicine and Blood Bank of Policlinico General Hospital in Bari. Participants signed a written consent and filled out a questionnaire including items on demographic characteristics, risk factors, disease memory, and raw food consumption. Serum samples, collected from each patient, were tested for anti-HAV using the chemiluminescent microparticle immunoassay. Vaccination status against hepatitis A was checked on Regional Digital Immunization Registry (GIAVA).In total 1827 donors agreed to participate (77.7% male) with a mean age of 38.4 ± 11.7 years. However, 1172 (64.1%) donors were seropositive with no difference by sex. The highest proportion of seronegative subjects was in the 27 to 35 years age group. 91.8% of 1-dose vaccinated subjects (n = 190/207; 95%CI = 87.2-95.1) and 96.1% (n = 171/178; 95%CI = 92.1-98.1) of 2-doses vaccinated subjects were immune to the disease. Sensitivity of disease memory in unvaccinated subjects was 14.4% (95%CI = 12.2-16.7), specificity was 97.8% (95%CI = 96.3-98.8), positive predictive value was 91% (95%CI = 85.3-95), and negative predictive value was 42.6% (95%CI = 40-45.2). Raw seafood consumption in unvaccinated subjects was associated with the anti-HAV IgG positivity (OR = 2.1; 95%CI = 1.7-2.7; z = 7.4; P < 0.0001).The vaccination program seems to have changed the virus circulation pattern, with a higher seronegativity rate among subjects not included in the vaccination strategy: 67% of susceptible subjects were among younger people aged 27 to 35 years. Immunization program implementation with a catch-up strategy may be needed to avoid a possible increase of hepatitis A incidence and outbreaks in Apulia. Epidemiological surveillance should be continued and vaccination should actively be offer for free to all the cases contacts, in order to prevent new outbreaks onset.
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Affiliation(s)
- Maria Filomena Gallone
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Bari, Italy
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Han T, Li C, Zhang Y, Wang Y, Wu B, Ke L, Liu G, Li L, Liu Y, Liu Z. The prevalence of hepatitis A virus and parvovirus B19 in source-plasma donors and whole blood donors in China. Transfus Med 2015; 25:406-10. [PMID: 26564017 DOI: 10.1111/tme.12259] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/30/2015] [Accepted: 10/09/2015] [Indexed: 12/14/2022]
Abstract
AIMS To compare the prevalence of hepatitis A virus (HAV) and human parvovirus B19 (B19V) between source-plasma (SP) donors and whole blood (WB) donors. BACKGROUND In China, source plasma is in severe shortage while plasma recovered from WB is in surplus. Thus, the government is considering transferring the recovered plasma (RP) to produce plasma derivatives. HAV and B19V are two pathogens threatening the safety of plasma-based derivatives. However, there is no data about if transferring of the RP to produce plasma derivatives will increase the risk of HAV and B19V infection. Thus, we compared the prevalence of HAV and B19V between SP donors and WB donors in this study. METHODS A total of 5030 samples from SP donors and 5040 samples from WB donors were collected. All the samples were tested for HAV RNA and B19V DNA and tested for HAV IgM by enzyme-linked immunosorbent assay (ELISA). RESULTS The prevalence of B19V DNA was 0.06% (95% confidence interval (CI), 0-0.09%) in WB donors and 0.079% (95% CI, 0-0.12%) in SP donors, respectively. No significant difference was found in the prevalence of B19V DNA between SP donors and WB donors. The prevalence of anti-HAV IgM in SP donors was 0.079% whereas no WB donor sample was found anti-HAV IgM reactive. CONCLUSIONS The transfer of RP to producing plasma derivatives will not increase the risk of transmission of HAV and B19 through plasma products.
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Affiliation(s)
- T Han
- School of Public Health, Anhui Medical University, Hefei, China
| | - C Li
- Experimental Center of Transfusion Medicine, Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Y Zhang
- Chengdu Rongsheng Pharmaceuticals, Experimental Center, Chengdu, China
| | - Y Wang
- Experimental Center of Transfusion Medicine, Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - B Wu
- Experimental Center of Transfusion Medicine, Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - L Ke
- Experimental Center of Transfusion Medicine, Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - G Liu
- Experimental Center of Transfusion Medicine, Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - L Li
- Experimental Center of Transfusion Medicine, Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Y Liu
- Experimental Center of Transfusion Medicine, Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Z Liu
- Experimental Center of Transfusion Medicine, Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
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Bose M, Bose S, Saikia A, Medhi S, Deka M. Molecular epidemiology of hepatitis A virus infection in Northeast India. J Med Virol 2015; 87:1218-24. [PMID: 25881081 DOI: 10.1002/jmv.24168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2015] [Indexed: 01/31/2023]
Abstract
The present study was undertaken to screen the molecular epidemiology of Hepatitis A virus (HAV) in Northeast India (NEI) who are ethnically distinct, tribal dominated and of lower socio-economic status with almost no information available from NEI on these aspects. Briefly, 3 ml blood was collected from 324 random liver disease cases with jaundice, receiving care at Central Hospital, N.F. Railway, Guwahati, Assam with informed consent. The patients detected with HAV-IgM positive status were included and were stratified as acute viral hepatitis (AVH) and fulminant hepatitis (FHF) based on clinical profile. Viral RNA was isolated and HAV-RNA was detected by Real-time PCR using primers for the VP3-VP1 region. HAV genotyping was studied by PCR-direct sequencing-phylogenetic analysis approach using the VP1/2A region of HAV isolates. Statistical analysis was performed using SPSS13.0 software. A total of 69 cases were HAV infected with two HBV co-infected cases (n = 69 + 2 = 71), 62 cases and two co-infected cases were AVH and others were FHF cases. HAV infection was predominant in especially in the young and adult age group. HAV-RNA was detected in 28 cases, out of which 19 cases could be genotyped (12 AVH, 7 FHF); which showed the prevalence of genotype IIIA or IA only. Although HAV genotype IIIA was the major genotype in both the AVH (10/12, 83.33%) and FHF (5/7, 71.43%) group, but the difference in distribution of genotypes in AVH and FHF cases was statistically non-significant (P = 0.550). HAV genotype IIIA is associated with the majority of HAV infected cases and severity in NEI.
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Affiliation(s)
- Moumita Bose
- Biotechnology, Gauhati University, Guwahati, India
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Kotwal A, Singh H, Verma A, Gupta R, Jain S, Sinha S, Joshi R, Teli P, Khunga V, Bhatnagar A, Ranjan R. A study of Hepatitis A and E virus seropositivity profile amongst young healthy adults in India. Med J Armed Forces India 2014; 70:225-9. [PMID: 25378774 PMCID: PMC4213908 DOI: 10.1016/j.mjafi.2014.06.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 06/23/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Various Serosurveys and studies provide ample evidence of differing perspectives regarding epidemiology of HAV and HEV in India. This study was conducted to assess the seroprevalence of HAV and HEV and its associated factors with an aim to provide inputs to planners regarding requirement of HAV vaccine. METHODS A multi-centric cross sectional survey amongst 4175 healthy trainees (young adults) was carried out in training centres, selected by multistage random sampling, giving equal representation to all regions of India. Sample size was calculated by taking prevalence of HAV seropositivity amongst adults as 60% and alpha 0.05. RESULTS Seroprevalence for HAV and HEV was 92.68% (95% CI 91.82, 93.47) and 17.05% (15.90, 18.26), respectively. Logistic regression showed that hand washing without soap, regular close contact with domestic animals, consumption of unpasteurized milk and regular consumption of food outside home were risk factors for HAV (p < 0.05). For HEV, irregular hand washing, consumption of unpasteurized milk and irregular consumption of freshly prepared food were risk factors (p < 0.05). CONCLUSION High level of immunity against HAV among the healthy young adults clearly demonstrates that vaccination against HAV is not required at present in our country. The large proportion being susceptible to HEV points towards the requirement of preventive strategies in the form of safe drinking water supply, hygiene, sanitation, increasing awareness and behaviour change with respect to personal hygiene especially hand and food hygiene.
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Affiliation(s)
- Atul Kotwal
- Director, AFMS (Med Research), O/o DGAFMS, Ministry of Defence, New Delhi, India
- Professor and Head, Dept of Community Medicine, Army College of Medical Sciences, New Delhi 11001, India
| | | | - A.K. Verma
- Formerly, Professor & Head, Dept of Community Medicine, Armed Forces Medical College, Pune 411040, India
| | - R.M. Gupta
- Dy DGMS (IT), O/o DGMS (Army), L Block IHQ of MoD (A), New Delhi, India
| | | | - S. Sinha
- ADH, HQ 1 Corps, C/o 56 APO, India
| | - R.K. Joshi
- Classified Specialist (Community Medicine & Epidemiology), National Aids Research Institute, Pune, India
| | | | | | - Anuj Bhatnagar
- Assistant Professor, Dept of Community Medicine, Armed Forces Medical College, Pune 411040, India
| | - Richa Ranjan
- Classified Specialist (Pathology), Command Hospital (Central Command), Lucknow, India
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Ozawa S, Privor-Dumm LA, Nanni A, Durden E, Maiese BA, Nwankwo CU, Brodovicz KG, Acosta CJ, Foley KA. Evidence-to-policy gap on hepatitis A vaccine adoption in 6 countries: Literature vs. policymakers’ beliefs. Vaccine 2014; 32:4089-96. [DOI: 10.1016/j.vaccine.2014.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 04/23/2014] [Accepted: 05/01/2014] [Indexed: 10/25/2022]
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Ceran N, Yüksel Kocdogan F, Mert D, Erdem I, Dede B, Adaleti R, Ozyürek S, Karagül E, Göktaş P. Hepatitis A seroprevalence in children and young adults in Istanbul, Turkey: seroprevalence change and associated factors. J Viral Hepat 2012; 19:72-6. [PMID: 22187947 DOI: 10.1111/j.1365-2893.2011.01454.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Hepatitis A is a widespread infectious disease. The prevalence of the disease is closely related to socioeconomic status (SES) and environmental factors. Understanding its prevalence is essential for instituting appropriate precautions. The aim of this study was to determine the prevalence of hepatitis A and evaluate the associated demographic features in children and young adults in Istanbul. In total, 630 individuals between the ages of 5-24 were included in the study. They were classified into four age groups (5-9, 10-14, 15-19 and 20-24 years). The seropositivity of hepatitis A in the whole study population was 40%. Age-specific prevalence was 11.4% in children 5-9 years old, 29% in those 10-14 years old, 49.7% in those 15-19 years old and 69% in those 20-25 years old. Seropositivity was associated with increasing age, low SES, large family size, low maternal educational level, use of unsafe drinking water and living in regions with poor infrastructure and incomplete urbanization. When we compared our results with previous seroprevalence studies performed in Istanbul, we found an epidemiological shift towards increasing age. Factors associated with changes in prevalence were urbanization and associated infrastructure improvement, knowledge of the disease by the population, use of good hygiene and use of vaccination in those at high risk.
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Affiliation(s)
- N Ceran
- Haydarpaşa Numune Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
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