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Ștefan I, Cristea IM, Ștefan AT, Ranetti AE, Sirbu CA, Rusu E, Moldovan CA, Leru PM, Nistor CE. A Surprising Case of Triple Acute Hepatitis Infection. Life (Basel) 2023; 13:1761. [PMID: 37629618 PMCID: PMC10455544 DOI: 10.3390/life13081761] [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: 06/19/2023] [Revised: 07/10/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Viral hepatitis continues to be the leading cause of morbidity and mortality worldwide, but the burden has significantly diminished thanks to the large-scale use of vaccines and antivirals. However, there are still challenges regarding viral hepatitis management, especially when more than one pathogenic agent is involved. We present the case of a 45-year-old woman who had a simultaneous infection involving three hepatitis viruses: HAV, HBV, and HEV.
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Affiliation(s)
- Ion Ștefan
- Department of Infectious Diseases, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania
| | - Ioana-Mădălina Cristea
- Department of Infectious Diseases, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania
| | - Alexia-Teodora Ștefan
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Aurelian-Emil Ranetti
- Endocrinologic Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Carmen Adella Sirbu
- Clinical Neurosciences Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Academy of Romanian Scientists, 50044 Bucharest, Romania
| | - Elena Rusu
- Department of Preclinical Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania;
| | - Cosmin Alec Moldovan
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania
| | - Polliana M. Leru
- Clinical Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Claudiu-Eduard Nistor
- Thoracic Surgery Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Medić S, Anastassopoulou C, Pustahija T, Petrović V, Dragnić N, Boufidou F, Tsakris A, Šaponjić V. Epidemiological Transition and Strategies for the Control of Hepatitis A in Serbia. Viruses 2023; 15:v15030753. [PMID: 36992462 PMCID: PMC10056894 DOI: 10.3390/v15030753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/27/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Improvements in socioeconomic and hygienic conditions during the past decades led to declining hepatitis A (HA) seroprevalence in many countries. Aiming at informing HA vaccination policy, we assessed current epidemiological trends in Serbia by analyzing surveillance data for 2002–2021. Methods: Data on cases and outbreaks were obtained from the Serbian national surveillance database and descriptively analyzed. HA incidence was calculated in relation to time, patients’ residence, and demographics. Results: Overall, 13,679 HA cases and 419 outbreaks were recorded with the highest incidence in the southeast. Downward HA trends were observed, while infant mortality was halved, and gross domestic product based on purchasing power parity (GDP PP) per capita, tripled. The average incidence dropped from 14.8 (95% CI 14.4–15.2)/100,000) in 2002–2006 to 1 (95% CI 0.9–1.1)/100,000)/100,000 in 2017–2021, while the number of outbreaks decreased (from 174 to 14). Sporadic cases and family clusters living in poor sanitary conditions occurred in recent years. The contact route of transmission was dominant (410/419, 97.9%). The highest average age-specific HA incidence shifted from 5–9 years in 2002–2006 to 10–19 years in 2017–2021.Serbia is transitioning towards very low HA endemicity. Enhanced surveillance and vaccination of high-risk groups are recommended as future public health priorities.
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Affiliation(s)
- Snežana Medić
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Futoška 121, 21000 Novi Sad, Serbia
- Correspondence: ; Tel.: +381-21-4897-800
| | - Cleo Anastassopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Tatjana Pustahija
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Futoška 121, 21000 Novi Sad, Serbia
| | - Vladimir Petrović
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Futoška 121, 21000 Novi Sad, Serbia
| | - Nataša Dragnić
- Department of Social Medicine and Health Statistics with Informatics, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
- Center for Informatics and Biostatistics, Institute of Public Health of Vojvodina, Futoška 121, 21000 Novi Sad, Serbia
| | - Fotini Boufidou
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vladan Šaponjić
- Institute of Public Health of Serbia, “Dr Milan Jovanović Batut”, Belgrade, Dr Subotića 5, 11000 Belgrade, Serbia
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Guzman-Holst A, Luna-Casas G, Burguete Garcia A, Madrid-Marina V, Cervantes-Apolinar MY, Andani A, Huerta-Garcia G, Sánchez-González G. Burden of disease and associated complications of hepatitis a in children and adults in Mexico: A retrospective database study. PLoS One 2022; 17:e0268469. [PMID: 35584365 PMCID: PMC9116942 DOI: 10.1371/journal.pone.0268469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/29/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hepatitis A virus (HAV) infection is a leading cause of viral hepatitis in children, yet the HAV vaccine is not included in the national immunization program (NIP) in Mexico. This study addresses an identified evidence gap of the burden of hepatitis A disease, complications, and associated costs in Mexico by analyzing surveillance and healthcare data. Data review included disease morbidity (incidence and hospitalization), mortality, and healthcare resource utilization costs. METHODS In this observational, retrospective database study, we conducted a systematic screening, extraction, and analysis of outcome data from the national surveillance system in Mexico from January 2000 to December 2019. RESULTS During the analysis period (2000-2019), the average incidence rate/year of HAV cases was 14.7 (5.4-21.5) per 100,000 inhabitants. Children 1-9 years of age (YoA) had the highest average incidence rate/year with 47.8 (14.7-74.5). The average hospitalization rate/year due to HAV infection was 5.8% (2.9-9.6%). Although the highest burden of HAV continued to be in children (1-9 YoA), an increase in incidence and hospitalizations (with complications) in older age groups (≥ 10-64 YoA) was observed. The annual average fatality rate was estimated to be 0.44% (0.26-0.83%) of which 28.8% of deaths were concentrated in adults ≥ 65 YoA. The total direct costs of medical attention due to HAV and related complications were estimated at $382 million Mexican pesos. CONCLUSION The overall results suggest an uptrend in HAV infections in adolescents/adults compared to children in Mexico. Therefore, as the overall incidence risk of HAV infection decreases, the mean age of infection increases. This consequently increases the risk of severity and complications in older age groups, thus increasing the demand for healthcare resources. Our findings provide evidence for including the inactivated HAV vaccine in the Mexican NIP.
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Kelly D, O'Hare C, McKeown P, Cianci F, Doyle S. Detection and control of an ongoing international outbreak of hepatitis A among the Irish Traveller community beginning September 2020. Epidemiol Infect 2022; 150:1-13. [PMID: 35168695 PMCID: PMC8931807 DOI: 10.1017/s0950268822000309] [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: 12/21/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/06/2022] Open
Abstract
Hepatitis A virus (HAV) infection is a notifiable disease in Ireland, with national coverage of clinical and laboratory surveillance. In December 2020, a cluster of 11 HAV cases among the Irish Traveller community was detected. The outbreak investigation identified 61 total HAV cases from September 2020 to November 2021. Sequenced isolates were sub-genotype IA with identical genome sequence. Case-patients were predominantly aged under 18 (77%), hospitalised (46%) and lived on communal residential sites. Mass onsite HAV vaccination was employed following failure of initial ring vaccination to contain the outbreak. This is the largest outbreak of HAV described in Ireland, involving spillover to the UK and Netherlands. We recommend mass HAV vaccination and tailored communication for outbreak control in migratory subpopulations.
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Affiliation(s)
- David Kelly
- Health Protection Surveillance Centre, HSE, Dublin, Ireland
| | - Colette O'Hare
- Department of Public Health, HSE South-East, Kilkenny, Ireland
| | - Paul McKeown
- Health Protection Surveillance Centre, HSE, Dublin, Ireland
| | - Fiona Cianci
- Department of Public Health, HSE East, Dublin, Ireland
| | - Sarah Doyle
- Department of Public Health, HSE South-East, Kilkenny, Ireland
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Prevalence of Anti-Hav IgG Antibodies in the Population of the Łódź Macroregion by Age Group. POLISH HYPERBARIC RESEARCH 2021. [DOI: 10.2478/phr-2021-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Over the last several decades, a gradual decrease in the incidence of hepatitis A and an increase in the population of non-immune people, especially in the group of young people have been observed in Poland. The aim of this study was to assess of the presence of specific anti-hepatitis A virus IgG class antibodies (anti-HAV IgG) in relation to age among non-vaccinated hepatitis A patients. There were statistically significantly more patients up to 45 years of age with anti-HAV IgG negative results than those over 45 years of age, and the Fi-square correlation coefficient (Φ2) was 0.263 between the analyzed variables. The data analysis shows that the number of people with specific IgG antibodies against hepatitis A increases with age. The risk of hepatitis A infection in people under 45 is high due to widespread seronegativity in this age group.
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Badur S, Öztürk S, Ozakay A, Khalaf M, Saha D, Van Damme P. A review of the experience of childhood hepatitis A vaccination in Saudi Arabia and Turkey: implications for hepatitis A control and prevention in the Middle East and North African region. Hum Vaccin Immunother 2021; 17:3710-3728. [PMID: 34213403 DOI: 10.1080/21645515.2021.1920871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In most countries of the Middle East and Northern African (MENA) region, a high hepatitis A virus (HAV) endemicity has been documented. Few others, such as Saudi Arabia and Turkey, are transitioning from high to intermediate endemicity. There is a paucity of recently published HAV disease burden that could be useful to inform or strengthen relevant national hepatitis A vaccination policy and other prevention strategies in the region. This review summarizes information on HAV epidemiology before and after the implementation of a childhood hepatitis A vaccination program in Saudi Arabia and Turkey. In both countries, a clear shift in the age of first HAV exposure has been documented, with more homogeneous trends across regions in Saudi Arabia compared to Turkey. Utilizing the experience of Saudi Arabia and Turkey with hepatitis A vaccination, countries in the region are encouraged to foster discussions on potential vaccination strategies suitable for their own setting.
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Affiliation(s)
- Selim Badur
- Medical & Clinical Emerging Markets, GSK, Istanbul, Turkey
| | - Serdar Öztürk
- Medical & Clinical Emerging Markets, GSK, Istanbul, Turkey
| | - Alev Ozakay
- Medical & Clinical Emerging Markets, GSK, Istanbul, Turkey
| | | | - Debasish Saha
- Medical & Clinical Emerging Markets, GSK, Wavre, Belgium
| | - Pierre Van Damme
- Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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7
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Abstract
The public health response to sporadic hepatitis A virus (HAV) infection, hepatitis A, can be complex especially when the index case is a child and no obvious source is identified. Identifying an infection source may avoid mass immunisation within schools when transmission is found to have occurred within the household. Screening of asymptomatic contacts via venepuncture can be challenging and unacceptable, as a result non-invasive methods may facilitate public health intervention. Enzyme-linked immunoassays were developed to detect HAV immunoglobulin M (IgM) and immunoglobulin G (IgG) in oral fluid (ORF). A validation panel of ORF samples from 30 confirmed acute HAV infections were all reactive for HAV IgM and IgG when tested. A panel of 40 ORF samples from persons known to have been uninfected were all unreactive. Two hundred and eighty household contacts of 72 index cases were screened by ORF to identify HAV transmission within the family and factors associated with household transmission. Almost half of households (35/72) revealed evidence of recent infection, which was significantly associated with the presence of children ⩽11 years of age (odds ratio 9.84, 95% confidence interval: 2.74-35.37). These HAV IgM and IgG immunoassays are easy to perform, rapid and sensitive and have been integrated into national guidance on the management of hepatitis A cases.
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8
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The seroprevalence of cytomegalovirus infection in Belgium anno 2002 and 2006: a comparative analysis with hepatitis A virus seroprevalence. Epidemiol Infect 2020; 147:e154. [PMID: 31063104 PMCID: PMC6518518 DOI: 10.1017/s0950268819000487] [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: 11/06/2022] Open
Abstract
Cytomegalovirus (CMV) infection is endemic worldwide but its seroprevalence varies widely. The goal of this study was to estimate the age-specific seroprevalence of CMV infection in Belgium based on two cross-sectional serological datasets from 2002 and 2006. The seroprevalence was estimated relying on diagnostic test results based on cut-off values pre-specified by the manufacturers of the tests as well as relying on mixture models applied to continuous pathogen-specific immunoglobulin G antibody titre concentrations. The age-specific seroprevalence of hepatitis A virus (HAV), based on three Belgian cross-sectional serological datasets from 1993, 2002 and 2006, was used as a comparator since individuals acquire lifelong immunity upon recovery, implying an increasing seroprevalence with age. The age group weighted overall CMV seroprevalence derived from the mixture model was 32% (95% confidence interval (CI) 31-34%) in 2002 and 31% (95% CI 30-32%) in 2006. We demonstrated that CMV epidemiology differs from the immunizing infection HAV. This was the first large-scale study of CMV and HAV serial datasets in Belgium, estimating seroprevalence specified by age and birth cohort.
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Medić S, Anastassopoulou C, Milošević V, Dragnić N, Rajčević S, Ristić M, Petrović V. Declining seroprevalence of hepatitis A in Vojvodina, Serbia. PLoS One 2019; 14:e0217176. [PMID: 31163046 PMCID: PMC6548380 DOI: 10.1371/journal.pone.0217176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/07/2019] [Indexed: 11/18/2022] Open
Abstract
To assess the current hepatitis A virus (HAV) endemicity in the Autonomous Province of Vojvodina, Serbia, we examined the seroprevalence and susceptibility profiles of the general population. A serum bank of 3466 residual samples, collected in 2015-16 as per the specifications of the European Sero-Epidemiology Network 2 project (ESEN2), was tested for anti-HAV antibodies with an enzyme immunoassay. Relationships between anti-HAV positivity and demographic features of respondents were examined by univariable and multivariable analyses. Present-day HAV seroprevalence was compared with that obtained in 1978-79. Surveillance data for hepatitis A recorded between 2008 and 2017 were also analyzed. Age was the only demographic variable found to be independently associated with a HAV seropositive status. Seropositivity (17% overall vs. 79% in 1978-79) increased with age to a maximum of 90% in the elderly ≥60 years. Only 5% of subjects <30 years were seropositive, unlike the 44% of seropositives ≥30 years. The estimated age at midpoint of population immunity (AMPI) increased markedly from 14 years in the late 70s to 55 years in 2015-16. Meanwhile, disease incidence decreased noticeably in recent years (from 11 in 2008 to 2 per 100,000 population in 2017). In the ongoing pre-vaccine era, natural infection provides immunity for merely a third (31%) and two thirds (57%) of people in their 40s and 50s, respectively. Hence, the majority of people ≤40 years (94%) and middle-aged adults 40-49 years (69%) are susceptible to HAV. Older susceptible individuals, particularly those ≥50 years (24%), are prone to severe symptoms. Taken together, these changes reflect the epidemiological transition of Vojvodina and Serbia from high to very low HAV endemicity, thereby supporting the current national policy of immunization of only high-risk groups.
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Affiliation(s)
- Snežana Medić
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- * E-mail:
| | - Cleo Anastassopoulou
- Division of Genetics, Cell and Developmental Biology, Department of Biology, University of Patras, Patras, Greece
| | - Vesna Milošević
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Center for Virology, Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Nataša Dragnić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Center for Informatics and Biostatistics, Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Smiljana Rajčević
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Mioljub Ristić
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vladimir Petrović
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Abstract
Increased economic interdependence, social integration, and other aspects of globalization are contributing to significant changes in hepatitis A epidemiology. Globally, the incidence of hepatitis A virus (HAV) infection is decreasing, the age at midpoint of population immunity (AMPI) is increasing, and the proportion of symptomatic cases is increasing as the average age at infection increases. In low-income countries, HAV remains endemic but improved water and sanitation systems are reducing transmission rates among young children. In high-income countries, most adults remain susceptible to HAV and foodborne outbreaks are becoming more frequent. Middle-income countries have diverse epidemiological profiles, and they play important roles in the global spread of HAV through international trade and travel. Future changes in the epidemiology of hepatitis A will be heavily influenced by globalization processes.
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Affiliation(s)
- Kathryn H Jacobsen
- College of Health and Human Services, George Mason University, Fairfax, Virginia 22030
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11
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Lemon SM, Ott JJ, Van Damme P, Shouval D. Type A viral hepatitis: A summary and update on the molecular virology, epidemiology, pathogenesis and prevention. J Hepatol 2017; 68:S0168-8278(17)32278-X. [PMID: 28887164 DOI: 10.1016/j.jhep.2017.08.034] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 02/08/2023]
Abstract
Although epidemic jaundice was well known to physicians of antiquity, it is only in recent years that medical science has begun to unravel the origins of hepatitis A virus (HAV) and the unique pathobiology underlying acute hepatitis A in humans. Improvements in sanitation and the successful development of highly efficacious vaccines have markedly reduced the worldwide prevalence and incidence of this enterically-transmitted infection over the past quarter century, yet the virus persists in vulnerable populations and remains a common cause of food-borne disease outbreaks in economically-advantaged societies. Reductions in the prevalence of HAV have led to increases in the median age at which infection occurs, often resulting in more severe disease in affected persons and paradoxical increases in disease burden in some developing nations. Here, we summarize recent advances in the molecular virology of HAV, an atypical member of the Picornaviridae family, survey what is known of the pathogenesis of hepatitis A in humans and the host-pathogen interactions that typify the infection, and review medical and public health aspects of immunisation and disease prevention.
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Affiliation(s)
- Stanley M Lemon
- Lineberger Comprehensive Cancer Center, and the Departments of Medicine and Microbiology & Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7292, USA.
| | - Jördis J Ott
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany.
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, Antwerp University, Antwerp, Belgium
| | - Daniel Shouval
- Liver Unit, Institute for Gastroenterology and Hepatology, Hadassah-Hebrew University Hospital, P.O.Box 12000, Jerusalem 91120, Israel
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Carrillo-Santisteve P, Tavoschi L, Severi E, Bonfigli S, Edelstein M, Byström E, Lopalco P. Seroprevalence and susceptibility to hepatitis A in the European Union and European Economic Area: a systematic review. THE LANCET. INFECTIOUS DISEASES 2017. [PMID: 28645862 DOI: 10.1016/s1473-3099(17)30392-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Most of the European Union (EU) and European Economic Area (EEA) is considered a region of very low hepatitis A virus (HAV) endemicity; however, geographical differences exist. We did a systematic review with the aim of describing seroprevalence and susceptibility in the general population or special groups in the EU and EEA. We searched databases and public health national institutes websites for HAV seroprevalence records published between Jan 1, 1975, and June 30, 2014, with no language restrictions. An updated search was done on Aug 10, 2016. We defined seroprevalence profiles (very low, low, and intermediate) as the proportion of the population with age-specific anti-HAV antibodies at age 15 and 30 years, and susceptibility profiles (low, moderate, high, and very high) as the proportion of susceptible individuals at age 30 and 50 years. We included 228 studies from 28 of 31 EU and EEA countries. For the period 2000-14, 24 countries had a very low seroprevalence profile, compared with five in 1975-89. The susceptibility among adults ranged between low and very high and had a geographical gradient, with three countries in the low susceptibility category. Since 1975, EU and EEA countries have shown decreasing seropositivity; however, considerable regional variability exists. The main limitations of this study are that the studies retrieved for analysis might not be representative of all EU and EEA publications about HAV and might have poor national representativeness. A large proportion of EU and EEA residents are now susceptible to HAV infection. Our Review supports the need to reconsider specific prevention and control measures, to further decrease HAV circulation while providing protection against the infection in the EU and EEA, and could be used to inform susceptible travellers visiting EU and EEA countries with different HAV endemicity levels.
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Affiliation(s)
| | - Lara Tavoschi
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Ettore Severi
- European Centre for Disease Prevention and Control, Solna, Sweden; Karolinska Institutet, Stockholm, Sweden
| | - Sandro Bonfigli
- European Centre for Disease Prevention and Control, Solna, Sweden; Ministry of Health, Rome, Italy
| | - Michael Edelstein
- European Centre for Disease Prevention and Control, Solna, Sweden; Public Health Agency of Sweden, Stockholm, Sweden
| | - Emma Byström
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Pierluigi Lopalco
- European Centre for Disease Prevention and Control, Solna, Sweden; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Zucman D, Farfour E, Mazaux L, Hillaire S, Dimi S, Lesprit P, Kahn JE, Vasse M. How to Face the Outbreak of Viral Hepatitis A in Men Who Have Sex With Men in France Without Vaccines? Clin Infect Dis 2017; 65:1053-1054. [DOI: 10.1093/cid/cix458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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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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Koroglu M, Jacobsen KH, Demiray T, Ozbek A, Erkorkmaz U, Altindis M. Socioeconomic indicators are strong predictors of hepatitis A seroprevalence rates in the Middle East and North Africa. J Infect Public Health 2017; 10:513-517. [PMID: 28162965 DOI: 10.1016/j.jiph.2016.09.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/10/2016] [Accepted: 09/10/2016] [Indexed: 10/20/2022] Open
Abstract
The goal of this analysis was to examine the association between age-specific hepatitis A virus (HAV) seroprevalence rates and various socioeconomic indicators within the Middle East and North Africa (MENA) region. We conducted a systematic review of all recently published studies on HAV conducted in the MENA region and identified the highest quality studies for inclusion in our analysis. We calculated the age at midpoint of population immunity (AMPI) for each study and estimated seroprevalence rates at the ages of 5, 10, and 15 years. Next, we identified the correlations between these metrics and several socioeconomic variables. HAV data collected in or after 2000 were available for 14 of the 19 countries in the MENA region. Four of the 14 included countries had intermediate HAV endemicity (Algeria, Saudi Arabia, Turkey, and UAE), five had high endemicity (Iran, Jordan, Lebanon, Morocco, and Tunisia), and five had very high endemicity (Egypt, Iraq, Palestine, Syria, and Yemen). Water and sanitation were not significant predictors of AMPI or seroprevalence, most likely because most countries in this region have high rates of access to these utilities. However, gross domestic product (GDP), gross national income (GNI), and the human development index (HDI) were all highly associated with AMPI and prevalence. The observed correlations suggest that of the MENA countries without recent HAV data, Bahrain, Kuwait, and Qatar most likely have low endemicity, Oman likely has intermediate endemicity, and Libya likely has high endemicity. While it is unlikely that a single correlation model would be suitable for use in all world regions, the approach utilized in this analysis might provide a simple but accurate method for using economic data to impute the endemicity profiles of countries without recent data in regions where at least several neighboring countries have conducted recent serostudies.
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Affiliation(s)
- Mehmet Koroglu
- Department of Medical Microbiology, School of Medicine, Sakarya University, Sakarya, Turkey.
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Tayfur Demiray
- Clinical Microbiology Laboratory, Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Ahmet Ozbek
- Department of Medical Microbiology, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Unal Erkorkmaz
- Department of Biostatistics, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Mustafa Altindis
- Department of Medical Microbiology, School of Medicine, Sakarya University, Sakarya, Turkey
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16
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Hosseini Shokouh SJ, Dadashi A, Abiri M, zohrevand I, Eshraghian A, Khoshdel A, Heidari B, Khoshkish S. HAV Immunity in Iranian Medical Students. HEPATITIS MONTHLY 2015; 15:e26219. [PMID: 25825590 PMCID: PMC4359362 DOI: 10.5812/hepatmon.26219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/01/2015] [Accepted: 02/16/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatitis A, a fecal-oral transmitted disease, which has been considered endemic in developing countries, seems to change its pattern in developing countries because of their improved socioeconomic status. OBJECTIVES In the present study, we aimed to determine the need of vaccination in 270 students at AJA University of Medical Sciences. MATERIALS AND METHODS The serum level of anti-HAV antibody was checked in 270 students of AJA University of medical students, and effect of different factors, including age, gender, pre-university entrance exam region, familial education, familial income, clean water availability, and previous history of jaundice were tested. RESULTS Of total 270 students, 30 were female. Their age ranged between 18 and 30 years old with the mean age of 20.58 years and just 34% of students had positive level of anti-HAV antibody. Age and sex had no role in positive serum level of anti-HAV antibody. According to analyzed data, lack of clean water availability, pre-university entrance exam region, lower family education, and poor health status estimation increased statistically the risk of HAV infection. CONCLUSIONS Because 66% of students were anti-HAV antibody negative and they will work as health care workers in future, our study suggest vaccinating all students accepted at AJA University of Medical Sciences.
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Affiliation(s)
| | - Alireza Dadashi
- Infectious Diseases Research Center, AJA University of Medical Sciences, Tehran, IR Iran
| | - Mohamad Abiri
- Infectious Diseases Research Center, AJA University of Medical Sciences, Tehran, IR Iran
| | - Iraj zohrevand
- Infectious Diseases Research Center, AJA University of Medical Sciences, Tehran, IR Iran
| | - Ahad Eshraghian
- Infectious Diseases Research Center, AJA University of Medical Sciences, Tehran, IR Iran
| | - Alireza Khoshdel
- Epidemiology Research Centre, AJA University of Medical Sciences, Tehran, IR Iran
| | - Behnam Heidari
- Infectious Diseases Research Center, AJA University of Medical Sciences, Tehran, IR Iran
| | - Shayan Khoshkish
- Infectious Diseases Research Center, AJA University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Shayan Khoshkish, Infectious Diseases Research Center, AJA University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122767954, Fax: +98-2122767955, E-mail:
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17
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Estimating seroprevalence of vaccine-preventable infections: is it worth standardizing the serological outcomes to adjust for different assays and laboratories? Epidemiol Infect 2014; 143:2269-78. [PMID: 25420586 DOI: 10.1017/s095026881400301x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aim of the European Sero-Epidemiology Network 2 (ESEN2) project was to estimate age-specific seroprevalence for a number of vaccine-preventable diseases in Europe. To achieve this serosurveys were collected by 22 national laboratories. To adjust for a variety of laboratory methods and assays, all quantitative results were transformed to a reference laboratory's units and were then classified as positive or negative to obtain age-specific seroprevalence. The aim of this study was to assess the value of standardization by comparing the crude and standardized seroprevalence estimates. Seroprevalence was estimated for measles, mumps, rubella, diphtheria, varicella zoster and hepatitis A virus (HAV) and compared before and after serological results had been standardized. The results showed that if no such adjustment had taken place, seroprevalence would have differed by an average of 3·2% (95% bootstrap interval 2·9-3·6) although this percentage varied substantially by antigen. These differences were as high as 16% for some serosurveys (HAV) which means that standardization could have a considerable impact on seroprevalence estimates and should be considered when comparing serosurveys performed in different laboratories using different assay methods.
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18
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Purcell B, Dabrera G, Busby A, Mason A, Balogun K, Mandal S, Ngui SL. A Cluster of Hepatitis A cases with a novel sequence in South East England, 2013-14. J Infect 2014; 69:630-2. [PMID: 25246362 DOI: 10.1016/j.jinf.2014.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 09/10/2014] [Accepted: 09/15/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Bernadette Purcell
- Kent Surrey and Sussex Public Health England Centre, County Hall North, Chart Way, Horsham, West Sussex RH12 1XA, UK
| | - Gavin Dabrera
- Field Epidemiology Training Programme, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; European Programme for Intervention Epidemiology Training, European Centre for Disease Control and Prevention, Stockholm, Sweden; Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Araceli Busby
- Kent Surrey and Sussex Public Health England Centre, County Hall North, Chart Way, Horsham, West Sussex RH12 1XA, UK
| | - Alison Mason
- Kent Surrey and Sussex Public Health England Centre, County Hall North, Chart Way, Horsham, West Sussex RH12 1XA, UK
| | - Koye Balogun
- Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Sema Mandal
- Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Siew-Lin Ngui
- Virus Reference Department, Microbiology Services, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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19
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Hall V, Abrahams A, Turbitt D, Cathcart S, Maguire H, Balasegaram S. No evidence of transmission from an acute case of hepatitis A in a foodhandler: follow-up of almost 1,000 potentially exposed individuals, London, United Kingdom, April 2012. ACTA ACUST UNITED AC 2014; 19. [PMID: 25108536 DOI: 10.2807/1560-7917.es2014.19.30.20865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Identification of acute hepatitis A virus (HAV) infection in a foodhandler in a London hotel led to a large incident response. We identified three potentially exposed groups: hotel staff who had regularly consumed food prepared by the case and shared toilet facilities with the case, patients who shared the same hospital ward as the case and hotel guests who consumed food prepared by the case. We arranged post-exposure HAV vaccination for all 83 potentially exposed hotel staff and all 17 patients. We emailed 887 guests advising them to seek medical care if symptomatic, but did not advise vaccination as it was too late to be effective for most guests. Through the International Health Regulations national focal points and the European Union Early warning and response system (EWRS), we communicated the details of the incident to public health agencies and potential risk of HAV transmission to international guests. Potentially exposed hotel staff and guests were asked to complete an online or telephone-administered questionnaire 50 days following possible exposure, to identify any secondary cases. Survey response was low, with 155 responses from guests and 33 from hotel staff. We identified no secondary cases of HAV infection through follow-up.
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Affiliation(s)
- V Hall
- United Kingdom Field Epidemiology Programme, Field Epidemiology Services, Public Health England, London, United Kingdom
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20
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Evidence of hepatitis A virus person-to-person transmission in household outbreaks. PLoS One 2014; 9:e102925. [PMID: 25050760 PMCID: PMC4106857 DOI: 10.1371/journal.pone.0102925] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/23/2014] [Indexed: 01/11/2023] Open
Abstract
The person-to-person transmission of the hepatitis A virus primarily occurs in enclosed spaces, particularly in the presence of inadequate hygiene conditions and a high proportion of susceptible individuals. Thus, intimate family contact stands out as a risk factor for HAV infection dissemination. The present study aimed to evaluate the occurrence of household HAV transmission. Blood samples were collected from patients with hepatitis A (index cases) and their family members (contacts) that were referred to an ambulatory care clinic specializing in viral hepatitis. A total of 97 samples were collected from 30 families with a confirmed hepatitis A case (index case). Serological and molecular techniques for the diagnosis of hepatitis A were conducted on all samples. HAV infection (anti-HAV IgM + and/or HAV RNA +) was detected in 34.3% (23/67) of the contacts; 34.3% (23/67) of the contacts were immune to HAV, and 31.4% (21/67) were susceptible. In the household contacts, HAV immunity was significantly associated with older age; susceptibility to infection and HAV infection were associated with younger age. Household outbreaks were detected in 16/30 families studied. Co-circulation of subgenotypes IA and IB was found in the household outbreaks, and person-to-person transmission was evidenced in six of the household outbreaks, with 100% homology between the index case and contact strains. The results demonstrated the relevance of HAV household transmission, reaffirming the need for hepatitis A vaccine administration in susceptible contacts and effective infection control procedures to prevent the extension of household outbreaks.
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Harvala H, Wong V, Simmonds P, Johannessen I, Ramalingam S. Acute viral hepatitis – Should the current screening strategy be modified? J Clin Virol 2014; 59:184-7. [DOI: 10.1016/j.jcv.2014.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 12/16/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
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22
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Prevalence of antibodies against hepatitis A virus among children and adolescents in Germany. Med Microbiol Immunol 2013; 202:417-24. [DOI: 10.1007/s00430-013-0303-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/13/2013] [Indexed: 01/29/2023]
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