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Grover M, Gupta E, Samal J, Prasad M, Prabhakar T, Chhabra R, Agarwal R, Raghuvanshi BB, Sharma MK, Alam S. Rising trend of symptomatic infections due to Hepatitis A virus infection in adolescent and adult age group: An observational study from a tertiary care liver institute in India. Indian J Med Microbiol 2024; 50:100653. [PMID: 38906330 DOI: 10.1016/j.ijmmb.2024.100653] [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: 02/12/2024] [Revised: 05/27/2024] [Accepted: 06/19/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Hepatitis A Virus (HAV) is the most common cause of Acute Viral Hepatitis (AVH) in children. It causes self-limiting illness and rarely acute liver failure. The shifting pattern in HAV endemicity is rendering adolescents and adults vulnerable to infection. METHODS In this retrospective study, samples received from 14,807 patients with acute onset icteric illness from January 2014-December 2022 were analyzed. HAV infection was detected by anti-HAV IgM positivity. The cases were divided into 3 age groups, pediatric, adolescents and adults, and clinical presentations were compared. RESULTS Overall, 7.72%(1144) were positive for anti-HAV IgM. Of these, 60%(690) were finally included in the study. The positive cases were divided into adults, ≥18 years (44%, 304); pediatric, <12 years (31%, 212) and adolescents (25%,174) age groups. Overall males were predominant [72.4%(500)], with a median age of 16 (IQR:9-21) years. Cases were characterised into AVH (68.1%, 470/690), Acute Liver Failure (ALF) (31.4%, 217/690) and Acute-on-Chronic Liver Failure (0.43%, 3/690). AVH in the pediatric age group was 69%(146/212), adolescents was 67%(117/174), and adults was 68%(207/304). ALF cases among the 3 groups were 30%(65/212), 33%(57/174), and 31%(95/304) respectively. Overall mortality was seen in 6.52%(45/690), maximum in adolescents with ALF presentation [10.3%(18/174)]. On molecular characterization of infection, viremia was seen in 28.9%(200/690) and all the isolates were Genotype IIIA. CONCLUSIONS The number of adults experiencing symptomatic HAV infection was seen to increase over the years in the present study. Infection in adolescents was associated with higher mortality and ALF as the clinical presentation.
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Affiliation(s)
- Malika Grover
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - Ekta Gupta
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - Jasmine Samal
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - Manya Prasad
- Department of Epidemiology and Clinical Research, Institute of Liver & Biliary Sciences, New Delhi, India.
| | - Tushar Prabhakar
- Department of Epidemiology and Clinical Research, Institute of Liver & Biliary Sciences, New Delhi, India.
| | - Ruchita Chhabra
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - Reshu Agarwal
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | | | - Manoj Kumar Sharma
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - Seema Alam
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
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Ming BW, Li L, Huang HN, Ma JJ, Shi C, Xu XH, Yang Z, Ou CQ. The Effectiveness of National Expanded Program on Immunization With Hepatitis A Vaccines in the Chinese Mainland: Interrupted Time-Series Analysis. JMIR Public Health Surveill 2024; 10:e53982. [PMID: 38416563 PMCID: PMC10938223 DOI: 10.2196/53982] [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: 10/26/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The high prevalence of hepatitis A delivered a blow to public health decades ago. The World Health Organization (WHO) set a goal to eliminate viral hepatitis including hepatitis A by 2030. In 2008, hepatitis A vaccines were integrated into the Expanded Program on Immunization (EPI) in China to alleviate the burden of hepatitis A, although the effectiveness of the EPI has not been well investigated. OBJECTIVE We aimed to evaluate the intervention effect at both provincial and national levels on the incidence of hepatitis A in the Chinese mainland from 2005 to 2019. METHODS Based on the monthly reported number of hepatitis A cases from 2005 to 2019 in each provincial-level administrative division, we adopted generalized additive models with an interrupted time-series design to estimate province-specific effects of the EPI on the incidence of hepatitis A among the target population (children aged 2-9 years) from 2005 to 2019. We then pooled province-specific effect estimates using random-effects meta-analyses. We also assessed the effect among the nontarget population and the whole population. RESULTS A total of 98,275 hepatitis A cases among children aged 2-9 years were reported in the Chinese mainland from 2005 to 2019, with an average annual incidence of 5.33 cases per 100,000 persons. Nationally, the EPI decreased the hepatitis A incidence by 80.77% (excess risk [ER] -80.77%, 95% CI -85.86% to -72.92%) during the study period, guarding an annual average of 28.52 (95% empirical CI [eCI] 27.37-29.00) cases per 100,000 persons among the target children against hepatitis A. Western China saw a more significant effect of the EPI on the decrease in the incidence of hepatitis A among the target children. A greater number of target children were protected from onset in Northwest and Southwest China, with an excess incidence rate of -129.72 (95% eCI -135.67 to -117.86) and -66.61 (95% eCI -67.63 to -64.22) cases per 100,000 persons on average, respectively. Intervention effects among nontarget (ER -32.88%, 95% CI -39.76% to -25.21%) and whole populations (ER -31.97%, 95% CI -39.61% to -23.37%) were relatively small. CONCLUSIONS The EPI has presented a lasting positive effect on the containment of hepatitis A in the target population in China. The EPI's effect on the target children also provided a degree of indirect protection for unvaccinated individuals. The continuous surveillance of hepatitis A and the maintenance of mass vaccination should shore up the accomplishment in the decline of hepatitis A incidence to ultimately achieve the goal set by the WHO.
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Affiliation(s)
- Bo-Wen Ming
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Li Li
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Hao-Neng Huang
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jia-Jun Ma
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Chen Shi
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Xiao-Han Xu
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhou Yang
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
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Gloriani NG, de Paz-Silava SLM, Allison RD, Takashima Y, Avagyan T. The Shifting Epidemiology of Hepatitis A in the World Health Organization Western Pacific Region. Vaccines (Basel) 2024; 12:204. [PMID: 38400187 PMCID: PMC10891653 DOI: 10.3390/vaccines12020204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 02/25/2024] Open
Abstract
Within the past few decades, improvement in sanitation and economic growth has driven a changing epidemiology of hepatitis A in the Western Pacific Region (WPR) of the World Health Organization (WHO). In this review, we gathered available published information on hepatitis A epidemiology of the countries in the WPR and reviewed the trends reported in the literature from the years 2000 to 2021. Many countries have shifted from high endemicity to low endemicity. Moreover, the administration of the hepatitis A vaccine among children in recent years has shifted disease susceptibility to the older population. Seroprevalence among children has decreased in most countries, while nearly 100% seropositivity is seen in mid adulthood. This is contrary to the epidemiology seen in previous decades when most children achieved immunity by age ten. This also presents a paradox in that better living conditions have caused more vulnerability to the older age groups who are at higher risk for severe disease. Given these trends, we recommend vaccination of vulnerable populations such as the older age groups and inclusion of the hepatitis A vaccine in government immunization programs.
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Affiliation(s)
- Nina G. Gloriani
- Institute of Pathology, St. Luke’s Medical Center, Quezon City 1112, Philippines;
| | | | - Robert D. Allison
- Accelerated Disease Control Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;
| | - Yoshihiro Takashima
- Vaccine-Preventable Diseases and Immunization Unit, Division of Programmes for Disease Control, Western Pacific Regional Office, World Health Organization, Manila 1000, Philippines; (Y.T.); (T.A.)
| | - Tigran Avagyan
- Vaccine-Preventable Diseases and Immunization Unit, Division of Programmes for Disease Control, Western Pacific Regional Office, World Health Organization, Manila 1000, Philippines; (Y.T.); (T.A.)
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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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Hu X, Hu W, Dong Y, Lu X, Xu F, Zhang S. Epidemiology and transmission of hepatitis A in Shaanxi (western China) after more than ten years of universal vaccination. PeerJ 2023; 11:e16305. [PMID: 38025675 PMCID: PMC10652842 DOI: 10.7717/peerj.16305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background Hepatitis A (HepA) vaccination and economic factors can change the epidemiology of HepA. In China, the implementation of free vaccination for children under 1.5 years of age in 2008 has resulted in a decline in the overall incidence of HepA. Nevertheless, further investigation is required to comprehensively understand the epidemiological patterns of HepA in economically disadvantaged regions of China. Method In this study, we evaluated the incidence, seroprevalence, and transmission characteristics of HepA in Shaanxi with less economically developed. We obtained data on reported cases of HepA from 2005 to 2020. Blood samples from 1,559 individuals aged 0 to 60 years were tested for anti-hepatitis A (HAV) antibodies. A questionnaire survey and blood sample collection were conducted in two sentinel sites from 2019 to 2021. Result Between 2008 to 2020, the number of reported cases of HepA decreased from 3.44/100,000 person-years to 0.65/100,000 person-years, indicating an 81.1% decrease, which was particularly pronounced among younger age groups (0-19 years). From 2015-2020, infections were more likely to occur in people in their 40s and those over the age of 60. Farmers were still the most common occupation of HepA in the last decade. The results of the serological investigation showed the highest anti-HAV seroprevalence was observed in adults aged 39-60 years (94.6%) and those aged 28-38 years (87.8%). The 10-15 years group had the lowest seroprevalence at 49.3%. During the study period, a total of 22 cases were reported by sentinel sites, but the common risk factors (like raw food exposure, travel history, and closed contact with patients) were not identified. Conclusion Given the greater severity of illness in the adult population and the ambiguous transmission routine, enhanced surveillance for HepA and evaluations that identify feasible approaches to mitigate the risk of HAV transmission are urgent priorities.
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Affiliation(s)
- Xiaotong Hu
- The Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Weijun Hu
- Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, China
| | - Yuanyuan Dong
- Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, China
| | - Xuan Lu
- Department of Geriatric and Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Fujie Xu
- Bill& Melinda Gates Foundation, Beijing, China
| | - Shaobai Zhang
- Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, China
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Van Damme P, Pintó RM, Feng Z, Cui F, Gentile A, Shouval D. Hepatitis A virus infection. Nat Rev Dis Primers 2023; 9:51. [PMID: 37770459 DOI: 10.1038/s41572-023-00461-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
Hepatitis A is a vaccine-preventable infection caused by the hepatitis A virus (HAV). Over 150 million new infections of hepatitis A occur annually. HAV causes an acute inflammatory reaction in the liver that usually resolves spontaneously without chronic sequelae. However, up to 20% of patients experience a prolonged or relapsed course and <1% experience acute liver failure. Host factors, such as immunological status, age, pregnancy and underlying hepatic diseases, can affect the severity of disease. Anti-HAV IgG antibodies produced in response to HAV infection persist for life and protect against re-infection; vaccine-induced antibodies against hepatitis A confer long-term protection. The WHO recommends vaccination for individuals at higher risk of infection and/or severe disease in countries with very low and low hepatitis A virus endemicity, and universal childhood vaccination in intermediate endemicity countries. To date, >25 countries worldwide have implemented such programmes, resulting in a reduction in the incidence of HAV infection. Improving hygiene and sanitation, rapid identification of outbreaks and fast and accurate intervention in outbreak control are essential to reducing HAV transmission.
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Affiliation(s)
- Pierre Van Damme
- Centre for the Evaluation of Vaccination, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Rosa M Pintó
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Zongdi Feng
- Centre for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Angela Gentile
- Department of Epidemiology, Hospital de Niños Ricardo Gutierrez, University of Buenos Aires, Buenos Aires, Argentina
| | - Daniel Shouval
- Institute of Hepatology, Hadassah-Hebrew University Hospital, Jerusalem, Israel
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Zhao X, Li M, Haihambo N, Wang X, Wang B, Sun M, Guo M, Han C. Periodic Characteristics of Hepatitis Virus Infections From 2013 to 2020 and Their Association With Meteorological Factors in Guangdong, China: Surveillance Study. JMIR Public Health Surveill 2023; 9:e45199. [PMID: 37318858 DOI: 10.2196/45199] [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: 12/20/2022] [Revised: 03/18/2023] [Accepted: 04/28/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND In the past few decades, liver disease has gradually become one of the major causes of death and illness worldwide. Hepatitis is one of the most common liver diseases in China. There have been intermittent and epidemic outbreaks of hepatitis worldwide, with a tendency toward cyclical recurrences. This periodicity poses challenges to epidemic prevention and control. OBJECTIVE In this study, we aimed to investigate the relationship between the periodic characteristics of the hepatitis epidemic and local meteorological elements in Guangdong, China, which is a representative province with the largest population and gross domestic product in China. METHODS Time series data sets from January 2013 to December 2020 for 4 notifiable infectious diseases caused by hepatitis viruses (ie, hepatitis A, B, C, and E viruses) and monthly data of meteorological elements (ie, temperature, precipitation, and humidity) were used in this study. Power spectrum analysis was conducted on time series data, and correlation and regression analyses were performed to assess the relationship between the epidemics and meteorological elements. RESULTS The 4 hepatitis epidemics showed clear periodic phenomena in the 8-year data set in connection with meteorological elements. Based on the correlation analysis, temperature demonstrated the strongest correlation with hepatitis A, B, and C epidemics, while humidity was most significantly associated with the hepatitis E epidemic. Regression analysis revealed a positive and significant coefficient between temperature and hepatitis A, B, and C epidemics in Guangdong, while humidity had a strong and significant association with the hepatitis E epidemic, and its relationship with temperature was relatively weak. CONCLUSIONS These findings provide a better understanding of the mechanisms underlying different hepatitis epidemics and their connection to meteorological factors. This understanding can help guide local governments in predicting and preparing for future epidemics based on weather patterns and potentially aid in the development of effective prevention measures and policies.
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Affiliation(s)
- Xixi Zhao
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Meijia Li
- Faculty of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium
| | - Naem Haihambo
- Faculty of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Brussel, Belgium
| | - Xinni Wang
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Bin Wang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Meirong Sun
- School of Psychology, Beijing Sport University, Beijing, China
| | - Mingrou Guo
- The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Chuanliang Han
- The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- The Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, Shenzhen, China
- Chinese Academy of Sciences Key Laboratory of Brain Connectome and Manipulation, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
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Ming BW, Yang Z, Yan ZL, Shi C, Xu XH, Li L, Ou CQ. Impact of urbanization on morbidity of hepatitis A: a national panel study in China during 2005-2018. Infect Dis Poverty 2023; 12:56. [PMID: 37231511 DOI: 10.1186/s40249-023-01104-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The effect of urbanization on the morbidity of hepatitis A remains unclear. We aimed to estimate the association between various urbanization-related indices and hepatitis A morbidity in China. METHODS Data on the annual morbidity of hepatitis A, urbanization-related measures (i.e., gross domestic product per capita, the number of hospitalization beds per 1000 persons, illiteracy rate, tap water coverage, motor vehicles per 100 persons, population density, and the proportion of arable land), and meteorological factors in 31 provincial-level administrative divisions of Chinese mainland during 2005-2018 were collected from the National Population and Health Science Data Sharing Platform, China Statistical Yearbooks, and the China Meteorological Data Sharing Service System, respectively. Generalized linear mixed models were applied to quantify the impacts of different urbanization-related indices on the morbidity of hepatitis A in China after adjusting for covariates. RESULTS A total of 537,466 hepatitis A cases were reported in China during 2005-2018. The annual morbidity had a decline of 79.4% from 5.64 cases to 1.16 cases per 100,000 people. There were obvious spatial variations with higher morbidity in western China. Nationally, gross domestic product per capita and the number of hospitalization beds per 1000 persons increased from 14,040 to 64,644 CNY and from 2.45 to 6.03 during 2005-2018, respectively. The illiteracy rate decreased from 11.0 to 4.9%. Gross domestic product per capita [relative risk (RR) = 0.96, 95% confidence interval (CI): 0.92-0.99], and the number of hospitalization beds per 1000 persons (RR = 0.79, 95% CI: 0.75-0.83) were associated with the declined morbidity of hepatitis A. By contrast, the increased morbidity of hepatitis A was linked to the illiteracy rate (RR = 1.04, 95% CI: 1.02-1.06). Similar influential factors were detected for children and adults, with greater effects witnessed for children. CONCLUSIONS People in the western region suffered the heaviest burden of hepatitis A in Chinese mainland. Nationally, there was a sharp decline in the morbidity of hepatitis A. The urbanization process was associated with the reduction of hepatitis A morbidity in China during 2005-2018.
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Affiliation(s)
- Bo-Wen Ming
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Zhou Yang
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Ze-Lin Yan
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Chen Shi
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Xiao-Han Xu
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Li Li
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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Li YS, Zhang BB, Zhang X, Fan S, Fei LP, Yang C, Ren NJ, Li X, Luo YM, Zhang JH. Trend in the incidence of hepatitis A in mainland China from 2004 to 2017: a joinpoint regression analysis. BMC Infect Dis 2022; 22:663. [PMID: 35915398 PMCID: PMC9341093 DOI: 10.1186/s12879-022-07651-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/27/2022] [Indexed: 12/15/2022] Open
Abstract
Background China has experienced a continuous decreasing trend in the incidence of hepatitis A in recent years. Temporal trend analyses are helpful in exploring the reasons for the changing trend. Thus, this study aims to analyse the incidence trend of viral hepatitis A by region and age group in mainland China from 2004 to 2017 to evaluate the effectiveness of prevention and control measures. Methods Data on hepatitis A and population information were collected and analysed with a joinpoint regression model. Annual percentage changes (APCs) and average annual percentage changes (AAPCs) were estimated for the whole country and for each region and age group. Results From 2004 to 2017, the seasonality and periodicity of hepatitis A case numbers were obvious before 2008 but gradually diminished from 2008 to 2011 and disappeared from 2012–2017. The national incidence of hepatitis A (AAPC = − 12.1%) and the incidence rates for regions and age groups showed decreasing trends, with differences in the joinpoints and segments. Regarding regions, the hepatitis A incidence in the western region was always the highest among all regions, while a nonsignificant rebound was observed in the northeastern region from 2011 to 2017 (APC = 14.2%). Regarding age groups, the hepatitis A incidence showed the fastest decrease among children (AAPC = − 15.3%) and the slowest decrease among elderly individuals (AAPC = − 6.6%). Among all segments, the hepatitis A incidence among children had the largest APC value in 2007–2017, at − 20.4%. Conclusion The national annual incidence of hepatitis A continually declined from 2004 to 2017 and the gaps in hepatitis A incidence rates across different regions and age groups were greatly narrowed. Comprehensive hepatitis A prevention and control strategies, including the use of routine vaccination during childhood in mainland China, especially the implementation of the national Expanded Program on Immunization (EPI) in 2008, resulted in substantial progress from 2004 to 2017. However, gaps remain. Regular monitoring and analysis of hepatitis A epidemic data and prompt adjustment of hepatitis A prevention and control strategies focusing on children, elderly individuals and those living in certain regions are recommended.
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Hu X, Zhou W, Zhang L, Lv J, Yan B, Zhou Y, Hu W, Dong Y, Chen B, Liu M, Cao J, Xu F, Li L. Implementing sequencing-based surveillance in developing countries: findings from a pilot rollout for hepatitis A in China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1119. [PMID: 34430560 PMCID: PMC8350710 DOI: 10.21037/atm-21-1193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/10/2021] [Indexed: 01/15/2023]
Abstract
Background The emergence of SARS-Cov2 variants has highlighted the need to implement sequencing-based surveillance in developing countries for early response to mutant viruses of concern. However, limited information on how to implement sequencing-based surveillance is available, and the feasibility and performance of this new type of surveillance are still in question. Methods To understand the challenges with the implementation and to promote sequencing-based surveillance, we reported findings from a pilot for hepatitis A (HepA) in five sentinel provinces in China as an example of sequencing-based surveillance implementation. The performance of the surveillance system was evaluated by indicators related to acceptability, data quality, simplicity, utility, and timeliness. We use a scale from 1 to 3 was used to provide a score for each aspect. Results During the pilot, 306 cases of HepA were reported, and 49.79% of samples were available for sequencing. Eleven genomic clusters were found, of which seven clusters were potentially related to a foodborne outbreak oyster based on identical viral sequence and epidemiologic investigations. The greatest strength of the system was its simplicity (Score: 2.63). The acceptability (Score: 2.0) and utility (Score: 2.33) were modest, but data quality (Score: 1.75) and timeliness (Score: 1.75) were the main challenges. Conclusions Overall, the system performed satisfactorily and proved to be useful for virological characterization of cases and early outbreak detection, with a great potential for scale-up. Further efforts are required to address financial and human resource constraints and inadequate support among physicians. Education should be given to health care professionals to improve the data quality. The establishment of decentralized surveillance networks can be an approach to improve timeliness for emerging infections.
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Affiliation(s)
- Xiaotong Hu
- The First Affiliated Hospital, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wenting Zhou
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Zhang
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Jingjing Lv
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Bingyu Yan
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Yang Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, Dept. of Immunization Program, Division of Immunization Surveillance & Evaluation, Hangzhou, China
| | - Weijun Hu
- Immunization Program Department, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, China
| | - Yuanyuan Dong
- Immunization Program Department, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, China
| | - Biyu Chen
- Hainan Center for Disease Control and Prevention, Haikou, China
| | - Man Liu
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Jingyuan Cao
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fujie Xu
- The First Affiliated Hospital, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, China.,China Country Office, Bill& Melinda Gates Foundation, Beijing, China
| | - Lanjuan Li
- The First Affiliated Hospital, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, China
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Cao G, Jing W, Liu J, Liu M. The global trends and regional differences in incidence and mortality of hepatitis A from 1990 to 2019 and implications for its prevention. Hepatol Int 2021; 15:1068-1082. [PMID: 34345993 PMCID: PMC8514357 DOI: 10.1007/s12072-021-10232-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/01/2021] [Indexed: 12/24/2022]
Abstract
Background and purpose Despite decades of improved sanitation and hygiene measures and vaccine introduction, hepatitis A has been spread through numerous outbreaks globally. We used data from the Global Burden of Disease (GBD) study to quantify hepatitis A burden at the global, regional and national levels. Methods Annual incident cases, deaths, age-standardized incidence rates (ASIRs), and age-standardized mortality rates (ASMRs) of hepatitis A between 1990 and 2019 were derived from the GBD study 2019. Percentage changes of cases and deaths, and estimated annual percentage changes (EAPCs) of ASIRs and ASMRs were calculated to quantify their temporal trends. Results Global hepatitis A incident cases increased by 13.90% from 139.54 million in 1990 to 158.94 million in 2019. ASIR of hepatitis A remained stable (EAPC = 0.00, 95% CI −0.01 to 0.01), whereas ASMR decreased (EAPC = −4.63, 95% CI −4.94 to −4.32) between 1990 and 2019. ASIR increased in low (EAPC = 0.09, 95% CI 0.04 to 0.14) and low-middle (EAPC = 0.04, 95% CI 0.03 to 0.06) socio-demographic index (SDI) regions. For GBD regions, the most significant increases of ASIR were detected in high-income Asia Pacific (EAPC = 0.53, 95% CI 0.41 to 0.66), Oceania (EAPC = 0.31, 95% CI 0.25 to 0.36), and Australasia (EAPC = 0.28, 95% CI 0.13 to 0.44). EAPC of ASIR was positively associated with SDI value in countries and territories with SDI value ≥ 0.7 (ρ = −0.310, p < 0.001). Conclusion There is an unfavorable trend that hepatitis A is still pending in hyperendemic regions and is emerging in low endemic regions. These highlight the need of targeted and specific strategies to eliminate hepatitis A, such as sanitation measures and a comprehensive plan for surveillance and vaccination against hepatitis A. Supplementary Information The online version contains supplementary material available at 10.1007/s12072-021-10232-4.
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Affiliation(s)
- Guiying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Haidian District, No. 38 Xueyuan Road, Beijing, 100191, China.
| | - Wenzhan Jing
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Haidian District, No. 38 Xueyuan Road, Beijing, 100191, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Haidian District, No. 38 Xueyuan Road, Beijing, 100191, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Haidian District, No. 38 Xueyuan Road, Beijing, 100191, China.
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12
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Epidemiologic trends of hepatitis A in different age groups and regions of China from 1990 to 2018: observational population-based study. Epidemiol Infect 2021. [PMCID: PMC8365862 DOI: 10.1017/s0950268821001552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This study characterises changes in the incidence and mortality of hepatitis A in different age groups and provinces of China from 1990 to 2018, and evaluates the effect of the nation-wide expanded programme on immunisation (EPI). A mathematical model was used to estimate the relative change in incidence and mortality in different provinces and age groups. Interrupted time series regression was applied to evaluate the impacts of the inclusion of vaccination in the EPI during 2007–2018. The geographic clustering of hepatitis A incidence was assessed using global Moran's I and changing trends over time were estimated using joinpoint regression analysis. Both the incidence (odds ratio (OR) for overall relative change: 0.86; 95% confidence interval (CI): 0.85–0.87; P < 0.0001) and the mortality rate (OR for overall relative change: 0.84; 95% CI: 0.83–0.85; P < 0.0001) decreased. Most age groups had significant declines in reported incidence over time. The incidence and mortality of hepatitis A significantly reduced after inclusion of hepatitis A vaccine in EPI, showing that the EPI strategy had a continuous effect on the decreasing trend of hepatitis A burden. Increasing the coverage rate of the vaccine and improving hygiene conditions are the key measures for the control of hepatitis A in China.
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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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