Community-based cross-sectional seroprevalence study of hepatitis A in Bangladesh

Prevalence of Hepatocellular Carcinoma in Hepatitis B Population within Southeast Asia: A Systematic Review and Meta-Analysis of 39,050 Participants

BACKGROUND AND AIM

Hepatocellular carcinoma (HCC) is a significant complication of hepatitis B and still poses a global public health concern. This systematic review and meta-analysis provide adequate details on the prevalence of HCC in the HBV population within Southeast Asian countries.

METHOD

Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria, a thorough search for literature discussing the prevalence of HCC in the HBV population within southeast Asia was performed. Eligible studies were subjected to a meta-analysis utilising a DerSimonian and Laird approach and a random effect model. A protocol was registered with PROSPERO (CRD42023423953).

RESULT

Our study meticulously recovered 41 articles from seven countries in Southeast Asia, namely Cambodia, Indonesia, Malaysia, the Philippines, Singapore, Thailand, and Vietnam. A total of 39,050 HBV patients and 7479 HCC cases in southeast Asia were analysed. The pooled prevalence of HCC in HBV cases within southeast Asia was 45.8% (95% CI, 34.3-57.8%, I2 = 99.51%, p < 0.001). Singapore (62.5%, CI: 42.4-79.1) had the highest pooled prevalence of HCC in the HBV population compared to Vietnam, with the lowest estimate (22.4%, CI: 9.9-44.9). There was a drop in the pooled prevalence of HCC in HBV from 2016 until now (37.6%, CI: 19.2-60.5).

CONCLUSION

The findings of this review reveal a high pooled prevalence of HCC in the HBV population and therefore stir the need for routine screening, management, and surveillance.

Food safety knowledge, attitude, and practice of street food vendors and associated factors in low-and middle-income countries: A Systematic review and Meta-analysis

Access to safe food is considered a basic human right, but food-borne disease presents a significant public health concern globally. The problem is exacerbated in low- and middle-income countries. Due to the rise in urbanization and the popularity of street food in low- and middle-income countries, understanding the Knowledge, Attitude, and Practice (KAP) of street food vendors is crucial to ensuring food safety. Therefore, this review was aimed to estimate the pooled proportion of KAP of street food vendors toward food safety and its associated factors in low- and middle-income countries. A comprehensive search of published studies before January 30, 2023, was identified using databases like PubMed/MEDLINE, Cochrane Library, HINARI, Science Direct, and African Journals Online, as well as other sources. The preferred reporting items for systematic reviews and meta-analysis guidelines were followed. Data were extracted using Microsoft Excel, and analysis was performed using STATA 14/SE software. The quality of the included studies was assessed using the Joanna Briggs Institute's quality appraisal tool. A random-effects model was used to estimate the pooled proportion of KAP of street food vendors toward food safety and associated factors. The funnel plot and Egger's regression test were used to assess publication bias, and I2 test statistics were used to assess heterogeneity. Furthermore, sensitivity analysis and subgroup analysis was also conducted. In this study, fourteen eligible studies with a total of 2,989 study populations were included. The pooled proportions of good knowledge 62% (95% CI: 51-73), positive attitude 66% (95% CI: 47-86), and good practice 51% (95% CI: 36-65) toward food safety were found among street food vendors. Being of secondary school education (OR = 5.95, 95% CI: 4.05-7.85), having training in food safety (OR = 4.64, 95% CI: 2.62-6.67), having a higher monthly income (OR = 2.98, 95% CI: 1.06-4.9), and having good knowledge of food handling (OR = 2.26, 95% CI: 1.17-3.16) were found to be associated factors in the food safety practice of street food vendors. Based on the findings of this study, there was a significant gap in the KAP of street food vendors toward food safety. Therefore, the provision of training and strengthening health education about food safety are invaluable strategies for improving food safety.

Epidemiology and Risk Factors for Acute Viral Hepatitis in Bangladesh: An Overview

Viral infections by hepatotropic viruses can cause both acute and chronic infections in the liver, resulting in morbidity and mortality in humans. Hepatotropic viruses, including hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV), are the major pathogens that cause acute and chronic infections in humans. Although all of these viruses can cause acute hepatitis in humans, HAV and HEV are the predominant causative agents in Bangladesh, where the occurrence is sporadic throughout the year. In this review, we provide an overview of the epidemiology of hepatotropic viruses that are responsible for acute hepatitis in Bangladesh. Additionally, we focus on the transmission modes of these viruses and the control and prevention of infections.

Hepatitis E Virus Capsid Antigen (HEV-Ag) - A practical diagnostic biomarker in the HEV outbreak scenario

BACKGROUND

The increased global incidence of hepatitis E virus (HEV) infections, warrants accurate and affordable diagnostics across different geographical regions. The soluble and highly conserved HEV open reading frame 2 (ORF2) capsid antigen (HEV-Ag) is detectable in self-limited acute enteric hepatitis by HEV-Ag ELISA which is a promising serological assay in settings where HEV-RNA testing is not feasible. Our aim was to assess the HEV-Ag biomarker in an HEV outbreak in a low income country.

METHODS

A prospective single center longitudinal study during HEV outbreaks in the Chittagong, Bangladesh region between October 2018 and October 2019 was conducted based on recruitment of acute jaundice cases with clinical signs and symptoms of suspect HEV infections. Acute HEV infection was defined as a positive test result for anti-HEV IgM antibodies.

RESULTS

Forty four of the 51 enrolled enteric hepatitis cases (86 %) were confirmed HEV by anti-HEV IgM ELISA at day 0 hospital entry. The anti-HEV-IgM and IgG were positive in all patients and did not reveal significant differences; neither between the time points day 0 and follow-up hospitalization on day 2-6 or day 7-10 nor between RNA-positive (n = 36) versus RNAnegative (n = 8) HEV groups. The HEV-Ag positivity was higher in viral RNA-positive (29/36, 81 %) than the viral RNA-negative (1/8, 12 %) group, p < 0.001 and the HEV-Ag levels positively correlated with viremia, r = 0.77, p < 0.0001. All non-HEV cases; n = 7 tested negative anti-HEV IgM and HEV-Ag and 5 of 7 (71 %) tested anti-HAV IgM positive.

CONCLUSIONS

The HEV-Ag ELISA is a reliable and practical diagnostic tool in this acute HEV outbreak.

Nationwide Hospital-Based Seroprevalence of Hepatitis A and Hepatitis E Virus in Bangladesh

Background:

Hepatitis A virus (HAV) and hepatitis E virus (HEV) are transmitted by the fecal-oral route and are responsible for epidemic and sporadic outbreaks of acute hepatitis in low-income countries like Bangladesh.

Objective:

The purpose of this study was to describe the seroprevalence of acute hepatitis due to HAV and HEV infection in Bangladesh.

Methods:

The nationwide food-borne illness surveillance started in 2014 at 10 different hospitals which covered seven divisions of Bangladesh. Blood samples were collected from suspected acute hepatitis cases and screened for the anti-HAV IgM and anti-HEV IgM using enzyme-linked immunosorbent assay (ELISA). Participants’ socioeconomic status, clinical, sanitation and food history were recorded. Multivariate logistic regression was performed to determine the risk factors associated with HAV and HEV infection.

Findings:

A total of 998 patients were enrolled and tested for both HAV and HEV. Among these, 19% (191/998) were identified as HAV positive and 10% (103/998) were HEV positive. The median age was 12 years and 25 years for HAV and HEV positive patients, respectively. The prevalence of HAV was higher among the females (24.9%), whereas HEV was higher among males (11.2%). The highest occurrence of HAV was observed among children while HEV was most prevalent in the 15–60 years age group (12.4%).

Conclusion:

Through our nationwide surveillance, it is evident that hepatitis A and hepatitis E infection is common in Bangladesh. These data will be useful towards planning preventive and control measures by strengthening the sanitation programs and vaccination strategies in Bangladesh.

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birth-dose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region.

Increasing Burden of Hepatitis A in Adolescents and Adults and the Need for Long-Term Protection: A Review from the Indian Subcontinent

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.

Bacteriological profile, antimicrobial susceptibility patterns of the isolates among street vended foods and hygienic practice of vendors in Gondar town, Northwest Ethiopia: a cross sectional study

Background

There are numerous advantages offered by street vended foods, but evidence exists that foods exposed for sale on the road side may be contaminated by pathogenic microorganisms. However, information on the bacteriological profile, bacterial load and antimicrobial susceptibility patterns of bacterial isolates from street food in Gondar town are lacking. The aim of this study was to assess bacterial profile, bacterial load, and antimicrobial susceptibility patterns of bacterial isolates among street vended foods and also the hygienic practice of vendors in Gondar town, Northwest Ethiopia.

Methods

Socio-demographic characteristics and the hygienic practices of 24 vendors were collected using structured questionnaire. A total of 72 food samples from four different food items were analyzed and counted by standard aerobic plate count method. Ten grams of each food sample was transferred in to 90 ml of buffered peptone water and homogenized. The homogenates were serially dilute and a volume of 0.1 ml dilution was spread on solid media and incubated at 35-37 °C for 24 h. Antibiotic susceptibility testing was done for isolated species using Muller Hinton agar and data was entered and analyzed by using SPSS version 20.0.

Results

Seventy two food samples of street vended food were analysed for bacterial pathogens. 44/72 tested positive, a total of 63 isolates were identified as 19 samples contained two pathogens. The total mean aerobic bacterial count was 6.64 × 10⁴ CFU/g which is varied from 1 × 10⁴–1.86 × 10⁵ CFU/g. S. aureus is the most frequent isolate 34 (53.96%) followed by E.coli 15(23.8%), Enterobacter species 10(15.87%) and Citrobacter species 4(6.3%). Gentamycin, chloramphenicol, tetracycline, ciprofloxacin, and trimethoprim-sulfamethoxazole were found to be the most effective antimicrobials against all isolates but the enterobactereaceae were resistant to ampicillin and Ceftaziidime and S.aureus were resistant to penicillin.

Conclusion

The results of this study showed that, the majority of street-vended food items in Gondar were contaminated with one or more different pathogenic bacteria. The presence of these bacteria in foods could lead to potential health problems for consumers. Therefore, health education as well as training in food safety and hygienic handling is required for food handlers to minimize contamination and the likelihood of people falling ill.

Epidemiology of sexually transmitted viral hepatitis in human immunodeficiency virus-positive men who have sex with men in Asia

Both human immunodeficiency virus (HIV) and viral hepatitis constitute major disease burden globally. As with other parts of the world, the HIV epidemic in Asia impacts mainly on men who have sex with men, one of the at-risk populations for sexually transmitted viral hepatitis. With the increasing availability of effective antiretroviral therapy, HIV-related mortality of people living with HIV has markedly reduced. Liver disease has become an important cause of mortality and morbidity in the HIV-infected population. With the improvement of socioeconomic conditions and availability of healthcare in Asian countries in recent years, the epidemiology of sexually transmitted viral hepatitis among HIV-positive men who have sex with men has also evolved. This review updates the epidemiology of different types of sexually transmitted viral hepatitis in this defined population in Asia.

Microbiological quality of selected street food items vended by school-based street food vendors in Dhaka, Bangladesh

A cross sectional study was conducted to assess the microbiological quality of local food items vended by the school-based street food vendors in Dhaka City. A total of 80 schools from 19 school-zones of Dhaka City and its outskirts were chosen for the study. A total of 110 food samples, one each from 110 school-based street food vendors, were collected for laboratory analysis. Face to face interviews were conducted with the food vendors using a pre-tested questionnaire. The food samples were analyzed for coliform counts in the Public Health Laboratory, Institute of Public Health, Dhaka, which is a national level central food testing laboratory in Bangladesh. Microbiological criteria recommended by the International Commission on Microbiological Specifications for Foods (ICMSF) were considered to classify food samples as 'satisfactory' (total coliforms <100 per g or ml) and 'unsatisfactory' (total coliforms ≥ 100 per g or ml). Multivariable logistic regression was used to explore the association of selected socio-demographic characteristics of school-based street food vendors with the presence of unsatisfactory levels of coliforms in their food items. Of the 110 school-based street food samples analyzed in the laboratory, 44% were unsatisfactory. Among different items of street vended foods, 54% of sliced fruits samples, 59% of jhalmuri samples, 29% of chotpotis samples, 53% of vajavuji samples, and all (100%) sharbat samples were unsatisfactory, while all samples from achar (100%) and ice cream (100%) were found to be satisfactory. Logistic regression models showed that the food samples collected from the vendors belonging to the age group '15-24 years' and the vendors possessing an educational status higher than primary level were less likely to be unsatisfactory, while the food samples collected from the vendors having a daily income of more than 200 Bangladeshi Taka (equivalent to 3.00 USD) were more likely to be unsatisfactory. Our study findings reflected poor microbiological quality for a considerable proportion of the school-based street vended foods indicating a health threat to the school children of Dhaka City.

An immunoenzymatic assay for the diagnosis of hepatitis A utilising immunoglobulin Y

The detection of anti-hepatitis A virus (HAV) antibody levels by diagnostic kits in the convalescent period of disease generally use immunoglobulin G (IgG), which is expensive. An alternative to IgG is immunoglobulin Y (IgY), an immunoglobulin antibody encountered in birds and reptiles. The aim of this study was to develop a competitive immunoenzymatic assay to measure total anti-HAV antibody levels using anti-HAV IgY as the capture and conjugated immunoglobulins. For this purpose, anti-HAV IgY was conjugated to horseradish peroxidase (HRP) and the optimal dilution of HRP-conjugated antibodies was evaluated to establish the competitive immuneenzymatic assay. The results obtained from our "in-house" assay were plotted on a receiver operator curve, which showed a sensitivity of 95% and a specificity of 98.8%, demonstrating that a competitive anti-HAV IgY immunoenzymatic assay developed "in house" could be used as an alternative to commercial assays that utilise IgG.

Knowledge and awareness of children's food safety among school-based street food vendors in Dhaka, Bangladesh

We carried out a cross-sectional study to determine the level of knowledge and awareness regarding children's food safety issues among the school-based street food vendors in Dhaka city. A total of 250 school-based street food vendors were interviewed employing a pre-tested structured questionnaire comprising foodborne illness and food hygiene-related questions. We used a scoring system based on the responses obtained from them, and categorized the overall level of knowledge and awareness into "adequate" and "inadequate." Multivariable logistic regression was used to explore the association between selected sociodemographic characteristics and the level of knowledge and awareness. The most common food item vended by school-based street food vendors was chotpoti/fuchka (37.2%). The median number of schoolchildren customers was 120 per vendor per day. All (100%) vendors were male with a mean age of 30.95±8.8 years, and their mean daily income was 131.16±62.54 Bangladeshi Taka (1.97±0.94 USD). Most (40.1%) of the respondents belonged to the age group 25-34 years, and the majority (43.6%) did not have any formal education. More than two-thirds (68%) vendors could not show adequate level of knowledge and awareness of children's food safety issues. The most common source of obtaining food safety information by vendors was electronic media (91.8%). Elderly (≥45 years) vendors were 17.73 times more likely to have adequate level of knowledge and awareness than the vendors belonging to age group 15-24 years (p<0.001; adjusted OR=17.73; 95% CI=4.38-71.73). Individuals who had an education of higher than primary level were 9.87 times more likely to possess adequate level of knowledge and awareness than those who did not have any formal education (p<0.01; adjusted OR=9.87; 95% CI=2.07-46.93). The majority of school-based street food vendors showed an inadequate level of knowledge and awareness of children's food safety issues.

Low Socioeconomic Status (Measured by Education) and Outcomes in Systemic Sclerosis: Data from the Canadian Scleroderma Research Group

Objective.

In systemic lupus erythematosus, socioeconomic status (SES) affects outcomes. SES can modify outcomes by altering timing of access to care and adherence. It is unknown whether SES affects systemic sclerosis (SSc) outcomes. Disease can affect income and cause work disability, thus education (completed long before SSc onset) may be a proxy for SES.

Methods.

The Canadian Scleroderma Research Group collects annual data on patients with SSc. Baseline data were used from a prevalent cohort. Education was stratified by whether participants completed high school. Regression models assessed effects of education on organ complications and survival.

Results.

In our study, 1145 patients with SSc had 11.0 ± 9.5 years' disease duration; 86% were women, with a mean age of 55.4 ± 12.1 years. About one-quarter did not complete high school; this was more common in older patients (p < 0.0001), men (p = 0.017), those with lower income (p < 0.0001), the unemployed (p < 0.054), smokers (p < 0.001), where DLCO was < 70% predicted (p = 0.009), in those with arthritis (p = 0.047), higher Health Assessment Questionnaire-Disability Index (p = 0.017), elevated erythrocyte sedimentation rate (p = 0.019), median C-reactive protein (p = 0.002), proteinuria (p = 0.016), steroid use ever (p = 0.039), and those more likely to have died in followup (12.7% vs 8.0%; p = 0.024). However, adjusting for confounders, there was no effect of education on mortality; whereas mortality was related to age, diffuse cutaneous SSc (dcSSc) subset, elevated pulmonary arterial (PA) pressure on echocardiography, low forced vital capacity expressed as percentage of predicted, and proteinuria (similar in the dcSSc subset and in limited cutaneous SSc), mortality was increased in older patients, those with elevated PA pressure, and those with low DLCO.

Conclusion.

Completing less education than high school was not associated with a worse prognosis in SSc after adjustment for confounding characteristics.

Seroprevalence of hepatitis A virus antibody in a population aged 0-30 years in Shanghai, China: implications for hepatitis A immunization

This study aimed to determine current seroprevalence of hepatitis A virus (HAV) antibody in subjects aged 0-30 years in Shanghai. A total of 5515 subjects were recruited through random clustering sampling in 2009. Basic clinical and demographic information and records of HAV vaccination were acquired by questionnaire interviews and review of immunization records. Serum samples were collected and tested for anti-HAV IgM and total anti-HAV. The overall seroprevalence of total anti-HAV was 52·9%. Subjects aged 20-24 years had the lowest (34·4%) anti-HAV seropositivity and subjects aged 5-9 years had the highest (74·6%) positivity. Seroprevalence was significantly greater in subjects from suburban areas than in subjects from urban areas. Subjects who had HAV immunizations had significantly greater seropositivity for total anti-HAV. Previous hepatitis A immunization policies had a significant impact on the presence of anti-HAV seroprevalence in a population aged 0-30 years from Shanghai.

A nationwide seroprevalence of total antibody to hepatitis A virus from 2005 to 2009: age and area-adjusted prevalence rates

Background/Aims

Recent outbreak of hepatitis A in Korea is clearly related to the epidemiological shift of hepatitis A virus (HAV). However, nationwide seroprevalence data have been limited. This study estimated the nationwide, age- and area-adjusted anti-HAV prevalence from 2005 to 2009.

Methods

Retrospective analysis of the results of total anti-HAV test in 25,140 cases which were requested by 1,699 medical institutions throughout the nation to Seoul Clinical Laboratory from Jan. 1 2005 to Dec. 31 2009 was performed. The estimated seroprevalence was adjusted by area and age of the standard population based on the 2005 Census data from Korea National Statistical Office.

Results

The area-adjusted anti-HAV prevalence in the children younger than 10 years were 33.4% in 2005 and 69.9% in 2009. The most susceptible age groups to HAV infection during the last 5 years were teenagers and the young adults in their age of twenties. The area-adjusted seroprevalence in 2009 were 11.9% in the age group of 20-29 years, 23.4% in the age group of 10-19 years, 48.4% in the age group of 30-39 years. The population in 40-49 years showed geographically different seroprevalence with the lowest rate in Seoul (80%).

Conclusions

The most susceptible age group to HAV infection is 10-29 years, while the young children less than 10 years showed about 70% seropositivity. The changing seroepidemiology should be monitored continuously for the proper vaccination and patient care.

Seroprevalence study of hepatitis A virus in Fars province, southern Iran

BACKGROUND

There are several studies on seroprevalence of hepatitis A virus (HAV) in adults in the Middle East.

OBJECTIVES

To determine seroprevalence of HAV among adult population in Fars province, southern Iran.

PATIENTS AND METHODS

In a cross-sectional study, we checked anti-HAV antibody (IgG) in subjects refereed to our health care centers to perform laboratory tests before getting married between March 2008 and March 2009. Age-specific seroprevalence was also determined. Some risk factors like level of education, type of residence, job, numbers of family members, and access to treated water were also evaluated in these participants.

RESULTS

From 1050 subjects studied, 927 (88.2%) had ant-HAV antibody; 123 (11.8%) were antibody negative. Among subjects aged < 20 years, the anti-HAV seroprevalence was the lowest (79.3%) followed by subjects aged 20-30 years (91.3%) and those > 30 years (99%) (p = 0.01). 85.1% of studied individuals in urban areas had anti-HAV IgG while 95.9% of subjects in rural regions were anti-HAV positive (p = 0.001). The seroprevalence of HAV antibody was significantly associated with number of family members (p = 0.001).

CONCLUSION

HAV is highly prevalent in our region especially in rural areas. It is better to vaccinate the children for HAV by the time they receive HBV vaccine or when they are five years.

Epidemiology and risk factors of incident hepatitis E virus infections in rural Bangladesh

Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in the world. Most of South Asia is HEV endemic, with frequent seasonal epidemics of hepatitis E and continuous sporadic cases. This author group's epidemiologic work and clinical reports suggest that Bangladesh is HEV endemic, but there have been few population-based studies of this country's HEV burden. The authors calculated HEV infection rates, over an 18-month interval between 2003 and 2005, by following a randomly selected cohort of 1,134 subjects between the ages of 1 and 88 years, representative of rural communities in southern Bangladesh. Baseline prevalence of antibody to hepatitis E virus (anti-HEV) was 22.5%. Seroincidence was 60.3 per 1,000 person-years during the first 12 months and 72.4 per 1,000 person-years from >12 to 18 months (during the monsoon season), peaking by age 50 years and with low rates during childhood. Few of the seroconverting subjects reported hepatitis-like illness. Overall incidence was calculated to be 64 per 1,000 person-years, with 1,172 person-years followed. No significant associations were found between anti-HEV incidence and demographic or socioeconomic factors for which data were available. This is the first study to document annual HEV infection rates among "healthy" and very young to elderly subjects in a rural Bangladeshi population.