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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 PMCID: PMC8437515 DOI: 10.1080/21645515.2021.1920871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/18/2021] [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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Ayouni K, Naffeti B, Ben Aribi W, Bettaieb J, Hammami W, Ben Salah A, Ammar H, Ben Miled S, Triki H. Hepatitis a virus infection in Central-West Tunisia: an age structured model of transmission and vaccination impact. BMC Infect Dis 2020; 20:627. [PMID: 32842988 PMCID: PMC7477833 DOI: 10.1186/s12879-020-05318-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The epidemiological pattern of hepatitis A infection has shown dynamic changes in many parts of the world due to improved socio-economic conditions and the accumulation of seronegative subjects, which leads to possible outbreaks and increased morbidity rate. In Tunisia, the epidemiological status of hepatits A virus is currently unknown. However, over the past years higher numbers of symptomatic hepatitis A virus infection in school attendants and several outbreaks were reported to the Ministry of Health, especially from regions with the lowest socio-economic levels in the country. The aim of this study was to investigate the current seroprevalence of hepatitis A virus antibodies in central-west Tunisia and assess the impact of hepatitis A virus vaccination on hepatitis A epidemiology. METHODS Serum samples from 1379 individuals, aged 5-75 years, were screened for hepatitis A virus antibodies. Adjusted seroprevalence, incidence and force of infection parameters were estimated by a linear age structured SEIR (Susceptible-Exposed-Infectious-Recovered) compartmental model. A vaccine model was then constructed to assess the impact on hepatitis A virus epidemiology of 3 scenarios of vaccination strategies: one dose at 12-months of age, one dose at 6-years and one dose at 12-months and another at 6-years of age during 6 years. RESULTS A rapid increase in anti-hepatitis A virus seroprevalence was noted during infancy and adolescence: 47% of subjects under 10-years-old are infected; the prevalence increases to 77% at 15-years and reaches 97% in subjects aged 30-years. The force of infection is highest between 10 and 30-years of age and the incidence declines with increasing age. The vaccine model showed that the 3-scenarios lead to a significant reduction of the fraction of susceptibles. The two doses scenario gives the best results. Single-dose vaccination at 6-years of age provides more rapid decrease of disease burden in school-aged children, as compared to single-dose vaccination at 12-months, but keeps with a non-negligible fraction of susceptibles among children < 6-years. CONCLUSIONS Our study confirms the epidemiological switch from high to intermediate endemicity of hepatitis A virus in Tunisia and provides models that may help undertake best decisions in terms of vaccinations strategies.
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Affiliation(s)
- Kaouther Ayouni
- Laboratory of Clinical Virology – Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
- Faculty of Sciences of Tunis, University of Tunis El Manar, Campus Universitaire 2092-El Manar, Tunis, Tunisia
| | - Bechir Naffeti
- Laboratory of Intelligent Networks and Nanotechnology, LARINA, University of Carthage, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Avenue de la République, P. O. Box 77-1054, Tunis, Amilcar Tunisia
| | - Walid Ben Aribi
- Laboratory of Intelligent Networks and Nanotechnology, LARINA, University of Carthage, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Avenue de la République, P. O. Box 77-1054, Tunis, Amilcar Tunisia
| | - Jihène Bettaieb
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
- Department of Epidemiology - Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15 Rue Djebel Lakhdhar. La Rabta, 1007 Tunis, Tunisia
| | - Walid Hammami
- Laboratory of Clinical Virology – Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
| | - Afif Ben Salah
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
- Department of Epidemiology - Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15 Rue Djebel Lakhdhar. La Rabta, 1007 Tunis, Tunisia
| | - Hamadi Ammar
- Laboratory of Intelligent Networks and Nanotechnology, LARINA, University of Carthage, Tunis, Tunisia
- Faculty of Economic Sciences and Management of Nabeul, University of Carthage, Avenue de la République, BP 77-1054, Tunis, Amilcar Tunisia
| | - Slimane Ben Miled
- Laboratory of Bioinformatics, Biomathématics and Biostatistics, Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology – Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 15 Rue Djebel Lakhdhar. La Rabta, 1007 Tunis, Tunisia
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