Hepatitis a virus seropositivity in nurses and paramedical personnel at a university hospital in north iran

Hepatitis A in the Eastern Mediterranean Region: a comprehensive review

Introduction

With 583 million inhabitants, the Eastern Mediterranean Region (EMR) is a worldwide hub for travel, migration, and food trade. However, there is a scarcity of data on the epidemiology of the hepatitis A virus (HAV).

Methods

The MEDLINE and grey literature were systematically searched for HAV epidemiological data relevant to the EMR region published between 1980 and 2020 in English, French, or Arabic.

Results

Overall, 123 publications were extracted. The proportion of HAV cases among acute viral hepatitis cases was high. HAV seroprevalence rate ranged from 5.7% to 100.0% and it was decreasing over time while the average age at infection increased.

Conclusion

In the EMR, HAV remains a significant cause of acute viral hepatitis. The observed endemicity shift will likely increase disease burden as the population ages. Vaccinating children and adopting sanitary measures are still essential to disease prevention; vaccinating at-risk groups might reduce disease burden even further.

What is the context?

Hepatitis A is a viral liver disease caused by the hepatitis A virus.

It is generally transmitted by ingestion of contaminated food or water or through contact with an infected person.

Disease severity increases with age. Children under 6 years of age are usually asymptomatic, while adults are the most affected.

Limited information exists on the number of cases and transmission of hepatitis A in the Eastern Mediterranean region, which includes 21 countries and Palestine, as defined by the World Health Organization.

What is new?

We performed a literature review to summarize data on hepatitis A disease in the Eastern Mediterranean region over the last 40 years (1980-2020). As information for many countries is scarce or outdated, most of the data is from Egypt, Iran and Saudi Arabia.

We found that:

Hepatitis A virus is the most common cause of acute viral hepatitis.

Hepatitis A exposure varied according to the country’s income level.

Low- and middle-income countries showed a universal immunity to hepatitis A virus, although this is not the case anymore.

What is the impact?

Hepatitis A infections have decreased worldwide. Lower exposure to the virus has led to an increase in the susceptible population (including adolescent and adults).

Hepatitis A vaccination for children and high-risk groups such travelers should be considered in the Eastern Mediterranean region.

Hepatitis A Virus Infection, Vaccination and Iranian Healthcare Workers

CONTEXT

Hepatitis A virus (HAV) infection is an important public health problem. It is estimated that about 1.4 million cases of HAV infection occur every year worldwide. Non-immune healthcare workers (HCWs) can be at higher risk of HAV infection in comparison to general population and an appropriate preventive method should be considered for them.

EVIDENCE ACQUISITION

For finding related articles, a comprehensive search was performed in Scopus, PubMed and Google Scholar and all appropriate combinations of following keywords were considered; "healthcare provider", "healthcare personnel", "healthcare worker", "nurse" "medical students", "Iran", "Hepatitis A" and "vaccination". Also we did a search in Persian language in Google scholar and scientific information database (SID) to find related Persian literature.

RESULTS

A gradual shift in age of HAV infection has been seen from childhood toward adulthood. Data about HAV seropositivity among Iranian HCWs are very limited. However based on the recent studies, it seems that HAV seropositivity has been reduced among HCWs in comparison with the past. All recent studies have suggested HAV vaccination for HCWs.

CONCLUSIONS

Available limited studies show that Iranian healthcare personnel need HAV vaccination. However, for selecting an appropriate preventive method for this high risk group, more original studies are still needed.

A new method for imputing country-level estimates of hepatitis A virus endemicity levels in the Eastern Mediterranean region

BACKGROUND

Few country-level estimates for hepatitis A virus (HAV) seroprevlance are available for the 23 countries in the Eastern Mediterranean region (EMRO) of the World Health Organization.

METHODS

We used a three-stage approach to assign an HAV endemicity level to each country in North Africa and the Middle East based on the age at midpoint of population immunity. First, we conducted a systematic review to identify all age-seroprevalence studies conducted within the past 10 years. Second, for countries without first-stage evidence we searched for incidence data and older seroprevalence data. Third, for countries with no hepatitis A data, we estimated HAV endemicity based on socioeconomic and water indicators.

RESULTS

This three-stage method allowed us to estimate country-specific endemicity levels for every country in EMRO even though first-stage evidence was only available for nine countries and for three countries only third-stage evidence was available. The region has a heterogeneous hepatitis A risk profile, with 13 countries having very high endemicity (an age at midpoint of population immunity in early childhood), three having high endemicity (late childhood), and seven having intermediate endemicity (early adulthood).

CONCLUSIONS

The three-stage estimation approach enables the creation of a complete country-level map of HAV risk in EMRO. Given the heterogeneity of HAV endemicity levels in the region and the likelihood of transitions to lower incidence rates and greater adult susceptibility in the near future, enhanced surveillance for hepatitis A would strengthen decisions about vaccination policy in the region.