Comparative hepatitis A seroepidemiology in 10 European countries

Kurkela, Satu; Pebody, Richard; Kafatos, George; Andrews, Nick; Barbara, Christopher; Bruzzone, Bianca; Butur, D.; Čaplinskas, Saulius; Davidkin, Irja; Hatzakis, Angelos; Hellenbrand, Wiebke; Hesketh, Louise; Nardone, Anthony; Němeček, Vratislav; Pistol, Adrianna; Sobotová, Zdenka; Vranckx, R.; Anastassopoulou, Cleo

doi:10.1017/s0950268812000015

Cited by 29 publications

(37 citation statements)

References 40 publications

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“…Younger household contacts had a higher frequency of HAV infection, corroborating recent studies showing an increase in the age at which HAV infection occurs [4], [25], [26]. However, the presence of previous immunity was associated with older (>20 years of age) household contacts; this finding was in accordance with many epidemiological studies reporting a strong association between age and anti-HAV prevalence [5], [26], [27], [28].…”

Section: Discussionsupporting

confidence: 88%

Evidence of Hepatitis A Virus Person-to-Person Transmission in Household Outbreaks

et al. 2014

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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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Section: Discussionsupporting

confidence: 88%

Evidence of Hepatitis A Virus Person-to-Person Transmission in Household Outbreaks

et al. 2014

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“…This was an expected finding and concordant with other previous studies carried out in Europe, which reported 70% to 94% susceptibility rate of those aged <30 years. [14] In other hands, this group revealed a lower seroprevalence because people were not target of vaccination program but experimented the effect of the reduction of HAV circulation due to the vaccination program.…”

Section: Discussionmentioning

confidence: 99%

Serosurveillance of hepatitis A in a region which adopted the universal mass vaccination

Gallone

Desiante²,

Gallone³

et al. 2017

Medicine

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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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“…High-income countries usually have low or very low HAV incidence rates, and seroprevalence studies typically show an AMPI that is in middle adulthood. For example, in many Western and Northern European countries, the AMPI is above 50 years, which means that more than half of 50-year-olds and the vast majority of children and younger adults remain susceptible to HAV infection (Kurkela et al 2012;Carrillo-Santisteve et al 2017). When a large proportion of hepatitis A cases occur among adolescents and adults, the case detection rate is usually fairly high because nearly all infected individuals in these age groups develop jaundice.…”

Section: Hepatitis a Virus (Hav) Epidemiologymentioning

confidence: 99%

Globalization and the Changing Epidemiology of Hepatitis A Virus

Jacobsen

2018

Cold Spring Harb Perspect Med

124

170

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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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Comparative hepatitis A seroepidemiology in 10 European countries

Cited by 29 publications

References 40 publications

Evidence of Hepatitis A Virus Person-to-Person Transmission in Household Outbreaks

Evidence of Hepatitis A Virus Person-to-Person Transmission in Household Outbreaks

Serosurveillance of hepatitis A in a region which adopted the universal mass vaccination

Globalization and the Changing Epidemiology of Hepatitis A Virus

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