Hepatitis A virus in the Middle East and North Africa region: a new challenge

Abstract

During the past three decades, a gradual shift in the age of infection with hepatitis A virus (HAV) from early childhood to adulthood has been observed. There is a general lack of updated data on HAV burden of disease, incidence and age-specific seroprevalence in countries of the Middle East and North Africa (MENA) region. The aim of this article is to review the published data on anti-HAV seroprevalence, an important tool to monitor infections rates, in countries of the MENA region and associated risk factors including water and socioeconomic data when available. Data on anti-HAV seroprevalence were found for 12 of 25 MENA countries. We show that MENA countries, similar to other areas in the world, have a clear shift in HAV incidence with a decline among young age groups and an increase among adults and older individuals. This would likely be associated with increased morbidity and increased risks of outbreaks among younger age groups. Consequently, the continuous surveillance of hepatitis A cases and the inclusion of hepatitis A vaccine in the expanded immunization programmes are needed in countries of the MENA.

Detection and Molecular Characterization of Hepatitis A Virus from Tunisian Wastewater Treatment Plants with Different Secondary Treatments

“…HAV is still endemic in Tunisia, with a high/intermediate ranking (4,12,31,36,37), and in the Mediterranean region (8,38,39). Despite the potential public health hazard linked to the use of contaminated treated sewage, few studies have been carried out on the prevalence of HAV in wastewater and its seasonal and geographical distribution in Tunisia.…”

“…Due to its nonenveloped nature, HAV is very stable in the environment for long periods and is particularly resistant to the current wastewater treatment processes (10,11). Even though Tunisia has developed its secondary sewage treatment plants (12), the quality of treated wastewater is still poor (13). Unfortunately, Tunisia, among other Mediterranean countries with high endemicity of HAV infections, is using contaminated treated wastewater for irrigation and to refill aquifers to palliate the lack of water resources (14), which may pose a real threat for public health.…”

“…Unfortunately, Tunisia, among other Mediterranean countries with high endemicity of HAV infections, is using contaminated treated wastewater for irrigation and to refill aquifers to palliate the lack of water resources (14), which may pose a real threat for public health. Indeed, the lack of a specific system in Tunisia for surveillance of HAV or other enteric viruses in wastewaters (15) and the changing epidemiology of HAV (16) are among the many risk factors (3,5,12,17) that increase the potential human risk associated with viral contamination in wastewater. …”

Ten-year analysis of hepatitis-related papers in the Middle East: a web of science-based scientometric study

“…However, despite its prevalence across the world, updated data about HAV infections in the ME, including their burdens and seroprevalence, are limited. It has been reported that a slow shift in the age of infected subjects from childhood to adulthood has been observed (14). The hepatitis D virus (HDV) appears to be endemic in the ME region (15), and the hepatitis E virus is reported to have a prevalence ranging from 2.0% to 37.5% in countries of the ME and North Africa (16).…”

“…Approximately 32% of hemodialysis patients in countries within the purview of the Eastern Mediterranean Regional Office of the World Health Organization (WHO) have acquired HCV infections (13). Furthermore, other countries neighboring the ME such as Pakistan and Azerbaijan have a considerable rate of HCV infections (11,14), and these rates can directly influence those within the ME region.…”