Hepatitis A virus infections, immunisations and demographic determinants in children and adolescents, Germany

Abstract

Hepatitis A is a vaccine-preventable disease with a global distribution. It predominantly occurs in regions with inadequate living conditions, but also affects populations in industrialised countries. Children are frequently involved in the transmission of hepatitis A virus (HAV) and thus play a central role in the epidemiology of hepatitis A. Here, we investigated HAV infections, immunisations, and associated demographic determinants in a nationwide, population-based, cross-sectional survey conducted in Germany from 2003–2006. Out of 17,640 children and adolescents, complete data sets (HAV serology, demographic information and vaccination card) were available for 12,249 (69%), all aged 3–17 years. We found protective antibody levels (>=20 IU/L) in 1,755 (14%) individuals, 1,395 (11%) were vaccinated against hepatitis A, 360 (3%) individuals were HAV seropositive without prior hepatitis A vaccination, thus indicating a previous HAV infection. Antibody prevalence (attributable to vaccination or infection) increased significantly with age. Multivariate logistic regression revealed that predominantly children and adolescents with migration background–even if they were born in Germany–are affected by HAV infections. Our results provide a rationale to emphasise existing vaccination recommendations and, moreover, to consider additional groups with a higher risk of infection for targeted vaccination, especially children with a migration background.

Immunity to hepatitis A among men who have sex with men attending a large sexual health clinic in Melbourne, Australia, 2012–2018

“…The lower rate in younger MSM is supported by the observation that in high-income countries hepatitis A immunity is generally lower in children and adolescents. For example, seroprevalence of antibodies to the hepatitis A virus among younger generations is reported to be as low as 0%–2% in Japan20 and 14% in Germany 21. Since 2012, MSHC has had an in-house free vaccination programme targeting MSM aged under 20 years, who only had 19% immunity reported as of 2011 11.…”

Foodborne viral outbreaks associated with frozen produce

“…Under current World Health Organization (WHO) guidelines, HAV vaccination is recommended for immunosuppressed patients and individuals aged ≥1 year who are travelling to countries or areas with moderate to high risk of infection (, 2019). Therefore, HAV vaccine is not advocated for universal childhood vaccination globally [57], and due to the vaccination gap, millions of people still contract HAV [19].…”

“…who.int/ith/vaccines/hepatitisA/en/, 2019). Therefore, HAV vaccine is not advocated for universal childhood vaccination globally [57], and due to the vaccination gap, millions of people still contract HAV [19].…”

Incidence of hepatitis A in children with acute icteric hepatitis of district Shopian of Kashmir

“…5 HAV spreads mainly through the fecal-oral route through close personal contact or contaminated food and water. 6,7 The incidence rate and clinical course vary by age and are strongly associated with socioeconomic and hygiene conditions. 8 In India, the antibodies to HAV are found in more than 90% of adults; however, limited information is available on anti-HAV among children.…”