1
|
Gandhi AP, AL-Mohaithef M, Aparnavi P, Bansal M, Satapathy P, Kukreti N, Rustagi S, Khatib MN, Gaidhane S, Zahiruddin QS. Global outbreaks of foodborne hepatitis A: Systematic review and meta-analysis. Heliyon 2024; 10:e28810. [PMID: 38596114 PMCID: PMC11002584 DOI: 10.1016/j.heliyon.2024.e28810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024] Open
Abstract
Hepatitis A Virus (HAV) is a significant threat in terms of food safety. A systematic literature search with the research question "What are the clinical outcomes of foodborne Hepatitis A virus infections?" was conducted. The pooled estimate of the outcomes-mortality, hospitalization, and severity rates, along with a 95% confidence interval (CI), was estimated. After screening, 33 studies were included for the data extraction and meta-analysis. The pooled prevalence of hospitalization among the HAV-positive patients was estimated to be 32% (95% CI 21-44), with high heterogeneity (I2 = 98%, p < 0.01). Australia had the highest hospitalization rate, with 82%, followed by Europe (42%). The hospitalization rate showed a significantly increasing trend (beta = 0.015, p=0.002) over the period. The pooled prevalence of mortality among the HAV-positive patients was estimated to be <1%, with low heterogeneity (I2 = 5%, p = 0.39). A wide range of food products were linked with the HAV outbreaks.
Collapse
Affiliation(s)
- Aravind P. Gandhi
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Mohammed AL-Mohaithef
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - P. Aparnavi
- Department of Community Medicine, KMCH Institute of Health Sciences & Research, Coimbatore, India
| | - Monika Bansal
- MarksMan Healthcare, Research Services, Hyderabad, India
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001, Hillah, Babil, Iraq
| | - Neelima Kukreti
- School of Pharmacy, Graphic Era Hill University, Dehradun, 248001, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Shilpa Gaidhane
- One Health Centre (COHERD), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- South Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| |
Collapse
|
2
|
Assiry F, Hafiz T, Dandachi I, Wani T, Alghofaili FA, Alsughayir AH, Alhatlani B, Aleid AA, Aljabr W. Seroprevalence of Hepatitis A antibodies among Blood Donors at a tertiary care hospital, Saudi Arabia. J Infect Public Health 2024; 17:143-144. [PMID: 38000315 DOI: 10.1016/j.jiph.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/28/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Affiliation(s)
- Fatimah Assiry
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Taghreed Hafiz
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Iman Dandachi
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tariq Wani
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fayez A Alghofaili
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Saudi Arabia
| | - Ammar H Alsughayir
- Transfusion Medicine & Department of Hematopathology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Bader Alhatlani
- Unit of Scientific Research, Applied College, Qassim University, Saudi Arabia
| | - Ahmed A Aleid
- Gastroenterology & Department of Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Waleed Aljabr
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia.
| |
Collapse
|
3
|
Karami A, El Fihry R, Haddaji A, Jadid FZ, Zaidane I, Chihab H, Ouladlahsen A, Tahiri M, Pineau P, Akarid K, Benjelloun S, Ezzikouri S. Epidemiological characteristics of acute hepatitis A, 2013-2016: a cross-sectional study in Morocco. Infect Dis (Lond) 2023; 55:625-634. [PMID: 37368360 DOI: 10.1080/23744235.2023.2228405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Hepatitis A virus (HAV) is the common cause of acute hepatitis worldwide. Indeed, hepatitis A is endemic in developing countries such in Morocco and most residents are exposed in childhood. The characterisation of circulating strains of HAV remains crucial to understand the virological evolution and geo-temporal characteristics, which are essential for controlling infections and outbreaks. The purpose of the current study was the detection and characterisation of HAV strains circulating in Morocco by performing serological test, RT-PCR, sequencing and phylogenetic analysis. METHODS In this cross-sectional study, 618 suspected acute hepatitis cases were examined by Architect HAV abIgM. Of the 162 positives, 64 underwent RNA extraction. None of the suspected cases was immune to HAV and none of them had received a blood transfusion. Samples found positive by RT-PCR using primers targeting the VP1/VP2A junction and the VP1/VP3 capsid region of HAV were subjected to sequencing and phylogenetic analyses. RESULTS HAV Acute infection rate was 26.2% [95% CI, 22.8-29.9], while viraemia reached 45% (29/64) after amplification of the VP3/VP1 region. Phylogenetic analysis of the VP1/2A segment revealed the presence of sub-genotypes IA and IB. Eighty-seven percent of the strains belonged to the subgenotype IA, while twelve percent to IB subgenotype. CONCLUSION This first molecular study of acute hepatitis A in Morocco provided information about genetic diversity of HAV, revealing the co-circulating of only two subgenotypes (IA and IB). Notably, subgenotype IA was found to be the predominant subgenotype in Morocco.
Collapse
Affiliation(s)
- Adnane Karami
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
- Santé et Environnement, Faculté des Sciences Aïn Chock, Casablanca, Morocco
| | - Raouia El Fihry
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
- Santé et Environnement, Faculté des Sciences Aïn Chock, Casablanca, Morocco
| | - Asmaa Haddaji
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Fatima-Zahra Jadid
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | | | - Hajar Chihab
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Ahd Ouladlahsen
- Service des Maladies Infectieuses, CHU Ibn Rochd, Casablanca, Morocco
- Faculté de médecine et de pharmacie, Université Hassan II, Casablanca, Morocco
| | - Mohamed Tahiri
- Faculté de médecine et de pharmacie, Université Hassan II, Casablanca, Morocco
- Service d'Hépato-Gastro-Entérologie, CHU Ibn Rochd, Casablanca, Morocco
| | - Pascal Pineau
- Unité "Organisation Nucléaire et Oncogenèse", INSERM U993, Institut Pasteur, Paris, France
| | - Khadija Akarid
- Santé et Environnement, Faculté des Sciences Aïn Chock, Casablanca, Morocco
| | - Soumaya Benjelloun
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Sayeh Ezzikouri
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| |
Collapse
|
4
|
Enkelmann J, Kuhnert R, Stark K, Faber M. Hepatitis A seroprevalence, vaccination status and demographic determinants in children and adolescents in Germany, 2014-2017, a population-based study. Sci Rep 2023; 13:9762. [PMID: 37328526 PMCID: PMC10275889 DOI: 10.1038/s41598-023-36739-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/08/2023] [Indexed: 06/18/2023] Open
Abstract
Children play an important role in hepatitis A virus (HAV) transmission but, due to frequent asymptomatic or mild courses, these infections are underrecognized in routine surveillance. Here, we analyzed hepatitis A (HA) seroprevalence, vaccination status and demographic determinants and estimated previous HAV infections in a cross-sectional population-based study of children and adolescents with residence in Germany 2014-2017, performing weighted univariable and multivariable logistic regression. Of 3567 participants aged 3-17 years, serological results were available for 3013 (84.5%), vaccination records for 3214 (90.1%) and both for 2721 (76.3%). Of 2721 with complete results, 467 (17.2%) were seropositive, thereof 412 (15.1%) with and 55 (2.0%) without previous HA vaccination, indicating previous HAV infection. Seropositivity was associated with age, residence in Eastern states, high socioeconomic status and migration background with personal migration experience. Participants with migration background and personal migration experience also had the highest odds ratios for previous HAV infection. Germany remains a country with very low HA endemicity. The current vaccination recommendations focusing on individuals with a high risk for HAV exposure (e.g. travelers to endemic countries) or severe disease appear appropriate. Migration and travel patterns as well as the endemicity in other countries influence the domestic situation, warranting further monitoring.
Collapse
Affiliation(s)
- Julia Enkelmann
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
| | - Ronny Kuhnert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Klaus Stark
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Mirko Faber
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
5
|
Ming BW, Yang Z, Yan ZL, Shi C, Xu XH, Li L, Ou CQ. Impact of urbanization on morbidity of hepatitis A: a national panel study in China during 2005-2018. Infect Dis Poverty 2023; 12:56. [PMID: 37231511 DOI: 10.1186/s40249-023-01104-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The effect of urbanization on the morbidity of hepatitis A remains unclear. We aimed to estimate the association between various urbanization-related indices and hepatitis A morbidity in China. METHODS Data on the annual morbidity of hepatitis A, urbanization-related measures (i.e., gross domestic product per capita, the number of hospitalization beds per 1000 persons, illiteracy rate, tap water coverage, motor vehicles per 100 persons, population density, and the proportion of arable land), and meteorological factors in 31 provincial-level administrative divisions of Chinese mainland during 2005-2018 were collected from the National Population and Health Science Data Sharing Platform, China Statistical Yearbooks, and the China Meteorological Data Sharing Service System, respectively. Generalized linear mixed models were applied to quantify the impacts of different urbanization-related indices on the morbidity of hepatitis A in China after adjusting for covariates. RESULTS A total of 537,466 hepatitis A cases were reported in China during 2005-2018. The annual morbidity had a decline of 79.4% from 5.64 cases to 1.16 cases per 100,000 people. There were obvious spatial variations with higher morbidity in western China. Nationally, gross domestic product per capita and the number of hospitalization beds per 1000 persons increased from 14,040 to 64,644 CNY and from 2.45 to 6.03 during 2005-2018, respectively. The illiteracy rate decreased from 11.0 to 4.9%. Gross domestic product per capita [relative risk (RR) = 0.96, 95% confidence interval (CI): 0.92-0.99], and the number of hospitalization beds per 1000 persons (RR = 0.79, 95% CI: 0.75-0.83) were associated with the declined morbidity of hepatitis A. By contrast, the increased morbidity of hepatitis A was linked to the illiteracy rate (RR = 1.04, 95% CI: 1.02-1.06). Similar influential factors were detected for children and adults, with greater effects witnessed for children. CONCLUSIONS People in the western region suffered the heaviest burden of hepatitis A in Chinese mainland. Nationally, there was a sharp decline in the morbidity of hepatitis A. The urbanization process was associated with the reduction of hepatitis A morbidity in China during 2005-2018.
Collapse
Affiliation(s)
- Bo-Wen Ming
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Zhou Yang
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Ze-Lin Yan
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Chen Shi
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Xiao-Han Xu
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Li Li
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| |
Collapse
|
6
|
Rao A, Wanjari MB, Prasad R, Munjewar PK, Sharma R. From Mystery to Clarity: Uncovering the Possible Cause of Hepatitis Outbreak in Children. Cureus 2023; 15:e38388. [PMID: 37265892 PMCID: PMC10231522 DOI: 10.7759/cureus.38388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/01/2023] [Indexed: 06/03/2023] Open
Abstract
Hepatitis A is a viral infection that can cause liver inflammation and damage. Hepatitis A outbreaks in children are of particular concern due to the potential long-term health effects they can have. In recent years, several outbreaks of hepatitis A have been reported worldwide, affecting mainly children and young adults. Since 2016, hepatitis A outbreaks have been reported in 37 states of the United States alone, involving approximately 44,650 cases, 27,250 hospitalizations, and 415 deaths as of September 23, 2022. The epidemiology of hepatitis A outbreaks in children is complex and multifactorial, with various risk factors such as poor sanitation and hygiene practices, crowded living conditions, low socioeconomic status, lack of vaccination, and travel to endemic areas. Investigations of outbreaks involve identifying suspected cases, laboratory testing, contact tracing, and investigation of possible sources of infection. Contaminated food and water, poor sanitation and hygiene procedures, intimate contact with infected people, and environmental variables are all potential causes of outbreaks in children. Preventive measures include vaccination, improving sanitation and hygiene practices, food safety and inspection, and health education and community outreach programs. Understanding the epidemiology of hepatitis A outbreaks in children and the risk factors associated with infection is essential for developing effective preventive strategies and reducing the global burden of this disease.
Collapse
Affiliation(s)
- Ashritha Rao
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur B Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Prasad
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratiksha K Munjewar
- Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ranjana Sharma
- Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
7
|
Yamamoto K, Asai Y, Nakatani I, Hayashi K, Nakagawa H, Shinohara K, Kanai S, Shimatani M, Yamato M, Shimono N, Kitaura T, Komiya N, Nagasaka A, Mikawa T, Manabe A, Matono T, Yamamoto Y, Ogawa T, Kutsuna S, Ohmagari N. Characteristics and potential quality indicators for evaluating pre-travel consultations in Japan hospitals: the Japan Pretravel consultation registry (J-PRECOR). Trop Dis Travel Med Vaccines 2022; 8:6. [PMID: 35101123 PMCID: PMC8805374 DOI: 10.1186/s40794-021-00160-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Awareness of pre-travel consultations (PTCs) and prevention methods for overseas travel-related diseases, and the understanding of PTCs among Japanese travelers and medical professionals remains low in Japan. A multicenter registry was established to examine PTCs in Japan. This study assessed the PTC implementation rate and examined the indicators of PTCs that can be used as criteria for evaluating quality. Methods Clients who presented for their PTCs at 17 facilities and were registered between February 1, 2018, and May 31, 2020, were included. Medical information was extracted retrospectively via a web-based system. Correlations between vaccination risk categories and advice/intervention proportions by the facility were evaluated using Spearman’s ordered phase relations (α = 0.05). Results Of the 9700 eligible clients (median age, 32 years; 880 [9.1%] aged < 16 years and 549 [5.7%] aged ≥65 years), the most common travel duration was ≥181 days (35.8%); higher among younger clients. The most common reason for travel was business (40.5%); the US (1118 [11.5%]) and Asia (4008 [41.3%]) were the most common destinations and continents, respectively. The vaccine number (median three per person) increased after the PTCs except for the tetanus toxoid. Only 60.8% of the clients recommended for malaria prophylaxis received anti-malarial agents. The gross national income; the incidence of human rabies, typhoid fever, falciparum malaria; and dengue risk category were associated with the percentage of hepatitis-A vaccines; explaining rabies post-exposure prophylaxis, typhoid-fever vaccinations, malaria-prophylaxis prescriptions; and mosquito repellants, respectively. Conclusions Although the characteristics of the travelers differed, the quality of the PTCs should be improved to address, for example, the lower rate of acceptance of malaria prophylaxis in Japan. Supplementary Information The online version contains supplementary material available at 10.1186/s40794-021-00160-4.
Collapse
|
8
|
Uwishema O, Abbass M, Rai A, Arab S, El Saleh R, Uweis L, Wellington J, Musabirema F, Adanur I, Onyeaka H. Hepatitis A virus outbreak in Lebanon: Is it a matter of concern? Ann Med Surg (Lond) 2022; 82:104585. [PMID: 36148083 PMCID: PMC9486044 DOI: 10.1016/j.amsu.2022.104585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/04/2022] [Indexed: 02/07/2023] Open
Abstract
Lebanon has been grappling with hepatitis A virus (HAV) outbreaks for 3 decades, to an extent that it has been now termed an endemic zone for HAV. However, the rise in cases above the annual average concerns a potential outbreak in the North, and the Bekaa governorates of Lebanon must be highlighted. Although the Lebanese health authorities have ordered a probe into the possible causes of the outbreak, it has been speculated that the immigration of Syrian refugees has overburdened public health services. Reduced seroprevalence of HAV immunoglobulin G has also led to an epidemiological shift from child to adult populations. The current economic crisis affecting Lebanese society is another significant problem that could have contributed to the rise in incidents. This article examines Lebanon's current HAV outbreak and epidemiological status, offering suggestions for the future. In the event of an outbreak, the infrastructure for water sanitation and sewage is known to allow HAV to spread via the faecal-oral pathway. Maintaining personal hygiene, early detection, and vaccination have all been recommended as significant regional and individual control measures.
Collapse
|
9
|
Badur S, Öztürk S, AbdelGhany M, Khalaf M, Lagoubi Y, Ozudogru O, Hanif K, Saha D. Hepatitis A in the Eastern Mediterranean Region: a comprehensive review. Hum Vaccin Immunother 2022; 18:2073146. [PMID: 35617508 PMCID: PMC9621081 DOI: 10.1080/21645515.2022.2073146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
Collapse
|
10
|
Akbulut UE, Arslan E. Hepatitis A Seroprevalence in Mogadishu, Somalia. J Trop Pediatr 2022; 68:6521071. [PMID: 35134249 DOI: 10.1093/tropej/fmac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The hepatitis A virus (HAV) is the most frequent global causes of vaccine-preventable viral hepatitis. Since Somalia is regarded as highly endemic for hepatitis A, the hepatitis A vaccine was not included in the World Health Organization's expanded immunization program. The purpose of this study was to determine the prevalence of hepatitis A infection in the Somalia capital, Mogadishu. METHODS The serological results of 1153 individuals presenting to the Mogadishu Training and Research Hospital between January 2019 and January 2021 were examined retrospectively to evaluate the presence of anti-HAV IgG and IgM. The seroprevalence of anti-HAV IgG and IgM was analyzed on the basis of age and sex. The seroprevalence of anti-HAV IgG was also compared among the 11-year age group. FINDINGS The seroprevalence of anti-HAV IgG and IgM did not vary significantly between the sexes. Overall, the seroprevalence of anti-HAV IgG was 67.6%. The percentage of seropositivity for anti-HAV IgG was highest in adults aged ≥41 years (88.9%) and lowest in children aged 1-2 years (29.4%). Estimated age at midpoint of population immunity was 5 years which is compatible high endemicity. In addition, a significant rate of hepatitis A infection was also observed in the adolescent age group. CONCLUSIONS This study confirms the high HAV endemicity in Mogadishu. These data will be useful towards planning preventive and control measures by improving the sanitation programs in Mogadishu. Furthermore, prospective studies are needed to confirm these findings and evaluate urban-rural heterogeneity.
Collapse
Affiliation(s)
- Ulas Emre Akbulut
- Department of Pediatrics, Somalia-Turkey Training and Research Hospital, Mogadishu, Somalia
| | - Ebubekir Arslan
- Department of Emergency, Somalia-Turkey Training and Research Hospital, Mogadishu, Somalia
| |
Collapse
|
11
|
Lewin BJ, Rodriguez J, Yang SJ, Tartof SY. Predictors of hepatitis A immunity in adults in California in order to better utilize hepatitis A vaccine. Vaccine 2021; 39:5484-5489. [PMID: 34454784 DOI: 10.1016/j.vaccine.2021.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hepatitis A vaccine recommendations now include homelessness, illegal drug use, and HIV, as well as traditional risk factors and travel to areas endemic for hepatitis A. We examined a large diverse population for predictors of Hepatitis A immunity in order to better utilize Hepatitis A vaccine. METHODS We performed a cross-sectional descriptive study of members of a large integrated health plan with a test for Hepatitis A Immunoglobulin G (IgG) between January 1st, 2007, and December 31st, 2017. Exclusion criteria included age <18 years, <6 months of continuous enrollment, and Hepatitis A vaccine prior to Hepatitis A test. Variables of interest were age, gender, primary language spoken, ethnicity/race, neighborhood household income, and history of travel or history of jaundice. Multivariable logistic regression was performed to evaluate the association of risk factors on Hepatitis A immunity. RESULTS Of the 318,170 persons ≥ 18 years tested for Hepatitis A immunity, 155, 842 persons had a reactive Hepatitis A IgG test (49%). The lowest prevalence was for Whites at 28.1% followed by Blacks at 35.8%. Hispanics and Asian/Pacific Islanders had prevalence rates of 63% and 68.2% respectively. In adjusted analyses, Asian/Pacific Islanders, Hispanics and Blacks were 5.17, 3.44 and 1.42 times more likely to have Hepatitis A immunity than Whites. Those that spoke Spanish or language other than English or Spanish as their primary preferred language were 6.11 and 3.27 time more likely to have immunity than English speakers. Known travel history conferred a 2.16 likelihood of Hepatitis A immunity. CONCLUSIONS Persons of Hispanic and Asian/Pacific Islander background as well as persons with a preferred spoken language other than English have a high prevalence of Hepatitis A immunity. Testing for Hepatitis A immunity prior to vaccination should be considered for these groups.
Collapse
Affiliation(s)
- Bruno J Lewin
- Kaiser Permanente Southern California, Department of Family Medicine, Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Clinical Science, United States.
| | - Janelle Rodriguez
- Kaiser Permanente Southern California, Department of Family Medicine, United States
| | - Su-Jau Yang
- Kaiser Permanente Southern California, Department of Research & Evaluation, United States
| | - Sara Y Tartof
- Kaiser Permanente Southern California, Department of Research & Evaluation, Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, United States
| |
Collapse
|
12
|
Kareem N, Al-Salahat K, Bakri FG, Rayyan Y, Mahafzah A, Sallam M. Tracking the Epidemiologic Shifts in Hepatitis A Sero-Prevalence Using Age Stratification: A Cross-Sectional Study at Jordan University Hospital. Pathogens 2021; 10:pathogens10091081. [PMID: 34578114 PMCID: PMC8468970 DOI: 10.3390/pathogens10091081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
The study of hepatitis A virus (HAV) epidemiology and sero-prevalence has important public health implications. Changes in the epidemiology of hepatitis A can result in a larger pool of susceptible persons in countries with improved sanitation and hygienic conditions if vaccination is not provided. The aim of this study was to investigate the prevalence of HAV immunoglobulin G (IgG) in Jordan. In addition, we aimed to identify the potential differences in HAV sero-prevalence based on age, among other variables. We recruited the study participants at Jordan University Hospital in Amman, Jordan, during October 2020-June 2021. Assessment of participants' socio-demographic variables was done using a paper-based questionnaire. Testing for HAV IgG was based on a competitive enzyme linked immunosorbent assay (ELISA). The study population comprised 360 individuals with a median age of 18 years. The overall sero-prevalence of HAV in our study sample was 38.3%. Divided by age, the sero-prevalence of HAV was 8.2%, 12.3%, and 20.8% among individuals aged 10 years or less, 15 years or less, and 30 years or less, respectively. The estimated age at mid-population immunity was between 21 and 30 years. Besides age, individuals residing outside the Central region of Jordan had a significantly higher HAV sero-prevalence. Additionally, the use of filtered municipal water was associated with a lower sero-prevalence of HAV compared with the use of unfiltered municipal water among individuals aged 15 years or less. The results of this study suggest an intermediate to low endemicity of HAV in Jordan. An epidemiologic shift of HAV sero-prevalence with a declining rate of positivity for HAV IgG was noticed in this study. This highlights the importance of the recently introduced HAV vaccination in Jordan. Future research to evaluate the public health benefits of HAV vaccination in Jordan is recommended.
Collapse
Affiliation(s)
- Nariman Kareem
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (N.K.); (K.A.-S.); (A.M.)
| | - Khaled Al-Salahat
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (N.K.); (K.A.-S.); (A.M.)
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Faris G. Bakri
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (F.G.B.); (Y.R.)
- Infectious Diseases and Vaccine Center, The University of Jordan, Amman 11942, Jordan
| | - Yaser Rayyan
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (F.G.B.); (Y.R.)
- Gastroenterology and Liver Division, Department of Internal Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Azmi Mahafzah
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (N.K.); (K.A.-S.); (A.M.)
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (N.K.); (K.A.-S.); (A.M.)
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Correspondence: ; Tel.: +962-79-184-5186
| |
Collapse
|
13
|
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 DOI: 10.1080/21645515.2021.1920871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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.
Collapse
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
| |
Collapse
|
14
|
Herzog C, Van Herck K, Van Damme P. Hepatitis A vaccination and its immunological and epidemiological long-term effects - a review of the evidence. Hum Vaccin Immunother 2021; 17:1496-1519. [PMID: 33325760 PMCID: PMC8078665 DOI: 10.1080/21645515.2020.1819742] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 01/11/2023] Open
Abstract
Hepatitis A virus (HAV) infections continue to represent a significant disease burden causing approximately 200 million infections, 30 million symptomatic illnesses and 30,000 deaths each year. Effective and safe hepatitis A vaccines have been available since the early 1990s. Initially developed for individual prophylaxis, HAV vaccines are now increasingly used to control hepatitis A in endemic areas. The human enteral HAV is eradicable in principle, however, HAV eradication is currently not being pursued. Inactivated HAV vaccines are safe and, after two doses, elicit seroprotection in healthy children, adolescents, and young adults for an estimated 30-40 years, if not lifelong, with no need for a later second booster. The long-term effects of the single-dose live-attenuated HAV vaccines are less well documented but available data suggest they are safe and provide long-lasting immunity and protection. A universal mass vaccination strategy (UMV) based on two doses of inactivated vaccine is commonly implemented in endemic countries and eliminates clinical hepatitis A disease in toddlers within a few years. Consequently, older age groups also benefit due to the herd protection effects. Single-dose UMV programs have shown promising outcomes but need to be monitored for many more years in order to document an effective immune memory persistence. In non-endemic countries, prevention efforts need to focus on 'new' risk groups, such as men having sex with men, prisoners, the homeless, and families visiting friends and relatives in endemic countries. This narrative review presents the current evidence regarding the immunological and epidemiological long-term effects of the hepatitis A vaccination and finally discusses emerging issues and areas for research.
Collapse
Affiliation(s)
- Christian Herzog
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Koen Van Herck
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
15
|
Genetic diversity, haplotype analysis, and risk factor assessment of hepatitis A virus isolates from the West Bank, Palestine during the period between 2014 and 2016. PLoS One 2020; 15:e0240339. [PMID: 33306686 PMCID: PMC7732126 DOI: 10.1371/journal.pone.0240339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/26/2020] [Indexed: 01/05/2023] Open
Abstract
Background Hepatitis A virus (HAV) infection is one of the major causes of acute viral hepatitis. HAV genotypes and its genetic diversity is rarely investigated in our region as well as worldwide. Aims The aims of the present study were to determine the HAV genotypes and its risk factors and to investigate the genetic diversity of the HAV isolates in the West Bank, Palestine. Study design A cohort of 161 clinically and laboratory-confirmed HAV (IgM-positive) cases and 170 apparently healthy controls from all the districts of the West Bank, Palestine during the period of 2014 to 2016 were tested for HAV infection using IgM antibodies, RT-PCR and sequence analysis of the VP3/VP1 junction region of the HAV genome. Phylogenetic analysis, genetic diversity and haplotypes analysis were used to characterize the VP3/VP1 sequences. Results All the 34 sequences of the HAV were found to be of HAV-IB sub-genotype. The phylogenetic analysis showed four main clusters with cluster III exclusively consisting of 18 Palestinian isolates (18/23-78%), but with weak bootstrap values. A high haplotype diversity (Hd) and low nucleotide diversity (π) were observed. Cluster III showed high number of haplotypes (h = 8), but low haplotype (gene) diversity (Hd = 0.69). A total of 28 active haplotypes with some consisting of more than one sequence were observed using haplotype network analysis. The Palestinian haplotypes are characterized by closely related viral haplotypes with one SNV away from each other which ran parallel to cluster III in the phylogenetic tree. A smaller Palestinian haplotype (4 isolates) was three SNVs away from the major haplotype cluster (n = 10) and closer to others haplotypes from Iran, Spain, and South Africa. Young age, low level of parent’s education, infrequent hand washing before meals, and drinking of un-treated water were considered the major HAV risk factors in the present study. Conclusion Haplotype network analysis revealed haplotype variation among the HAV Palestinian sequences despite low genetic variation and nucleotide diversity. In addition, this study reconfirmed that age and parent’s level of education as HAV risk factors, while hand washing and treating drinking water as protective factors.
Collapse
|
16
|
Rapid Salivary IgG Antibody Screening for Hepatitis A. J Clin Microbiol 2020; 58:JCM.00358-20. [PMID: 32759356 DOI: 10.1128/jcm.00358-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/29/2020] [Indexed: 01/19/2023] Open
Abstract
Hepatitis A virus (HAV) is a common infection that is transmitted through the fecal-oral route, shed in the stool of infected individuals, and spread either by direct contact or by ingesting contaminated food or water. Each year, approximately 1.4 million acute cases are reported globally with a major risk factor for exposure being low household socioeconomic status. Recent trends show a decrease in anti-HAV antibodies in the general population, with concomitant increases in the numbers of HAV outbreaks. In line with a recreational water study, this effort aims to assess the prevalence of salivary IgG antibodies against HAV and subsequent incident infections (or immunoconversions) in visitors to a tropical beach impacted by a publicly owned treatment works (POTW). We applied a multiplex immunoassay to serially collected saliva samples gathered from study participants who recreated at Boquerón Beach, Puerto Rico. Analysis of assay results revealed an immunoprevalence rate of 16.17% for HAV with 1.43% of the cohort immunoconverting to HAV. Among those who immunoconverted, 10% reported chronic gastrointestinal symptoms and none experienced diarrhea. Tests on water samples indicated good water quality with low levels of fecal indicator bacteria; however, the collection and analysis of saliva samples afforded the ability to detect HAV infections in beachgoers. This rapid assay serves as a cost-effective tool for examining exposure to environmental pathogens and can provide critical information to policy makers, water quality experts, and risk assessment professionals seeking to improve and protect recreational water and public health.
Collapse
|
17
|
Andani A, van Elten TM, Bunge EM, Marano C, Salgado F, Jacobsen KH. Hepatitis A epidemiology in Latin American countries: a 2020 view from a systematic literature review. Expert Rev Vaccines 2020; 19:795-805. [PMID: 32955965 DOI: 10.1080/14760584.2020.1813575] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The World Health Organization recommends vaccination against hepatitis A virus (HAV) for children aged 1 year and older in areas where endemicity has shifted from high to intermediate. There are no recent comprehensive reviews of the epidemiology of HAV infection in Latin America, but seroprevalence and socioeconomic data suggest that, with improved clean water and sanitation systems, countries are transitioning to intermediate endemicity. AREAS COVERED We conducted a systematic literature review of the epidemiology of HAV infection in 25 countries in the Latin American region, which included gray literature. We compiled data on HAV incidence and prevalence, including the identification of epidemiological changes observed in countries that established pediatric HAV vaccination programs. EXPERT OPINION We identified 59 relevant articles, including 34 peer-reviewed seroprevalence studies (12 recent studies from Brazil), three incidence studies, and six vaccine impact studies (three from Argentina). Based on the estimated age at midpoint of population immunity in each country, most have a high-intermediate, intermediate, or low-intermediate level of HAV endemicity, suggesting that national childhood immunization may be an appropriate disease prevention strategy. However, recent data were lacking for most countries. Improved data quality and continued epidemiological surveillance are required for this region.
Collapse
Affiliation(s)
| | - Tessa M van Elten
- Pallas Health Research and Consultancy B.V ., Rotterdam, The Netherlands
| | - Eveline M Bunge
- Pallas Health Research and Consultancy B.V ., Rotterdam, The Netherlands
| | | | | | - Kathryn H Jacobsen
- Department of Global & Community Health, George Mason University , Fairfax, VA, USA
| |
Collapse
|
18
|
Immunity to Hepatitis-A virus: A nationwide population-based seroprevalence study from Iran. Vaccine 2020; 38:7100-7107. [PMID: 32917416 DOI: 10.1016/j.vaccine.2020.08.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/15/2020] [Accepted: 08/30/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The mortality rate of acute Hepatitis A increases from 0.1% in the children to 1.2%, in the adults. Hepatitis A is efficiently prevented by HAV-vaccine, but the strategy for distributing this vaccine among countries is dependent on their level of immunity to HAV. This study aimed to detect the level of immunity to HAV in Iran. METHODS In this population-based seroprevalence study, 5419 participants from 12 of provinces of Iran, including 57 urban and 120 rural areas were chosen through a multi-stage cluster random sampling. Participants were interviewed by filling checklists and 3 cc of blood sample was obtained from each of them. IBM SPSS statistics V.21 software was used for univariable and multivariable analysis of data. RESULTS Mean of age of Interviewees was 26.4 ± 16 years, ranging from 1 to 94 years with a male to female ratio 1.02. Overall, 3603 (66.5%) of subjects were seropositive for HAV-IgG. Among the age groups, 41.1% of children by the age 15 years and 82.6% of adults around 30 years old were immune to HAV. The Mid-point age of population immunity was 21 years. Residents of the borders of the country, people who had less access to the safe water or sanitary toilet, individuals with low socioeconomic status and persons who were a member of dense families had the most probability of seropositivity. CONCLUSIONS This study showed that Iran is among HAV low endemic countries and vaccination against HAV is recommended only in the high-risk population, including patients with chronic liver diseases, patients with coagulopathy, travelers to the high endemic areas, and homosexuals. Establishment of national HAV surveillance system, concerning of health system about the occurrence of the HAV outbreaks, implementation of harm reduction strategies, improving economic indices and sanitation and access to the safe water in the deprived regions is recommended.
Collapse
|
19
|
Acikgoz A, Cimrin D, Kizildag S, Esen N, Balci P, Sayiner AA. Hepatitis A, B and C seropositivity among first-year healthcare students in western Turkey: a seroprevalence study. BMC Infect Dis 2020; 20:529. [PMID: 32698841 PMCID: PMC7374894 DOI: 10.1186/s12879-020-05247-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 07/14/2020] [Indexed: 12/03/2022] Open
Abstract
Background The risk of viral hepatitis among healthcare students (HCSs) is greater than that among the general population. Therefore, this study was conducted to investigate the seroprevalence of the hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among first-year HCSs at a university in Turkey and as a secondary objective, to determine the factors associated with HAV and HBV seropositivity. Methods This cross-sectional study was performed in first-year HCSs in Izmir, western Turkey. Data were collected using a self-administered questionnaire including items on sociodemographic characteristics, medical history, and hygiene. A total of 650 HCSs were tested for the HAV, HBV and HCV markers. Categorical variables were compared using the chi-square test. The association between independent variables and anti-HAV seropositivity and anti-HBs seropositivity was assessed by multinomial logistic regression analysis. Results The overall frequency of total anti-HAV seropositivity was 34.9%. HBsAg, total anti-HBc and anti-HBs seropositivity were found in 0.3, 1.2 and 93.7% of samples, respectively. All of the HCSs were negative for anti-HCV. Total anti-HAV seropositivity was found to be 1.73 times higher in those ≥21 years old, and it was 1.61 times higher in those who perceived their economic status to be average and 2.75 times higher in those who perceived their economic status to be low. Total anti-HAV seropositivity was found to be 4.37 times higher in those who lived in provinces with intermediate human development index levels. Total anti-HBs seropositivity was found to be 2.48 times higher in those ≤20 years old, and it was 2.13 times higher in those who perceived their economic status to be average. Conclusions Approximately two out of three HCSs were susceptible to HAV infection. Since HCSs are at high risk for HAV infection, they should be vaccinated before medical clerkships begin. Our results indicate that there is a high prevalence of anti-HBs seropositivity among HCSs. This result may be largely attributed to the implementation of a successful vaccination program in Turkey since 1998.
Collapse
Affiliation(s)
- Ayla Acikgoz
- Vocational School of Healthcare, Dokuz Eylul University, Balcova, 35340, Izmir, Turkey.
| | - Dilek Cimrin
- Vocational School of Healthcare, Dokuz Eylul University, Balcova, 35340, Izmir, Turkey
| | - Servet Kizildag
- Vocational School of Healthcare, Dokuz Eylul University, Balcova, 35340, Izmir, Turkey
| | - Nuran Esen
- Department of Microbiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Balci
- Department of Radiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ayca Arzu Sayiner
- Department of Microbiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
20
|
Gecgel S, Demir C. The Effect of Vaccine Policy on HAV Seropositivity of Syrian Immigrants and Local Turkish People. JOURNAL OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASES 2020. [DOI: 10.29252/jommid.8.3.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
21
|
Immunization Against Hepatitis A in Migrant Children: Three Vaccination Strategies, A Retrospective Study. Pediatr Infect Dis J 2020; 39:164-169. [PMID: 31929432 DOI: 10.1097/inf.0000000000002526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hepatitis A is endemic in many countries. Swiss guidelines recommend vaccinating patients native from endemic areas. In Geneva's Children's hospital, migrant children are screened and vaccinated if seronegative. Because hepatitis A's prevalence is decreasing worldwide, more children are seronegative at arrival, highlighting the need for immunization in medical centers and refugee camps and questioning the benefits of systematic serology. Other Swiss hospitals vaccinate regardless of serostatus. This study's aim is to assess migrant children's immunity according to origin and age, and the cost-effectiveness of different immunization strategies. METHODS We retrospectively analyzed 329 children's serostatus (1-16 years of age) between 2012 and 2015, using enzyme-linked fluorescent assay method. Serology and vaccine costs were based on local prices. Groups were compared with χ test and the age-seropositivity relationship was studied with linear regression. RESULTS The predominant regions were the Eastern Mediterranean and European Regions with mostly negative serologies (71% and 83%) and the African Region with mostly positive serologies (79%). Immunity varied depending on birth country. Regardless of region, seropositivity increased with age (P < 0.001). The most cost-effective vaccination strategy was an individualized approach based on age and origin, reducing costs by 2% compared with serology-guided immunization and by 17% compared with systematic vaccination. CONCLUSIONS Many migrant children >5 years old are seronegative and at risk of clinical infection. They need to be immunized. New guidelines according to age and origin should be defined to reduce immunization costs. We recommend systematic vaccination for patients <5 years old or native from low endemicity areas (≤25.7% of seropositivity). For the others, we propose serology-based vaccination.
Collapse
|
22
|
Patterson J, Abdullahi L, Hussey GD, Muloiwa R, Kagina BM. A systematic review of the epidemiology of hepatitis A in Africa. BMC Infect Dis 2019; 19:651. [PMID: 31331281 PMCID: PMC6647100 DOI: 10.1186/s12879-019-4235-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/30/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hepatitis A, caused by the hepatitis A virus (HAV), is a vaccine preventable disease. In Low and Middle-Income Countries (LMICs), poor hygiene and sanitation conditions are the main risk factors contributing to HAV infection. There have been, however, notable improvements in hygiene and sanitation conditions in many LMICs. As a result, there are studies showing a possible transition of some LMICs from high to intermediate HAV endemicity. The World Health Organization (WHO) recommends that countries should routinely collect, analyse and review local factors (including disease burden) to guide the development of hepatitis A vaccination programs. Up-to-date information on hepatitis A burden is, therefore, critical in aiding the development of country-specific recommendations on hepatitis A vaccination. METHODS We conducted a systematic review to present an up-to-date, comprehensive synthesis of hepatitis A epidemiological data in Africa. RESULTS The main results of this review include: 1) the reported HAV seroprevalence data suggests that Africa, as a whole, should not be considered as a high HAV endemic region; 2) the IgM anti-HAV seroprevalence data showed similar risk of acute hepatitis A infection among all age-groups; 3) South Africa could be experiencing a possible transition from high to intermediate HAV endemicity. The results of this review should be interpreted with caution as the reported data represents research work with significant sociocultural, economic and environmental diversity from 13 out of 54 African countries. CONCLUSIONS Our findings show that priority should be given to collecting HAV seroprevalence data and re-assessing the current hepatitis A control strategies in Africa to prevent future disease outbreaks.
Collapse
Affiliation(s)
- Jenna Patterson
- Vaccines for Africa Initiative, University of Cape Town, Room N2.09A, Werner Beit North, Health Sciences Campus, Anzio Road, Observatory, Cape Town, 7925 South Africa
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Leila Abdullahi
- Save the Children International, Somaliland Country Office, Nairobi, Kenya
| | - Gregory D. Hussey
- Vaccines for Africa Initiative, University of Cape Town, Room N2.09A, Werner Beit North, Health Sciences Campus, Anzio Road, Observatory, Cape Town, 7925 South Africa
- Division of Medical Microbiology & Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Rudzani Muloiwa
- Vaccines for Africa Initiative, University of Cape Town, Room N2.09A, Werner Beit North, Health Sciences Campus, Anzio Road, Observatory, Cape Town, 7925 South Africa
- Department of Paediatrics & Child Health, Groote Schuur Hospital, The University of Cape Town, Cape Town, South Africa
| | - Benjamin M. Kagina
- Vaccines for Africa Initiative, University of Cape Town, Room N2.09A, Werner Beit North, Health Sciences Campus, Anzio Road, Observatory, Cape Town, 7925 South Africa
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
23
|
Medić S, Anastassopoulou C, Milošević V, Dragnić N, Rajčević S, Ristić M, Petrović V. Declining seroprevalence of hepatitis A in Vojvodina, Serbia. PLoS One 2019; 14:e0217176. [PMID: 31163046 PMCID: PMC6548380 DOI: 10.1371/journal.pone.0217176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/07/2019] [Indexed: 11/18/2022] Open
Abstract
To assess the current hepatitis A virus (HAV) endemicity in the Autonomous Province of Vojvodina, Serbia, we examined the seroprevalence and susceptibility profiles of the general population. A serum bank of 3466 residual samples, collected in 2015-16 as per the specifications of the European Sero-Epidemiology Network 2 project (ESEN2), was tested for anti-HAV antibodies with an enzyme immunoassay. Relationships between anti-HAV positivity and demographic features of respondents were examined by univariable and multivariable analyses. Present-day HAV seroprevalence was compared with that obtained in 1978-79. Surveillance data for hepatitis A recorded between 2008 and 2017 were also analyzed. Age was the only demographic variable found to be independently associated with a HAV seropositive status. Seropositivity (17% overall vs. 79% in 1978-79) increased with age to a maximum of 90% in the elderly ≥60 years. Only 5% of subjects <30 years were seropositive, unlike the 44% of seropositives ≥30 years. The estimated age at midpoint of population immunity (AMPI) increased markedly from 14 years in the late 70s to 55 years in 2015-16. Meanwhile, disease incidence decreased noticeably in recent years (from 11 in 2008 to 2 per 100,000 population in 2017). In the ongoing pre-vaccine era, natural infection provides immunity for merely a third (31%) and two thirds (57%) of people in their 40s and 50s, respectively. Hence, the majority of people ≤40 years (94%) and middle-aged adults 40-49 years (69%) are susceptible to HAV. Older susceptible individuals, particularly those ≥50 years (24%), are prone to severe symptoms. Taken together, these changes reflect the epidemiological transition of Vojvodina and Serbia from high to very low HAV endemicity, thereby supporting the current national policy of immunization of only high-risk groups.
Collapse
Affiliation(s)
- Snežana Medić
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- * E-mail:
| | - Cleo Anastassopoulou
- Division of Genetics, Cell and Developmental Biology, Department of Biology, University of Patras, Patras, Greece
| | - Vesna Milošević
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Center for Virology, Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Nataša Dragnić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Center for Informatics and Biostatistics, Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Smiljana Rajčević
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Mioljub Ristić
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vladimir Petrović
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| |
Collapse
|
24
|
Amaruddin AI, Wahyuni S, Hamid F, Chalid MT, Yazdanbakhsh M, Sartono E. BCG scar, socioeconomic and nutritional status: a study of newborns in urban area of Makassar, Indonesia. Trop Med Int Health 2019; 24:736-746. [PMID: 30884012 PMCID: PMC6849812 DOI: 10.1111/tmi.13232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective To investigate factors that determine the response to Bacille Calmette–Guérin (BCG) vaccination in urban environments with respect to socioeconomic status (SES), prenatal exposure to infections or newborn's nutritional status. Methods The study was conducted in an urban area, in Makassar, Indonesia. At baseline, 100 mother and newborns pair from high and low SES communities were included. Intestinal protozoa, soil transmitted helminths, total IgE, anti‐Hepatitis A Virus IgG and anti‐Toxoplasma IgG were measured to determine exposure to infections. Information on gestational age, birth weight/height and delivery status were collected. Weight‐for‐length z‐score, a proxy for newborns adiposity, was calculated. Leptin and adiponectin from cord sera were also measured. At 10 months of age, BCG scar size was measured from 59 infants. Statistical modelling was performed using multiple linear regression. Results Both SES and birth nutritional status shape the response towards BCG vaccination at 10 months of age. Infants born to low SES families have smaller BCG scar size compared to infants born from high SES families and total IgE contributed to the reduced scar size. On the other hand, infants born with better nutritional status were found to have bigger BCG scar size but this association was abolished by leptin levels at birth. Conclusion This study provides new insights into the importance of SES and leptin levels at birth on the development of BCG scar in 10 months old infants.
Collapse
Affiliation(s)
- Aldian Irma Amaruddin
- Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.,Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sitti Wahyuni
- Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Firdaus Hamid
- Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Maisuri T Chalid
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erliyani Sartono
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
25
|
Liu CC, Lu CL, Notobroto HB, Tsai CC, Wen PH, Li CY. Individual and neighborhood socioeconomic status in the prediction of liver transplantation among patients with liver disease: A population-based cohort study in Taiwan. Medicine (Baltimore) 2019; 98:e14849. [PMID: 30882681 PMCID: PMC6426624 DOI: 10.1097/md.0000000000014849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Given the fact that >80% of liver transplantations (LTs) were living donor liver transplantation (LDLT) in Taiwan, we conducted this study to assess whether patients with lower socioeconomic status are subject to a lower chance of receiving hepatic transplantation.This was a cohort study including 197,082 liver disease patients admitted in 1997 to 2013, who were at higher risk of LT. Personal monthly income and median family income of living areas were used to indicate individual and neighborhood socioeconomic status, respectively. Cox proportional hazard model that considered death as a competing risk event was used to estimate subdistribution hazard ratio (sHR) of LT in association with socioeconomic status.Totally 2204 patients received LT during follow-up, representing a cumulative incidence of 1.12% and an incidence rate of 20.54 per 10 person-years. After adjusting for potential confounders, including age, sex, co-morbidity, location/urbanization level of residential areas, we found that patients with < median monthly income experienced significantly lower incidence of LT (aHR = 0.802, 95% confidence interval (CI) = 0.717-0.898), but those with >- median monthly income had significantly elevated incidence of LT (aHR = 1.679, 95% CI = 1.482-1.903), as compared to those who were not actively employed. Additionally, compared to areas with the lowest quartile of median family income, the highest quartile of median family income was also associated with significantly higher incidence rate of LT (aHR = 1.248, 95% CI = 1.055-1.478).Higher individual and neighborhood socioeconomic status were significantly associated with higher incidence of LT among patients with higher risk of LT.
Collapse
Affiliation(s)
- Chi-Chu Liu
- Department of Anesthesiology, Tainan Sin-Lau Hospital, Tainan
- Department of Health Care Administration, Chang Jung Christian University, Tainan
| | - Chin-Li Lu
- Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung Hsing University, Taichung, Taiwan
| | - Hari Basuki Notobroto
- Department of Biostatistics and Population Studies, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Chiang-Chin Tsai
- Department of Health Care Administration, Chang Jung Christian University, Tainan
- Department of Surgery, Tainan Sin-Lau Hospital, Tainan, Taiwan
| | - Pei-Hung Wen
- Department of Public Health, College of Medicine, National Cheng Kung University
- Department of Surgery, E-DA Cancer Hospital, I-Shou University
- Department of Surgery, E-DA Hospital, I-Shou University, Kaohsiung
| | - Chung-Yi Li
- Department of Biostatistics and Population Studies, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Department of Public Health, College of Medicine, National Cheng Kung University
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| |
Collapse
|
26
|
Talaat M, Afifi S, Reaves EJ, Abu Elsood H, El-Gohary A, Refaey S, Hammad R, Abdel Fadeel M, Kandeel A. Evidence of sustained reductions in the relative risk of acute hepatitis B and C virus infections, and the increasing burden of hepatitis a virus infection in Egypt: comparison of sentinel acute viral hepatitis surveillance results, 2001-17. BMC Infect Dis 2019; 19:159. [PMID: 30764780 PMCID: PMC6376689 DOI: 10.1186/s12879-019-3806-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/11/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Egypt ranks fifth for the burden of viral hepatitis worldwide. As part of Egypt's renewed national strategy for the elimination of viral hepatitis, surveillance for acute viral hepatitis (AVH) was re-established during 2014-2017 to describe the current epidemiology and associated risk factors, and changes from surveillance conducted during 2001-2004. METHODS Patients with suspected AVH were enrolled, completed a questionnaire, and provided blood for testing for hepatitis viruses A (HAV), B (HBV), C (HCV), D, and E (HEV) infections by enzyme-linked immunosorbent assay. Odds ratios and Chi2 were used to detect differences between hepatitis types by patient characteristics and exposures. Newcombe-Wilson method was used to compare results between surveillance periods 2001-2004 and 2014-2017. RESULTS Between 2014 and 2017, among 9321 patients enrolled, 8362 (89.7%) had one or more markers of AVH including 7806 (93.4%) HAV, 252 (3.0%) HCV, 238 (2.8%) HBV, and 31 (0.4%) HEV infection. HAV infection occurred most commonly among children < 16 years age, while HBV infection occurred among ages 16-35 years and HCV infection in ages greater than 45 years. Healthcare-associated exposures were significantly associated with HBV and HCV infections compared to HAV infection including receiving therapeutic injections, surgery, wound suture, or urinary catheter and IV line insertions, while significant lifestyle exposures included exposure to blood outside the healthcare system, IV drug use, or incarceration. Exposures significantly associated with HAV infection were attending nursery or pre-school, contact with person attending nursery or pre-school, having meals outside the home, or contact with HAV case. Compared with AVH surveillance during 2001-2004, there was a significant increase in the proportion of HAV infections from 40.2 to 89.7% (RR = 2.3) with corresponding reductions in the proportions of HBV and HCV infections from 30.0 to 2.8% (RR = 0.1) and 29.8 to 3.0% (RR = 0.1), respectively. CONCLUSIONS Healthcare-associated exposures were significantly association with and remain the greatest risk for HBV and HCV infections in Egypt. Additional studies to evaluate factors associated with the reductions in HBV and HCV infections, and cost effectiveness of routine HAV immunization might help Egypt guide and evaluate control measures.
Collapse
Affiliation(s)
- Maha Talaat
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Cairo, Egypt
- U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Salma Afifi
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Cairo, Egypt
- U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Erik J. Reaves
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Cairo, Egypt
| | | | | | | | - Radi Hammad
- Ministry of Health and Population, Cairo, Egypt
| | | | - Amr Kandeel
- Ministry of Health and Population, Cairo, Egypt
| |
Collapse
|
27
|
Abstract
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.
Collapse
Affiliation(s)
- Kathryn H Jacobsen
- College of Health and Human Services, George Mason University, Fairfax, Virginia 22030
| |
Collapse
|
28
|
Gassowski M, Michaelis K, Wenzel JJ, Faber M, Figoni J, Mouna L, Friesema IH, Vennema H, Avellon A, Varela C, Sundqvist L, Lundberg Ederth J, Plunkett J, Balogun K, Ngui SL, Midgley SE, Gillesberg Lassen S, Müller L. Two concurrent outbreaks of hepatitis A highlight the risk of infection for non-immune travellers to Morocco, January to June 2018. Euro Surveill 2018; 23:1800329. [PMID: 29991381 PMCID: PMC6152161 DOI: 10.2807/1560-7917.es.2018.23.27.1800329] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/05/2018] [Indexed: 12/02/2022] Open
Abstract
From January to June 2018, two ongoing hepatitis A outbreaks affected travellers returning from Morocco and cases in Europe without travel history, resulting in 163 patients in eight European countries. Most interviewed travel-related cases were unaware of the hepatitis A risk in Morocco. Molecular analysis revealed two distinct hepatitis A virus (HAV) strains (subgenotype IA DK2018_231; subgenotype IB V18-16428). Vaccination recommendations should be emphasised to increase awareness among non-immune travellers to Morocco and HAV-endemic countries.
Collapse
Affiliation(s)
- Martyna Gassowski
- These authors contributed equally to this work
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE, German Field Epidemiology Training Programme), Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Kai Michaelis
- These authors contributed equally to this work
- Department for Infectious Disease Epidemiology, Unit of Gastrointestinal Infections, Zoonoses, and Tropical Infections, Robert Koch Institute (RKI), Berlin, Germany
| | - Jürgen J Wenzel
- These authors contributed equally to this work
- National Consultant Laboratory for HAV and HEV, Institute of Clinical Microbiology and Hygiene, University Medical Centre Regensburg, Regensburg, Germany
| | - Mirko Faber
- Department for Infectious Disease Epidemiology, Unit of Gastrointestinal Infections, Zoonoses, and Tropical Infections, Robert Koch Institute (RKI), Berlin, Germany
| | - Julie Figoni
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Lina Mouna
- AP-HP, National Reference Centre for Enterically Transmitted Hepatitis Viruses, Paul Brousse hospital, Villejuif, France
| | - Ingrid Hm Friesema
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Harry Vennema
- Centre for Infectious Diseases Research, Diagnostics and Screening, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Ana Avellon
- Hepatitis Unit, National Center of Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Varela
- National Centre of Epidemiology, Instituto de Salud Carlos III, CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Lena Sundqvist
- Department of Communicable Disease Control and Health Protection, the Public Health Agency of Sweden, Stockholm, Sweden
| | | | - James Plunkett
- National Infection Service, Public Health England, London, United Kingdom
| | - Koye Balogun
- National Infection Service, Public Health England, London, United Kingdom
| | - Siew Lin Ngui
- National Infection Service, Public Health England, London, United Kingdom
| | - Sofie Elisabeth Midgley
- Department of Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Sofie Gillesberg Lassen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Luise Müller
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| |
Collapse
|