Hepatitis A seroprevalence in children and adolescents aged 1–18 years among a low socioeconomic population in Izmir, Turkey

Examining the changes in the prevalence of Hepatitis a in Türkiye: systematic review and metaanalysis

BACKGROUND

The incidence of Hepatitis A is increasing worldwide. Yearly classification of Hepatitis A Seroprevalence for different times in different regions of Türkiye allows indirect measurement of year-specific incidence rates of HAV infection and can be considered the best way to define Hepatitis A status. This study aimed to examine the change in the incidence of hepatitis A by systematically evaluating the available data on the seroprevalence of anti-HAV antibodies in the Turkish population.

METHODS

Studies published between First January, 2000- 31 December 2023 that meet the inclusion criteria searched between 16.09.2023 and 31.01.2024 in nine databases (MEDLINE, Web of Science, PubMed, ScienceDirect, Scopus, Eric, CINAHL Complate, TR DİZİN, TÜBİTAK Ulakbim). Independently by two reviewers evaluated all titles and abstracts with consensus-based decision making. The Joanna Briggs Institution (JBI) Analytical Cross Sectional Studies and Prevelance Studies list were used in this study. Pooled prevalence was calculated using 95% confidence intervals. Heterogeneity between studies was assessed by Cochrane's Q and I2. The random effect model was selected by Cochrane's Q and I2. Funnel plots were used for publication bias. The data were analyzed via Jamovi 1.2.22.

RESULTS

Data were extracted from 63 studies. Pooled prevalence was calculated using 95% confidence intervals. Funnel plots were used for publication bias. In this meta-analysis, data were obtained from all geographical regions of Türkiye, and the general prevalence of Hepatitis A in the population was found to be 53% [95% CI 0.47, 0.59; I2 = 99.94%]. In subgroup analysis conducted by year, the prevalence of hepatitis A was 45% [95% CI 0.22, 0.67; I2 = 99.8%] between 2002 and 2006, 52% [95% CI 0.39, 0.65; I2 = 99.54%] between 2007 and 2011, 60% [95% CI 0.49, 0.70; I2 = 99.9%] between 2012 and 2016, and 51% [95% CI 0.41, 0.61; I2 = 99.97%] as of 2017. Additionally, a systematic review revealed that vaccination, socioeconomic status, and sex may also affect HAV seroprevalence.

CONCLUSIONS

HAV seroprevalence in Türkiye; It was observed that it increased between 2002 and 2016 and decreased until today as of 2017. This systematic review provide a comprehensive overview of HAV virus epidemiology and identify key knowledge gaps, contributing crucial information for influencing factors.

TRIAL REGISTRATION

PROSPERO ID = CRD42023464384.

Age-Specific Seroprevalence of Hepatitis A Virus in Turkey Between 2000 and 2023: Systematic Review and Meta-Analysis

Background: Hepatitis A virus (HAV) is a leading cause of acute viral hepatitis and is primarily transmitted by the fecal-oral route. The clinical presentation and progression of the disease varies according to the age of the patient. Turkey is classified as a moderately endemic country, and HAV infection continues to be an important public health problem worldwide. Methods: In this study, a systematic meta-analysis was conducted to evaluate age-specific HAV seroprevalence rates in Turkey between 2000 and 2023. A comprehensive literature review identified 57 articles that met the inclusion criteria. The studies were assessed for quality, and seroprevalence rates were evaluated across four different age groups. Statistical analyses were performed using Comprehensive Meta-Analysis (CMA) software (CMAVersion 3.0) and SPSS (SPSS Statistics 25.0). Results: HAV seroprevalence rates were found to be 73.18% in the 0 < 5 age group and 90.90% in the >35 age group. The overall seroprevalence estimated using a random effects model was 64.5% (95% CI: 58.3-70). High heterogeneity was observed among the studies, and the prevalence estimates changed when low-quality studies were excluded. Conclusions: This meta-analysis suggests that the increasing trend in HAV IgG seroprevalence in Turkey, especially among young populations, is likely due to the vaccination program initiated in 2012. Furthermore, the heterogeneity observed among regions highlights the importance of regional public health strategies. Future studies should focus on providing more detailed data to evaluate the long-term effects of vaccination and to explain regional differences in HAV seroprevalence.

Seroprevalence of hepatitis A virus antibodies among children and adolescents living in Northern Thailand: an implication for hepatitis A immunization

This cross-sectional study aimed to assess seroprevalence of hepatitis A virus (HAV) antibodies and identify factors associated with HAV seropositivity among children and adolescents aged 1-18 years who resided in Chiang Mai, Thailand. Sociodemographic characteristics, sanitation/hygiene, and history of HAV vaccination were collected. Anti-HAV IgG antibody was determined, and a level ≥ 1.0 S/CO defined HAV seropositivity. We enrolled 300 participants; median age 8.7 years, 54% male, and 13% overweight (BMI z-score: + 1 to + 2 standard deviation [SD]). Sixty-five participants (22%) were vaccinated against HAV. Overall, 84/300 participants (28%) demonstrated HAV seropositivity, of whom 55/65 (85%) and 29/235 (12%) were among vaccinated and unvaccinated participants (P < 0.001), respectively. Previous HAV vaccination (adjusted odds ratio [aOR] 47.2; 95% CI 20.0-111.8) and overweight (aOR 4.4; 95% CI 1.7-11.3, compared with normal weight [BMI z-score: - 2 to + 1 SD]) were significantly associated with seropositivity of HAV. In the stratified analyses, crowded bedroom (aOR 3.2; 95% CI 1.3-7.8, per one person increase) and overweight (aOR 5.0; 95% CI 1.8-13.7) were factors associated with HAV seropositivity among vaccinated and unvaccinated participants, respectively. Seroprevalence of HAV antibodies in healthy Thai children and adolescents was relatively low. Recommendation of HAV vaccination for these populations, particularly those with high-risk conditions, should be considered.

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

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.

Comparison of the Prevalence and Risk Factors of Hepatitis A in 10 to 18-Year-Old Adolescents of Sixteen Iranian Provinces: The CASPIAN-III Study

BACKGROUND

Hepatitis A is a common health concern both in developing and developed countries. Hygienic and socioeconomic parameters deeply impact the prevalence and transmission of this disease. Evaluating the epidemiological distribution and risk factors for Hepatitis A virus (HAV) is necessary for policy makers to improve local and national preventive measures.

OBJECTIVES

The aim of this study was to compare the prevalence of hepatitis A infection in a sample of Iranian adolescents living in different provinces of Iran and to assess its family- and community-related risk factors.

METHODS

In this cross-sectional study, serum samples of 10 to 18-year-old adolescents, who were studied in a national health survey, were examined for anti-HAV antibodies. A total of 2,494 subjects were included from 16 provinces by multistage random cluster sampling. Demographic and socioeconomic factors related to HAV transmission were extracted by valid questionnaires. A multilevel analysis using mixed-effects logistic regression (melogit) was used to evaluate the association of risk factors with HAV infection.

RESULTS

The weighted prevalence of HAV varied significantly across the studied provinces (P = 0.001), ranging from 50.43% in the Fars province to 78.81% in Markazi province. HAV was significantly more prevalent in children whose mothers worked outside of the home (OR, 1.73; 95% CI, 1.14-2.62; P = 0.009).

CONCLUSIONS

The risk of symptomatic HAV infection is considerable in adolescents of all studied provinces; thus, universal HAV vaccination is recommended for all adolescents, regardless of their socioeconomic level. However, the risk is higher in some provinces, which seem to be transitioning from intermediate to low endemicity.

Seroprevalence of Hepatitis A Virus Antibodies among the Patients with Chronic Hepatitis B in Turkey

Background

Hepatitis A virus (HAV) can cause significant pathology in patients with chronic hepatitis B virus (HBV), however, HAV can be prevented by vaccination. The aim of this study was to determine the implication of vaccination against HAV vaccine in patients with chronic hepatitis B.

Materials and methods

The seroprevalence of anti-HAV IgG antibodies was investigated in the patients with chronic hepatitis B. Anti-HAV IgG antibodies were detected by commercially available ELISA kit.

Results

A total of 673 patients (354 males, 319 females with age range of 17-78 years) with chronic hepatitis B were included the study. Hepatitis A virus seropositivity rate was 34% in the patients younger than 20 years, 79% in the age group of 20 to 29 years, and 100% after 35 years of age.

Discussion

Hepatitis A virus vaccination may be recommended for young adult patients with chronic hepatitis B in Turkey.

How to cite this article

Tulek N, Ozsoy M, Moroglu C, Sonmezer MC, Temocin F, Ertem GT, Erdinc FS. Seroprevalence of Hepatitis A Virus Antibodies among the Patients with Chronic Hepatitis B in Turkey. Euroasian J Hepato-Gastroenterol 2015;5(2):95-97.

INTERMEDIATE ENDEMICITY OF HEPATITIS A VIRUS INFECTION IN RURAL SETTLEMENT PROJECTS OF SOUTHWEST GOIÁS, BRAZIL

BACKGROUND

Rural populations present an elevated risk of exposure to hepatitis A virus.

OBJECTIVE

The objective of this study was to estimate the prevalence and risk factors associated with hepatitis A virus infection among residents of rural settlement projects of southwest Goiás, Central Brazil.

METHODS

A total of 466 residents were interviewed and tested for the detection of anti- hepatitis A virus antibodies by ELISA.

RESULTS

The global prevalence of anti- hepatitis A virus was 82.2%. In individuals aged 5-9 years and 10-19 years, the prevalence was 15% and 58.8%, respectively. Persons in the 10-19 age group, with a history of life in encampments, with more than five people per residence consuming well water, were predictors for exposure to hepatitis A virus.

CONCLUSION

Our results suggest that the hepatitis A virus endemicity in rural settlements in southwest Goiás similar to that found in the urban population of the Midwest Region, confirming the implementation of universal hepatitis A vaccination in children.

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

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.

Declining incidence of hepatitis A in Amsterdam (The Netherlands), 1996-2011: second generation migrants still an important risk group for virus importation

BACKGROUND

The Netherlands is a very low endemic country for hepatitis A virus infections (HAV, notification rate of <1/100,000). Historically in Amsterdam, a large proportion of infections are imported from Turkey and Morocco in children returning from summer holiday. Annually since 1998, the public health service of Amsterdam has targeted these children for HAV vaccination before the summer. As the population of non-western immigrants and their descendents increases, we describe recent trends in HAV in ethnic groups in Amsterdam (1996-2011), identifying current risk groups and recommending targeted prevention through vaccination.

METHODS

We studied all cases of (non-homosexually acquired) HAV infection notified in the Amsterdam region (1996-2011, n=819) by ethnic group and generation (first/second generation migrants: FGM and SGM respectively). Incidence rates were estimated as the average number of cases per 100,000/year. Using Poisson regression, we calculated incidence rate ratios (IRR) by ethnic group and generation adjusted for age and calendar year, and modeled seasonal variation using a smoothed time series.

RESULTS

Incidence of HAV in Amsterdam dropped from 24.8/100,000 population in 1996 (178 cases) to 1.0/100,000 in 2011 (8 cases). Since 2005, 56% of cases are imported, the majority (62%) in second generation migrant (SGM) children of Moroccan, or other non-western ethnic backgrounds. The adjusted IRR in SGM relative to the ethnic Dutch population was 3.7 (95% CI: 2.3-6.1) in Moroccan SGM, 4.3 (95%CI: 2.6-7.2) in SGM of other non-western backgrounds and 1.9 (95%CI: 0.8-4.1) in Turkish SGM.

CONCLUSION

Though incidence of HAV in Amsterdam has declined substantially since 1996, it is still higher in SGM children of Moroccan & other non-western ethnic backgrounds. In line with WHO recommendations of June 2012, introduction of single-dose HAV vaccination, targeted at SGM children from HAV endemic countries, could be considered within the routine childhood vaccination schedule.