Abstract
Age-related seroprevalence studies that have been conducted in Brazil have indicated a transition from a high to a medium endemicity of hepatitis A virus (HAV) infection in the population. However, most of these studies have focused on urban populations that experience lower incidence rates of HAV infection. In the current study, the prevalence of anti-HAV antibodies was investigated in children with a low socioeconomic status (SES) that live on the periphery of three capital cities in Brazil. A total of 1,162 dried blood spot samples were collected from individuals whose ages ranged from one-18 years and tested for anti-HAV antibodies. A large number of children under five years old (74.1-90%) were identified to be susceptible to HAV infection. The anti-HAV antibody prevalence reached ≥ 50% among those that were 10-14 years of age or older. The anti-HAV prevalence rates observed were characteristics of regions with intermediate level of hepatitis A endemicity. These data indicated that a large proportion of children with a low SES that live at the periphery of urban cities might be at risk of contracting an HAV infection. The hepatitis A vaccine that is currently offered in Brazil is only available for high-risk groups or at private clinics and is unaffordable for individuals with a lower SES. The results from this study suggest that the hepatitis A vaccine should be included in the Brazilian National Program for Immunisation.
Highlights
Infection with hepatitis A virus (HAV) is the most common cause of acute viral hepatitis worldwide (Jacobsen & Wiersma 2010)
Having an accurate understanding of the epidemiology of HAV infection is important for understanding its effect on population groups that have not benefited from the recent improvements in sanitation conditions in Brazil
The results from this study indicated that only 10%, 13.2% and 25.9% of children under the age of five from the SE, MW and NO Regions of Brazil, respectively, were HAV seropositive
Summary
A total of 1,162 children and adolescents were enrolled in the current study. Of the study participants, 686 were from the SE Region, 322 were from the MW Region and 154 were from the NO Region. HAV seroprevalence was significantly associated with other variables, including the study participant’s race, the educational level of the study participant’s father and mother, the family’s income, the number of siblings, the use of filtered water, the number of family members, the habitation in reinforced concrete houses and the SES index (Table I). The presence of anti-HAV antibodies was significantly associated with the following: the female gender (46.9% vs 31.3%, OR =1.9, CI 95%: 1.2-3.2, p = 0.006), the number of siblings in the household (p < 0.0001) and a previous history of hepatitis (p = 0.01). Analysis of the age-associated prevalence of antiHAV antibodies in the three studied Regions – Fig. 2 indicates the overall results of the HAV seroprevalence rates according to age group in the three studied population groups. Among those participants from one-18 years of age, the prevalence was 41.9% (varied from 39.8-49%), which characterised the overall population group that was evaluated as having an intermediate level of hepatitis A endemicity
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