HIGH PREVALENCE OF HEPATITIS A IN TUNISIA

Abstract

Purpose: To establish the epidemiological profile of hepatitis A in Tunisia, to identify risk factors and propose a possible vaccination strategy. Methods: 351 patients were included in this study. They represented 5 different groups: 174 consecutive children and adolescents (mean age 9 yrs) who presented to the hospital laboratory, over aperiod of 2 months, for out-patient labs; 61 volunteer blood donors (mean age 22 yrs); 58 health professionals (mean age 32 yrs); 47 hemodialysis patients (mean age 60 yrs); and 11 cir-rhotics (mean age 47yrs). ELISA (Pasteur-Merieux) was used for detection of IgG anti-hepatitis A virus (HAV) antibodies (Ab). Results: The total prevalence of anti-HAV Ab was 69%. The table below summarizes prevalence by group.TableIn the children and adolescents group, anti-HAV Ab prevalence increased with age: 8% in those 6 months to 5 yrs old (p = 0.003; odds ratio = 5.5); 32% in those 5 to 10 yrs old (p = 0.01; odds ratio = 2.1); 59% in those 10 to 15 yrs old, and reaching 76% in those 15 to 20 yrs old. We also found 4 independent risk factors associated with a high anti-HAV Ab prevalence: living in rural areas, origin from the North-West of the country, and past personal or family history of icterus or hepatitis (adjusted odds ratios were respectively: 5.24; 2.42; 9.87; and 3.08). Conclusions: Even though there is a general tendency towards a lower prevalence of HAV in Tunisia, and a shift of the age of contact with the virus towards adolescence, the fact that the prevalence is 76% in those 15 to 20 yrs old and reaches 100% in adults still places us in a highly endemic area. No vaccination strategy is justifiable at this time. Prevention depends on the application of hygiene measures, which remain unsatisfactory even with the continuous improvement of socio-economic conditions.