Abstract
A previous review on hepatitis A virus (HAV) seroprevalence in 2005 categorized Southeast Asia as a low HAV endemicity region. In 2010, the World Health Organization modified this from low to low/medium endemicity, pointing out that these estimates were based on limited evidence. Since then, there has been no attempt to review HAV epidemiology from this region. We conducted a systematic review of literature to collect information on HAV incidence and seroprevalence in select countries in the Southeast Asian region, specifically, The Association of Southeast Asian Nations over the last 20 years. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. From the relevant articles, we extracted data and conducted a risk of bias assessment of individual studies. The search yielded 22 and 13 publications on HAV seroprevalence and incidence, respectively. Overall, our findings point to a very low HAV endemicity profile in Thailand and Singapore and evidence of a shift towards low HAV endemicity in Indonesia, Lao People's Democratic Republic, Malaysia, the Philippines, and Vietnam. Only Singapore, Thailand, Malaysia, and the Philippines have existing HAV disease surveillance and reported incidence rates below 1 per 100,000. Several outbreaks with varying magnitude documented in the region provide insights into the evolving epidemiology of HAV in the region. Risk of bias assessment of studies revealed that the individual studies were of low to medium risk. The available HAV endemicity profiles in Southeast Asian countries, aside from Thailand, are limited and outdated, but suggest an endemicity shift in the region that is not fully documented yet. These findings highlight the need to update information on HAV epidemiology through strengthening of disease surveillance mechanisms to confirm the shift in HAV endemicity in the region.
Highlights
Hepatitis A disease is caused by the hepatitis A virus (HAV) and is transmitted via the fecaloral route either through ingestion of contaminated food or water, or through close contact with an infectious person [1, 2]
HAV endemicity is typically high in low- and middle-income countries in comparison to the situation in highincome countries which typically have very low endemicity [4]
Hepatitis A in Southeast Asia systematic review with a single study to this review, two studies provided data for immigrants coming from Vietnam, Philippines, Cambodia, Lao PDR and Myanmar [18, 21], no publications were found from Timor-Leste and Brunei
Summary
Hepatitis A disease is caused by the hepatitis A virus (HAV) and is transmitted via the fecaloral route either through ingestion of contaminated food or water, or through close contact with an infectious person [1, 2]. HAV endemicity is typically high in low- and middle-income countries (where individuals are exposed to virus infection in their childhood years) in comparison to the situation in highincome countries which typically have very low endemicity (i.e. most of the population is naïve to HAV infection during their life) [4]. Low- and middle-income countries have seen rising incomes and rapid urbanization and nearly the entire population (especially in urban areas) have access to clean water. These countries have reported a transition from high to low endemicity levels of HAV due to a progressive decrease of exposure to HAV during their childhood [4]. We conducted a systematic review of literature to collect information on HAV incidence and seroprevalence in select countries in the Southeast Asian region, The Association of Southeast Asian Nations over the last 20 years
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