Spatial and temporal analysis of Hepatitis A cases in fier district, Albania, 1986–2016

Abstract

Purpose: To document long term changes in the prevalence of Hepatitis A and its use as an indicator of sanitary standards and public health capacity. Methods & Materials: Registers of infectious disease cases maintained by Public Health authorities in Fier District, Albania for the years 1986 – 2016 inclusive were scanned and digitised as part of national project to quantify the burden of such diseases in the population. In total over 21,000 individual records covering 29 separate diseases were computerized of which Hepatitis A was the most common diagnosis with nearly 9,000 recorded cases over the 31-year period. For each case, demographic and biographic details of the patient, as well as key dates such as onset of symptoms, first visit to doctor or clinic, diagnosis, recovery and reporting to PH authorities were recorded. Spatial and temporal analysis of the data were carried out to identify long term trends and geographical distribution of cases. Results: Overall, there was a significant decrease in the number of cases of Hepatitis A from nearly 1300 per year 1986 to less than 100 cases annually from 2003 onwards. In the 4 years 2010 to 2014, a total of 18 cases were recorded. The following year, however, the number of reported cases rose to 92, of which 50 were recorded in a single commune. This outbreak was the subject of substantial media coverage and a detailed investigation by public health authorities which identified a number of contributing factors. Throughout the time series, outbreaks of Hepatitis A occurred at intervals of roughly 4-6 years, the periodicity possibly reflecting waning levels of immunity in the paediatric population. There was also a progressive reduction in the duration of clinical cases (date of first symptoms to date of recovery) attributed to more effective therapeutic options and better overall standards of health care. Conclusion: Using Hepatitis A as a proxy for water borne infectious diseases, the study demonstrated the effects of improvements in water and sewage infrastructure over three decades on the health of the population of Fier District. Continued sporadic cases and localised outbreaks could be used to identify communities where further investment was needed.