Changes in the seroprevalence of IgG anti-hepatitis A virus between 2001 and 2013: experience at a single center in Korea

BACKGROUND/AIMS: The incidence of symptomatic hepatitis A reportedly increased among 20- to 40-year-old Korean during the late 2000s. Vaccination against hepatitis A was commenced in the late 1990s and was extended to children aged <10 years. In the present study we analyzed the changes in the seroprevalence of IgG anti-hepatitis A virus (HAV) over the past 13 years. METHODS: Overall, 4903 subjects who visited our hospital between January 2001 and December 2013 were studied. The seroprevalence of IgG anti-HAV was analyzed according to age and sex. In addition, the seroprevalence of IgG anti-HAV was compared among 12 age groups and among the following time periods: early 2000s (2001-2003), mid-to-late 2000s (2006-2008), and early 2010s (2011-2013). The chi-square test for trend was used for statistical analysis. RESULTS: The seroprevalence of IgG anti-HAV did not differ significantly between the sexes. Furthermore, compared to the seroprevalence of IgG anti-HAV in the early 2000s and mid-to-late 2000s, that in the early 2010s was markedly increased among individuals aged 1-14 years and decreased among those aged 25-44 years (P<0.01). We also found that the seroprevalence of IgG anti-HAV in individuals aged 25-44 years in the early 2010s was lower than that in the early 2000s and mid-to-late 2000s. CONCLUSIONS: The number of symptomatic HAV infection cases in Korea is decreasing, but the seroprevalence of IgG anti-HAV is low in the active population.

Immunogenicity and safety of live attenuated hepatitis A vaccine: a multicentric study.

OBJECTIVE: To evaluate immunogenicity and tolerability of single dose live attenuated injectable hepatitis A vaccine in four metropolitan cities of India. METHODS: Live attenuated hepatitis A vaccine was administered to 505 children aged 18 to 60 months in four centers across India. Immunogenicity of the vaccine was assessed by estimation of anti-HAV antibody titer at 6 weeks and 6 months following administration of the vaccine. Safety evaluation of the vaccine was also done during the visits. RESULTS: At 6 weeks, 480 subjects (95%) came for the follow-up and 411 (81.4%) subjects reported at the end of 6 months. The geometric mean titer (GMT) of anti-HAV antibody of the subjects who did not have the seroprotective titer at the baseline were assessed at 6 weeks and 6 months which was 81.04 mIU/ml and 150.66 mIU/ml respectively. At 6 weeks, 95.1 % seroconverted and at the end of 6 months, 97.9 % had seroconverted. Both solicited and unsolicited vaccine-induced local and systemic adverse events were insignificant at all the centers, except swelling and induration in a few. CONCLUSION: Live attenuated injectable hepatitis A vaccine was immunogenic and tolerable with minimal reactogenecity, in this study of single dose schedule. Safety profile was also satisfactory in the study population.

Epidemiology and clinical features of acute hepatitis A: from the domestic perspective / 대한간학회지

Acute viral hepatitis A has recently become a major public health problem in Korea, and the incidence of symptomatic hepatitis A is growing rapidly. With improvements in socioeconomic conditions and environmental hygiene, the chances of exposure to hepatitis A virus (HAV) during childhood have decreased and, in turn, the proportion of young adults with positive anti-HAV has significantly decreased. This has led to the incidence of symptomatic acute hepatitis A increasing since the late 1990s. The incidence of serious complications including fulminant hepatic failure and acute kidney injury has also showed an increasing trend. Variation of the genotype of virus isolated from recent hepatitis A patients suggests an inflow of the hepatitis virus from other countries. In this review article, we present the situation and epidemiology of hepatitis A in Korea, and recommend further investigation and policies for vaccination on a national level.

Is hepatitis A vaccination necessary in Indian patients with cirrhosis of liver?

OBJECTIVE: Hepatitis A vaccine has been recommended for patients with chronic liver disease since they have high mortality following acute hepatitis. This study was done to assess the prevalence of antibodies to hepatitis A virus in Indian patients with liver cirrhosis to determine the relevance of this recommendation in India. METHODS: Consecutive patients with cirrhosis of liver seen at two referral hospitals in southern India were tested for antibodies to hepatitis A virus using EIA. Age-matched non-cirrhotic adults attending the OPD served as controls. RESULTS: Of the 52 patients (mean [SD] age 57.1 [11.0] years; 33 men) and 50 control subjects (52.0 [14.8] 5 years; 39 men), 51 patients and all the controls tested positive (p=ns). CONCLUSION: Most patients with liver cirrhosis have antibodies against hepatitis A virus and thus immunization against this infection without screening appears unnecessary in them.

Seroprevalence of hepatitis A virus antibody in patients with chronic liver disease--experience from a tertiary care hospital in north India.

Patients with chronic liver disease of any etiology are at a high risk for a more severe outcome when superinfected with hepatitis A virus (HAV). Prevention of hepatitis A, by inactivated vaccine has been shown to be safe and effective in this subgroup of patients. Most countries in the West recommend prophylaxis against hepatitis A virus for patients with chronic liver disease. However, hepatitis A virus is endemic in India. Before advocating a uniform prophylaxis against hepatitis A for chronic liver disease patients in India, we prospectively evaluated the seroprevalence of hepatitis A virus antibody (Anti HAV) among the patients with cirrhosis of liver registered at our hospital, using a commercial enzyme-immunoassay (ELISA). Prevalence of protective antibody against HAV among the 42 Cirrhotic patients included in the study was documented to be 97.6% (41/42). Therefore, vaccination against hepatitis A virus infection may not be needed among patients with chronic liver disease in our population. However, further studies including adequate sample size is needed to confirm the observation encountered in the present study.

Vaccination for hepatitis A virus is not required for patients with chronic liver disease in India.

BACKGROUND: Hepatitis A virus (HAV) vaccination is recommended worldwide for patients with chronic liver disease to prevent decompensation due to superinfection with HAV. India being endemic for HAV, the prevalence of pre-existing antibodies against HAV due to subclinical exposure to the virus in childhood among patients with chronic liver disease may be high and, therefore, vaccination may not be needed. However, data are lacking on the prevalence of HAV antibody among patients with chronic liver disease in India. METHODS: Two hundred fifty-four patients attending the Liver Clinic at the All India Institute of Medical Sciences, New Delhi during the past 5 years and diagnosed to have either chronic hepatitis due to the hepatitis B virus (n = 76), hepatitis C virus (n = 84) or cirrhosis of the liver due to the hepatitis B (n = 47) or C (n = 47) virus were tested for the presence of IgG anti-HAV antibody in their sera (using a commercial ELISA kit). RESULTS: Two hundred forty-eight (97.6%) patients tested positive for IgG anti-HAV. The prevalence of anti-HAV positivity was similar among patients with chronic hepatitis B (74, 97.4%), chronic hepatitis C (82, 97.6%), cirrhosis of the liver due to the hepatitis B (46, 97.8%) and hepatitis C (46, 97.8%) virus. CONCLUSION: Vaccination against HAV is not required among patients with chronic liver disease in India as there is a very high prevalence of pre-existing antibodies in these patients.

Hepatite viral A: frequência de positividade para anticorpos das classes IgG e IgM sgundo faixa etária e tremestre sazonal (São Paulo, SP/1996) / HV virus: positivity frequency of anti-HAV antibodies IgG (HAV-G) and IgM (HAV-M)

Foram analisados os resultados dos testes imunoenzimáticos ELISA (Roche Diagnóstica) para anticorpos anti-HAV das classes IgG (HAV-G) e IgM (HAV-M) obtidos no período de dezembro de 1995 a novembro de 1996. Os 1177 pacientes estavam assim distribuídos: 1042 (88,5%) adultos (≥ 15 anos), sendo 49,4% do sexo masculino e 50,6% feminino, e 135 crianças (54,1% masculino e 45,9% feminino). Foram obtidos os seguintes índices de positividade para HAV-G: 76,2% para adultos (77,5% dos homens e 75,0% das mulheres) e 48,9% para as crianças (56,2% entre os meninos e 40,3% entre as meninas). Os adultos apresentaram maior frequência de positividade que as crianças (p<0,05). O contrário foi observado para anticorpos IgM: 4,6% de positividade para adultos e 29,6% entre as crianças.