Seroprevalence of hepatitis A virus in children

ABSTRACT

Earlier surveys in Saudi Arabia indicated that HAV is endemic in Saudi Arabia, however improvement of socioeconomic conditions in this country has led to changes in the epidemiological pattern of hepatitis A and made a determination of the seroprevalence of this disease advisable. To determine the current seroprevalence of antibodies against hepatitis A virus in selected group of children aged 1-6 years living in Northern borders region, Saudi Arabia, and to identify risk factors for infection. A cross-sectional seroepidemiological study of children 1-6 years of age [n= 950] attending 10 randomly selected primary health care centers [5 urban and 5 rural] was done. The sample size was distributed between urban and rural proportionally. Verbal informed consent was taken from parents or guardian of the recruited child. The parents of all children were subjected to a questionnaire included sociodemographic and housing environmental data. The determination of anti-HAV antibodies was carried out by ELISA-test. The prevalence of HAV-IgG was 33.8% overall, 35.5% among males and 32.0% among females with no statistically significant difference. There was a significant increase in the HAV-IgG with increasing age from 18.9% at [1-<3 years], to 44.1% at [5-<7 years. Rural children were at more risk than urban ones to have exposure to hepatitis A infection. A higher proportion of non Saudi children were anti-HAV seropositive than Saudi ones [43.1% and 32.7% respectively]. The anti-HAV seroprevalence was not associated with family size, but was related to parent's education, occupation, family income and crowding index. Other factors associated with increased risk of HAV seropositivity included non availability of municipal treated water, non hygienic refuse disposal and low social score. From multivariate logistic regression analysis, increasing age, rural residence, non Saudi nationality, and non availability of safe municipal water source were the most important independent predictors for HAV seropositivity in studied children. This study showed a clear decrease in hepatitis A prevalence in the studied children particularly in urban and indicates that a transition may be underway to intermediate endemicity and consequently possible shift of the risk to the adult age with increased morbidity. So, we recommend including Hepatitis A in the schedule of routine childhood vaccinations