Journal Reading
HEPATITIS A : EPIDEMIOLOGY AND
PREVENTION IN DEVELOPING
COUNTRIES
World Journal of Hepatology, 27 March 2012, Volume 4, Issue 3, pp 68-73
Elisbetta Franco, Cristina Meleleo, Laura Serino, Debora Sorbara, Laura Zaratti
Journal Reading
HEPATITIS A : EPIDEMIOLOGY AND PREVENTION
IN DEVELOPING COUNTRIES
Pembimbing : Penyusun:
dr. Arief Wijaya Rusli, Sp.A Dyah Puspa Ardani
SMF Ilmu Kesehatan Anak
RSU Haji Surabaya
2018
INTRODUCTION
• most common form of acute viral hepatitis worldwide.
• HAV is a thermostable, acid resistant single-stranded DNA.
• HAV replicates in hepatocytes --> interferes liver function --> spark
immune response --> inflammation
• Fecal-oral route, person-to-person transmission, close contacts
Presentation • prodormal symptoms decrease
prodormal symptoms : with the onset of jaundice
• fever
• malaise • jaundice lasts for several weeks
• weakness
• anorexia • peak infectivity is 2 weeks before
jaundice or elevation of liver
• nausea enzyme level
• vomitting
IgM anti-HAV is required to confirm diagnosis,
detectable when symptops appear and disappear
after 6 mo
• 50% of children under age of 6 are asymptomatic
• <5% of children below 4 yrs develops jaundice
• <10% of children between 4-6 develops jaundice
from 6 years to adulthood 75% develop traits with jaundice and dark urine
0,2 % of clinical case of HAV may cause acute liver failure and death
GLOBAL EPIDEMIOLOGY OF HEPATITIS A
• 1,5 million of clinical cases worldwide
• incidence are strongly related to socioeconomic and accsess to
safe drinking water
Areas determined as having high, intermediate, and low endemicity of hepatitis A
developing countries
with very poor
sanitary and
hygene,household
crowding = highly
endemic areas
peak rates of infection
= later childhood and
adolescence
developed countries with good sanitation and hygiene = low infection rates in children
peak infection rates = adolescents and young adults
very low prevalence countries = specific adult risk group e.g. travelers to endemic areas, homosexual
men, IV drug users
Africa
• mostly endemic in all areas execpt subpopulation of white people in South
Africa
• 1990s -> almost all black children is HAV + by the age of 12, almost 100% of
black adults have antibodies to HAV before 20 yrs. white adults 30-40 % anti-
HAV + at 20 yrs old and 60% at 40-49 yrs
• 1980s --> nearly universal immunity in many countries; 100% immunity rate
by age 10 years in Algeria, 100% of adults anti-HAV positive in Morocco.
• 2002 --> seropravelence in urban areas (21,3% with HAV antibodies) < rural
areas (87,7%)
• low social background --> non educated parents --> highest prevalence
• Sub-saharan Africa have very high incidence rate
Asia
• low endemicity --> Japan and Taiwan
• moderate endemicity --> Korea, Indonesia, Thailand, Sri Lanka,
Malaysia
• China and India shown rapid socio-economic development --> high
endemicity to moderate endemicity
• 1990s one-half of 10 yrs old have antibodies in China, 2006 two major
outbreaks
• 2007 cord blood anti-HAV level found in 100% newborns in India, recent
studies --> lowered by 50%-60%
Central and South America
• endemicity continue high in Latin America, 1990-1999 very high
seroprevalance more than half 2 yrs old are immune to HAV and all
adults are immune to HAV
• recent studies --> decreased in several South America countries,
improvement in public health and sanitary
• Argentina underwent vaccination program in 2005 --> sharp
reduction of infectio rate
Prevention
1. adequate supplies of safe drinking water
2. proper disposal of sewage
3. personal hygiene practice
4. vaccines to protect risk group and stop outbreaks
1. cost-effective studies
2. sustainability
Conclusion
• a rapidly developing societies need a conclusive guidelines for HAV vaccination
• WHO is revising its position paper on Hepatitis A with a view to update, evaluate
data on disease burden, epidemiology, vaccine products, availibility and
immunization protection, the use of vaccine in outbreaks and for contacts of
cases
• determining national policies --> consider appropiate epidemiological and cost-
benefit studies
