A study of hepatitis A virus seropositivity among children aged between 1 and 5 years of age: Implications for universal immunization
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Published on: June 20, 2020
Rakesh Gupta1, R K Sanjeev2, A Agarwal3
1Director, Government Institute of Medical Sciences, Greater Noida, Gautam Buddha Nagar 201310, India.
Insights
Hepatitis A virus (HAV) seroprevalence was 43.5% in Indian children under five. Younger children showed lower seroprevalence, indicating susceptibility and a need for vaccination and improved public health measures.
Area of Science:
- * Infectious Diseases
- * Pediatrics
- * Public Health
Background:
- * Hepatitis A virus (HAV) is an enterically transmitted viral disease prevalent in developing countries, primarily affecting children.
- * An epidemiological shift indicates an increasing incidence of symptomatic HAV cases in children.
- * This study assesses HAV seroprevalence in young children in India to inform immunization strategies.
Purpose of the Study:
- * To determine the seroprevalence of Hepatitis A virus (HAV) IgG antibodies among children under five years of age in Northern India.
- * To evaluate the association between HAV seropositivity and demographic/environmental factors.
- * To assess the need for universal HAV immunization in this age group.
Main Methods:
- * A cross-sectional study involving 1084 healthy children aged 1-5 years was conducted in Northern India from April 2014 to July 2015.
- * Serum IgG against HAV was analyzed using the enzyme-linked immunosorbent assay (ELISA) method.
- * Sample size was determined based on an estimated 40% HAV seropositivity and a 5% alpha error.
Main Results:
- * Overall HAV IgG seroprevalence was 43.5% among the 1084 enrolled children.
- * Seroprevalence was significantly lower in younger children (12-23 months) (OR=0.73, p=0.03).
- * Lower seropositivity was observed in boys, and families with safe drinking water and improved sanitation.
Conclusions:
- * Younger children (<5 years) exhibit lower HAV seropositivity, increasing their susceptibility to infection.
- * Risk factors for lower seropositivity include younger age, unsafe water, poor sanitation, and lower parental education.
- * Optional vaccination at one year, alongside public health initiatives for water, hygiene, and food safety, is recommended.
Background:
Hepatitis A virus (HAV) causes an enterically transmitted viral disease mainly affecting children and endemic in many developing countries, including India. There is an epidemiological shift with an increased incidence of symptomatic cases among children. This study was conducted to assess the seroprevalence of HAV among young children aged below 5 years and the need for universal immunization.
Method:
This cross-sectional study was conducted at two tertiary care hospitals in Northern India, from Apr 2014 to Jul 2015, among healthy children aged between 1 and 5 years. The sample size was calculated based on the prevalence of HAV seropositivity of 40% among children aged <10 years [16-60%] and alpha error of 5%. Analysis of serum IgG against HAV was performed by enzyme-linked immunosorbent assay method, and results were analyzed.
Results:
A total of 1084 children aged between 12 and 60 months were enrolled, with male-to-female ratio of 1.86:1. A total of 471 children (43.5%) were found to be positive for IgG against HAV. The seroprevalence of HAV was lower among younger children aged 12-23 months (odds ratio [OR] = 0.73, 95% confidence interval [CI] = 0.52-0.87, p = 0.03), which was statistically significant. Seropositivity of HAV was lower among boys and families consuming safe drinking water and having improved sanitation facilities.
Conclusion:
The study observed lower seropositivity against HAV among younger children, making them susceptible of contracting the disease. Possible underlying risk factors were younger age, unsafe drinking water, poor sanitation, and low education status of parents. Therefore, vaccination may be recommended as optional vaccine at one year of age, along with improved public health efforts for safe drinking water, hygiene practices, and food safety.
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