Changing seroepidemiology of hepatitis A virus infection between two regions in Taiwan differing in socioeconomic...

In Taiwan, hepatitis A virus (HAV) infection is hyperendemic, and prior to the late 1970s more than 85% of the population was infected by 15 years of age. In this study, the prevalence of HAV infection in two regions of Taiwan with differing standards of living is evaluated. Serum antibody to HAV (anti-HAV) was determined by enzyme immunoassay. A total of 4,218 subjects under the age of 16 years were enrolled. The first group of 1,581 subjects were residents of the prosperous western plain region where the socioeconomic status and living environment have improved greatly in the past 20 years; the second group of 2,637 subjects were aborigines inhabiting the eastern and central mountain regions where improvement in the standard of living lags far behind the western region. All serum samples were collected in 1991 except for 1,100 samples collected in 1989 from elementary and junior middle school students in Tainan city. The prevalence of HAV infection was 11.9% for the western region and 81.0% for the eastern and central regions. In the eastern and central regions, 80% of the subjects had been infected with HAV before the age of six years, in contrast to 0% in the western region. By the age of 13 years, only 6% of the subjects were infected in the western region; however 97% had been infected in the eastern and central regions. Among children under the age of 10 years, only 10.6% (10/94) of the IgM-anti-HAV positive cases had clinical symptoms. These findings indicate that HAV infection has a close relationship with socioeconomic status and environmental sanitation.