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Hepatitis A virus in India more common in older children
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In India, there is a higher prevalence of hepatitis A virus in older children, with socioeconomic class, education of parents and the source of drinking water also found to be key factors in the seroprevalence of the virus, study researchers have found.
The prospective, multicenter, cross-sectional study was conducted at five hospitals in New Delhi, Kolkata, Pune and Chennai between September 2011 and July 2012. Children aged 18 months to 10 years (n=928) who sought medical treatment or needed blood drawn for any reason were included in the study. Those with a history of hepatitis A virus (HAV) vaccination or symptoms of HAV were excluded from the study.
Comprehensive physical evaluations of the children were performed, and the researchers also gleaned various data about medical history, environment and lifestyle factors. Data collected included the following: medical history, area of residence, home sanitary conditions (such as source of drinking water), waste disposal (private toilet in house, private outdoor toilet, public toilet, open field), and education level/occupation of parents. Kuppuswamy’s scale was used to calculate the family’s socioeconomic class.
The researchers also collected serum samples, which were screened for anti-HAV antibodies.
The researchers found that anti-HAV antibodies were detected in the blood samples of 348 (37.5%) children. Seropositivity for HAV was more common in the 6- to 10-year age group (50.3%) than in the 18-month-old to 6-year-old demographic (30.3%). There was a significant link between socioeconomic class and education level of parents and positive HAV results in children.
There was an increase in seropositivity proportionate to increase in age seen in all socioeconomic classes, with the exception of upper socioeconomic class. There were fewer seropositive children among those with access to a private indoor toilet (33.1%) than in those who used an open field (75%) for waste disposal.
The researchers said the overall seropositivity rates of HAV have decreased in India, but the widely varying trends in endemicity across India calls for immunization as a standard of care.
“The diverse variation in the rates of seropositivity across various cities in different locations of India in the urban settings confirms the need for routine vaccination,” the researchers wrote. “Considering the diversity of endemicity, there is scope for a single-dose vaccine schedule for both inactivated and live-attenuated hepatitis A vaccine, as highlighted by the WHO for developing countries.”
Disclosure: Some of the researchers report receiving research grants for the study and are employees of or have received payment from Medclin Research Private Limited or Wockhardt Limited.
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