• 1

    Dubois F, Thevernas C, Caces E, 1992. Séroépidémiologie de l’hépatite a dans six départements du Centre ouest de la France. Gastroenterol Clin Biol 16 :674–679.

    • Search Google Scholar
    • Export Citation
  • 2

    World Health Organization, 2000. Hepatitis A. Geneva: World Health Organization. WHO/CDS/CSR/EDC/2000-7.

  • 3

    Feinstone SM, 2000. Hepatitis A Virus. Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. Fifth edition. New York: Churchill Livingstone, 1924–1928.

  • 4

    Berge JJ, Drennan DP, Jacobs RJ, Jakins A, Meyerhoff AS, Stubblefield W, Weinberg M, 2000. The cost of hepatitis A infections in American adolescents and adults in 1997. Hepatology 31 :469–473.

    • Search Google Scholar
    • Export Citation
  • 5

    Alter MJ, Mast EE, 1994. The epidemiology of viral hepatitis in the United States. Gastroenterol Clin North Am 23 :437–455.

  • 6

    Melnick J, 1995. History and epidemiology of hepatitis A virus. J Infect Dis 171 :S2–S8.

  • 7

    Hadker SG, 1991. Global impact of hepatitis A virus infection: changing patterns. Hollinger FB, Lemon SM, Margolis HS, eds. Viral Hepatitis and Liver Disease. Baltimore, MD: Williams and Wilkins, 14–19.

  • 8

    Wang SM, Liu CC, Huang YS, Yang YJ, Lei HY, 2001. Change in hepatitis A virus seroepidemiology in southern Taiwan: a large percentage of the population lack protective antibody. J Med Virol 64 :104–108.

    • Search Google Scholar
    • Export Citation
  • 9

    Mall ML, Rai RR, Philip M, 2001. Seroepidemiology of hepatitis A infection in India: changing pattern. Indian J Gastroenterol 20 :132–135.

    • Search Google Scholar
    • Export Citation
  • 10

    Baudin AL, Gaumer B, 1971. Situation épidémiologique du gouvernerat de Sousse en 1970. Tunis Med 49 :213–217.

  • 11

    Bulletin Épidémiologique, 1998. Ministère de la Santé Publique de Tunisie. No. 4. Tunis, Tunisia: Imprimerie Nationale.

  • 12

    National Institute of Statistics, 2002. Available from, www.ins.nat.tn

  • 13

    Dentinger CM, Heinrich NL, Bell BP, 2001. A prevalence study of hepatitis A virus infection in a migrant community. J Pediatr 38 :705–709.

    • Search Google Scholar
    • Export Citation
  • 14

    Dal-Re R, Garcia-Corbeira P, Garcia-de-Lomas J, 2000. A large percentage of the Spanish population under 30 years of age is not protected against hepatitis A. J Med Virol 60 :363–366.

    • Search Google Scholar
    • Export Citation
  • 15

    Stroffolini T, Chiaramonte M, Franco E, 1991. Baseline seroepidemiology of hepatitis A virus infection among children and teenagers in Italy. Infection 19 :97–100.

    • Search Google Scholar
    • Export Citation
  • 16

    Gay NJ, Morgan-Capner P, Wright J, Farrington CP, Miller E, 1994. Age-specific antibody prevalence to hepatitis A in England: implications for disease control. Epidemiol Infect 113 :113–120.

    • Search Google Scholar
    • Export Citation
  • 17

    Fix AD, Martin OS, Gallicchiol L, Vial PA, Lagos R, 2002. Age specific prevalence of antibodies to hepatitis A in Santiago, Chile: risk factors and shift in age of infection among children and young adults. Am J Trop Med Hyg 66 :628–632.

    • Search Google Scholar
    • Export Citation
  • 18

    Das K, Jain A, Gupta S, Kapoor S, Gupta RK, Chakravorty A, Kar P, 2000. The changing epidemiological pattern of hepatitis A in an urban population of India: emergence of a trend similar to the European countries. Eur J Epidemiol 16 :507–510.

    • Search Google Scholar
    • Export Citation
  • 19

    Hawkes RA, Boughton CR, Ferguson V, 1981. The seroepidemiology of hepatitis in Papua New Guinea. A long term study of hepatitis A. Am J Epidemiol 114 :554–562.

    • Search Google Scholar
    • Export Citation
  • 20

    Willner IR, Uhl MD, Howard SC, Williams EQ, Riely CA, Waters B, 1998. Serious hepatitis A: an analysis of patients hospitalized during an urban epidemic in the United States. Ann Intern Med 128 :111–114.

    • Search Google Scholar
    • Export Citation
  • 21

    Andre F, van Damme P, Safary A, Banatvala J, 2002. Inactivated hepatitis A vaccine: immunogenicity, efficacy, safety and review of official recommendations for use. Expert Rev Vaccines 1 :9–23.

    • Search Google Scholar
    • Export Citation
 
 
 

 

 
 
 

 

 

 

 

 

 

AGE-SPECIFIC SEROPREVALENCE OF HEPATITIS A AMONG SCHOOL CHILDREN IN CENTRAL TUNISIA

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  • 1 Department of Internal Medicine and Infectious Diseases Unit, Microbiology Unit, and Epidemiology Unit, University Hospital Farhat Hached, Sousse, Tunisia; School Health Department, Sousse, Tunisia

Hepatitis A virus (HAV) has different epidemiologic and clinical patterns, depending on the level of endemicity in a given geographic area. Tunisia is considered a region of high endemicity for hepatitis. Improvement of socioeconomic conditions in this country has made a determination of the seroprevalence of this disease advisable. We assessed the seroprevalence of HAV in Sousse in central Tunisia. A total of 2,400 school children 5–20 years of age (mean ± SD age = 11.7 ± 3.5 years) were selected by two-stage cluster sampling and tested serologically for IgG antibody to HAV by using an enzyme-linked immunosorbent assay. The overall seroprevalence among this population was 60% (44%, in children < 10 years old, 58% in those 10–15 years of age, and 83% in those > 15 years of age. Seroprevalence also varied according to area of residence. At the age of 10, 21.3% of school children living in the urban areas and 87.7% of those living in rural areas had antibodies to HAV. Other factors that increased seroprevalence included non-potable water, crowding, and a low education level of parents with odds ratios of 4.37, 2.96, and 2.62, respectively. This study has shown an increase of seroprevalence with age, suggesting that transmission among younger children has decreased, particularly in urban areas. Programs to prevent hepatitis A may need to be modified based upon the changing age distribution of the disease and mass vaccination program could be indicated if additional incidence and prevalence data confirm the intermediate endemicity of HAV.

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