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The epidemiology of hepatitis A infection in Palestine: a universal vaccination programme is not yet needed

Published online by Cambridge University Press:  26 November 2001

K. YASSIN ,
R. AWAD ,
A. TEBI ,
A. QUEDER  and
U. LAASER
K. YASSIN
Affiliation:
Section of International Public Health, School of Public Health, University of Bielefeld, Postfach 100131, 33501 Bielefeld, Germany
R. AWAD
Affiliation:
Management Information System, Ministry of Public Health, Palestinian National Authority, Palestine
A. TEBI
Affiliation:
Department of Primary Health Care, Ministry of Public Health, Palestinian National Authority, Palestine
A. QUEDER
Affiliation:
Department of Primary Health Care, Ministry of Public Health, Palestinian National Authority, Palestine
U. LAASER
Affiliation:
Section of International Public Health, School of Public Health, University of Bielefeld, Postfach 100131, 33501 Bielefeld, Germany
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Abstract

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In Palestine, there has been an increase in the reported incidence of acute hepatitis A virus (HAV) infection since 1995. Since overt clinical disease occurs only among adults, questions were raised whether or not a shift in the epidemiology of HAV has occurred. This is generally characterized by a decrease in the overall incidence rate and a shifting in the mean age of infection towards adolescence and early adulthood. The need for a vaccination programme is being discussed. To resolve this issue, we examined the prevalence of anti-HAV in a representative sample of 396 school children in the Gaza Strip. The prevalence of anti-HAV was 93·7% (95% CI: 91·3, 96·1%). Stratifying the prevalence by age showed that 87·8% (95% CI: 78·6, 97%) were HAV antibody positive by the age of 6. By the age of 14, almost 98% (95% CI: 92·7, 100%) were HAV antibody positive. This means that the majority of HAV infection is still taking place in early childhood, when it is usually asymptomatic and of little clinical significance. The results refuted the shifting epidemiology theory and we recommend that a vaccination programme against HAV infection is not yet needed. Alternative explanations for the increase in reported cases are discussed.

Type
Research Article
Information
Epidemiology & Infection , Volume 127 , Issue 2 , October 2001 , pp. 335 - 339
Copyright
2001 Cambridge University Press