Gupta Rakesh, Sanjeev R K, Agarwal A, Tomar R P S, Kumar N, Dutt Vipul, Gupta Shishir
Director, Government Institute of Medical Sciences, Greater Noida, Gautam Buddha Nagar 201310, India.
Assistant Professor (Pediatrics), Pravara Institute of Medical Sciences, Loni, Ahmadnagar, India.
Med J Armed Forces India. 2019 Jul;75(3):335-338. doi: 10.1016/j.mjafi.2018.11.007. Epub 2019 Mar 28.
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.
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.
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.
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.
甲型肝炎病毒（HAV）引起一种经肠道传播的病毒性疾病，主要影响儿童，在包括印度在内的许多发展中国家呈地方性流行。随着儿童中有症状病例的发病率增加，出现了流行病学转变。本研究旨在评估5岁以下幼儿中HAV的血清流行率以及普遍免疫的必要性。
本横断面研究于2014年4月至2015年7月在印度北部的两家三级护理医院对1至5岁的健康儿童进行。样本量根据10岁以下儿童中HAV血清阳性率40%[16 - 60%]和5%的α错误率计算得出。采用酶联免疫吸附测定法对血清抗HAV IgG进行分析，并对结果进行分析。
共纳入1084名年龄在12至60个月之间的儿童，男女比例为1.86:1。共发现471名儿童（43.5%）抗HAV IgG呈阳性。12至23个月的年幼儿童中HAV的血清流行率较低（优势比[OR]=0.73，95%置信区间[CI]=0.52 - 0.87，p = 0.03），具有统计学意义。男孩以及饮用安全饮用水且卫生设施改善的家庭中HAV血清阳性率较低。
该研究观察到年幼儿童中抗HAV血清阳性率较低，使他们易患该疾病。可能的潜在危险因素包括年龄较小、饮用水不安全、卫生条件差以及父母教育程度低。因此，建议在1岁时将疫苗接种作为选择性疫苗，同时加强公共卫生措施以保障安全饮用水、卫生习惯和食品安全。
