GSK, Medical & Clinical Emerging Markets, Wavre, Belgium.
GSK, Medical Affairs Philippines, Manila, The Philippines.
PLoS One. 2021 Dec 1;16(12):e0258659. doi: 10.1371/journal.pone.0258659. eCollection 2021.
A previous review on hepatitis A virus (HAV) seroprevalence in 2005 categorized Southeast Asia as a low HAV endemicity region. In 2010, the World Health Organization modified this from low to low/medium endemicity, pointing out that these estimates were based on limited evidence. Since then, there has been no attempt to review HAV epidemiology from this region. We conducted a systematic review of literature to collect information on HAV incidence and seroprevalence in select countries in the Southeast Asian region, specifically, The Association of Southeast Asian Nations over the last 20 years.
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. From the relevant articles, we extracted data and conducted a risk of bias assessment of individual studies.
The search yielded 22 and 13 publications on HAV seroprevalence and incidence, respectively. Overall, our findings point to a very low HAV endemicity profile in Thailand and Singapore and evidence of a shift towards low HAV endemicity in Indonesia, Lao People's Democratic Republic, Malaysia, the Philippines, and Vietnam. Only Singapore, Thailand, Malaysia, and the Philippines have existing HAV disease surveillance and reported incidence rates below 1 per 100,000. Several outbreaks with varying magnitude documented in the region provide insights into the evolving epidemiology of HAV in the region. Risk of bias assessment of studies revealed that the individual studies were of low to medium risk.
CONCLUSIONS/SIGNIFICANCE: The available HAV endemicity profiles in Southeast Asian countries, aside from Thailand, are limited and outdated, but suggest an endemicity shift in the region that is not fully documented yet. These findings highlight the need to update information on HAV epidemiology through strengthening of disease surveillance mechanisms to confirm the shift in HAV endemicity in the region.
2005 年关于甲型肝炎病毒（HAV）血清流行率的一篇综述将东南亚归类为 HAV 低度流行地区。2010 年，世界卫生组织将其从低度流行改为低度/中度流行，并指出这些估计是基于有限的证据。此后，该地区没有尝试对 HAV 流行病学进行综述。我们进行了系统的文献回顾，以收集过去 20 年东南亚特定国家（即东南亚国家联盟）的 HAV 发病率和血清流行率信息。
这项系统综述是根据系统评价和荟萃分析的首选报告项目进行的。从相关文章中，我们提取了数据，并对个体研究进行了偏倚风险评估。
搜索结果分别为 22 篇和 13 篇关于 HAV 血清流行率和发病率的文章。总体而言，我们的研究结果表明，泰国和新加坡的 HAV 低度流行率非常高，印度尼西亚、老挝人民民主共和国、马来西亚、菲律宾和越南的 HAV 流行率呈低度流行趋势。只有新加坡、泰国、马来西亚和菲律宾有现有的 HAV 疾病监测系统，并报告发病率低于每 10 万人 1 例。该地区发生的几起规模不同的暴发为了解 HAV 在该地区的不断变化的流行病学提供了线索。对研究的偏倚风险评估显示，个别研究的风险为低到中等。
结论/意义：除了泰国之外，东南亚国家现有的 HAV 流行率概况有限且过时，但表明该地区的流行率发生了变化，只是尚未得到充分记录。这些发现强调了需要通过加强疾病监测机制来更新 HAV 流行病学信息，以确认该地区 HAV 流行率的变化。
