Risk factors and prevalence of antibodies against hepatitis A virus (HAV) in children from day-care centers, in Goiania, Brazil

Queiróz, D.A.O.; Cardoso, D.D.P.; Martelli, C.M.T.; Martins, R.M.B.; Porto, S.O.B.; Borges, A.M.T.; Azevedo, M.S.P.; Daher, R.R.

doi:10.1590/S0036-46651995000500008

Abstracts

A seroepidemiologic survey about hepatitis A virus (HAV) infection was carried out in a group comprising 310 children, ranging in age from 3 months to 9 years, from day-care centers, in Goiania, a middle sized city in the central region of Brazil. The biomarkers employed in the investigation of previous infection include total IgG and IgM anti-HAV antibodies, and for the detection of more recent infection, IgM anti-HAV antibodies were analyzed. The study was performed in 1991 and 1992. According to the results, 69.7% of the children presented total IgG/IgM anti-HAV antibodies, with 60% of the group in the age range of 1 to 3 years. Among 10 day-care centers analyzed, the prevalence of the biomarker IgM anti-HAV was 3.2%, with an uniform distribution of the cases in the group of children ranging in age from 1 to 4 years. Multi-variate analysis was performed to investigate the sociodemographic factors that could influence the results. It was verified that the risk for the infection increased with the length of the attendance in the day-care centers, i.e., the risk for children with attendance of one year or more was 4.7 times higher, when compared with children with one month attendance (CI 95% 2.3-9.9). According to the results, hepatitis A is an endemic infection in day-care centers in the study area. The length of attendance in the day-care settings was demonstrated to be a risk factor for the HAV infection. Such findings suggest that if hepatits A vaccination becomes available as a routine policy in our region, the target group should be children under one year. Moreover, those children should receive the vaccine before they start to attend the day-care centers.

Hepatitis A survey; Seroepidemiology; Day-care children

Um estudo soroepidemiológico para o vírus da hepatite A (VHA), investigando os marcadores de infecção passada (anti-VHA total - IgG e IgM) e infecção recente (anti-VHA IgM), foi realizado entre 1991 e 1992, em crianças de creche de Goiânia-Brasil central. Das 310 crianças com idade entre 03 meses e 09 anos, 69,7% mostraram soropositividade ao anti-VHA total, sendo 60%, na faixa etária entre 1 e 3 anos. A prevalência do marcador anti-VHA IgM foi de 3,2%, visto em idade de 1-4 anos e com distribuição uniforme nas 10 creches estudadas. Entre as variáveis sócio-demográficas estudadas, apenas o tempo de freqüência das crianças nas creches, igual ou superior a um ano, mostrou, em análise multivariada ajustada para idade, um risco 4,7 vezes maior quando comparado com o período de um mês (LC 95% 2,3-9,9). De acordo com os resultados, a hepatite A é uma infecção endêmica no tipo populacional estudado e o tempo de freqüência prolongado das crianças, nas creches públicas, constitui um fator de risco para infecção ao VHA. Tais resultados sugerem que, uma vez que a vacina seja instituída na região, as crianças de creche devem recebê-la antes de um ano de idade, ou no mais tardar antes de ingressarem nas creches públicas.

SEROEPIDEMIOLOGY

Risk factors and prevalence of antibodies against hepatitis A virus (HAV) in children from day-care centers, in Goiania, Brazil

Fatores de risco e prevalência de anticorpos contra o vírus da hepatite A (VHA) em crianças de creche em Goiânia, Brasil

D.A.O. Queiróz^I; D.D.P. Cardoso^I; C.M.T. Martelli^I; R.M.B. Martins^I; S.O.B. Porto^II; A.M.T. Borges^I; M.S.P. Azevedo^I; R.R. Daher^I

^IInstituto de Patologia Tropical e Saúde Pública (IPTESP)/UFG, Goiania, GO, Brazil

^IIFaculdade de Medicina/UFG, Goiania, GO, Brazil

^{Correspondence to} Correspondence to: Laboratório de Virologia do IPTESP/UFG Rua Delenda Rezende de Melo c/1ª Avenida 74605-050 Goiânia, GO, Brasil telefax: (062)261-6414

SUMMARY

A seroepidemiologic survey about hepatitis A virus (HAV) infection was carried out in a group comprising 310 children, ranging in age from 3 months to 9 years, from day-care centers, in Goiania, a middle sized city in the central region of Brazil. The biomarkers employed in the investigation of previous infection include total IgG and IgM anti-HAV antibodies, and for the detection of more recent infection, IgM anti-HAV antibodies were analyzed. The study was performed in 1991 and 1992. According to the results, 69.7% of the children presented total IgG/IgM anti-HAV antibodies, with 60% of the group in the age range of 1 to 3 years.

Among 10 day-care centers analyzed, the prevalence of the biomarker IgM anti-HAV was 3.2%, with an uniform distribution of the cases in the group of children ranging in age from 1 to 4 years. Multi-variate analysis was performed to investigate the sociodemographic factors that could influence the results. It was verified that the risk for the infection increased with the length of the attendance in the day-care centers, i.e., the risk for children with attendance of one year or more was 4.7 times higher, when compared with children with one month attendance (CI 95% 2.3-9.9).

According to the results, hepatitis A is an endemic infection in day-care centers in the study area. The length of attendance in the day-care settings was demonstrated to be a risk factor for the HAV infection. Such findings suggest that if hepatits A vaccination becomes available as a routine policy in our region, the target group should be children under one year. Moreover, those children should receive the vaccine before they start to attend the day-care centers.

Keywords: Hepatitis A survey; Seroepidemiology; Day-care children.

RESUMO

Um estudo soroepidemiológico para o vírus da hepatite A (VHA), investigando os marcadores de infecção passada (anti-VHA total - IgG e IgM) e infecção recente (anti-VHA IgM), foi realizado entre 1991 e 1992, em crianças de creche de Goiânia-Brasil central. Das 310 crianças com idade entre 03 meses e 09 anos, 69,7% mostraram soropositividade ao anti-VHA total, sendo 60%, na faixa etária entre 1 e 3 anos.

A prevalência do marcador anti-VHA IgM foi de 3,2%, visto em idade de 1-4 anos e com distribuição uniforme nas 10 creches estudadas. Entre as variáveis sócio-demográficas estudadas, apenas o tempo de freqüência das crianças nas creches, igual ou superior a um ano, mostrou, em análise multivariada ajustada para idade, um risco 4,7 vezes maior quando comparado com o período de um mês (LC 95% 2,3-9,9).

De acordo com os resultados, a hepatite A é uma infecção endêmica no tipo populacional estudado e o tempo de freqüência prolongado das crianças, nas creches públicas, constitui um fator de risco para infecção ao VHA. Tais resultados sugerem que, uma vez que a vacina seja instituída na região, as crianças de creche devem recebê-la antes de um ano de idade, ou no mais tardar antes de ingressarem nas creches públicas.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

ACKNOWLEDGMENTS

This project was supported by the Pró-Reitoria de Pesquisa e Pós-Graduação/UFG, and by the Conselho Estadual de Ciência e Tecnologia do Estado de Goiás (CONCITEG). We would like to thank Vera Saddi for the English translation of this paper.

Recebido para publicação em 09/12/1994

Aceito para publicação em 27/09/1995

1. ABUZWAIDA, A.R.N.; SIDONI, M.: YOSHIDA, C.F.T. & SCHATZMAYR, H.G. - Seroepidemiology of hepatitis A and B in two urban communities of Rio de Janeiro, Brazil. Rev. Inst. Med. trop. S. Paulo, 29: 219-223, 1987.
2. BENENSON, M.W.; TACAFUJI, E.T.; BRANCROFT, W.H. et al. - A military community outbreak of hepatitis type A related to transmission in a child care facility. Amer. J. Epidem., 112: 471-481, 1980.
3. BENSABATH, G.; HADLER, S.C.; SOARES, M.C.P.; FIELDS, H. & MAYNARD, J.E. - Caracteristicas serologicas y epidemiologicas de la hepatitis vírica aguda en la cuenca amazonica del Brasil. Bol. Ofic. sanit. panamer., 103: 351-362, 1987.
4. BILE, K.; ACETI, A.; HAGI, M.A. et al. - Primary hepatitis A virus infection in developing countries: decline of maternal antibodies and time of infection. Boll. Ist. sieroter. milan., 65: 464-466, 1986.
5. BRIEM, H.; WEILAND, O.; FRIDRIKSSON, I. & BERG, R. - Prevalence of antibody to hepatitis A in Iceland in relation to age, sex, and number of notified cases of hepatitis. Amer. J. Epidem., 116: 451-455, 1982.
6. CHEN, C.J.; YOU, S.L.; YOU, S.L.; LU, C.F. & HSU, S.T. - Seroepidemiology of hepatitis A, B and D viruses among children in Taiwan. In: SUNG, J.L. & CHEN, D.S., ed. Viral hepatitis and liver disease. Taipei, Excerpta Medica, 1990. p. 9-15.
7. DEINHARDT, F. - Prevention of viral hepatitis A: past, present and future. Vaccine, 10 (suppl. 1): S10-S14, 1992
8. EGRET - Reference manual. 1. draft, 2nd. rev. Seattle, Statistics and Epidemiology Research Corp. & Cytel Software Corp., 1985/1991.
9. GALEN, R.S. & GAMBINO, S.R. - Beyond normality: the predetive value and efficiency of medical diagnoses. New York, John Wiley & Sons, 1975. p. 1-237.
10. GREEN, M.S.; TSUR, S. & SLEPON, R. - Sociodemographic factors and the declining prevalence of anti-hepatitis A antibodies in young adults in Israel: implications for the new hepatitis A vaccines. Int. J. Epidem., 21: 136-140, 1992.
11. HADLER, S.C. - Global impact of hepatitis A virus infection changing patterns. In: HOLLINGER, F.B.; LEMON, S.M. & MARGOLIS, H.S., ed. Viral hepatitis and liver disease. Baltimore, Williams & Wilkins, 1991. p. 14-20.
12. HADLER, S.C. & MCFARLAND, L. - Hepatitis in day care centers: epidemiology and prevention. Rev. infect. Dis., 8: 548-557, 1986.
13. HADLER, S.C.; WEBSTER, H.M.; ERBEN, J.J.; SWANSON, J.E. & MAYNARD, J.E. - Hepatitis A in day-care centers a community-wide assessment. New Engl. J. Med., 302: 1222-1227, 1980.
14. HOLLINGER, F.B.; ANDRÉ, F.E. & MELNICK, J. - Proceedings of the International Symposium on Active Immunization against Hepatitis A, Vienna 27-29 Januray, 1992. Vaccine, 10 (suppl. 1): S1-S176, 1992.
15. HU, M.; SCHENZLE, D.; DEINHARDT, F. & SCHEID, R. - Epidemiology of hepatitis A and B in the Shanghai area: prevalence of serum markers. Amer. J. Epidem., 20: 404-413, 1984.
16. LEMON, S.M. - Type A viral hepatitis: new developments in an old disease. New Engl. J. Med., 313: 1059-1067, 1985.
17. MANTEL, N. - Chi-square tests with one degree of freedom: extensions of the Mantel-Hanszel procedures. J . Amer. stat. Ass., 58: 690-700, 1963.
18. MINUK, G.Y., WAGGONER, J.G.; JERNIGAN, R. et al. - Prevalence of antibody to hepatitis A virus in a Canadian inuit community. Canad. Med. Ass. J., 127: 850-852, 1982
19. OLIVEIRA, L.H.S.; YOSHIDA, C.F.T.; MONTEIRO, S.S. & CAMARA, F.P. - Seroepidemiologic survey for hepatitis A and B markers in health care students from a Public University of Rio de Janeiro, Brazil. Rev. Microbiol. (S. Paulo), 22: 226-231, 1991.
20. PANNUTI, C.S.; MENDONÇA, J.S.; CARVALHO, M.J.M.; OSELKA, G.W. & AMATO NETO, V. - Hepatitis A antibodies in two socioeconomically distinct populations of Săo Paulo, Brazil. Rev. Inst. Med. trop. S. Paulo, 27: 162-164, 1985.
21. PAPAEVANGELOU, G.; FROSNER, G.; ECONOMIDOU, J.; PARCHA, S. & ROUMELIOTOU, A. - Prevalence of hepatitis A and B infectious in polytransfused thalassemic patients. Brit. med. J., 1: 689-691, 1978.
22. PURCELL, R.H. - Hepatitis viruses: changing patterns of human disease. Proc. nat. Acad. Sci. (Wash.), 91: 2401-2406, 1994.
23. RECOMENDATIONS for protection against viral hepatitis. M.M.W.R., 34: 313-316, 1985.
24. REVES, R.R. & PICKERING, L.K. - Infections in child day care centers as they relate to internal medicine. Ann. Rev. Med., 41: 383-391, 1990.
25. RUIZ-GOMEZ, J. & BUSTAMANTE-CALVILLO, M.E. - Hepatitis A antibodies: prevalence and persistence in a group of Mexican children. Amer. J. Epidem., 121: 116-119, 1985.
26. SHAPIRO, C.N.; SHAW, F.E.; MANDEL, E.J. & HADLER, S.C. - Epidemiology of Hepatitis A in the United States. In: HOLLINGER, F.B.; LEMON, S.M. & MARGOLIS, H.S., ed. Viral hepatitis and liver disease. Baltimore, Williams & Wilkins, 1991. p.71-73.
27. SHAW, F.E.; HADLER, S.C.; MAYNARD. J.E.; et al. - Hepatitis A in Mauritius: an apparent transition from endemic to epidemic patterns. Ann. trop. Med. Parasit., 83: 179-185, 1989 apud HADLER, S.C. - Global impact of hepatitis A virus infection changing patterns. In: HOLLINGER, F.B.; LEMON, S.M. & MARGOLIS, H.S., ed. Viral hepatitis and liver disease. Baltimore, Williams & Wilkins, 1991. p. 14-20.
28. STROFFOLINI, T.; CHIARAMONTE, M.; FRANCO, E. et al. - Baseline seroepidemiology of hepatitis A virus infection among children and teenagers in Italy. Infection, 19: 97-100, 1991.
29. TANDON, B.N.; GANDHI, B.M. & JOSHI, Y.K. - Etiological spectrum of viral hepatitis and prevalence of markers of hepatitis A and B virus infection in north India. Bull. Wld. Hlth. Org., 62: 67-73, 1984.
30. VITRAL, C.L.; GASPAR, A.M.C. & YOSHIDA, C.F.T. - Two competitive enzyme immunoassays for the detection of IgG class antibodies to hepatitis A antigen. Rev. Soc bras. Med. trop., 24: 79-85, 1991.
31. VOLLER, A.; BARTLETT, A. & BIDWELL, D.E. - Enzyme immunoassays with special reference to Elisa techniques. J. clin. Path., 31: 507-520, 1978.
32. VRANCKX, R. & MUYLLE, L. - Hepatitis A virus antibodies in Belgium: relationship between prevalence and age. Infection, 18: 364-366, 1990.
33. YAP, I. & GUAN, R. - Hepatitis A seroepidemiology in Singapore: a changing pattern. Trans. roy. Soc. trop. Med. Hyg., 87: 22-23, 1983.
34. WU, J.S.; CHEN, C.H.; CHIANG, Y.H. et al. - Hepatitis A virus infection in Taiwan. J. form. med. Ass., 79: 694-699, 1980.
35. ZUCKERMAN, A.J. - Hepatitis 2000. In: HOLLINGER, F.B.; LEMON, S.M. & MARGOLIS, H.S., ed. Viral hepatitis and liver disease. Baltimore, Williams & Wilkins, 1991. p. 894-897.

Correspondence to:

Laboratório de Virologia do IPTESP/UFG

Rua Delenda Rezende de Melo c/1ª Avenida

74605-050 Goiânia, GO, Brasil

telefax: (062)261-6414

Publication Dates

Publication in this collection
21 Sept 2006
Date of issue
Oct 1995

History

Accepted
27 Sept 1995
Received
09 Dec 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ABUZWAIDA, A.R.N.; SIDONI, M.: YOSHIDA, C.F.T. & SCHATZMAYR, H.G. - Seroepidemiology of hepatitis A and B in two urban communities of Rio de Janeiro, Brazil. Rev. Inst. Med. trop. S. Paulo, 29: 219-223, 1987.

[2] 2. BENENSON, M.W.; TACAFUJI, E.T.; BRANCROFT, W.H. et al. - A military community outbreak of hepatitis type A related to transmission in a child care facility. Amer. J. Epidem., 112: 471-481, 1980.

[3] 3. BENSABATH, G.; HADLER, S.C.; SOARES, M.C.P.; FIELDS, H. & MAYNARD, J.E. - Caracteristicas serologicas y epidemiologicas de la hepatitis vírica aguda en la cuenca amazonica del Brasil. Bol. Ofic. sanit. panamer., 103: 351-362, 1987.

[4] 4. BILE, K.; ACETI, A.; HAGI, M.A. et al. - Primary hepatitis A virus infection in developing countries: decline of maternal antibodies and time of infection. Boll. Ist. sieroter. milan., 65: 464-466, 1986.

[5] 5. BRIEM, H.; WEILAND, O.; FRIDRIKSSON, I. & BERG, R. - Prevalence of antibody to hepatitis A in Iceland in relation to age, sex, and number of notified cases of hepatitis. Amer. J. Epidem., 116: 451-455, 1982.

[6] 6. CHEN, C.J.; YOU, S.L.; YOU, S.L.; LU, C.F. & HSU, S.T. - Seroepidemiology of hepatitis A, B and D viruses among children in Taiwan. In: SUNG, J.L. & CHEN, D.S., ed. Viral hepatitis and liver disease. Taipei, Excerpta Medica, 1990. p. 9-15.

[7] 7. DEINHARDT, F. - Prevention of viral hepatitis A: past, present and future. Vaccine, 10 (suppl. 1): S10-S14, 1992

[8] 8. EGRET - Reference manual. 1. draft, 2nd. rev. Seattle, Statistics and Epidemiology Research Corp. & Cytel Software Corp., 1985/1991.

[9] 9. GALEN, R.S. & GAMBINO, S.R. - Beyond normality: the predetive value and efficiency of medical diagnoses. New York, John Wiley & Sons, 1975. p. 1-237.

[10] 10. GREEN, M.S.; TSUR, S. & SLEPON, R. - Sociodemographic factors and the declining prevalence of anti-hepatitis A antibodies in young adults in Israel: implications for the new hepatitis A vaccines. Int. J. Epidem., 21: 136-140, 1992.

[11] 11. HADLER, S.C. - Global impact of hepatitis A virus infection changing patterns. In: HOLLINGER, F.B.; LEMON, S.M. & MARGOLIS, H.S., ed. Viral hepatitis and liver disease. Baltimore, Williams & Wilkins, 1991. p. 14-20.

[12] 12. HADLER, S.C. & MCFARLAND, L. - Hepatitis in day care centers: epidemiology and prevention. Rev. infect. Dis., 8: 548-557, 1986.

[13] 13. HADLER, S.C.; WEBSTER, H.M.; ERBEN, J.J.; SWANSON, J.E. & MAYNARD, J.E. - Hepatitis A in day-care centers a community-wide assessment. New Engl. J. Med., 302: 1222-1227, 1980.

[14] 14. HOLLINGER, F.B.; ANDRÉ, F.E. & MELNICK, J. - Proceedings of the International Symposium on Active Immunization against Hepatitis A, Vienna 27-29 Januray, 1992. Vaccine, 10 (suppl. 1): S1-S176, 1992.

[15] 15. HU, M.; SCHENZLE, D.; DEINHARDT, F. & SCHEID, R. - Epidemiology of hepatitis A and B in the Shanghai area: prevalence of serum markers. Amer. J. Epidem., 20: 404-413, 1984.

[16] 16. LEMON, S.M. - Type A viral hepatitis: new developments in an old disease. New Engl. J. Med., 313: 1059-1067, 1985.

[17] 17. MANTEL, N. - Chi-square tests with one degree of freedom: extensions of the Mantel-Hanszel procedures. J . Amer. stat. Ass., 58: 690-700, 1963.

[18] 18. MINUK, G.Y., WAGGONER, J.G.; JERNIGAN, R. et al. - Prevalence of antibody to hepatitis A virus in a Canadian inuit community. Canad. Med. Ass. J., 127: 850-852, 1982

[19] 19. OLIVEIRA, L.H.S.; YOSHIDA, C.F.T.; MONTEIRO, S.S. & CAMARA, F.P. - Seroepidemiologic survey for hepatitis A and B markers in health care students from a Public University of Rio de Janeiro, Brazil. Rev. Microbiol. (S. Paulo), 22: 226-231, 1991.

[20] 20. PANNUTI, C.S.; MENDONÇA, J.S.; CARVALHO, M.J.M.; OSELKA, G.W. & AMATO NETO, V. - Hepatitis A antibodies in two socioeconomically distinct populations of Săo Paulo, Brazil. Rev. Inst. Med. trop. S. Paulo, 27: 162-164, 1985.

[21] 21. PAPAEVANGELOU, G.; FROSNER, G.; ECONOMIDOU, J.; PARCHA, S. & ROUMELIOTOU, A. - Prevalence of hepatitis A and B infectious in polytransfused thalassemic patients. Brit. med. J., 1: 689-691, 1978.

[22] 22. PURCELL, R.H. - Hepatitis viruses: changing patterns of human disease. Proc. nat. Acad. Sci. (Wash.), 91: 2401-2406, 1994.

[23] 23. RECOMENDATIONS for protection against viral hepatitis. M.M.W.R., 34: 313-316, 1985.

[24] 24. REVES, R.R. & PICKERING, L.K. - Infections in child day care centers as they relate to internal medicine. Ann. Rev. Med., 41: 383-391, 1990.

[25] 25. RUIZ-GOMEZ, J. & BUSTAMANTE-CALVILLO, M.E. - Hepatitis A antibodies: prevalence and persistence in a group of Mexican children. Amer. J. Epidem., 121: 116-119, 1985.

[26] 26. SHAPIRO, C.N.; SHAW, F.E.; MANDEL, E.J. & HADLER, S.C. - Epidemiology of Hepatitis A in the United States. In: HOLLINGER, F.B.; LEMON, S.M. & MARGOLIS, H.S., ed. Viral hepatitis and liver disease. Baltimore, Williams & Wilkins, 1991. p.71-73.

[27] 27. SHAW, F.E.; HADLER, S.C.; MAYNARD. J.E.; et al. - Hepatitis A in Mauritius: an apparent transition from endemic to epidemic patterns. Ann. trop. Med. Parasit., 83: 179-185, 1989 apud HADLER, S.C. - Global impact of hepatitis A virus infection changing patterns. In: HOLLINGER, F.B.; LEMON, S.M. & MARGOLIS, H.S., ed. Viral hepatitis and liver disease. Baltimore, Williams & Wilkins, 1991. p. 14-20.

[28] 28. STROFFOLINI, T.; CHIARAMONTE, M.; FRANCO, E. et al. - Baseline seroepidemiology of hepatitis A virus infection among children and teenagers in Italy. Infection, 19: 97-100, 1991.

[29] 29. TANDON, B.N.; GANDHI, B.M. & JOSHI, Y.K. - Etiological spectrum of viral hepatitis and prevalence of markers of hepatitis A and B virus infection in north India. Bull. Wld. Hlth. Org., 62: 67-73, 1984.

[30] 30. VITRAL, C.L.; GASPAR, A.M.C. & YOSHIDA, C.F.T. - Two competitive enzyme immunoassays for the detection of IgG class antibodies to hepatitis A antigen. Rev. Soc bras. Med. trop., 24: 79-85, 1991.

[31] 31. VOLLER, A.; BARTLETT, A. & BIDWELL, D.E. - Enzyme immunoassays with special reference to Elisa techniques. J. clin. Path., 31: 507-520, 1978.

[32] 32. VRANCKX, R. & MUYLLE, L. - Hepatitis A virus antibodies in Belgium: relationship between prevalence and age. Infection, 18: 364-366, 1990.

[33] 33. YAP, I. & GUAN, R. - Hepatitis A seroepidemiology in Singapore: a changing pattern. Trans. roy. Soc. trop. Med. Hyg., 87: 22-23, 1983.

[34] 34. WU, J.S.; CHEN, C.H.; CHIANG, Y.H. et al. - Hepatitis A virus infection in Taiwan. J. form. med. Ass., 79: 694-699, 1980.

[35] 35. ZUCKERMAN, A.J. - Hepatitis 2000. In: HOLLINGER, F.B.; LEMON, S.M. & MARGOLIS, H.S., ed. Viral hepatitis and liver disease. Baltimore, Williams & Wilkins, 1991. p. 894-897.