Shifting Seropositivity for Hepatitis A in Children in Istanbul, Turkey, From 1996 to 2011 and Evaluation of Hepatitis AAssociated Risk Factors

Hepatitis A virus (HAV) is transmitted by the fecal-oral route, and the epidemiology of HAV is associated with hygiene and socioeconomic status. In this study, we investigated the seropositivity for HAV and the associated socioeconomic factors in children. In addition, we compared the results with previously reported seropositivity data from the same center in Uskudar, Istanbul, Turkey, from 1996. A number of 400 children aged between 2-18 years, from the outpatient clinics, were tested for anti-HAV IgG antibodies and a questionnaire was administered that addressed gender, age, number of household members, monthly family income, history of jaundice and immunization, number of rooms in the house, education level of the parents, day-care/school attendance, and type of water supply. The overall seropositivity was 12.5%. The seropositivity increased with increasing age: 11.5% in children 2-<6 years old and 13.2% in children 10-18 years old. Significant associations between anti-HAV seropositivity and socioeconomic status, a history of jaundice, monthly family income were found (p<0.001, p<0.001, p=0.04, respectively). Also children under 6 years old, who were attending day-care had higher seropositivity rates. Only the association between the history of jaundice and anti-HAV seropositivity remained significant in the multivariate analysis, with an adjusted Odds ratio of 13.1 (95% CI, 2.9-59.5; p=0.001). There was a significant decline in the overall seropositivity for anti-HAV between 1996 and 2011. The frequency and severity of clinical HAV infection may increase in older age groups, and as a consequence, outbreaks can occur.