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Comprehensive Research Journal of Medicine and Medical Science (CRJMMS) Vol. 2 (1) pp. 008 - 013 January, 2014
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Full Length Research Paper
Investigation of Hepatitis A Seropositivity in
Children with Different Age Groups in Iğdır, Turkey
Gülhan Arvas1, Aydoğan Bora1,Tamer Özsarı2, Bülent Kaya2, Güneş Açıkgöz3
1
Yüzüncü Yil University, Faculty of Pharmacy, Pharmaceutical Microbiology, Van, Turkey,
2
Iğdır State Hospital, Pediatric Department, Iğdır, Turkey,
3
Mustafa Kemal University, Vocational School of Health Services, Hatay, Turkey.
Accepted 31 January, 2014
Aim: Hepatitis A virus (HAV) is the most common cause of hepatitis in childhood and one of the
serious morbidity and mortality reason. In this study HAV values were investigated.
Material and methods: In between December 2011 and January 2011 hepatitis values of 832
patients whose ages are between 1 and 15 years old were analyzed. This patients results were
examined with Enzyme Linked Immunosorbend Assay (ELISA) (Vitros ECI QJ8J Company Ortho
Clinical Diagnostic makro ELISA). SPSS package programe was used. The results were
evaluated as statistical by chi-square test according to age groups and genders.
Results: Serum samples were analyzed according to age groups and gender. Acording to
gender, Immunoglobulin M antibodies to HAV (IgM anti-HAV) was found 8,4%, Immunoglobulin
G antibodies to HAV (anti-HAV IgG) was found 1,9%, total anti- HAV was found 16,1%, anti-HAV
IgG + anti-HAV IgM was found 0,7%, respectively. According to age groups rates were found
that 32,4% from 1 to 5 ages, 58,1% from 6 to10 ages, 9,5% from 11 to 15 ages. Seroprevalence of
HAV increased with ages.
Conclusion: Hepatitis A is important a health problem in Iğdır province. The low level of socioeconomic development of the province and the lack of clean drinking water, inadequate
infrastructure cause diseases such as hepatitis A which is transmitted through the digestive.
Keywords: Hepatitis A virus; Anti-HAV IgM; Anti-HAV IgG; Total Anti-HAV
INTRODUCTION
Hepatitis is a general term meaning inflammation of
the liver and can be caused by a variety of different
viruses (WHO). Globally, there are an estimated 1.4
million cases of hepatitis A every year (WHO,
Jacobsen and Koopman, 2004; WHO, 2008).
*Corresponding
Author
E-mail: [email protected]
HAV is the most common cause of hepatitis in
childhood. Spread of infection is generally person to
person (Cuthbert, 2001; Franco et al. 2012; Center
for Disease Control and Prevention, 2006; Nainan et
al., 2006) or by oral intake after fecal contamination
of skin or mucous membranes; less commonly, there
is fecal contamination of food or water (Cuthbert,
2001). Unfortunately, because of the long incubation
period of HAV infection, virus detection in food is
Gülhan et al. 009
Table I. Anti-HAV positive values according to gender
Gender
Anti-HAV IgM
Anti-HAV IgG
Anti-HAV Total
Anti-HAV
n(%)
n(%)
n(%)
IgG+IgM
Total
n(%)
Male
37 (8.1)
10 (2.2)
74 (14.0)
5 (1.1)
126
Female
33 (8.8)
6 (1.6)
60 (18.7)
1 (0.3)
100
Total
70 (8.4)
16 (1.9)
134 (16.1)
6 (0.7)
226
p=0.716
p=0.539
p=0.690
p=0.160
Table II. Anti-HAV positive values according to ages
Anti-HAV IgM
Anti-HAV IgG
Anti-HAV Total
Anti-HAV
Total
n(%)
n(%)
n(%)
IgG+IgM
(%)
n(%)
1 to 5 ages
22(32.4)
3(18.8)
34(24.8)
2(33.3)
61(27)
6 to10 ages
41(58.1)
6(37.5)
68(51.1)
3(50)
118(52.21)
11 to 15 ages
7(9.5)
7(43.8)
32(24.1)
1(16.7)
47(20.79)
Total
70
16
134
6
226
p=26.543
p=0.804
p=0.314
p=0.230
difficult, unless some of the food was kept or
contamination is ongoing (Nainan et al. 2006).
HAV is a small, non-enveloped RNA virus
(Cuthbert, 2001; Franco et al. 2012). It is
thermostable and acid-resistant (Franco et al. 2012).
Usually, hepatitis A affects children without producing
symptoms, but in adults it causes clinically apparent
disease, often with jaundice (Koff, 1998).
HAV infection rates are very low in industrialized
countries (Raffaele et al., 2005). This virus is more
common in low soci-oeconomic societies, crowded
regions and those using untreated water (Taghavi et
al. 2011).
The changing epidemiology of hepatitis A virus
(HAV) in many world regions heightens the need for
up-to-date risk maps. Most children in low-income
areas become infected in early childhood when HAV
infections are typically asymptomatic, and infection
confers lifelong immunity. (Hanafiah et al. 2011).
Incidence of hepatitis A is highest among children 514 years of age (Center for Disease Control and
Prevention; Averhoff et al. 2001). Many more children
have unrecognized, asymptomatic infection and can
be the source of infection for others (Center for
Disease Control and Prevention, 2006).
HAV infections are often acute and relief from
symptoms occurs in a short time but sometimes
prolonged or relapsing hepatitis is induced (Ghorbani,
2011). Until recently, immunoglobulin and improved
hygiene were the only measures available to prevent
and control hepatitis A (Averhoff et al. 2001).
In this study ıt was aimed that to detect hepatitis A
seropositivity in children between 0-15 years who
applied to Igdır State Hospital.
MATERIAL AND METHOD
This retrospective hospital based exploratory study
was conducted in the department of pediatrics, from
January 2011 through December 2011 in Iğdır
province. Hepatitis values of 832 children aged
between 1 and 15 years with were analyzed with
ELISA (Vitros ECI QJ8J Company Ortho Clinical
Diagnostic makro ELISA ). The third generation of
kits were used in accordance with the manufacturer's
procedure. In total, 226 patients were found to HAV.
SPSS 17.0 package programe was used. The
results were evaluated as statistical by chi-square
test according to age groups and genders.
RESULTS
According to the results of 832 patients, 226 patients
results were found positive. Anti-HAV IgM
seropositivity was detected in 70 patients (8.4%),
anti-HAV IgG seropositivity was detected in 16
010 Compr. Res. J. Med. Med. Sci.
Case Processing Summary(ANTI-HAV IgM)
Cases
Valid
N
hastasayısı * sonuç
Missing
Percent
832
N
94,4%
Total
Percent
49
5,6%
N
Percent
881
100,0%
Hastasayısı * sonuç Crosstabulation
sonuç
hastasayısı
1-5
5-10
10-15
Total
pozitif
2
Total
Count
22
254
276
% within hastasayısı
8,0%
92,0%
100,0%
% within sonuç
31,4%
33,3%
33,2%
% of Total
2,6%
30,5%
33,2%
Count
41
239
280
% within hastasayısı
14,6%
85,4%
100,0%
% within sonuç
58,6%
31,4%
33,7%
% of Total
4,9%
28,7%
33,7%
Count
7
269
276
% within hastasayısı
2,5%
97,5%
100,0%
% within sonuç
10,0%
35,3%
33,2%
% of Total
,8%
32,3%
33,2%
Count
70
762
832
% within hastasayısı
8,4%
91,6%
100,0%
% within sonuç
100,0%
100,0%
100,0%
% of Total
8,4%
91,6%
100,0%
df
Asymp. Sig. (2sided)
2
2
1
,000
,000
,022
Chi-Square Tests
Value
Pearson Chi-Square
Likelihood Ratio
Linear-by-Linear Association
N of Valid Cases
26,543
28,512
5,283
a
832
a. 0 cells (,0%) have expected count less than 5. The minimum expected count is 23,22.
patients (1.9%), total anti-HAV seropositivity was
detected in 134 patients (16.1%), both anti-HAV IgM
and anti-HAV IgG seropositivity was detected in 6
patients (0.7%), respectively. These results in the
distribution of male and female children are shown in
Table I.
Seventy (70) patients were evaluated according to
age groups, 22 children aged 1-5 years (32.4%), 41
children aged 6-10 years (58.1%), and 7 children
aged 11-15 (9.5% ) were detected anti-HAV IgM
seropositivity, respectively.
Sixteen (16) patients were evaluated according to
age groups, 3 children aged 1-5 years (18.8%), 6
children aged 5-10 years (37.5%), 7 children aged
10-15 years (43.8%) were detected anti-HAV IgG
seropositivity, respectively.
One hundred and thirty four (134) patients were
evaluated according to age groups, 61(27%) children
aged 1-5 years, 118 (52.21%) children aged 6-10
years and 47(20.79%) children aged 11-15 were
total anti-HAV seropositivity, respectively.
Six (6) patients were evaluated according to age
groups, 2 children aged 1-5 years (33.3%), 3 children
aged 6-10 years (50%), and 1 children aged 11-15
(24.1%) were detected both anti-HAV IgM and antiHAV IgG seropositivity, respectively. Table II shows
the distribution of seropositivity according to age
groups.
Gülhan et al. 011
Directional Measure
Nominal by Nominal Lambda
Value
Asymp.
a
Error
Symmetric
,048
,035
1,332
,183
hastasayısı Dependent
,054
,040
1,332
,183
sonuç Dependent
Somers' d
Nominal by Interval Eta
c
Approx. Sig.
c
,016
,005
,000
sonuç Dependent
,032
,011
,000
Symmetric
,059
,020
2,818
,005
hastasayısı Dependent
,156
,053
2,818
,005
sonuç Dependent
,036
,013
2,818
,005
hastasayısı Dependent
,080
sonuç Dependent
,179
c. Cannot be computed because the asymptotic standard error equals zero.
.
b
,000
a. Not assuming the null hypothesis.
b. Using the asymptotic standard error assuming the null hypothesis.
d. Based on chi-square approximation
Approx. T
,000
Goodman and Kruskal tau hastasayısı Dependent
Ordinal by Ordinal
Std.
.
d
d
012 Compr. Res. J. Med. Med. Sci.
Symmetric Measures
Symmetric Measures
Value
Nominal by Nominal
Asymp.
a
Error
Std.
Approx. T
b
Approx. Sig.
Phi
,179
,000
Cramer's V
,179
,000
Contingency Coefficient ,176
Ordinal by Ordinal
Gamma
,231
c
Measure of Agreement Kappa
.
N of Valid Cases
832
,000
,005
,078
2,818
a. Not assuming the null hypothesis.
a. Not assuming the null hypothesis.
b. Using the asymptotic standard error assuming the null hypothesis.
c. Kappa statistics cannot be computed. They require a symmetric 2-way table in which the values of the first variable match the
values of the second variable.
DISCUSSION AND CONCLUSION
Hepatitis A is the most common type of viral hepatitis
infections (Cuthbert, 2001; Franco et al. 2012). It can
cause debilitating symptoms and fulminant hepatitis
(acute liver failure), which is associated with high
mortality (Koff, 1998).
A positive IgM anti-HAV indicates that infection has
taken place within the past 3 to 6 months (Center for
Disease Control and Prevention, 2006; Nainan et al.
2006; Minuk et al. 2005). Shortly after the
appearance of the IgM anti-HAV, IgG anti-HAV
appears in the circulation. IgG antibodies to HAV
(IgG anti-HAV) appear soon after IgM, persist for
years after infection (Nainan et al. 2006; Minuk et al.
2005).
Anti-HAV seroprevalence may vary significantly
between countries and regions with age. In countries,
socioeconomic status, urbanization level, ethnic
origin, regional hygienic standards, access to clean
water and sanitation facilities may vary (Center for
Disease Control and Prevention, 2006; Nainan et al.
2006; Jacobsen and Koopman, 2004). The
prevalence of anti-HAV increases gradually with age
(Franco et al. 2012). In this study the most patient
numbers were found in the range from 6 to 10 years.
The present cross-sectional study reports the
burden of viral hepatitis in a population of one
geographically defined area of Igdır, Turkey and
potential associations with basic socio-demographic
characteristics such as gender and age. There are a
lot of study similarity with our study in our country.
Tekay, didn’t determine any anti-HAV IgM
seropositivity of children aged 0-14 years, but he
detected that anti-HAV IgG+IgM seropositivity was
5.04%, anti-HAV IgG seropositivity was 62.98%, total
anti-HAV seropositivity was 68.2% in his study in
Hakkari, Turkey (Tekay, 2006). In our study anti-HAV
IgM was determined 8.4%, anti-HAV IgG + IgM was
determined 0.7%, anti-HAV IgG was determined
1.9% and anti-HAV total was determined 16.1%.
Arvas et al. studied with 990 children in Igdır in their
another study and they determined that anti-HAV IgM
seropositivity was 18.1% in 2010 (Arvas et al. 2011).
In this study, anti-HAV IgM was found 8.4%.
Ceylan et al. found that children aged 0-15 years
anti-HAV seropositivity was 35.5% in Istanbul, Turkey
(Ceylan et al. 1997). Şahin et al. found that children
aged 1–16 years anti-HAV seropositivity was 79.33%
in Gaziantep, Turkey (Şahin and Aydın, 2005).
In this study, male and female childrens’ results
were close to each other. Based on these data, our
findings suggest that the incidence of acute hepatitis
was lower than other studies in the region. However,
If we compare with other studies done in our country,
total anti-HAV and anti-HAV IgG seropositivity is
found low.
Anti-HAV seroprevalence rates in the Middle East
are high. More than half of Turkish children have IgG
antibodies in their late teenage years (Jacobsen and
Koopman, 2004). Three epidemiological patterns of
HAV endemicity are commonly observed worldwide:
low, intermediate and high (WHO). Turkey is a
developing country and is considered an intermediate
endemic region for HAV (Dinç et al. 2012).
Hepatitis A is important a health problem in Iğdır
province. The low level of socio-economic
development and the lack of clean drinking water,
inadequate infrastructure cause diseases such as
hepatitis A. The endemicity of HAV infection varies
according to regional hygienic standards (Nainan et
al. 2006).
Most studies around the world, report that the HAV
epidemiologic pattern is declining in seropositivity
especially in the lower age (Center for Disease
Control and Prevention, 2006; 20) groups. The
Gülhan et al. 013
statement about the change of epidemiologic pattern
of HAV (Hanafiah et al. 2011; Center for Disease
Control and Prevention, 2006; Nainan et al. 2006;
Minuk et al. 2005) is feasible by comparing the
seroepidemiology of HAV at two different time points
in the same region (Ardakani et al. 2013).
The spread of hepatitis A can be reduced, such as
adequate supplies of safe drinking water, proper
disposal of sewage within communities, personal
hygiene practices such as regular hand-washing with
safe water (WHO- Center for Disease Control and
Prevention, 2006; Averhoff et al., 2001 - WHO.,
2008). In addition to low-income (Hanafiah et
al.,2011) households may have limited access to
clean water sources, which increases risk of HAV
(Jacobsen and Koopman 2004). Improvements in the
hygiene of food and water have caused the
displacement of HAV infections from children to adult
populations which has increased the mortality rate
(Hanafiah et al. 2011; Nainan et al. 2006).
The national vaccination program for hepatitis A
was entered to national vaccination program for
September 2011 in children at Turkey. But all
children between their first and second birthdays (12
through 23 months of age) should be routinely
vaccinated with hepatitis A vaccine, and the other
children were not made vaccination for 2011.
Children and adolescents 2 through 18 years of age
who live in states or communities where routine
vaccination has been implemented because of high
disease incidence.
It is important issue for Igdır, Turkey. It is
suggested that necessary precautions should be
taken in order to prevent sewage water intermingling
with drinking water during the time of vaccination for
pre-school children and seasons of frequent rainfall.
In addition to the necessary training should be given
to Igdır people about this infection.
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