The prevalence of hepatitis A virus (HAV) antibodies was assessed in adolescents (age ranging from 10.4 to 19.9 years) at an Adolescent Outpatient Clinic in São Paulo, Brazil. Anti-HAV was detected in 137 (54.2%) out of 253 individuals. When separated into two age groups, anti-HAV frequency was higher in the 15 to 19 year-old group (64%) in comparison to the 10 to 14 year-old group (46%) (Chi-square test: p = 0.004). These results suggest that adolescents in São Paulo are at risk of hepatitis A infection and are probably contracting HAV infection during this age period.A prevalência de anticorpos contra o vírus da hepatite A foi avaliada em adolescentes de 10,4 a 19,9 anos atendidos no Ambulatório de Adolescentes da Universidade Federal de São Paulo. Entre 253 indivíduos analisados, a prevalência de anticorpos foi de 54,2%. Quando os adolescentes foram separados em duas faixas etárias, a prevalência foi maior no grupo de 15 a 19 anos (64%) em comparação com os de 10 a 14 anos (46%) (Qui-quadrado: p = 0,004). Estes resultados sugerem que muitos adolescentes de São Paulo estão sob risco de infecção pelo vírus da hepatite A e alguns deles estão provavelmente se infectando durante a adolescência

Dinelli, Maria Isabel Saraiva

Fisberg, Mauro

Moraes-Pinto, Maria Isabel de

Revista do Instituto de Medicina Tropical de São Paulo

English

The prevalence of hepatitis A virus (HAV) antibodies was assessed in adolescents (age ranging from 10.4 to 19.9 years) at an Adolescent Outpatient Clinic in São Paulo, Brazil. Anti-HAV was detected in 137 (54.2%) out of 253 individuals. When separated into two age groups, anti-HAV frequency was higher in the 15 to 19 year-old group (64%) in comparison to the 10 to 14 year-old group (46%) (Chi-square test: p = 0.004). These results suggest that adolescents in São Paulo are at risk of hepatitis A infection and are probably contracting HAV infection during this age period.A prevalência de anticorpos contra o vírus da hepatite A foi avaliada em adolescentes de 10,4 a 19,9 anos atendidos no Ambulatório de Adolescentes da Universidade Federal de São Paulo (UNIFESP). Entre 253 indivíduos analisados, a prevalência de anticorpos foi de 54,2%. Quando os adolescentes foram separados em duas faixas etárias, a prevalência foi maior no grupo de 15 a 19 anos (64%) em comparação com os de 10 a 14 anos (46%) (Qui-quadrado: p = 0,004). Estes resultados sugerem que muitos adolescentes de São Paulo estão sob risco de infecção pelo vírus da hepatite A e alguns deles estão provavelmente se infectando durante a adolescência.Federal University of São Paulo Department of Pediatrics Division of Pediatric Infectious DiseasesFederal University of São Paulo Department of Pediatrics Adolescent Outpatient ClinicUNIFESP, Department of Pediatrics Division of Pediatric Infectious DiseasesUNIFESP, Department of Pediatrics Adolescent Outpatient ClinicSciEL

Dinelli, Maria Isabel Saraiva [UNIFESP]

Fisberg, Mauro [UNIFESP]

De Moraes-Pinto, Maria Isabel [UNIFESP]

Repositório Institucional UNIFESP

Rev. Inst. Med. trop. S. Paulo48(1):43-44, January-February, 2006(1) Department of Pediatrics, Division of Pediatric Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil.(2) Department of Pediatrics, Adolescent Outpatient Clinic, Federal University of São Paulo, São Paulo, Brazil.Correspondence to: Maria Isabel de Moraes-Pinto, Rua Pedro de Toledo 781, 9º andar, 04039-032 São Paulo, SP, Brazil. Phone: 55 11 5574.6471. e-mail: m.isabelmp@uol.com.brANTI-HEPATITIS A VIRUS FREQUENCY IN ADOLESCENTS AT AN OUTPATIENTCLINIC IN SÃO PAULO, BRAZILMaria Isabel Saraiva DINELLI(1), Mauro FISBERG(2) & Maria Isabel de MORAES-PINTO(1)SUMMARYThe prevalence of hepatitis A virus (HAV) antibodies was assessed in adolescents (age ranging from 10.4 to 19.9 years) at anAdolescent Outpatient Clinic in São Paulo, Brazil. Anti-HAV was detected in 137 (54.2%) out of 253 individuals. When separatedinto two age groups, anti-HAV frequency was higher in the 15 to 19 year-old group (64%) in comparison to the 10 to 14 year-oldgroup (46%) (Chi-square test: p = 0.004). These results suggest that adolescents in São Paulo are at risk of hepatitis A infectionand are probably contracting HAV infection during this age period.KEYWORDS: Hepatitis A; Adolescents; Seroprevalence; Brazil.INTRODUCTIONThe epidemiological pattern of hepatitis A virus (HAV) infectionhas been changing in Latin America in the last few years. Somecountries shifted from high to intermediate rates of antibodyseroprevalence12,13. Intermediate endemicity was also observed in theNortheastern, Southern and Southeastern regions of Brazil4. In SãoPaulo State there was an important decrease in antibody prevalencerate in the last two decades7,9, probably related to an improvement insocioeconomic conditions.It is noteworthy that many Brazilian studies have shown an inverserelation between seroprevalence of HAV infection and socioeconomicand sanitary conditions1,4,6,9,10,11,14.Periodic and updated seroprevalence studies are important tools toevaluate the susceptibility of a population to HAV infection and projectPublic Health policies.MATERIAL AND METHODSFrom May to the beginning October 2001, 253 adolescents (ageranging from 10.4 to 19.9 years, 63% male and 37% female) wereassessed at the Adolescent Outpatient Clinic of the Federal Universityof São Paulo in São Paulo, Brazil. Around 240 adolescents attend theClinic every month, and individuals come mainly from middle/lowsocioeconomic class.Adolescents were invited to participate in this study and aquestionnaire and blood sample were collected on the same day. Mostnew patients were included in the study and one in each four individualsalready followed up at the Clinic was recruited. Information regardinghome water supply and public sewerage service was obtained.Qualitative determination of antibodies to hepatitis A virus (anti-HAV) was performed using a competitive ELISA commercial kit(DiaSorin, Italy). The study was submitted to the Ethics Committeeand written informed consent was obtained before enrolment.RESULTSThe prevalence of anti-HAV in adolescents was 54.2% (137/253).When separated into two age groups, those from the 10 to 14 year-oldgroup showed lower hepatitis A seroprevalence than those from the 15to 19 year-old group (46% versus 65%, respectively; Chi-square test,p = 0.004).Four individuals had previously received vaccine against hepatitisA and had anti-HAV antibodies. Eleven adolescents reported hepatitisA infection in the past and anti-HAV was detected in ten of them(90.9%).Anti-HAV seropositivity was found in 132/246 (53.7%) ofadolescents living in houses with public water supply, and in 5/7(71.4%) without it. (Fisher’s exact test, p = 0.46). Antibodies againstHAV were present in 109/210 (51.9%) individuals living in houseswith public sewerage service and in 28/43 (65.1%) of those without it(Chi-square test, p = 0.11).44DINELLI, M.I.S.; FISBERG, M. & MORAES-PINTO, M.I. - Anti hepatitis A virus frequency in adolescents at an outpatient clinic in São Paulo, Brazil. Rev. Inst. Med. trop. S. Paulo, 48(1):43-44, 2006.DISCUSSIONIn this study, 46.8% adolescents were susceptible to hepatitis Avirus infection. This is especially worrying because the disease isfrequently symptomatic in adolescents and adults, while hepatitis Ainfection in children is usually asymptomatic or has nonspecificmanifestations2,3.Lower anti-HAV seroprevalence rates were obtained in a previousstudy performed in São Paulo city including individuals from allsocioeconomic levels: 36% and 56% among 10 to 14 year-oldadolescents and 15 to 19 year-old ones, respectively7. This differencemay be due to the fact that the population in our study belonged to themiddle/low socioeconomic group.Anti-HAV seropositivity was higher in individuals living in houseswithout public water supply or sewerage service. However, thatdifference was not statistically significant probably because of thesample size.As already shown in previous studies, our data points to a decreasein HAV seroprevalence in Brazil4,7. However, the higher percentage ofHAV seropositive individuals from 15 to 19 years in comparison tothose from 10 to 14 years suggests that many individuals might beinfected by hepatitis A virus during adolescence.Besides improvement in education and sanitary conditions,immunization against hepatitis A could be a strategy to preventinfection. In regions of intermediate endemicity like the city of SãoPaulo, large-scale vaccination in childhood may be considered.Interestingly, a vaccination program with preadolescents in Catalonia,Spain, reduced the incidence of hepatitis A infection in all age groupsbelow 60 years of age5,8.RESUMOSoroprevalência de hepatite A em adolescentes de ambulatórioem São Paulo, BrasilA prevalência de anticorpos contra o vírus da hepatite A foi avaliadaem adolescentes de 10,4 a 19,9 anos atendidos no Ambulatório deAdolescentes da Universidade Federal de São Paulo. Entre 253indivíduos analisados, a prevalência de anticorpos foi de 54,2%. Quandoos adolescentes foram separados em duas faixas etárias, a prevalênciafoi maior no grupo de 15 a 19 anos (64%) em comparação com os de10 a 14 anos (46%) (Qui-quadrado: p = 0,004). Estes resultados sugeremque muitos adolescentes de São Paulo estão sob risco de infecção pelovírus da hepatite A e alguns deles estão provavelmente se infectandodurante a adolescência.ACKNOWLEDGEMENTWe thank “Fundo de Auxílio ao Docente e ao Aluno” (FADA) ofthe Federal University of São Paulo, for financial support.REFERENCES1. ALMEIDA, L.M.; WERNECK, G.L.; CAIRNCROSS, S. et al. - The epidemiology ofhepatitis A in Rio de Janeiro: environmental and domestic risk factors. Epidem.Infect., 127: 327-333, 2001.2. AMERICAN ACADEMY OF PEDIATRICS - Hepatitis A. In: PICKERING, L.K., ed.Red book. Report of the Committee on infectious diseases. 26 ed. Elk GroveVillage, American Academy of Pediatrics, 2003. p. 309-310.3. ARMSTRONG, G.L. & BELL, B.P. - Hepatitis A virus infection in the United States:model-based estimates and implications for childhood immunization. Pediatrics,109: 839-845, 2002.4. CLEMENS, S.A.C.; FONSECA, J.C.; AZEVEDO, T. et al. - Soroprevalência para hepatiteA e B em quatro centros no Brazil. Rev. Soc. bras. Med. trop., 33: 1-10, 2000.5. DOMINGUEZ, A.; SALLERAS, L.; CARMONA, G. & BATALLA, J. - Effectiveness ofa mass hepatitis A vaccination program in preadolescents. Vaccine, 21: 698-701,2003.6. FERREIRA, C.T.; SILVA, G.L.; BARROS, F.C. & PEREIRA-LIMA, J. -Soroepidemiologia da hepatite A em dois grupos populacionais economicamentedistintos de Porto Alegre. GED, 5: 85-90, 1996.7. FOCACCIA, R.; CONCEIÇÃO, O.J.G.; SETTE Jr., H. et al. - Estimated prevalence ofviral hepatitis in the general population of the municipality of São Paulo, measuredby a serologic survey of a stratified randomized and residence-based population.Braz. J. infect. Dis., 2: 269-284, 1998.8. LOPALCO, P.L.; SARELLAS, L.; BARBUTI, S. et al. - Hepatitis A and B in childrenand adolescents: what can we learn from Puglia (Italy) and Catalonia (Spain). Vaccine,19: 470-474, 2001.9. PANNUTI, C.S.; MENDONÇA, J.S.; CARVALHO, M.J.M.; OSELKA, G.W. & AMATONETO, V. - Hepatitis A antibodies in two socioeconomically distinct populations ofSão Paulo, Brazil. Rev. Inst. Med. trop. S. Paulo, 27: 162-164, 1985.10. PINHO, J.R.R.; SUMITA, L.M.; MOREIRA, R.C. et al. - Duality of patterns in hepatitisA epidemiology: a study involving two socioeconomically distinct populations inCampinas, São Paulo State, Brazil. Rev. Inst. Med. trop. S. Paulo, 40: 105-106,1998.11. SABACK, F.L.; PALMER, T.E.; SABINO, R.R. et al. - Infection with hepatitis A and TTviruses and socioeconomic status in Rio de Janeiro, Brazil. Scand. J. infect. Dis.,33: 121-125, 2001.12. TANAKA, J. - Hepatitis A shifting epidemiology in Latin America. Vaccine, 18: S57-S60, 2000.13. TAPIA-CONYER, R.; SANTOS, J.I.; CAVALCANTI, A.M. et al. - Hepatitis A in LatinAmerica: a changing epidemiologic pattern. Amer. J. trop. Med. Hyg., 61: 825-829, 1999.14. VITRAL, C.L.; YOSHIDA, C.F.T.; LEMOS, E.R.S.; TEIXEIRA, C.S. & GASPAR, A.M.C.- Age-specific prevalence of antibodies to hepatitis A in children and adolescentsfrom Rio de Janeiro, Brazil, 1978 and 1995. Relationship of prevalence toenvironmental factors. Mem. Inst. Oswaldo Cruz, 93: 1-5, 1998.Received: 17 March 2005Accepted: 29 September 2005

Soroprevalência de hepatite A em adolescentes de ambulatório em São Paulo, Brasil

A prevalência de anticorpos contra o vírus da hepatite A foi avaliada em adolescentes de 10,4 a 19,9 anos atendidos no Ambulatório de Adolescentes da Universidade Federal de São Paulo (UNIFESP). Entre 253 indivíduos analisados, a prevalência de anticorpos foi de 54,2%. Quando os adolescentes foram separados em duas faixas etárias, a prevalência foi maior no grupo de 15 a 19 anos (64%) em comparação com os de 10 a 14 anos (46%) (Qui-quadrado: p = 0,004). Estes resultados sugerem que muitos adolescentes de São Paulo estão sob risco de infecção pelo vírus da hepatite A e alguns deles estão provavelmente se infectando durante a adolescência.The prevalence of hepatitis A virus (HAV) antibodies was assessed in adolescents (age ranging from 10.4 to 19.9 years) at an Adolescent Outpatient Clinic in São Paulo, Brazil. Anti-HAV was detected in 137 (54.2%) out of 253 individuals. When separated into two age groups, anti-HAV frequency was higher in the 15 to 19 year-old group (64%) in comparison to the 10 to 14 year-old group (46%) (Chi-square test: p = 0.004). These results suggest that adolescents in São Paulo are at risk of hepatitis A infection and are probably contracting HAV infection during this age period.Federal University of São Paulo Department of Pediatrics Division of Pediatric Infectious DiseasesFederal University of São Paulo Department of Pediatrics Adolescent Outpatient ClinicUNIFESP, Department of Pediatrics Division of Pediatric Infectious DiseasesUNIFESP, Department of Pediatrics Adolescent Outpatient ClinicSciEL

LAReferencia - Red Federada de Repositorios Institucionales de Publicaciones Científicas Latinoamericanas

A prevalência de anticorpos contra o vírus da hepatite A foi avaliada em adolescentes de 10,4 a 19,9 anos atendidos no Ambulatório de Adolescentes da Universidade Federal de São Paulo. Entre 253 indivíduos analisados, a prevalência de anticorpos foi de 54,2%. Quando os adolescentes foram separados em duas faixas etárias, a prevalência foi maior no grupo de 15 a 19 anos (64%) em comparação com os de 10 a 14 anos (46%) (Qui-quadrado: p = 0,004). Estes resultados sugerem que muitos adolescentes de São Paulo estão sob risco de infecção pelo vírus da hepatite A e alguns deles estão provavelmente se infectando durante a adolescência.The prevalence of hepatitis A virus (HAV) antibodies was assessed in adolescents (age ranging from 10.4 to 19.9 years) at an Adolescent Outpatient Clinic in São Paulo, Brazil. Anti-HAV was detected in 137 (54.2%) out of 253 individuals. When separated into two age groups, anti-HAV frequency was higher in the 15 to 19 year-old group (64%) in comparison to the 10 to 14 year-old group (46%) (Chi-square test: p = 0.004). These results suggest that adolescents in São Paulo are at risk of hepatitis A infection and are probably contracting HAV infection during this age period

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Anti-hepatitis A virus frequency in adolescents at an outpatient clinic in São Paulo, Brazil

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Soroprevalência de hepatite A em adolescentes de ambulatório em São Paulo, Brasil

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