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Modeling the hepatitis A epidemiological transition in Brazil and Mexico.
Hum Vaccin Immunother. 2017 08 03; 13(8):1942-1951.HV

Abstract

BACKGROUND

Many low- to middle-income countries have completed or are in the process of transitioning from high or intermediate to low endemicity for hepatitis A virus (HAV). Because the risk of severe hepatitis A disease increases with age at infection, decreased incidence that leaves older children and adults susceptible to HAV infection may actually increase the population-level burden of disease from HAV. Mathematical models can be helpful for projecting future epidemiological profiles for HAV.

METHODS

An age-specific deterministic, dynamic compartmental transmission model with stratification by setting (rural versus urban) was calibrated with country-specific data on demography, urbanization, and seroprevalence of anti-HAV antibodies. HAV transmission was modeled as a function of setting-specific access to safe water. The model was then used to project various HAV-related epidemiological outcomes in Brazil and in Mexico from 1950 to 2050.

RESULTS

The projected epidemiological outcomes were qualitatively similar in the 2 countries. The age at the midpoint of population immunity (AMPI) increased considerably and the mean age of symptomatic HAV cases shifted from childhood to early adulthood. The projected overall incidence rate of HAV infections decreased by about two thirds as safe water access improved. However, the incidence rate of symptomatic HAV infections remained roughly the same over the projection period. The incidence rates of HAV infections (all and symptomatic alone) were projected to become similar in rural and urban settings in the next decades.

CONCLUSION

This model featuring population age structure, urbanization and access to safe water as key contributors to the epidemiological transition for HAV was previously validated with data from Thailand and fits equally well with data from Latin American countries. Assuming no introduction of a vaccination program over the projection period, both Brazil and Mexico were projected to experience a continued decrease in HAV incidence rates without any substantial decrease in the incidence rates of symptomatic HAV infections.

Authors+Show Affiliations

a GSK Vaccines , Wavre , Belgium.a GSK Vaccines , Wavre , Belgium.a GSK Vaccines , Wavre , Belgium.b Centro de Investigaciones en Salud Poblacional , Instituto Nacional de Salud Pùblica , Morelos , México.c Department of Global and Community Health , George Mason University , Fairfax , VA , USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28481680

Citation

Van Effelterre, Thierry, et al. "Modeling the Hepatitis a Epidemiological Transition in Brazil and Mexico." Human Vaccines & Immunotherapeutics, vol. 13, no. 8, 2017, pp. 1942-1951.
Van Effelterre T, Guignard A, Marano C, et al. Modeling the hepatitis A epidemiological transition in Brazil and Mexico. Hum Vaccin Immunother. 2017;13(8):1942-1951.
Van Effelterre, T., Guignard, A., Marano, C., Rojas, R., & Jacobsen, K. H. (2017). Modeling the hepatitis A epidemiological transition in Brazil and Mexico. Human Vaccines & Immunotherapeutics, 13(8), 1942-1951. https://doi.org/10.1080/21645515.2017.1323158
Van Effelterre T, et al. Modeling the Hepatitis a Epidemiological Transition in Brazil and Mexico. Hum Vaccin Immunother. 2017 08 3;13(8):1942-1951. PubMed PMID: 28481680.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modeling the hepatitis A epidemiological transition in Brazil and Mexico. AU - Van Effelterre,Thierry, AU - Guignard,Adrienne, AU - Marano,Cinzia, AU - Rojas,Rosalba, AU - Jacobsen,Kathryn H, Y1 - 2017/05/08/ PY - 2017/5/10/pubmed PY - 2018/4/10/medline PY - 2017/5/9/entrez KW - Latin America KW - clean water KW - hepatitis A KW - mathematical model KW - seroprevalence KW - urbanization SP - 1942 EP - 1951 JF - Human vaccines & immunotherapeutics JO - Hum Vaccin Immunother VL - 13 IS - 8 N2 - BACKGROUND: Many low- to middle-income countries have completed or are in the process of transitioning from high or intermediate to low endemicity for hepatitis A virus (HAV). Because the risk of severe hepatitis A disease increases with age at infection, decreased incidence that leaves older children and adults susceptible to HAV infection may actually increase the population-level burden of disease from HAV. Mathematical models can be helpful for projecting future epidemiological profiles for HAV. METHODS: An age-specific deterministic, dynamic compartmental transmission model with stratification by setting (rural versus urban) was calibrated with country-specific data on demography, urbanization, and seroprevalence of anti-HAV antibodies. HAV transmission was modeled as a function of setting-specific access to safe water. The model was then used to project various HAV-related epidemiological outcomes in Brazil and in Mexico from 1950 to 2050. RESULTS: The projected epidemiological outcomes were qualitatively similar in the 2 countries. The age at the midpoint of population immunity (AMPI) increased considerably and the mean age of symptomatic HAV cases shifted from childhood to early adulthood. The projected overall incidence rate of HAV infections decreased by about two thirds as safe water access improved. However, the incidence rate of symptomatic HAV infections remained roughly the same over the projection period. The incidence rates of HAV infections (all and symptomatic alone) were projected to become similar in rural and urban settings in the next decades. CONCLUSION: This model featuring population age structure, urbanization and access to safe water as key contributors to the epidemiological transition for HAV was previously validated with data from Thailand and fits equally well with data from Latin American countries. Assuming no introduction of a vaccination program over the projection period, both Brazil and Mexico were projected to experience a continued decrease in HAV incidence rates without any substantial decrease in the incidence rates of symptomatic HAV infections. SN - 2164-554X UR - https://www.unboundmedicine.com/medline/citation/28481680/Modeling_the_hepatitis_A_epidemiological_transition_in_Brazil_and_Mexico_ L2 - http://www.tandfonline.com/doi/full/10.1080/21645515.2017.1323158 DB - PRIME DP - Unbound Medicine ER -