Changes in the epidemiology of hepatitis A in three socio-economic regions of China, 1990–2017

Abstract

Background Hepatitis A (HepA) vaccination and economic transitions can change the epidemiology of HepA. China’s Gross Domestic Product (GDP) per capita was known to be inversely associated with the incidence of HepA, but a deeper understanding of the epidemiology of HepA in different socio-economic regions is lacking. We compare the changing epidemiology of HepA in three socioeconomic-geographic regions of China. Methods We obtained data on all HepA cases reported through the National Notifiable Disease Reporting System and assessed trends and changes in age-specific incidence rates by age quartile and season. We categorized the country into three regions, the sequential years into five era, compared the incidence, quartile age, seasonal intensity and coverage of HepA of the three regions. Linear regression was performed to analyse trends in incidence of HepA and to analyse the association between coverage and incidence. Results The annual mean incidences of HepA in the eastern, central, and western regions decreased from 63.52/100 000, 50.57/100 000 and 46.39/100 000 in 1990–1992 to 1.18/100 000, 1.05/100 000 and 3.14/100 000 in 2012–2017, respectively. Decreases in incidence were seen in all age groups in the three regions; the incidence was highest (9.3/100 000) in the youngest age group (0–4 years) of the western region, while in the central region, the age group with the highest incidence changed from 0 to 9 years to adults ≥60 years old. In 2017, the median age of HepA cases was 43 years (Q1–Q3: 33–55), 47 years (Q1–Q3: 32–60) and 33 years (Q1–Q3: 9–52) in the eastern, central, and western provinces, respectively. Seasonal peaks became smaller or were nearly elimination nationwide, but seasonality persisted in some provinces. After the Expanded Program on Immunization (EPI) included HepA vaccine into the routine schedule in 2007, HepA coverage increased to > 80% in the three regions and was negatively association with the HepA incidence. Conclusion The incidence of HepA decreased markedly between 1990 and 2017. A socioeconomic inequity in coverage of HepA vaccine was almost eliminated after HepA vaccine was introduced into China’s EPI system, but inequity in incidence still existed in lower socio-economic developed region.

The Global Trends and Regional Differences in Incidence of Hepatitis a from 1990 to 2019 and Implications for its Prevention

“…For example, a shell shassociated hepatitis A outbreak caused 300,000 cases in Shanghai, China, in two months of the rst quarter of 1988 33 . With the very rapid socioeconomic development, improved sanitary and hygienic conditions, and the introduction of hepatitis A vaccine in China, the incidence rate of hepatitis A dropped dramatically in the following couple of decades [34][35][36] . Despite the above effective ways combating hepatitis A being available for several decades, the incidence of hepatitis A still increased in high endemic countries and even some low endemic countries, such as Japan, Germany, Canada, and Italy.…”

Epidemiologic trends of hepatitis A in different age groups and regions of China from 1990 to 2018: observational population-based study

“…China has experienced great declines in the incidence and mortality of hepatitis A from 1990 to 2018. The control of hepatitis A in eastern, northern and northeastern regions of China is better than that in northwestern and southwestern regions, although the incidence and reported cases in the eastern and northern regions were highest during the early 1990s [20]. This may be related to differences in per capita GDP, the quality of drinking water and general sanitation practices in these regions [20].…”

“…The control of hepatitis A in eastern, northern and northeastern regions of China is better than that in northwestern and southwestern regions, although the incidence and reported cases in the eastern and northern regions were highest during the early 1990s [20]. This may be related to differences in per capita GDP, the quality of drinking water and general sanitation practices in these regions [20]. The greatest relative decreases in incidence were in Hunan, Shandong and Jiangsu, and the decline in incidence was slowest in Xinjiang, Qinghai and other provinces in northwestern China.…”

Implementing sequencing-based surveillance in developing countries: findings from a pilot rollout for hepatitis A in China

“…Public health infrastructure, geographic representation, and financial resources needed were considered in the selection and duration of the pilot project. These five provinces (Zhejiang, Shandong, Shaanxi, Hainan, and Hubei) represented all three social-economical tiers of China with different HepA morbidity and healthcare resource levels (10). The incidence of HAV infection varied and was highest in Hubei at 1.47/100,000, and lowest in Shandong at 0.53/100,000 in 2015 (11).…”