Recent trends in hepatitis A incidence in Brazil

Abstract

Hepatitis A incidence has been decreasing in Brazil since child vaccination was implemented in 2014. This trend was interrupted by an outbreak among adult male in São Paulo in 2017. This study was outlined to estimate whether the increase of hepatitis A cases among adult men in Brazil was restricted to São Paulo. Cases reported to the national surveillance system from 14 large cities of all Brazilian regions were analyzed. Trends in time series from 2012 to 2018 were estimated by Prais‐Winsten regression. The outbreak in São Paulo extended to 2018. In Rio de Janeiro, the number of cases rose again, achieving the same levels reported before the vaccination era. Three of six cities from South and Southeast regions showed an upward trend in the number of cases among adult men (P < .005). The large cities in the other three Brazilian macroregions showed a decrease or stabilization of cases without an increase among male adults. The increase of hepatitis A virus (HAV) cases in Brazil has happened not only in São Paulo, but also in other cities of South and Southeast regions. The northernmost cities were not affected. A change in the epidemiological pattern of HAV infection is emerging in Southern Brazil.

HAV infection in Brazilian men who have sex with men: The importance of surveillance to avoid outbreaks

“…Although sexual transmission presents an important role in HAV spread in MSM and TW groups, unsafe sexual behaviors were not associated with HAV infection. The HAV sequence found in the study was similar to Argentine strains and not related to MSM European outbreak strains, as occurred in Chile and Southeast Brazil [ 4 , 14 , 20 ]. The declining trend in HAV incidence and the transition of the infection age may cause a major impact on the burden of the disease.…”

“…Areas more developed in socio-economic terms, as developed countries and South and Southeast regions of Brazil, present lower HAV prevalence [ 1 , 3 ]. However, due to the men’s HAV outbreak between 2017–2019 in Brazilian southeastern states, some of these regions that had low HAV prevalence as a reflection of 2014 vaccination, have presented an upward trend, showing levels of infection similar to the pre-vaccine period [ 14 ].…”

The Impact of an Inactivated Hepatitis A Vaccine with One Dose in Brazil: A Retrospective Time-Series

“…Since February 2016, hepatitis A outbreaks in MSM populations have been reported in many parts of the world including the major cities of Latin America [3,[18][19][20]. Molecular epidemiology shows similar HAV strains circulating among HAV-infected MSM, suggesting a distinct route of transmission through sexual contact [11].…”

Prevalence of hepatitis A in the capitals of the States of North, Southeast and South regions of Brazil: decrease in prevalence and some consequences

“…The large cities in the other three Brazilian regions showed a decrease or stabilization of cases without an increase among male adults. A change in the epidemiological pattern of HAV infection is emerging in the Southern and the South of Brazil 27 , 28 .…”