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

Abstract

Background & PurposeDespite decades of improved sanitation and hygiene measures and the introduction of hepatitis A vaccine, hepatitis A has been spread through numerous outbreaks globally. We used data from the Global Burden of Disease (GBD) study to quantify the burden of hepatitis A at the global, regional and national levels. MethodsDetailed information on annual incident cases and age-standardized incidence rate (ASR) of hepatitis A between 1990-2019 were derived from the GBD study 2019. Estimated annual percentage change (EAPC) of ASR was calculated to quantify the temporal trends in ASR of hepatitis A. ResultsGlobally, incident cases of hepatitis A increased 13.90% from 139.54 million in 1990 to 158.94 million in 2019. The ASR of hepatitis A remained stable (EAPC = 0.00, 95%CI: -0.01, 0.01) worldwide between 1990-2019. However, the ASR of hepatitis A increased in low (EAPC = 0.09, 95%CI: 0.04, 0.14) and low-middle (EAPC = 0.04, 95%CI: 0.03, 0.06) socio-demographic index (SDI) regions. For GBD regions, the most signi cant increases were detected in high-income Asia Paci c (EAPC = 0.53, 95%CI: 0.41, 0.66), Oceania (EAPC = 0.31, 95%CI: 0.25, 0.36), and Australasia (EAPC = 0.28, 95%CI: 0.13, 0.44). Of note, EAPC was positively associated with SDI value in the countries and territories with an SDI value ≥ 0.7 (ρ=-0.310, p < 0.001). ConclusionThere is an unfavorable trend that hepatitis A is still pending in hyperendemic regions and is emerging in low endemic regions. These highlight the need of targeted and speci c strategies to eliminate hepatitis A, such as sanitation measures and a comprehensive plan for surveillance and vaccination against hepatitis A.