Epidemiological Study of Hepatitis A Infection in Eastern Bulgaria

Gabriela St. Tsankova 1 , Tatina T. Todorova 1 , Neli M. Ermenlieva 2 , Tsvetelina K. Popova 2  and Dayana T. Tsankova 3
  • 1 Department of Preclinical and Clinical Sciences, Faculty of Pharmacy, Medical University of Varna, 3 Bregalnica St., 9000 Varna, Bulgaria
  • 2 Medical College, Medical University of Varna, Varna, Bulgaria
  • 3 Faculty of Dental Medicine, Medical University of Varna, Varna, Bulgaria


Background: Hepatitis A virus (HAV) infection is an acute, self-limited liver disease transmitted usually through the faecal-oral route via person-to-person contact. Bulgaria has intermediate HAV endemicity with higher susceptibility among adults and recurrent outbreaks.

Aim: As HAV infection is strongly related to human movements and represents a significant risk to travelers and migrants, as well as to local population receiving these groups, we set out to analyze the epidemiological data on hepatitis A in five of the largest tourist border regions of Bulgaria located in its eastern part: Varna, Shumen, Dobrich, Burgas and Yambol.

Materials and methods: We reviewed retrospectively all reported cases of acute hepatitis A in the eastern regions of Bulgaria over a 7-year period between 2008 and 2014.

Results: A total of 2879 newly infected patients were registered during the study period, the number varying widely: from 190 cases in 2014 to 923 in 2012. The average incidence of HAV was higher in the south-eastern regions than in the northeastern regions (55.30%000 vs 15.04%000 respectively, p < 0.0001). The most affected age group in all regions was the 5-9-year olds (p < 0.0001) and males were significantly more susceptible to HAV (p = 0.02).

Conclusion: Hepatitis A is still a major public health problem in Bulgaria; there is a significant difference in the incidence of the disease between the regions in the south-east and those in the north-east and between the different age groups and sexes.

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