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

Abstract

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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  • 1. Mellou K, Sideroglou T, Papaevangelou V, et al. Considerations on the current universal vaccination policy against hepatitis A in Greece after recent outbreaks. PLoS One 2015;10(1):e0116939.

  • 2. Gossner C. Changing hepatitis A epidemiology in the European Union: new challenges and opportunities. Eurosurveillance 2015;20(16):pii=21101.

  • 3. Dimitrova T. Viral hepatitis. In: Epidemiology of infectious diseases. Sofia: Arso; 2012. p. 84-90.

  • 4. Vaughan G, Goncalves Rossi LM, Forbi JC, et al. Hepatitis A virus: host interactions, molecular epidemiology and evolution. Infect Genet Evol 2014;21:227-43.

  • 5. Franco E, Meleleo C, Serino L, et al. Hepatitis A: Epidemiology and prevention in developing countries. World J Hepatol 2012;4(3):68-73.

  • 6. World Health Organization. Hepatitis A. WHO/CDS/ CSR/EDC/2000.7. http://www.who.int/csr/disease/hepatitis/HepatitisA_whocdscsredc2000_7.pdf

  • 7. Kojouharova M. Current outbreak of hepatitis A in Bulgaria. Eurosurveillance 2006;11(10-12):276.

  • 8. Nothdurft HD, Dahlgren A-L, Gallagher EA, et al. The risk of acquiring hepatitis A and B among travelers in selected Eastern and Southern Europe and non-European Mediterranean countries: review and consensus statement on hepatitis A and B vaccination. J Travel Med 2007;14(3):181-7.

  • 9. Todorova TT, Tsankova G, Lodozova N. Hepatitis B infection in eastern regions of Bulgaria. J IMAB - Annu Proceeding 2016;22(1):1033-5.

  • 10. Tiribelli C, Bellentani S, Campello C. Editorial: The north-to-south gradient of hepatitis C virus infection. Scand J Gastroenterol 2003;38(8):805-6.

  • 11. Stoycheva M, Vatev N, Petrov A, et al. Epidemiological study of hepatitis A in Plovdiv region, Bulgaria, 2005-2008. World J Vaccines 2011;01(04):162-8.

  • 12. Hajiov S, Mckee M. The health of the Roma people: a review of the published literature. J Epidemiol Community Heal 2000;54:864-9.

  • 13. Doycheva V, Dimitrova Т, Mitova Y, et al. Epidemiological analysis of epidemiological outbreak of viral hepatitis A in Sofi a region. Bulg Med J 2013;7(1):58-61.

  • 14. Freeman E, Torvaldsen S, Tobin S, et al. Trends and risk factors for hepatitis A in NSW, 2000-2009: the trouble with travel. N S W Public Health Bull 2012;23(7-8):153-7.

  • 15. Antony J, Celine T. A Hospital-based retrospective study on frequency and distribution of viral hepatitis. J Glob Infect Dis 2014;6(3):99-104.

  • 16. Wu J, Zou S, Giulivi A. Current hepatitis A status in Canada. Can J Infect Dis Pulsus Group; 2001;12(6):341-4.

  • 17. Al Faleh F, Al Shehri S, Al Ansari S, et al. Changing patterns of hepatitis A prevalence within the Saudi population over the last 18 years. World J Gastroenterol 2008;14(48):7371-5.

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