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  1. Fulltext Seroprevalence and incidence of hepatitis A in Southeast Asia: A systematic review
    Hernandez-Suarez G, Saha D, Lodroño K, Boonmahittisut P, Taniwijaya S, Saha A, et al.
    PLoS One, 2021;16(12):e0258659.
    PMID: 34851983 DOI: 10.1371/journal.pone.0258659
    BACKGROUND: A previous review on hepatitis A virus (HAV) seroprevalence in 2005 categorized Southeast Asia as a low HAV endemicity region. In 2010, the World Health Organization modified this from low to low/medium endemicity, pointing out that these estimates were based on limited evidence. Since then, there has been no attempt to review HAV epidemiology from this region. We conducted a systematic review of literature to collect information on HAV incidence and seroprevalence in select countries in the Southeast Asian region, specifically, The Association of Southeast Asian Nations over the last 20 years.

    METHODOLOGY: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. From the relevant articles, we extracted data and conducted a risk of bias assessment of individual studies.

    RESULTS: The search yielded 22 and 13 publications on HAV seroprevalence and incidence, respectively. Overall, our findings point to a very low HAV endemicity profile in Thailand and Singapore and evidence of a shift towards low HAV endemicity in Indonesia, Lao People's Democratic Republic, Malaysia, the Philippines, and Vietnam. Only Singapore, Thailand, Malaysia, and the Philippines have existing HAV disease surveillance and reported incidence rates below 1 per 100,000. Several outbreaks with varying magnitude documented in the region provide insights into the evolving epidemiology of HAV in the region. Risk of bias assessment of studies revealed that the individual studies were of low to medium risk.

    CONCLUSIONS/SIGNIFICANCE: The available HAV endemicity profiles in Southeast Asian countries, aside from Thailand, are limited and outdated, but suggest an endemicity shift in the region that is not fully documented yet. These findings highlight the need to update information on HAV epidemiology through strengthening of disease surveillance mechanisms to confirm the shift in HAV endemicity in the region.

    Matched MeSH terms: Hepatitis A/epidemiology*
  2. Fulltext Hepatitis A outbreak in Hulu Langat District, Selangor State, Malaysia during April--October 2002
    Venugopalan B, Nik Rubiah NAR, Meftahuddin T, Ayu M, Prema R, Ruhaini I, et al.
    Med J Malaysia, 2004 Dec;59(5):670-3.
    PMID: 15889571
    A Hepatitis A outbreak occurred in Mukim Hulu Langat, Hulu Langat district from April 2002 to October 2002. Of the 51 cases notified, most were among students and the ethnic groups involved were Malays and the Orang Asli (local indigenous community). Epidemiological investigations revealed that the cases were localized along rivers used for recreational activities in this area. River water analysis indicated human faecal contamination and it was believed that the contamination was due to the Orang Asli community living upstream. This occurred due to lack of toilet facilities, water at point of use and the existing traditional practices of the Orang Asli community. Control measures instituted were intense health education to the Orang Asli to avoid using the rivers for defecation, multi agency efforts to provide sanitary toilets and adequate water to the villages affected. Future measures include conducting a sero- prevalence survey to determine the feasibility of Hepatitis A immunization to the susceptible population in this area. The outbreak that began in April 2002 was controlled by October 2002.
    Matched MeSH terms: Hepatitis A/epidemiology*
  3. Hepatitis A shifting epidemiology in South-East Asia and China
    Barzaga BN
    Vaccine, 2000 Feb 18;18 Suppl 1:S61-4.
    PMID: 10683551
    A review of the epidemiology of hepatitis A virus (HAV) infection over the last 20 years shows shifting patterns in the prevalence of antibodies to HAV (anti-HAV) throughout South-East Asia and China. A number of countries have shifted from high to moderate and from moderate to low endemicity, with a corresponding increase in the age of exposure from childhood to early adulthood. The changes have resulted from improvements in hygiene, sanitation and the quality of drinking water, reflecting improvements in living standards and socioeconomic progress. In general in the late 1970s and early 1980s, 85-95% of the population of developing countries like the Philippines, Korea, China and Thailand were anti-HAV-positive by age 10-15 years, compared with only about 50% in the more affluent countries like Malaysia and Singapore. In the early 1990s, 85-95% of the population were immune by age 30-40 years in the Philippines, Korea, China and Thailand, and by 50 years of age and above in Malaysia and Singapore. Similar trends were noted in Hong Kong, Taiwan and Japan. Exposure to HAV at a later age may be associated with an increase in hepatitis A morbidity and a greater propensity for outbreaks.
    Matched MeSH terms: Hepatitis A/epidemiology*
  4. Fulltext Hepatitis A virus: declining seroprevalence in children and adolescents in Southeast Asia
    Kunasol P, Cooksley G, Chan VF, Isahak I, John J, Loleka S, et al.
    Southeast Asian J. Trop. Med. Public Health, 1998 Jun;29(2):255-62.
    PMID: 9886108
    The prevalence of hepatitis A virus (HAV) in a country largely reflects its standards of hygiene and socioeconomic conditions. Countries which undergo socioeconomic development show major change in HAV prevalence from high to low endemicity, and this is largely reflected in patterns of age-related seroprevalence. This paper presents age-related HAV seroprevalence patterns of SE Asian countries, and highlights how these patterns have changed over recent decades. Singapore, Thailand and Malaysia have experienced a decline in childhood and adolescent HAV seroprevalence, typical of countries which undergo socioeconomic development. By contrast, India has remained a country of high endemicity, with almost universal seroconversion in childhood. The Philippines and Vietnam show age-related seroprevalence patterns typical of high to moderate endemicity, while Indonesia shows significant regional variation in HAV seroprevalence. Populations within countries which exhibit major improvements in endemicity and age related HAV seroprevalence patterns are at risk of HAV epidemics, and a paradoxical increase in incidence tends to occur as seroconversion shifts from children to adults. The residents of these countries, a significant number of whom are at-risk, would benefit from a program of vaccination, as would non-infected individuals visiting high-risk areas.
    Matched MeSH terms: Hepatitis A/epidemiology*
  5. Fulltext Prevalence of hepatitis A virus infection in normal individuals and hospital patients in Kuala Lumpur
    Ton SH, Thiruselvam A, Lopez CG, Noriah R
    Med J Malaysia, 1983 Dec;38(4):279-81.
    PMID: 6100990
    110 normal, healthy adults were tested for antibody to hepatitis A (anti-HA) type IgG and 86 (78.2%) were found to be positive. An age-specific prevalence wasfound to be lowest in the lower agegroup and highest in the higher age-group. Out of 24 IgG positive individuals, only one was found to have type IgM. No significant difference in the incidence ofanti-HA type IgG was found between 42 patients in the Urology Unit, General Hospital, Kuala Lumpur and normal individuals (P > 0.1). 15 patients diagnosed as viral hepatitis were investigated for HA V IgG and IgM antibodies. 13 (86.7%) were positive for type IgG. Of this, only five (33%) were positive for the type IgM, suggesting that HA V is the cause of acute viral hepatitis in 33% of cases admitted to hospital as viral hepatitis.
    Matched MeSH terms: Hepatitis A/epidemiology*
  6. A seroepidemiologic study of hepatitis A in Malaysia
    Tan DS, Fang R, Collett D, Ooi BG
    Southeast Asian J. Trop. Med. Public Health, 1986 Jun;17(2):201-4.
    PMID: 3538434
    Sera from 494 non-icteric patients admitted with illnesses other than overt hepatitis into the various hospitals in rural and urban Malaysia were tested for IgG antibody to hepatitis A virus. The overall antibody prevalence rate was 67.0% with rates increasing steadily from childhood 10 years old and under (39.4%) to middle-age and above (96.0%). No significant differences were noted between males (68.4%) and females (65.3%). The highest rate was in the Indians (80.6%), the lowest in the Chinese (55.9%) with Malays occupying intermediate position (70.3%). The rate in the rural patients (74.7%) was higher than that in the urban patients (65.5%) especially in the 21 to 40 year age-group where the rural patients had a rate of 96.7% compared with that in urban patients (61.1%). A comparison of antibody prevalence rates in different countries was made.
    Matched MeSH terms: Hepatitis A/epidemiology*
  7. Hepatitis disease management programs in Malaysia
    Khairullah NS, Merican DI
    J Gastroenterol Hepatol, 2004 Mar;19 Suppl:S13-6.
    PMID: 15156929
    The MLF since its inception in 1996 has endeavored to develop a coordinated approach towards the improved care and treatment of liver diseases in Malaysia. Its close liaison with the Malaysian MOH, local medical associations, and corporate bodies has contributed to the success of its many programs. Educating the public, research, and training have been important elements of successful hepatitis disease control programs. Hepatitis Days have been proven to be very successful in raising the awareness of the general public to hepatitis disease. Rapid screening and vaccination has also helped to remove the social stigma associated with the disease, eliminated the need for numerous clinic appointments, and rendered vaccination more accessible to the public. The MLF perspective emphasizes the need for collaborative effort between Government bodies and other agencies, such as non-governmental organizations, laboratories, and the medical fraternity, to ensure the overall success of hepatitis disease management programs.
    Matched MeSH terms: Hepatitis A/epidemiology*
  8. Malaria, arbovirus and hepatitis infections in Macaca fascicularis from Malaysia
    Le Bras J, Larouze B, Geniteau M, Andrieu B, Dazza MC, Rodhain F
    Lab. Anim., 1984 Jan;18(1):61-4.
    PMID: 10628790
    Naturally occurring malaria, arbovirus infection and hepatitis in monkeys can be a hazard for the investigator and might interfere with the outcome of experiments. 63 young adult Macaca fascicularis from Malaysia were screened for these infections. About 1 year after their arrival in France, parasitaemia due to Plasmodium spp., was present in 6.4% of the animals and specific antibodies in 55.5%. 19 of 35 initially positive monkeys were tested again 2 years later. Parasitaemia was found in 1 of 4 monkeys and antibodies in 11 of 19 monkeys which were initially positive. 9 of the monkeys initially tested had low titres of antibodies to the Flavivirus genus. All animals were negative for the hepatitis B surface antigen and anti-HBc. The prevalence of IgG antibodies against hepatitis A was 46.0%. The implications in terms of control are discussed.
    Matched MeSH terms: Hepatitis A/epidemiology
  9. Fulltext The frequency of non-A, non-B hepatitis in acute and chronic liver disease
    Ross IN, Madhavan HN, Tan SH, Abdul Rahim K
    Med J Malaysia, 1985 Dec;40(4):301-6.
    PMID: 3025569
    Serological markers were used to determine the infective agents causing acute viral hepatitis in 246 patients. The frequencies of the five viral infections investigated were: non-A, non-B hepatitis - 99 patients (40.2%); hepatitis A - 98 patients (39.8%); hepatitis B - 43 patients (17.5%); cytomegalovirus - 4 patients (1.6%); and Epstein-Barr virus - 2 patients (0.8%). The log mean ages of presentation for the three predominant infections were: hepatitis A - 18 years; hepatitis B - 25 years; and non-A, non-B hepatitis - 30 years (F = 18.8, p =< 0.001). 52% of all cases were Malays (expected 32. 7%); 32% Chinese (expected 54.6%); and 16% Indians (expected 1l.5%) (X2 = 53, p = < 0.001). Hepatitis A virus infection was more common amongst Malays whilst non-A, non-B hepatitis was more frequent amongst Chinese and Indians. 28% of children <16 years) and 50% of adults had serological markers of previous hepatitis B infection. The variation in frequency for the different forms of hepatitis amongst the three main ethnic groups would suggest that socioeconomic and/or cultural factors are important in the propagation of acute viral hepatitis in Malaysia. HBsAg-negative chronic liver disease in our community may be a product of the high incidence of non-A, non-B hepatitis.
    Matched MeSH terms: Hepatitis A/epidemiology
  10. Fulltext Anti-hepatitis A seroprevalence among chronic viral hepatitis patients in Kelantan, Malaysia
    Ahmad F, Hamzah NA, Mustaffa N, Gan SH
    World J Gastroenterol, 2011 Sep 28;17(36):4130-4.
    PMID: 22039329 DOI: 10.3748/wjg.v17.i36.4130
    To determine the seroprevalence of anti-hepatitis A virus (HAV) antibodies in patients with chronic liver disease (CLD) and to justify the need for hepatitis A vaccination.
    Matched MeSH terms: Hepatitis A/epidemiology
  11. Probable Nipa Palm Wine-Associated Hepatitis A Outbreak after Attending a Funeral Ceremony in Sabah
    Jikal M, Mori D, Yusoff AF, Rai SB, Mukhsam MH, Ali I, et al.
    Am J Trop Med Hyg, 2021 07 12;105(3):777-782.
    PMID: 34255740 DOI: 10.4269/ajtmh.21-0036
    Foodborne outbreaks of hepatitis A virus (HAV) are most commonly associated with fresh and frozen produce and with various types of shellfish. Alcoholic beverage-borne outbreaks of hepatitis A are extremely rare. Here, we report an outbreak of hepatitis A associated with the consumption of a traditional wine at a funeral ceremony in the Sabah state of Malaysian Borneo. Confirmed cases were determined by serum anti-HAV immunoglobulin M and/or for fecal HAV by reverse transcription polymerase chain reaction (RT-PCR). The amplicons of RT-PCR were subjected to nucleotide sequencing followed by phylogenetic analysis. We conducted a 1:2 case-control study to identify the possible exposure that led to the outbreak. Sixteen patients met the case definition, they were 18 to 58 years old and 90% of them were males. The case-control study showed that the consumption of nipa palm wine during the ceremony was significantly associated (P = 0.0017) with hepatitis A infection (odds ratio, 5.44; 95% CI, 1.80-16.43). Untreated river water was used to dilute the traditional wine, which was assumed to be the source of the infection. Phylogenetically, these viruses belonged to genotype IA and formed an independent cluster with strains from Taiwan, Japan, and the Philippines. This strain might be an emerging HAV in Asian countries. Environmental assessments were performed and environmental samples were negative for HAV. The incidence of hepatitis A in Sabah was also determined and it was 0.795/100,000 population. Strict monitoring of traditional wine production should be implemented by the local authority to prevent future outbreaks.
    Matched MeSH terms: Hepatitis A/epidemiology*
  12. Fulltext Investigation of hepatitis A outbreak in district of Manjung, Perak, Malaysia, October 2012
    Yusoff FA, Rahman RA, May LH, Budart SB, Sulaiman LH
    Western Pac Surveill Response J, 2015 May 27;6(2):27-31.
    PMID: 26306213 DOI: 10.5365/WPSAR.2015.6.1.012
    In September 2012, 10 cases suspected to be hepatitis A were notified to the Manjung District Health Department. An investigation was conducted to identify the possible mode of transmission, source of the outbreak and to recommend prevention and control measures.
    Matched MeSH terms: Hepatitis A/epidemiology*
  13. Fulltext Review of the trends and causes of food borne outbreaks in Malaysia from 1988 to 1997
    Meftahuddin T
    Med J Malaysia, 2002 Mar;57(1):70-9.
    PMID: 14569721 MyJurnal
    This paper examines the trend and possible contributing factors for the occurrence of the food borne diseases outbreaks in Malaysia. These diseases mainly are cholera, typhoid fever, hepatitis A, dysentery and food poisoning. The outbreaks still occur sporadically in certain high risk areas throughout the country. The incidence rate of all the other three major food borne diseases steadily declined from the year 1988 to 1997 except for food poisoning and cholera. Statistic of food poisoning from the year 1996 to 1997 showed that 66.5% of the outbreak occurred in schools whereas only 0.4% originated from the contaminated food sold at various public food outlets. The school age group is always more affected than the general population. Amongst the contributing factors identified are related to unhygienic food handling practices followed by inadequate safe water supply and poor environmental sanitation. A multisectoral approach between Ministry of Health and other government agencies or private agents needs to be undertaken in the management of the food borne diseases in order to curb the incidences of food borne diseases in Malaysia.
    Matched MeSH terms: Hepatitis A/epidemiology*
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