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What is the shifting endemicity of the hepatitis A virus?

There are major geographical differences in endemicity of hepatitis A, which are closely related to hygienic and sanitary conditions and other indicators of the level of socioeconomic development. While the anti-hepatitis A (HAV) seroprevalence has been decreasing in many parts of the world, exposure to hepatitis A during the first year of life is still very common in less developed regions. In areas of intermediate HAV endemicity, the delay in the exposure to the virus has generated a huge number of susceptible adolescents and adults and significantly increased the average age at infection1

Watch this short video explaining shifting endemicity

Theoretical shift in age-specific seroprevalence across different endemicities2

Low endemicity

In high-income regions, hepatitis A incidence is low or very low; infected adults can be at risk of disease and of serious complications, such as acute liver failure1

Low endemicity graph

The same results were first published in WHO 2009.2 The chart has been independently created by GSK from the original data. The chart is intended to show the different patterns of endemicity and might not reflect exact data points

Intermediate endemicity

In middle-income regions, hepatitis A incidence is lower, but infections in adolescents and adults can cause serious complications, such as acute liver failure1

Intermediate endemicity graph

The same results were first published in WHO 2009.2 The chart has been independently created by GSK from the original data. The chart is intended to show the different patterns of endemicity and might not reflect exact data points

High endemicity

In low income regions, hepatitis A incidence is higher, with individuals typically experiencing asymptomatic infection during childhood1

High endemicity graph

The same results were first published in WHO 2009.2 The chart has been independently created by GSK from the original data. The chart is intended to show the different patterns of endemicity and might not reflect exact data points

What are the main factors contributing to the shifting endemicity of hepatitis A virus?

Better sanitation Icon

Better sanitation1,3,4

Improvements in safe water supply

Improvements in safe water supply1,3,4

Declining incidence of HAV

Declining incidence of HAV5

Why does long-term protection matter?

  • Long-term protection after childhood vaccination is critical for preventing disease that can be contracted in adulthood5,6
  • Since increasing age is a risk factor for symptomatic disease, contracting hepatitis A at an older age could increase risk of complications5,6

What are the consequences of shifting endemicity of hepatitis A virus for different population groups?

Every year, around 1.5 million hepatitis A infections are reported around the world, but it is estimated that the true number of infections may be over 100 million7

  • Improving socioeconomic conditions, safer water and food supplies, and universal vaccination programmes (albeit available so far in only a relatively small number of countries) contribute to decreased exposure to HAV but also to increased susceptibility to infection, especially in young and even middle-aged adults7
  • A systematic review of hepatitis A epidemiology revealed that the median age at seroconversion had increased between 1990–2005 in many parts of the world8
  • Infection during early childhood is most often entirely asymptomatic. By contrast, infection during late childhood, adolescence or in adulthood has a higher likelihood of severe disease and hospitalisation4,8
Globe Icon

For countries experiencing a shift in hepatitis A endemicity, WHO recommends vaccinating children ≥1 year against hepatitis A (along with adopting additional prevention methods).9 In such countries, the need for catch-up immunisation should be considered based on age-specific rates of hepatitis A or other markers of susceptibility9

Find out more about hepatitis A and Havrix Junior

Preventing hepatitis A

Key steps in hepatitis A prevention

Long-term protection

Discover the benefits of Havrix Junior

A summary of hepatitis A vaccines

A quick reference guide to hepatitis A vaccines

HAV, hepatitis A virus; WHO, World Health Organization

References

  1. Franco E. World J Hepatol 2012; 4:68–73.
  2. World Health Organization (WHO). The global prevalence of hepatitis A virus infection and susceptibility: a systematic review. Available at: https://apps.who.int/iris/handle/10665/70180 (Accessed April 2023). 
  3. Murphy TV et al. MMWR Suppl 2016; 65:29–41.
  4. World Health Organization (WHO). Hepatitis A fact sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-a (Accessed April 2023).
  5. Jacobsen K et al. Vaccine 2010; 28:6653–6657.
  6. Byrd K et al. J Pediatr Infect Dis 2010; 5:321–326.
  7. World Health Organization (WHO). WHO immunological basis for immunization series. Module 18: Hepatitis A. Available at: https://apps.who.int/iris/bitstream/handle/10665/326501/97892516327-eng.pdf (Accessed April 2023).
  8. Aggarwal R, Goel A. Curr Opin Infect Dis 2015; 28:488–496.
  9. World Health Organization. Wkly Epidemiol Rec 2022; 97:493–512.

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PM-RCH-HAV-WCNT-230002 | Date of preparation: Noember 2023