Hepatitis A virus infections, immunisations and demographic determinants in children and adolescents, Germany

Abstract

Hepatitis A is a vaccine-preventable disease with a global distribution. It predominantly occurs in regions with inadequate living conditions, but also affects populations in industrialised countries. Children are frequently involved in the transmission of hepatitis A virus (HAV) and thus play a central role in the epidemiology of hepatitis A. Here, we investigated HAV infections, immunisations, and associated demographic determinants in a nationwide, population-based, cross-sectional survey conducted in Germany from 2003-2006. Out of 17,640 children and adolescents, complete data sets (HAV serology, demographic information and vaccination card) were available for 12,249 (69%), all aged 3-17 years. We found protective antibody levels (>=20 IU/L) in 1,755 (14%) individuals, 1,395 (11%) were vaccinated against hepatitis A, 360 (3%) individuals were HAV seropositive without prior hepatitis A vaccination, thus indicating a previous HAV infection. Antibody prevalence (attributable to vaccination or infection) increased significantly with age. Multivariate logistic regression revealed that predominantly children and adolescents with migration background-even if they were born in Germany-are affected by HAV infections. Our results provide a rationale to emphasise existing vaccination recommendations and, moreover, to consider additional groups with a higher risk of infection for targeted vaccination, especially children with a migration background.

Figure 1

Flow chart and sample frequencies of participation by HAV serology and vaccination status.

Figure 2

Estimated (weighted) proportion of HAV-seropositive study participants by age (error bars indicate 95% confidence intervals (95% CI), German children and adolescents, aged 3–17 years, n = 13,063). The dashed line depicts the estimated mean of the HAV-seroprevalence (13%). Serum samples of children aged 0–2 years were not requested. (The specific values per age including the respective 95% confidence intervals are provided in the supplement; Supplementary Table S1).