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Observational Study
. 2022 May 18;17(5):e0268469.
doi: 10.1371/journal.pone.0268469. eCollection 2022.

Burden of disease and associated complications of hepatitis a in children and adults in Mexico: A retrospective database study

Adriana Guzman-Holst  1 , Gerardo Luna-Casas  2 , Ana Burguete Garcia  3 , Vicente Madrid-Marina  3 , Maria Yolanda Cervantes-Apolinar  4 , Anar Andani  5 , Gloria Huerta-Garcia  4 , Gilberto Sánchez-González  3
Affiliations
Observational Study

Burden of disease and associated complications of hepatitis a in children and adults in Mexico: A retrospective database study

Adriana Guzman-Holst et al. PLoS One. .

Abstract

Background: Hepatitis A virus (HAV) infection is a leading cause of viral hepatitis in children, yet the HAV vaccine is not included in the national immunization program (NIP) in Mexico. This study addresses an identified evidence gap of the burden of hepatitis A disease, complications, and associated costs in Mexico by analyzing surveillance and healthcare data. Data review included disease morbidity (incidence and hospitalization), mortality, and healthcare resource utilization costs.

Methods: In this observational, retrospective database study, we conducted a systematic screening, extraction, and analysis of outcome data from the national surveillance system in Mexico from January 2000 to December 2019.

Results: During the analysis period (2000-2019), the average incidence rate/year of HAV cases was 14.7 (5.4-21.5) per 100,000 inhabitants. Children 1-9 years of age (YoA) had the highest average incidence rate/year with 47.8 (14.7-74.5). The average hospitalization rate/year due to HAV infection was 5.8% (2.9-9.6%). Although the highest burden of HAV continued to be in children (1-9 YoA), an increase in incidence and hospitalizations (with complications) in older age groups (≥ 10-64 YoA) was observed. The annual average fatality rate was estimated to be 0.44% (0.26-0.83%) of which 28.8% of deaths were concentrated in adults ≥ 65 YoA. The total direct costs of medical attention due to HAV and related complications were estimated at $382 million Mexican pesos.

Conclusion: The overall results suggest an uptrend in HAV infections in adolescents/adults compared to children in Mexico. Therefore, as the overall incidence risk of HAV infection decreases, the mean age of infection increases. This consequently increases the risk of severity and complications in older age groups, thus increasing the demand for healthcare resources. Our findings provide evidence for including the inactivated HAV vaccine in the Mexican NIP.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: AG-H, MYC-A, AA, and GH-G are employed by the GSK group of companies. MYC-A, AA, and GH-G hold shares from the GSK group of companies. GL-C and GS-G are owners of Estimatio SC and report that this company received support from the GSK group of companies to conduct this study. GS-G is an investigator at the Instituto Nacional de Salud Pública (INSP, Mexico). AG-H, MYC-A, AA, GH-G, GL-C, and GS-G declare no other financial and non-financial relationships and activities. ABG and VM-M declare no financial and non-financial relationships and activities and no conflicts of interest.

Figures

Fig 1
Fig 1. Graphical abstract.
Fig 2
Fig 2. Incidence rate for diagnosed/detected HAV cases by age group and year.
YoA: Years of age.
Fig 3
Fig 3. Total number of hospitalizations and hospitalization rates for HAV infection by age groups in Mexico throughout the observation period (2000–2019).
A) Total sum of patients hospitalized for HAV infection by age group in Mexico throughout the observation period (2000–2019). B) Hospitalization rate due to HAV infection by year in Mexico throughout the observation period (2000–2019). HAV, hepatitis A virus; YoA, years of age.
Fig 4
Fig 4. Hospitalizations due to HAV +FHF or ALF infection by age group and year in Mexico.
YoA, years of age.
Fig 5
Fig 5. Total sum of patients with LT due to FHF or ALF by age group in Mexico throughout the observation period (2007–2019).
ALF: Acute liver failure; FHF: Fulminant hepatic failure; LT: Liver transplant; YoA: Years of age.
Fig 6
Fig 6. Deaths due to HAV infection by year and age group in Mexico throughout the observation period (2000–2019).
A) Fatality rate (%) due to HAV infection by year in Mexico throughout the observation period (2000–2019). B) Total sum of deaths due to HAV infection by age group in Mexico throughout the observation period (2000–2019). HAV, hepatitis A virus; YoA, years of age.
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References

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