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Modelling the Force of Infection for Hepatitis A in an Urban Population-Based Survey: A Comparison of Transmission Patterns in Brazilian Macro-Regions

Author

Listed:
  • Ricardo Arraes de Alencar Ximenes
  • Celina Maria Turchi Martelli
  • Marcos Amaku
  • Ana Marli C Sartori
  • Patricia Coelho de Soárez
  • Hillegonda Maria Dutilh Novaes
  • Leila Maria Moreira Beltrão Pereira
  • Regina Célia Moreira
  • Gerusa Maria Figueiredo
  • Raymundo Soares de Azevedo
  • for the Hepatitis Study Group

Abstract

Background: This study aimed to identify the transmission pattern of hepatitis A (HA) infection based on a primary dataset from the Brazilian National Hepatitis Survey in a pre-vaccination context. The national survey conducted in urban areas disclosed two epidemiological scenarios with low and intermediate HA endemicity. Methods: A catalytic model of HA transmission was built based on a national seroprevalence survey (2005 to 2009). The seroprevalence data from 7,062 individuals aged 5–69 years from all the Brazilian macro-regions were included. We built up three models: fully homogeneous mixing model, with constant contact pattern; the highly assortative model and the highly assortative model with the additional component accounting for contacts with infected food/water. Curves of prevalence, force of infection (FOI) and the number of new infections with 99% confidence intervals (CIs) were compared between the intermediate (North, Northeast, Midwest and Federal District) and low (South and Southeast) endemicity areas. A contour plot was also constructed. Results: The anti- HAV IgG seroprevalence was 68.8% (95% CI, 64.8%–72.5%) and 33.7% (95% CI, 32.4%–35.1%) for the intermediate and low endemicity areas, respectively, according to the field data analysis. The models showed that a higher force of infection was identified in the 10- to 19-year-old age cohort (∼9,000 infected individuals per year per 100,000 susceptible persons) in the intermediate endemicity area, whereas a higher force of infection occurred in the 15- to 29-year-old age cohort (∼6,000 infected individuals per year per 100,000 susceptible persons) for the other macro-regions. Conclusion: Our findings support the shift of Brazil toward intermediate and low endemicity levels with the shift of the risk of infection to older age groups. These estimates of HA force of infection stratified by age and endemicity levels are useful information to characterize the pre-vaccination scenario in Brazil.

Suggested Citation

  • Ricardo Arraes de Alencar Ximenes & Celina Maria Turchi Martelli & Marcos Amaku & Ana Marli C Sartori & Patricia Coelho de Soárez & Hillegonda Maria Dutilh Novaes & Leila Maria Moreira Beltrão Pereira, 2014. "Modelling the Force of Infection for Hepatitis A in an Urban Population-Based Survey: A Comparison of Transmission Patterns in Brazilian Macro-Regions," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-10, May.
    • Handle: RePEc:plo:pone00:0094622
    DOI: 10.1371/journal.pone.0094622
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    References listed on IDEAS

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    1. D. A. Griffiths, 1974. "A Catalytic Model of Infection for Measles," Journal of the Royal Statistical Society Series C, Royal Statistical Society, vol. 23(3), pages 330-339, November.
    2. Marcos Amaku & Raymundo Azevedo, 2010. "Estimating the True Incidence of Rubella," Mathematical Population Studies, Taylor & Francis Journals, vol. 17(2), pages 91-100.
    3. Joël Mossong & Niel Hens & Mark Jit & Philippe Beutels & Kari Auranen & Rafael Mikolajczyk & Marco Massari & Stefania Salmaso & Gianpaolo Scalia Tomba & Jacco Wallinga & Janneke Heijne & Malgorzata Sa, 2008. "Social Contacts and Mixing Patterns Relevant to the Spread of Infectious Diseases," PLOS Medicine, Public Library of Science, vol. 5(3), pages 1-1, March.
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    1. Lisie Souza Castro & Grazielli Rocha de Rezende & Fernanda Rodas Pires Fernandes & Larissa Melo Bandeira & Gabriela Alves Cesar & Barbara Vieira do Lago & Michele Soares Gomes Gouvêa & Ana R C Motta-C, 2021. "HAV infection in Brazilian men who have sex with men: The importance of surveillance to avoid outbreaks," PLOS ONE, Public Library of Science, vol. 16(9), pages 1-10, September.

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