Published: 26 February 2021
Prevalence of total hepatitis A antibody among 5 to 7 years old children and their mothers in Cambodia

Shintaro Nagashima, Ko Ko, Chikako Yamamoto, E. Bunthen, Serge Ouoba, Channarena Chuon, Masayuki Ohisa, Aya Sugiyama, Tomoyuki Akita, Md. Shafiqul Hossain, Vichit Ork, Bunsoth Mao & Junko Tanaka

Scientific Reports volume 11, Article number: 4778 (2021) Cite this article

Abstract
This study determined the prevalence of total hepatitis A antibody (anti-HAV) among 5–7 years old children and their mothers in the whole Cambodia, using a nationwide study, and examined the differences between the two cohorts. A total of 4535 dried blood spot-driven (DBS) samples (2021 mothers and their 2514 children of 5–7 years old) and the concomitant 922 whole blood samples (subset of the whole participants) were collected using a multistage random sampling strategy throughout Cambodia in 2017.
Total anti-HAV was detected using the chemiluminescence enzyme immunoassay method. Compared to gold standard whole blood samples, the sensitivity and specificity of DBS mediated anti-HAV detection were 94.8% and 98%, respectively. Total anti-HAV prevalence among mothers was 91.2% (95%CI: 90.0–92.5%), and that of their children was 31.5% (95%CI: 29.7–33.3%).

In our study, the low prevalence of total anti-HAV among children indicates the country’s improvement of safe water and food supply, hygiene and sanitation. If the hygiene and sanitation are consistently improved in Cambodia, the prevalence might be no longer increased when the children become adults.

Introduction
Viral hepatitis A is caused by hepatitis virus A (HAV), a small, naked single-stranded positive RNA virus which can survive on hands and non-porous environments as well as various kinds of foods1. Therefore, the transmission route is fecal–oral, and sporadic forms of epidemic outbreaks were reported worldwide. There were also reports on HAV outbreaks among vulnerable groups of people, such as Men who have sex with Men (MSM) and people with intravenous drug use (PWIDs)2. Once infected, almost all individuals fully recover with life-long immunity. But the outcome can be fatal, especially if the disease progresses rapidly to fulminant hepatitis.

According to World Health Organization (WHO), hepatitis A caused approximately 7134 deaths in 2016, which accounts for 0.5% of the mortality due to viral hepatitis3. The prevalence may vary in each continent or country, but it is closely associated with food and water safety, as well as personal hygiene and sanitation.

In Cambodia, there were only a few reports on the prevalence of HAV last decade7,8,9. The increasing trend of HAV prevalence by age was observed, and almost 100% of Cambodian adults were positive for antibodies to hepatitis A virus (anti-HAV) Immunoglobulin G (IgG)9.
No more studies were conducted for HAV infection in Cambodia since 1998, so that the current disease burden is unexplored. Additionally, the Kingdom of Cambodia is now vehemently moving forwards and the economics, environment, and health care system are improving day by day.

Positive economic and societal changes create better sanitation, safe food and water supply, and proper hygiene, leading to a healthy lifestyle. Alongside the development of Cambodia, understanding the trend of infectious diseases is crucial for its specific prevention and control. We expected that anti-HAV prevalence in Cambodia would decrease than before.
Thus, this study determined the prevalence of total hepatitis A antibody (anti-HAV) among 5–7 years old children and their mothers in the whole Cambodia, using a nationwide study and examined the differences between the two cohorts.
Methods

This study is the continuum of our nationwide epidemiological study on the prevalence of hepatitis virus, including HAV, among 5–7 years old children and their mothers in Cambodia. Data collection was conducted in 2017, using a multistage stratified random sampling strategy11. The detailed study design procedure and sampling strategy were described in our previously published work11. In this study, we report the total anti-HAV prevalence among children and their mothers.
https://www.nature.com/articles/s41598-021-83710-2