Hepatitis A and E among immigrants and refugees in Central Brazil

Silva, Grazielle Rosa da Costa e; Martins, Thaynara Lorrane Silva; Silva, Carla de Almeida; Caetano, Karlla Antonieta Amorim; Carneiro, Megmar Aparecida dos Santos; Silva, Bruno Vinicius Diniz e; Pacheco, Leonora Rezende; Villar, Livia Melo; Paula, Vanessa Salete de; Martins, Regina Maria Bringel; Teles, Sheila Araújo

doi:10.11606/s1518-8787.2022056003839

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Original Article • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056003839 linkcopy

Hepatitis A and E among immigrants and refugees in Central Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE To estimate the prevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) among immigrants and refugees in Goiás, Central Brazil.

METHODS Overall, 355 individuals were interviewed, and blood samples were tested for anti-HAV and anti-HEV IgG. Anti-HEV-positive samples were similarly tested for HEV RNA.

RESULTS All participants were from Latin American countries, most of whom, young adult males. The overall anti-HAV IgG prevalence was 87.4% (95%CI: 83.5–90.4), of whom 94.9%, 75.6%, and 60% were from Haiti, Venezuela, and other Latin American countries, respectively (p < 0.001). Age above 19 years and more than 36 months residing in Brazil were associated with a higher prevalence of previous HAV and HEV infection, respectively. Of the children eligible for HAV vaccination according to the National Immunization Program, only eight (44%) had been vaccinated. The overall anti-HEV IgG prevalence was 6.5% (95%CI: 4.4–9.5). All anti-HEV IgG-positive individuals were Haitians, including a child born in Brazil. HEV RNA was detected in two of the anti-HEV IgG-positive samples.

CONCLUSION The survey detected a high prevalence of anti-HAV and anti-HEV IgG among immigrants and refugees, and active HEV infection among some Haitian participants. Prevention measures are urgently required to interrupt enteric virus transmission in this emergent and vulnerable population.

Refugees; Latin America; Hepatitis A, epidemiology; Hepatitis E, epidemiology; Seroepidemiologic Studies

Variable	Total	Anti-HAV positive	%	p	Total^a	Anti-HEV positive	%	P
Country of origin
Haiti	216	205	94.9		218	23	10.6	< 0.001
Venezuela	127	96	75.6	0.001	132	-
Other	05	03	60.0		05	-
International migration category
Immigrant	251	223	88.8		254	21	8.3
Refugee	97	81	83.5	0.179	101	02	2.0	0.030
Sex
Male	196	174	88.8		199	14	7.0
Female	152	130	85.5	0.366	156	09	5.8	0.631
Age group
≤ 9 years	23	15	65.2		30	01	3.3
10–19 years	34	17	50.0	< 0.001	34	-	-	0.182
> 19 years	291	272	93.5		291	22	7.6
Years of formal education^a
Up to 9 years	115	93	80.9		115	7	6.1
10–12 years	85	78	91.8	0.06	85	5	5.9	0.839
> 12 years	113	100	88.5		113	5	4.4
Length of time in Brazil (month)
≤ 6	97	78	80.4		99	02	2.0
7–18	83	71	85.5	0.004	85	06	7.1	0.036
19–36	67	57	85.1		69	03	4.3
> 36	101	98	97.0		102	12	11.8

Variable	Anti-HAV positive		Anti-HEV positive
Variable	AdjPR (95%CI)^a	p	AdjPR (95%CI)^b	p
Haitian origin	1.09 (0.81–1.45)	0.574	-
Refugee	-		0.29 (0.07–1.26)	1.000
Age > 19 years	1.85 (1.15–2.96)	0.011
Formal Education > 9 years	0.91 (0.71–1.18)	0.500
Length of time in Brazil (months)^a
≤ 6	1.00		1.00
7–36	1.04 (0.77–1.41)	0.789	2.50 (0.54–11.62)	0.243
> 36	1.07 (0.76–1.52)	0.685	4.67 (1.03–21.02)	0.046

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[TFN1] ^a Only valid data.