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Epidemiology of Hepatitis A in Israel
Demographics
Israel's population: 6.3 million in 2000 Jewish population - 78% Non-Jewish population - 22%, of whom
• 82% Moslems • 9% Christians • 8.8% others
Reported Acute Viral Hepatitis Through Passive Surveillance
Incidence - Israel, 1960-1998
020406080
100120140160
1960 '65 1970 '75 1980 '85 1990 '95
Year
Rat
e pe
r 100
,000
6 4 6 6 6 8 7 0 7 2 7 4 7 6 7 8 8 0 8 2 8 4 8 6 8 8 9 0 9 2 9 4 9 6 0
2 0
4 0
6 0
8 0
1 0 0
1 2 0
1 4 0
1 6 0
Inci
denc
e pe
r 100
,000
Year
Incidence of Viral Hepatitis A per 100,000 in Israel During 1963-1996 by Population
J e w i s h p o p u l a t i o n Non-Jewish population
18.9
105.4
181.2
85.2
30
6.9 3.6
34.4
186.3
224.1
74.1
7 2.716.6
0
50
100
150
200
250
<1 1 - 4 5 - 9 10 - 14 15 - 44 45-64 >=65
JewsNon-Jews
Age-
spec
ific
inci
denc
e (r
epor
ts /
100,
000)
Age-group (years)
Overall incidence Per 100,000
Jews non-Jews
46.8 65.1
Age-Specific Incidence of Reported HAV in Israel during 1993-8
Highlights of HAV Epidemiology in Israel
Background information:
Heterogeneous population ( contact between high and low socioeconomic risk groups)
Highest attack rate in children 5-9 years old Maternal anti-HAV IgG is usually cleared in
babies by the age of 18 months Hepatitis A is rarely observed < age of 18m Toddlers seem to be the main vehicle for HAV
transmission (pilot study results)
HBV (13%) Other (14%) Drug (15%) Idiopathic (26%) HAV (32%)
HBV (13%)
Other (14%)
Drug (15%)Idiopathi
c (26%)
HAV (32%)
Etiology of Fulminant Hepatitis in Jerusalem (until 2000)
Hepatitis A Surveillance Systems in Israel
Passive surveillance: National Through notifications to the Ministry of Health (HAV committee: coordinator - Ron Dagan ) Active Surveillance: Only in Jerusalem (coordinator - Daniel Shouval)
0
30
60
90
120
150
Jeru
salem Ac
re
Raml
a
Safed
Beer
Sheb
a
Hade
ra
Ashk
elon
Naza
reth
Aful
a
Reho
vot
Kinn
eret
Haifa
Shar
on
Petah
-Tikv
a
Tel-A
viv
Overall incidence: 42.4/100,000 (N=5,066,200)
Ann
ual I
ncid
ence
/100
,000
*
*1999 data, active surveillance
Passive surveillance
Annual Incidence of Acute HAV per District
Hepatitis A Virus (HAV)• Picornaviridae• Non-enveloped single strand RNA • 27-32 nm diameter, 7.5 kb length• One ORF of ~ 6.7 kb• 4 structural proteins (capsid)• 7 non structural proteins
320nt
Detection of Hepatitis A Sequences by PCR Methods
• HAV RNA extracted from 10-100 µl serum • Nested RT-PCR • Purification of PCR products • Nucleic acid sequencing by automated sequencer • Sequence analysis - Wisconsin Genetic Computer Group • Epidemiological databases established using Access
Molecular Epidemiology of HAV in Jerusalem
Total population studied by HAV-RNA N=848
Number of subjects positive for HAV-RNA by PCR N=709 (84%)
Number of subjects analyzed by Geographic Information System (GIS) in the city of Jerusalem N=599*
*110 (16%) subjects were from the district and not the city of Jerusalem
Male/Female Ratio*
51.6% 959 MALE
48.4% 899 FEMALE
Total cohort (N=1858) PCR Tested (N=848)
52% 441 MALE
48% 407 FEMALE
M M F F
*1999-2003
63.6% 539 JEWISH
36.4% 309 NON-JEWISH
NJ J
Total Study Population Tested for HAV RNA by PCR (N=848)
52% 441 MALE
48% 407 FEMALE
F M
JEWISH/NON-JEWISH RATIO MALE/FEMALE RATIO
Hepatitis A Virus Genotypesהגדרות
Genotype: A group with >85% nucleotide sequence identity (6 genotypes)Sub-genotype: Defined as nucleotide identity within the sub-group is no less then 92.5%
I
a
b
II
III
a
b
IV
V
VI
DendogramGenotypes and Sub-genotypes
Distribution of HAV Genotypes and Sub-genotypes
1b a1
HAV Genotype Distribution inSub-populations - Jerusalem
Jewish population (N=466) Non-Jewish population (N=243)
1b (96%)
1a (4%)1b (19%)
1a (81%)
Incidence of acute HAV in Israel, 1998 – 2012, rate/100.000, by population group
Division of Epidemiology, Ministry of Health, Israel
0
10
20
30
40
50
60
70
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Non-Jews
Jews
