Key result
Low HAV knowledge is linked to a ~23-fold higher incidence of infection during outbreaks.
Why the study?
Molecular epidemiological data from hepatitis A virus outbreaks in two affected areas and the association between hepatitis A knowledge and infection incidence were not well characterized.
Cross-Sectional (n=172)
Yes
Hepatitis A outbreaks in two Indonesian districts were caused by the same subgenotype (IA) but different strains, with varying associations between knowledge level and infection incidence.
Answers are grounded in this paper and cite their sources.
Variable knowledge-incidence links across districts caution against uniform prevention; hypothesis-generating for strain-specific surveillance in endemic areas.
The present study aimed to analyse molecular epidemiological data from hepatitis A virus (HAV) outbreaks in two affected areas. The association between the knowledge of hepatitis A and incidence of infection was also determined. Serum samples were obtained from 88 individuals with clinical manifestations of acute hepatitis in Lamongan (n=54) in January 2018 and Bangkalan (n=34) in March 2018. The outbreak investigation was started one day after the outbreaks were reported by the Public Health Offices in Lamongan and Bangkalan. Anti-HAV immunoglobulin M (IgM) and PCR amplification products of the VP1 capsid protein-P2A protease and VP1-VP3 junctions were analysed. Positive PCR products were sequenced, and a phylogenetic tree was constructed using Molecular Evolutionary Genetics Analysis X software. The control group comprised healthy students and staff members from the two affected areas. Thus, 172 responses from the control and hepatitis A case groups were analysed to assess the association between the students' knowledge level and the incidence of HAV infection. A total of 32 (59.25%) of the 54 individuals from Lamongan and 19 (55.9%) of the 34 participants from Bangkalan were positive for anti-HAV IgM; 26 PCR tests were positive in the VP3-VP1 and/or VP1-P2A junction, which were identified as HAV subgenotype IA. The subtype of HAV in the two areas was IA, similar to those identified previously, but the viruses did not originate from the same strain, as identified by multiple alignment. The knowledge level of the students and staff members in Lamongan studying and working at a half-day school exhibited a significant association with the incidence; however, no association was observed among the students in Bangkalan studying at a full-day school with a dormitory.
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Setyowati et al. (2019) conducted a cross-sectional in Hepatitis A (n=172). Low knowledge of hepatitis A vs. High knowledge of hepatitis A was evaluated on Incidence of hepatitis A infection (Affected area I) (OR 22.523, p=0.001). Hepatitis A outbreaks in two Indonesian districts were caused by different strains of subgenotype IA, and low knowledge of the disease was associated with a higher incidence of infection in one district.
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