Changing epidemiology of hepatitis A and hepatitis E in urban and rural India (1982-98)

The epidemiology of hepatitis A virus (HAV) and hepatitis E virus (HEV) was assessed among age-stratified urban high socioeconomic, lower middle socio economic status and rural populations from western India in 1998. When comp ared with previous surveys, a clear shift from high to intermediate endemic ity of HAV was evident only for higher socioeconomic population (1982-98), raising the possibility of outbreaks of hepatitis A in this category. A dec rease in anti-HAV positivity was noted in rural children aged 6-10 years. L ower circulation of HEV was noted among < 25-year-old urban higher socioeco nomic and rural individuals. For both viruses, the lower middle socioeconom ic populations were comparable in 1982 and 1998. Socioeconomic status and f amily size (odds ratio = 23 and 1.6, respectively) were independently assoc iated with anti-HAV positivity. Age, lower middle socioeconomic status and well water were significant independent variables for HEV infection (odds r atio = 5.7, 2.4 and 1.9, respectively). Hence, vaccination policy for hepat itis A needs to be reviewed.