Epidemiol. Infect. (2008), 136, 406–409.

f 2007 Cambridge University Press

doi:10.1017/S0950268807008643 Printed in the United Kingdom

SHORT REPORT
Seroepidemiology of hepatitis A in voluntary blood donors from
Pune, western India (2002 and 2004–2005)

P. S. G A D GI L 1, R. S. F A D N I S 1, M. S. J O S H I 1, P. S. R A O 2 A N D S. D. C HI T A M B A R 1*
1
National Institute of Virology, Pune – 411001, India
2
Blood Bank, Inlaks and Budhrani Hospital, and Sahayadri Speciality Hospital Pune – 411001, India

(Accepted 3 April 2007 ; first published online 7 June 2007)

SUMMARY
Recently, a changing pattern of hepatitis A epidemiology has been reported in the Indian
population indicating a rise in the rate of hepatitis A infection among adults. The study’s
objective was to assess anti-HAV prevalence in voluntary blood donors from middle and high
socioeconomic strata. Serum samples collected from voluntary blood donors from Pune city and
its suburbs in the years 2002 and 2004–2005 were tested for anti-HAV IgG antibodies. Serum
samples collected during 2004–2005 were examined for anti-HAV IgM antibodies. Positive
samples were tested for HAV-RNA. Agewise anti-HAV positivity was significantly low in adults
aged 18–25 years (90.4%) compared to those aged >25 years (97.4%) (P<0.01). A decline in
anti-HAV prevalence was significant in 2004–2005 compared to that in 2002 (96.5 % vs. 92.1 %)
(P<0.01). Overall, in both adult age groups, the proportion of anti-HAV positivity was
remarkably low in the high socioeconomic group (HSG) (88.96%) compared to that of the
middle socioeconomic group (MSG) (95.86%) (P<0.01). Anti-HAV IgM positivity was not
significant (y1%), however, presence of HAV-RNA in one of the samples indicated the
possibility of horizontal transmission of HAV. Increase in seronegativity to HAV in HSG
implicates a rise in the susceptible pool and indicates the need for vaccination against hepatitis A.

Hepatitis A is an enterically transmitted disease and Asia, antibodies usually appear early in life and
caused by hepatitis A virus (HAV). The disease has a remain detectable in adulthood. However, several
wide distribution throughout the world. The severity previous reports have documented the changing trend
of the disease is related to the age at infection [1]. of hepatitis A epidemiology in developing countries
The rate of infection markedly depends on the socio- [4–8].
economic development of the region or country [2, 3]. In India, hepatitis A is mainly encountered by the
In the developed countries of western Europe and paediatric population [9]. Occurrence of outbreaks of
North America, and in Japan and Australia, the pro- hepatitis A have been also reported [10–12]. Recent
portion of anti-HAV seropositive persons is low in surveillance studies carried out in various communi-
childhood. This increases during adolescence and ties in India document declining anti-HAV prevalence
early adulthood, and reaches a high level by late and its association with improved socioeconomic
adulthood. In most developing countries in Africa status and the quality of water supply, and an increase
in education level and personal hygiene [13–16].
* Author for correspondence: Dr (Mrs) S. D. Chitambar, Deputy However, this has increased the risk of HAV infection
Director & HOD, Rotavirus Group, National Institute of Virology,
20-A, Dr. Ambedkar Road, Pune – 411001, India.
in the adult population [12, 17]. The present study
(Email: chitambars@hotmail.com) was conducted to assess the prevalence of anti-HAV
 Anti-HAV prevalence in voluntary blood donors 407

Table. Agewise anti-HAV prevalence in voluntary blood donors in the years 2002 and 2004–2005

No. positive/no. tested (% positivity) during the years

Age group
(years) 2002 2004–2005 Total

18–25 306/339 (90.3 %) 183/202 (90.6 %) 489/541 (90.4 %)**

>25 383/385 (99.5 %) 205/219 (93.6 %) 588/604 (97.4 %)**
Total 689/724 (96.5 %)* 388/421 (92.1 %)* 1077/1145 (94.1 %)

* P<0.01 (2002 vs. 2004–2005), ** P<0.01 (age group 18–25 vs.>25 years).

antibodies in voluntary blood donors who represent 100

(496)
the middle and high socioeconomic status population 98
of adults in India.
96
The subjects under study included healthy volun-

% anti-HAV positivity
tary blood donors from Pune city and the suburbs 94 (108)
(350)
of Pune district. These comprised 991 males and 154 92
females aged 18–50 years. Informed consent was 90
obtained from all individuals. A preset questionnaire
88 (191)
inclusive of jaundice, vaccination, source of water
supply, education level and monthly income, was 86

duly completed for each subject. Based on monthly 84

income, the study population was classified into 82
middle, and high socioeconomic status [18]. The test
80
specimens consisted of 724 and 421 blood samples 18–25 >25
collected respectively in 2002 and 2004–2005 during Age group (years)

blood donation camps. All serum samples were stored Fig. Anti-HAV prevalence in voluntary blood donors
at x20x C until tested. based on socioeconomic status. Figures in parentheses
indicate number of samples examined. %, High socio-
Serum samples collected during 2002 and 2004–
economic group; &, Middle socioeconomic group.
2005 were tested by ELISA for anti-HAV IgG anti-
bodies, a marker of past infection. The 2004–2005
samples were also tested by ELISA for anti-HAV A highly significant decline in anti-HAV prevalence
IgM antibodies, a marker of recent infection [19–21]. was noted in 2004–2005 (P<0.01). The decrease in
RT–PCR was performed according to the method anti-HAV prevalence was not uniform in the two
described previously [22] on anti-HAV IgM-positive age groups investigated in the study. In 2004–2005,
serum samples to detect HAV-RNA using primers anti-HAV positivity was significantly different in the
from the RNA polymerase region of the HAV >25 years age group (P<0.01) from that of 2002
genome. while for these years it was similar in the 18–25 years
The differences between the proportions of sero- age group (P>0.05).
positivity among different groups of donors were Since the blood donors of the study belonged to
compared using the x2 test. For small samples, Fisher’s high and middle socioeconomic groups (HSG and
exact test was used. MSG), the seroprevalence analysis was performed on
A total of 1145 serum samples collected during the basis of their socioeconomic status. Anti-HAV
2002 and 2004–2005 were tested for anti-HAV anti- positivity among adults of both age groups (18–25
body. The agewise prevalence of anti-HAV in blood and >25 years) was significantly low in the high
donors during the years 2002 and 2004–2005 is shown socioeconomic population (86.91%, 92.59 %) com-
in the Table. Anti-HAV positivity was significantly pared to the corresponding age groups from the
low in adults aged 18–25 years compared to that in the middle socioeconomic population (92.29 %, 98.39 %)
>25 years age group (P<0.01). Overall, 96.5 % (699/ (P<0.01) (Fig.). On the whole, HSG showed a sig-
724) of the donors in 2002 were found to be anti-HAV nificantly reduced anti-HAV prevalence compared to
positive compared to 92.16% (388/421) in 2004–2005. MSG (88.96 % vs. 95.86 %) (P<0.01).
408 P. S. Gadgil and others

Four of 421 serum samples showed positivity to Shri. Rajesh Kannalu and Shri. Prakash Jawalkar for
anti-HAV IgM antibodies. These four samples were technical assistance.
processed further to detect the presence of HAV-
RNA by RT–PCR. One of the samples testing posi-
D E C L A R A T I O N O F IN T E R E S T
tive was confirmed for HAV genome by sequencing
the amplicon. None.
The present study detects hepatitis A antibodies
in voluntary donors. All donors were negative for
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