Epidemiological Aspects of Hepatitis A: Endemicity Patterns and Molecular Epidemiology

Improvements in hygiene and socio-economic conditions in many parts of the world have led to an epidemiological shift in hepatitis A with a transition from high to low endemicity. Consequently, in these areas, higher proportion of symptomatic disease among adolescents resulting in large-scale community outbreaks has been described. In Tunisia, an increase in the average age at the time of infection has been reported, hence resulting in regular outbreaks, especially household and primary school epidemics. Molecular investigation of such outbreaks, based on the determination of viral genotype and genetic relatedness between hepatitis A virus (HAV) strains, is a useful tool to identify the potential source of HAV contamination but also to assess the virus molecular dynamics over time, such as the introduction of a new genotype or a specific clustering of HAV strains according to the geographical origin. In Sfax city, (Center-East of Tunisia), only HAV strains of genotype IA are circulating. In rural areas, HAV infection is still highly endemic with probably a water-borne transmission pattern. Nevertheless, the considerable genetic heterogeneity observed in urban areas highlights the changing pattern of hepatitis A epidemiology in these settings. Further molecular studies are strongly needed to better understand HAV epidemiology in Tunisia.