Division of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia.
Firman Suryadi Rahman
Doctoral Program of Public Health, Faculty of Public Health Universitas Airlangga, Surabaya, Indonesia.
Background: Hepatitis A often occurs in school among students in the form of an outbreak. The transmission was through fecal-oral (Common Source) provided that the epidemic curve is close to propagated. The aim of the current study was to analyze the determinants of Hepatitis A Infection among students.
Design and methods: This study was a case-control study which was conducted at SMAN Plus with a sample size of 80 students chosen by using simple random sampling. The data obtained were then analyzed using logistic regression with 95% confidence level (α = 0.05), while the strength of the relationship between variables was identified using Odds Ratio (OR).
Results: Most of the students were at the age of 17 to 19 years old (65%) and male (57.5%). The average age in the case group was 17.1 years old, while in the control group was 16.75 years old. The habit of consuming raw foods (p = 0.001) as well as eating and drink at the same time during an activity (p = 0.000) had a significant influence on the outbreak of Hepatitis A in the curve epidemic of common source.
Conclusions: The outbreak is confirmed as a transmission occurs through fecal-oral which the common source epidemic curve. Risk factors that have been proven to be related to Hepatitis A include consuming raw food, eating shared meals during an activity, and drinking with shared drinking utensils.
Linder KA, Malani PN. Hepatitis a. JAMA 2017;318:2393. DOI: https://doi.org/10.1001/jama.2017.17244
Vaughan G, Rossi LM, Forbi JC, et al. Hepatitis A virus: host interactions, molecular epidemiology and evolution. Infect Genet Evol 2014;21:227-43. DOI: https://doi.org/10.1016/j.meegid.2013.10.023
Aggarwal R, Goel A. Hepatitis A: epidemiology in resource-poor countries. Curr Opin Infect Dis 2015;28:488-96. DOI: https://doi.org/10.1097/QCO.0000000000000188
East Java Health Office. Hepatitis A Report. 2015.
Jember Health Office. Hepatitis A Report. 2015.
Ministry of Health of the Republic of Indonesia. Hepatitis Virus. 2014.
Hikmah F, Nuraini N, Sari EP. Mapping and analysis of hepatitis A disease distribution based on risk factors in Bondowoso district. KEMAS: Jurnal Kesehatan Masyarakat 2019;14:303-10. DOI: https://doi.org/10.15294/kemas.v14i3.11246
Franco E, Meleleo C, Serino L, et al. Hepatitis A: Epidemiology and prevention in developing countries. World J Hepatol 2012;4:68. DOI: https://doi.org/10.4254/wjh.v4.i3.68
Raveendran S, Rakesh PS, Dev S, et al. Investigation of an outbreak of hepatitis a in a coastal area, Kerala, southern India. J Prim Care Community Health 2016;7:288-90. DOI: https://doi.org/10.1177/2150131916647007
Arora D, Jindal N, Shukla RK, Bansal R. Water borne hepatitis a and hepatitis e in malwa region of punjab, India. J Clin Diagn Res 2013;7:2163-6. DOI: https://doi.org/10.7860/JCDR/2013/5966.3459
Mulyanto. Viral hepatitis in Indonesia: Past, present, and future. Euroasian J Hepatogastroenterol 2016;6:65-9. DOI: https://doi.org/10.5005/jp-journals-10018-1171
Seo JY, Choi BY, Ki M, et al. Risk factors for acute hepatitis A infection in Korea in 2007 and 2009: a case-control study. J Korean Med Sci 2013;28:908-14. DOI: https://doi.org/10.3346/jkms.2013.28.6.908
Verhoef L, Boot HJ, Koopmans M, et al. Changing risk profile of hepatitis A in The Netherlands: a comparison of seroprevalence in 1995–1996 and 2006–2007. Epidemiol Infect 2011;139:1172-80. DOI: https://doi.org/10.1017/S0950268810003043
Randazzo W, Sánchez G. Hepatitis A infections from food. J Appl Microbiol 2020;129:1120-32. DOI: https://doi.org/10.1111/jam.14727
Viray MA, Hofmeister MG, Johnston DI, et al. Public health investigation and response to a hepatitis A outbreak from imported scallops consumed raw – Hawaii, 2016. Epidemiol Infect 2018;147:e28. DOI: https://doi.org/10.1017/S0950268818002844
Food and Drug Administration. Hepatitis A virus. 2020. Available from: https://www.fda.gov/food/foodborne-pathogens/hepatitis-virus-hav#Outbreaks
Ministry of Health of the Republic of Indonesia. Guidelines for outbreak investigation. 2017.
Centers for Disease Control and Prevention [Internet]. Surveillance for Viral Hepatitis – United States, 2017 Available from: https://www.cdc.gov/hepatitis/statistics/2017surveillance/index.htm
Adelodun B, Ajibade FO, Ighalo JO, et al. Assessment of socioeconomic inequality based on virus-contaminated water usage in developing countries: a review. Environ Res 2021;192:110309. DOI: https://doi.org/10.1016/j.envres.2020.110309
Pérez-Sautu U, Costafreda MI, Lite J, et al. Molecular epidemiology of hepatitis A virus infections in Catalonia, Spain, 2005–2009: circulation of newly emerging strains. J Clin Virol 2011;52:98-102. DOI: https://doi.org/10.1016/j.jcv.2011.06.011
Pintó RM, Bosch A. Immunization recommendations against hepatitis A in Spain: Effectiveness of immunization in MSM and selection of antigenic variants – Authors' Reply. EbioMedicine 2019;45:21. DOI: https://doi.org/10.1016/j.ebiom.2019.06.028
Furlow B. Widespread hepatitis A outbreaks in the USA strain public health agencies. Lancet Gastroenterol Hepatol 2019;4:755-6. DOI: https://doi.org/10.1016/S2468-1253(19)30270-5
Zhou YH. Maternal immunisation and neonatal infection of hepatitis A or B virus. Lancet Infect Dis 2019;19:238. DOI: https://doi.org/10.1016/S1473-3099(19)30057-X
Zhang XS, Iacono GL. Estimating human-to-human transmissibility of hepatitis A virus in an outbreak at an elementary school in China, 2011. PloS One 2018;13:e0204201. DOI: https://doi.org/10.1371/journal.pone.0204201
Wu JB, Li XL, Zhang J, et al. Source identification through social networks in an epidemiological investigation of a hepatitis A outbreak at an elementary school in Anhui province, China. Epidemiol Infect 2014;142:1450-8. DOI: https://doi.org/10.1017/S0950268813002331
Xu YG, Cui FG, Zhuo JT, et al. An outbreak of hepatitis A associated with a contaminated well in a middle school, Guangxi, China. Western Pac Surveill Response J 2012;3:44–7. DOI: https://doi.org/10.5365/wpsar.2012.3.4.014
Andriati R, Indah FP, Pratiwi RD, et al. Determinant factors related to hepatitis A incidence outbreaks in Depok City, Indonesia. Malays J Med Health Sci 2020;16:84-7.
Retyono S, Rahardjo SS, Murti B. Multilevel analysis: Village does not have contextual effect on hepatitis A outbreak in Pacitan, East Java, Indonesia. J Epidemiol Public Health 2020;5:195-206. DOI: https://doi.org/10.26911/jepublichealth.2020.05.02.07
Harisma FB, Syahrul F, Mubawadi T, Mirasa YA. Analysis of hepatitis A outbreak in high school X Lamongan district 2018. Jurnal Berkala Epidemiologi 2018;6:112-21. DOI: https://doi.org/10.20473/jbe.V6I22018.112-121
Rahman FS. Hepatitis A outbreak in Jember Senior High School. Master Thesis, 2016.