Vaccine
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Data on the endemicity of hepatitis A virus (HAV) infection in Africa and the Middle East are scant, but most of Africa appears to remain a high endemicity region, with the exception of subpopulations in some areas, e.g. White people in South Africa. Saudi Arabia is a model for the Middle East, and is a country in which shifting HAV epidemiology has been documented in recent years, concurrent with the social and economic development that has occurred over the last two decades. ⋯ Seroprevalence is related to socioeconomic status, being highest in the lowest groups. Similar findings have been reported from other countries in the Middle East. The existence of pockets of high endemicity for HAV infection with surrounding areas shifting towards intermediate endemicity may lead to outbreaks, and widespread vaccination should be considered.
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The available data on prevalence of hepatitis B virus (HBV) infection in Latin America are incomplete and largely based on analysis of blood banks, which are not stratified by age or social class. An epidemiological study was recently undertaken in six countries in Latin America to update the data. The highest seroprevalence of antibody to the HBV core antigen (anti-HBc) was found in the Dominican Republic (21.4%), followed by Brazil (7.9%), Venezuela (3.2%) and Argentina (2.1%). ⋯ In both the Dominican Republic and Brazil, seroprevalence was high in childhood, and in Brazil and Argentina, anti-HBc was detected in 3.0-6.6% of children up to 1 year old, suggesting vertical transmission. Other risk factors included dental and surgical procedures, sexual activity and tattooing. There was an increase in seroprevalence in all countries at or after adolescence, suggesting that sexual activity is a major route of transmission.