Hepatitis A Virus Prevalence among Healthcare Students and Profissionals of Federal University of Bahia, Brazil

Research Article

Austin Hepatol. 2021; 6(1): 1014.

Hepatitis A Virus Prevalence among Healthcare Students and Profissionals of Federal University of Bahia, Brazils

Andrade J1,4,8, Freire SM2,5,6-8, Macedo LS1,6,8, de Souza Campos M2,3,5, Rego MAV1, Schaer RE2,6, Meyer R2,5,6,8,9, Simoes JM2,6, Parana R1,3,8, Schinoni MI1-3,8*

1Faculty of Medicine of Bahia, Brazil

2Institute of Health Sciences-Federal University of Bahia, Brazil

3University Hospital Professor Edgar Santos, Brazil

4Reference Center for Special Immunobiologicals, Brazil

5Graduate Program in Interactive Processes of Organs and Systems, Brazil

6Laboratory of Immunology and Molecular Biology-ICSUFBA, Brazil

7Bahiana School of Medicine and Public Health, Brazil

8CNPq Researcher, Brazil

*Corresponding author: Maria Isabel Schinoni, University Hospital Professor Edgar Santos, Institute of Health Sciences-Federal University of Bahia, Av, Prnicesa Isabel 86 Ap 1701, Barra Avenida, CEP 4014000, Salvador, Brazil

Received: December 01, 2020; Accepted: January 11, 2021; Published: January 18, 2021


Introduction: Hepatitis A Virus (HAV) is a hepatotrophic virus with oral-fecal transmission. Occupational exposition to the virus is not common in the health practice and this way of contagious is not considered as a risk of infection. Adults have more probability to have fulminate clinical manifestations and in Brazil, the most of population older than 20 years have had contact with this virus. Aim: to study the prevalence of antibodies anti A virus (IgGHAV) in students (group 1) and professionals (group 2) of the health area of the Federal University of Bahia (UFBA). Methods: was studied IgGHAV in 335 seras from volunteers who had completed an epidemiological questionnaire. Results: Antibodies IgGHAV+ in 56, 1% of the sample and 43,9 % of the individuals were susceptible to the infection. 94, 4% of the professional had IgGHAV+ and 48, 8% of the students had IgGHAV+ (p=0,000). There was an association between professional category and history of exposition to biological material (p=0,0017). There was not association between IgGHAV+ and history of exposition to biological material. This result could show the environment and occupational exposition to this virus. The more prevalence of IgGHAV titers in the professional individuals who were older shows the spread of the infection life through. Conclusion: this study showed that 43,9 % of the individual who start to work in contact with biological material are susceptible to the hepatitis A infection, this generate an new epidemiological reconsideration about the practice of vaccination in this special population in Brazil.

Keywords: Hepatitis A; Health personnel; Prevalence; Vacination


HAV: Hepatitis A Virus; HDI: Human Development Index; IBGE: Brazilian Institute of Geography and Statistics; UFBA: Federal University of Bahia; ICS: Institute of Health Sciences; SMURB: Rubens Brasil University Medical Service; CRIE-UFBA: Reference Center for Special Immunobiologicals; STD: Sexually Transmitted Disease


Infection with the hepatitis A virus (HAV) occurs worldwide, affecting approximately 1.4 million people per year [1]. Highly endemic regions are recognized, especially in South and Central America, Africa, the Middle East, Asia and the West Pacific coast [2]. Its prevalence is related to the low Human Development Index (HDI), due to the fact that it is transmitted via the fecal-oral route [3]. In these areas, epidemics are uncommon, since the adult population, where the disease manifests itself more severely, already has antibodies acquired in childhood due to early exposure to the virus [1]. According to the demographic census conducted in 2000 by the Brazilian Institute of Geography and Statistics (IBGE), more than half of the Brazilian municipalities do not have a sewage system (58.4%) [4], a fact that is directly related to the high prevalence of HAV. According to the demographic census conducted in 2010, 61.8% of Brazilian households were classified as “adequate” sanitation in a classification that involved the quality of the sewage system, water supply and waste disposal [5]. In South and Central America, according to population data from 1990, 162,000 new cases were estimated to occur each year [1]. In addition, a study carried out between 2001 and 2002 in nine centers in Latin America showed that hepatitis A was the main etiological agent of acute liver failure [6]. In Brazil, the Pan American Health Organization estimates that there are 130 new cases per year for every 100 thousand inhabitants and that more than 90% of the population over 20 years old has already had exposure to HAV [7]. Despite improvements in sanitation conditions, there is still a high circulation of HAV in Brazil, however population studies on the prevalence of HAV infection have been scarce in the country after the improvement in HDI over the past two decades [8]. The objective of this work was to study the seroprevalence of HAV in students and health professionals linked to the Federal University of Bahia (UFBA) and who work in a high-complexity hospital, therefore with a high risk of professional exposure.

Materials and Methods

It was a cross-sectional study with a sample of students and health professionals at UFBA. Students from medical, nursing and pharmacy courses participated, as well as professionals from the teaching units of the medical, nursing, pharmacy and multidisciplinary teaching units of the Institute of Health Sciences (ICS). The professional category included health professors, laboratory assistant technicians, nursing assistant technicians and technicians and employees responsible for hygiene, in pharmacy, medicine, nursing, physiotherapy and speech therapy and biology courses. The study excluded individuals from the administrative area without technical or higher education in health. Report of exposure to biological material was self-reported by the participants as any type of direct contact with at least one of the following biological materials: blood, saliva, pus, urine, feces, sputum, vomit, tissue, CSF. This study used the database obtained in the institutional vaccination campaign against Hepatitis B, carried out during 2007, which had the active participation and support of the boards of the teaching units of UFBA, of the Rubens Brasil Medical Service (SMURB) and the Reference Center for Special Immunobiologicals (CRIE-UFBA). During the campaign, the volunteers answered a clinical epidemiological survey and had their blood collected for analysis of the serological profile with the Anti- HAV IgG markers. The tests were performed by automation using the commercial ARCHITECT HAVAb IgG Reagent Kit for qualitative determination of the IgG antibody against HAV. The device used was Architect®. The clinical-epidemiological interview consisted of a questionnaire with socio-demographic variables such as age, gender, phenotypic “racial” self-classification, marital status and UFBA. For greater convenience, the questionnaire was divided into two parts. The first, applied by previously trained interviewers and the second, with questions of a private nature, which was self-applicable, which provided greater privacy to the participants.

The groups were categorized for analysis as follows:

1) Students x Professionals

2) Seropositive x Seronegative

3) Exposed to biological material x Not exposed

The data were analyzed using the statistical software SPSS version 13.0. Descriptive analysis of the data was performed and the Prevalence Ratios (PR) and respective 95% confidence intervals were calculated. The Chi-square test (Χ²) was applied to test the hypothesis of association between dichotomous variables. Stratified analysis was performed to control the average age and reports of exposure to biological material among students and professionals. The results were considered statistically significant with a value of p <0.05 or the null value was outside the confidence interval. The project was approved by the Research Ethics Committee of the Bahiana Foundation for the Development of Sciences, opinion nº 20/2004 and 36/2004.


335 blood samples were collected for analysis, 83.9% (281/335) students and 16.1% (54/335) professionals. Socio-demographic data can be found in (Table 1 & Graph 1). Among all participants, 69.9% (234/335) were women while 30.1% (101/335) were men. The average age of the sample was 25.44 years. The most prevalent ethnic group was “mulattos”, with 55.5% of the total, followed by “whites” with 27.2%, “blacks” with 15.2%, “indigenous” with 1.5% and “oriental” with 0.6% of the total number of volunteers. There was no significant difference in the prevalence of HAV between different ethnicities. Among the individuals evaluated of the total sample, 56.1% (188/335) presented IgG antibody positive for HAV and 43.9% (147/335) were negative. Among the professionals (n=54) working in health education and assistance, 94.4% (51/54) were seropositive, while in students (n=281), this seropositivity was 48.8% (137/281). This seropositivity relationship within the category proved to be relevant (p=0.000) for the professional category, (Table 2). When evaluating the entire sample, the stratified analysis of seropositivity by age indicated that older individuals had higher seropositivity for HAV, (Table 3). In addition, the Mann-Whitney statistical test revealed that the median age of individuals with a report of exposure biological material was significantly higher than the median age of those not exposed to these materials. When analyzing the average age in the category of those exposed to biological material, there was a higher average age among professionals (40.78+/-11.52), when compared to students (22.74+/-3.07) also with report of exposure to biological waste. In the non-exposed category, similar results were observed between these two classes, professionals (44.88+/-11.24) and students (21.64+/- 3.44). When analyzed the presence of exposure to biological material versus non-exposure between students and professionals, there was no age difference within each subcategory, student or professional. When HAV serology was evaluated, the presence of positive Anti- HAV IgG, it was observed that age in those exposed to biological materials was not a factor that contributed to the presence of these antibodies. Direct exposure to biological material was admitted by 69.2% (36/52) of health professionals and 50% (135/270) of students. There was a positive association (p=0.017) between reports of direct exposure to biological material and the professional category, with no positive association in the group of students, (Table 4). There was no statistically significant association (p=0.184) between reports of exposure to biological material and seropositivity for HAV, (Table 5). When the susceptibility (seronegativity to HAV) to exposure to HAV was evaluated in individuals in the health students category, it was found that among the 135 students who admitted contact with biological material, 66/135 (48.9%) were seronegative for the anti HAV IgG. On the other hand, among professionals, despite 36 out of 52 having admitted contact with biological material, seronegativity for this marker was only found in 3/36 (8.3%). This data demonstrates that there is considerable susceptibility in the group of students with reports of exposure to biological material. When assessing sexual habits, it was observed that among all HIV-positive individuals (188/335) for HAV, 98.9% (186/188) admitted to being heterosexual and only 1.1% (2/188) defined themselves as homo or bisexual. Of these HIV-positive people, 22.9% (43/188) had 3 or more sexual partners per year at some time in their lives; 14.4% (27/188) never or almost never used condoms in their sexual relationships; 2.7% (5/188) had sexual relations with sex workers and 7.4% (14/188) reported some Sexually Transmitted Disease (STD).