Estimation of Hepatitis A Virus Infection Prevalence Among Eastern Mediterranean and Middle Eastern Countries: A Systematic Review and Pooled Analysis

Context: Hepatitis A virus (HAV) infection is the most common type of acute viral hepatitis that has been proposed as an important public health issue. Most of the countries in WHO Eastern Mediterranean region (EMR) and Middle East (ME) have a high endemicity of HAV infection. To provide a comprehensive estimation of the epidemiology of HAV in this region, we carried out a systematic review on the literature reporting the prevalence of HAV infection in the EMR and ME..
Evidence Acquisition: We conducted a systematic search in the databases including PubMed, Scopus, Science Direct, and Web of science using appropriate search strategies. Observational studies published between January 1990 and July 2016 with clearly stated data regarding HAV Ab (IgG) in non-high-risk groups from countries of EMR and ME were examined. We estimated the prevalence of HAV infection and 95% confidence interval based on the pooled data from all included studies for each country, and the regions were weighted according to the population size of each country in that region..
The HAV prevalence in ME, WHO EMR, and in total was 61.60 (61.31 - 61.89), 65.74 (65.39 - 66.09), and 62.60 (62.32 - 62.89), respectively. We found no eligible study for Bahrain, Djibouti, Libya, Oman, Qatar, and Sudan. Cyprus had the lowest prevalence rate of HAV (2.61% (1.53 - 4.17)) that along with UAE and Kuwait, it had a prevalence rate below 50%. The most HAV prevalence rates were related to Afghanistan (99.01 (95.51 - 99.89)), Iraq (96.35 (95.97 - 96.70)), Somalia (96.00 (94.16 - 97.33)), and Palestine (93.70 (90.96 - 95.77)), in sequence..
The countries of EMR and ME need more and constant programs for prevention and control of HAV infection. Also, further primary original epidemiological studies are needed in some countries of the region..