Temporal Trends of Acute Hepatitis A in Brazil and Its Regions

Background: Hepatitis A is responsible for 126,000,000 cases of acute viral hepatitis distributed heterogeneously worldwide, with a high disability-adjusted life year (DALY) rate, especially in low-income countries. Data related to Hepatitis A provides information to improve control measures and identify the population at risk. This study aims to analyze temporal trends of Hepatitis A in Brazil and its regions from 2007 to 2018, based on official notification data. Methods: Data related to Hepatitis A reported cases from 2007 to 2018 were fitted to a joinpoint model by Brazilian regions, age groups, and gender, allowing the calculation of average annual percentage change (AAPC) and annual percentage change (APC) to estimate trends of Hepatitis A in Brazil. Findings: From 2007 to 2018, 65,284 Hepatitis A cases notified in Brazil were available for analysis. The Northeast Region reported 18,732 (28.69%) cases, followed by the North Region reporting 18,430 (28.23%), the Southeast Region reporting 14,073 (21.55%), the South Region reporting 7909 (12.11%), and the Central-West Region reporting 6140 (9.4%), respectively. Temporal trend analysis showed that Hepatitis A incidence decreased from 2007 to 2016 in all Brazilian regions for individuals less than 20 years old, but increased in the South and Southeast males between 20 to 39 years after 2016. Conclusions: Hepatitis A endemicity is heterogeneous among Brazilian regions. In addition, an unexpected outbreak of HAV among Southeast and South adult males in 2016 resembles the outbreak in Europe, revealing a vulnerable population that should be prioritized by vaccination programs and control measures.