Epidemiology and Prevalence

This viral hepatitis occurs worldwide, with variable prevalence. It is highest in countries where hygiene is poor and infection occurs year-round. In temperate climates, the peak incidence is in autumn and winter, but the trend is becoming less marked.

All age groups are susceptible if they are nonimmune or have not been vaccinated. In developing countries, the disease occurs in early childhood, whereas the reverse is true in countries where the standard of living is higher.

In the United Kingdom, there has been a gradual decrease in the number of reported cases from 1990 to 2000 (83,84). This results from, in part, improved standards of living and the introduction of an effective vaccine. The highest incidence occurs in the 15- to 34-year-old age group. Approximately 25% of people older than 40 years have natural immunity, leaving the remainder susceptible to infection (85).

Small clusters occur from time to time, associated with a breakdown in hygiene. There is also an increasing incidence of HAV in gay or bisexual men and their partners (86). An unpublished study in London in 1996 showed a seroprevalence of 23% among gay men (Young Y et al., unpublished).

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