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Challenges to mapping the health risk of hepatitis A virus infection

Khayriyyah Mohd Hanafiah1, Kathryn H Jacobsen2* and Steven T Wiersma1

Author Affiliations

1 Expanded Program on Immunization, Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland

2 Department of Global & Community Health, George Mason University, 4400 University Drive MS 5B7, Fairfax, Virginia 22030, USA

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International Journal of Health Geographics 2011, 10:57  doi:10.1186/1476-072X-10-57

Published: 18 October 2011



World maps are among the most effective ways to convey public health messages such as recommended vaccinations, but creating a useful and valid map requires careful deliberation. The changing epidemiology of hepatitis A virus (HAV) in many world regions heightens the need for up-to-date risk maps. HAV infection is usually asymptomatic in children, so low-income areas with high incidence rates usually have a low burden of disease. In higher-income areas, many adults remain susceptible to the virus and, if infected, often experience severe disease.


Several challenges associated with presenting hepatitis A risk using maps were identified, including the need to decide whether prior infection or continued susceptibility more aptly indicates risk, whether to display incidence or prevalence, how to distinguish between different levels of risk, how to display changes in risk over time, how to present complex information to target audiences, and how to handle missing or obsolete data.


For future maps to be comparable across place and time, we propose the use of the age at midpoint of population susceptibility as a standard indicator for the level of hepatitis A endemicity within a world region. We also call for the creation of an accessible active database for population-based age-specific HAV seroprevalence and incidence studies. Health risk maps for other conditions with rapidly changing epidemiology would benefit from similar strategies.

hepatitis A; geographic information systems; health risk maps; risk mapping; vaccine recommendations; global health; travel health