Epidemiological Transition and Strategies for the Control of Hepatitis A in Serbia.

Background: Improvements in socioeconomic and hygienic conditions during the past decades led to declining hepatitis A (HA) seroprevalence in many countries. Aiming at informing HA vaccination policy, we assessed current epidemiological trends in Serbia by analyzing surveillance data for 2002-2021.

Methods: Data on cases and outbreaks were obtained from the Serbian national surveillance database and descriptively analyzed. HA incidence was calculated in relation to time, patients' residence, and demographics.

Results: Overall, 13,679 HA cases and 419 outbreaks were recorded with the highest incidence in the southeast. Downward HA trends were observed, while infant mortality was halved, and gross domestic product based on purchasing power parity (GDP PP) per capita, tripled. The average incidence dropped from 14.8 (95% CI 14.4-15.2)/100,000) in 2002-2006 to 1 (95% CI 0.9-1.1)/100,000)/100,000 in 2017-2021, while the number of outbreaks decreased (from 174 to 14). Sporadic cases and family clusters living in poor sanitary conditions occurred in recent years. The contact route of transmission was dominant (410/419, 97.9%). The highest average age-specific HA incidence shifted from 5-9 years in 2002-2006 to 10-19 years in 2017-2021.Serbia is transitioning towards very low HA endemicity. Enhanced surveillance and vaccination of high-risk groups are recommended as future public health priorities.