Prevalence and associated factors of hepatitis A virus infection in Gaza strip during the 2023-2025 conflict.

BACKGROUND

Hepatitis A virus (HAV) remains a major public health concern in humanitarian settings, especially where water, sanitation, and hygiene (WASH) infrastructure is disrupted. This study aimed to estimate the prevalence of HAV and identify sanitation-related risk factors during the 2023-2025 conflict in the Gaza Strip.

METHODS

A cross-sectional online survey was conducted in Gaza between March and June 2025 including 440 participants. Participants aged ≥ 6 years were recruited through convenience sampling. The survey assessed sociodemographic factors, HAV diagnosis and symptoms, and WASH-related conditions. Data were analyzed using logistic regression to identify independent risk factors for HAV infection. STATA ver. 14.0 (Stata Corp., College Station, TX, USA) was used.

RESULTS

Among 440 participants (mean age 27.2 years, 57% female), 30.2% reported hepatitis A diagnosis during the 2023-2025 Gaza conflict. Infection was significantly higher among younger individuals and displaced populations, particularly residents of North Gaza. Living in shelters markedly increased infection risk (adjusted odds ratio [AOR] = 12.24; 95% CI: 4.66-32.15; p < 0.001). Poor sanitation conditions, including reliance on trucked water (AOR = 3.72; 95% CI: 1.19-11.60), inadequate handwashing before eating (AOR = 15.78; 95% CI: 6.24-39.89), and low satisfaction with toilet hygiene, were strongly associated with infection. Secondary education was protective (AOR = 0.30; 95% CI: 0.12-0.76). Interestingly, participants reporting rare access to clean drinking water had significantly lower odds of infection compared to those with consistent access (AOR = 0.12; 95% CI: 0.03-0.45).

CONCLUSIONS

The outbreak in Gaza highlights the urgent need for prioritized interventions. Immediate WASH measures, targeted vaccination programs, and improved hygiene infrastructure in conflict zones to mitigate disease spread.