One Russian government respondent noted: “seroprevalence data for some regions show high antibodies; however, we do not have exact learn more data for most regions in different age groups.” Overall, the published epidemiological data in Russia were quite variable, suggesting variations in measurement, reporting, or interpretation [27], [28] and [29]. In Russia, the literature reported several outbreaks in cities [30] and following natural disasters [31], [32] and [33], some of which

were mentioned by respondents. In India and Mexico, respondents and the literature agreed that the hepatitis A epidemiological evidence is weak, but some respondents did not find this alarming. In India, two respondents said there were no epidemiologic data available: “[We have] no mortality, no morbidity, no estimates of economic loss for the poor. But the technical advisory groups need to have these

data to review to make decisions.” A few respondents noted recent studies not yet completed and published. The literature review confirmed the lack of recent seroprevalence data in most areas of India [34], [35], [36], [37], [38] and [39]. Meanwhile, several respondents believed hepatitis A disease is not in India and that seroprevalence in India has not changed: “We don’t have [data] and we really don’t need it.” Policy articles from 1995 through 2011, however, indicate a growing recognition of the epidemiological transition in India and the growing threat of outbreaks [40], [41], Enzalutamide [42], [43], [44], [45], [46] and [47]: “The epidemiological transition needs to be documented as well as the potential for outbreak; Kerala was one state with a recent outbreak.” A 2005 outbreak in Hyderabad suggested a change in adult seroprevalence, warranting further assessment for vaccination [48]. Currently, there

is no national Phosphoprotein phosphatase surveillance system to track outbreaks and the burden of hepatitis A in India. In Mexico, respondents noted there is no data by age group, geography, or socioeconomic status, or data capturing private immunizations, disease severity and the extent of fulminant disease. The overall body of Mexican literature on hepatitis A epidemiology was relatively small, with old (1996) seroprevalence data for Mexico City [49] and more recent data through 2006 for other areas [50], [51] and [52]. Older data suggest the initiation of the epidemiological transition in Mexico [53]. The majority of stakeholders in 5 out of 6 countries reported that economic and financial data were very important in the decision making process (Table 3). A government implementer in Mexico noted the Ministry of Health is “quite willing to have a discussion on hepatitis A; that is why we need cost-effectiveness [data].” However, the literature and internet search identified only 4 economic analyses on hepatitis A in the six countries.