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Savage RD, Rosella LC, Brown KA, Khan K, Crowcroft NS. Underreporting of hepatitis A in non-endemic countries: a systematic review and meta-analysis. BMC Infect Dis 2016; 16:281. [PMID: 27297559 PMCID: PMC4906888 DOI: 10.1186/s12879-016-1636-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/07/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Information on reporting completeness of passive surveillance systems can improve the quality of and public health response to surveillance data and better inform public health planning. As a result, we systematically reviewed available literature on reporting completeness of hepatitis A in non-endemic countries. METHODS We searched Medline, EMBASE and grey literature sources, restricting to studies published in English between 1997 and 21 May 2015. Primary studies on hepatitis A surveillance and underreporting in non-endemic countries were included, and assessed for risk of bias. A pooled proportion of reporting completeness was estimated using a DerSimonian-Laird random-effects model. RESULTS Diagnosed hepatitis A cases identified through positive laboratory tests, physician visits, and inpatient hospital discharges were underreported to public health in all eight included studies. Reporting completeness ranged from 4 to 97 % (pooled proportion 59 %, 95 % confidence interval = 32 %, 84 %). Substantial heterogeneity was observed, which may be explained by differences in the referent data sources used to identify diagnosed cases and in case reporting mechanisms and/or staffing infrastructure. Completeness was improved in settings where case reporting was automated or where dedicated staff had clear reporting responsibilities. CONCLUSIONS Future studies that evaluate reporting completeness should describe the context, components, and operations of the surveillance system being evaluated in order to identify modifiable characteristics that improve system sensitivity and utility. Additionally, reporting completeness should be assessed across high risk groups to inform equitable allocation of public health resources and evaluate the effectiveness of targeted interventions.
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Affiliation(s)
- Rachel D. Savage
- />Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th Floor, Toronto, Ontario M5T 3M7 Canada
| | - Laura C. Rosella
- />Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th Floor, Toronto, Ontario M5T 3M7 Canada
- />Public Health Ontario, 480 University Ave, Suite 300, Toronto, Ontario M5G 1V2 Canada
- />Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Avenue G1 06, Toronto, Ontario M4N 3M5 Canada
| | - Kevin A. Brown
- />Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th Floor, Toronto, Ontario M5T 3M7 Canada
| | - Kamran Khan
- />St. Michael’s Hospital, 30 Bond St, Toronto, Ontario M5B 1W8 Canada
- />Department of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir #3172, Toronto, Ontario M5S 1A8 Canada
- />Department of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, Ontario M5T 3M7 Canada
| | - Natasha S. Crowcroft
- />Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th Floor, Toronto, Ontario M5T 3M7 Canada
- />Public Health Ontario, 480 University Ave, Suite 300, Toronto, Ontario M5G 1V2 Canada
- />Department of Laboratory Medicine and Pathobiology, University of Toronto, Medical Sciences Building, 6th Floor, 1 King’s College Cir, Toronto, Ontario M5S 1A8 Canada
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202
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Melhem N, Kreidieh K, Ramia S. The Syrian refugees crisis brings challenges to the health authorities in Europe: hepatitis A virus is a case in point. Eur J Epidemiol 2016; 31:711-4. [PMID: 27194123 PMCID: PMC7088383 DOI: 10.1007/s10654-016-0163-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/12/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Nada Melhem
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, P.O Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Khalil Kreidieh
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, P.O Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Sami Ramia
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, P.O Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
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203
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Pinheiro RS, Araújo LAD, Caetano KAA, Matos MAD, Carneiro MADS, Teles SA. INTERMEDIATE ENDEMICITY OF HEPATITIS A VIRUS INFECTION IN RURAL SETTLEMENT PROJECTS OF SOUTHWEST GOIÁS, BRAZIL. ARQUIVOS DE GASTROENTEROLOGIA 2016; 52:200-3. [PMID: 26486287 DOI: 10.1590/s0004-28032015000300009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/01/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rural populations present an elevated risk of exposure to hepatitis A virus. OBJECTIVE The objective of this study was to estimate the prevalence and risk factors associated with hepatitis A virus infection among residents of rural settlement projects of southwest Goiás, Central Brazil. METHODS A total of 466 residents were interviewed and tested for the detection of anti- hepatitis A virus antibodies by ELISA. RESULTS The global prevalence of anti- hepatitis A virus was 82.2%. In individuals aged 5-9 years and 10-19 years, the prevalence was 15% and 58.8%, respectively. Persons in the 10-19 age group, with a history of life in encampments, with more than five people per residence consuming well water, were predictors for exposure to hepatitis A virus. CONCLUSION Our results suggest that the hepatitis A virus endemicity in rural settlements in southwest Goiás similar to that found in the urban population of the Midwest Region, confirming the implementation of universal hepatitis A vaccination in children.
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204
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Manka P, Verheyen J, Gerken G, Canbay A. Liver Failure due to Acute Viral Hepatitis (A-E). Visc Med 2016; 32:80-5. [PMID: 27413724 PMCID: PMC4926881 DOI: 10.1159/000444915] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Viral hepatitis is still one of the key causes of acute liver failure (ALF) in the world. METHODS A selective literature search of the PubMed database was conducted, including current studies, reviews, meta-analyses, and guidelines. We obtained an overview of ALF due to viral hepatitis in terms of epidemiology, course, and treatment options. RESULTS Most fulminant viral courses are reported after infection with hepatitis A, B, and B/D, but not with hepatitis C. Hepatitis E is also known to cause ALF but has not gained much attention in recent years. However, more and more autochthonous hepatitis E virus infections have been recently observed in Europe. Reactivation of hepatitis B virus (HBV) under immunosuppressive conditions, such as after intensive chemotherapy, is also an increasing problem. For most viral-induced cases of ALF, liver transplantation represented the only therapeutic option in the past. Today, immediate treatment of HBV-induced ALF with nucleotide or nucleoside analogs is well tolerated and beneficially affects the course of the disease. CONCLUSION Although numbers in Western European countries are decreasing rapidly, reliable diagnostic screening for hepatitis A-E is necessary to identify the etiology and to determine those most at risk of developing ALF.
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Affiliation(s)
- Paul Manka
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
- Regeneration and Repair Group, The Institute of Hepatology, Foundation for Liver Research, London, UK
- Division of Transplantation Immunology and Mucosal Biology, King's College, London, UK
| | - Jens Verheyen
- Institute of Virology, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Ali Canbay
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
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205
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Declining Trend of Hepatitis A Seroepidemiology in Association with Improved Public Health and Economic Status of Thailand. PLoS One 2016; 11:e0151304. [PMID: 27008531 PMCID: PMC4805277 DOI: 10.1371/journal.pone.0151304] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 02/25/2016] [Indexed: 02/07/2023] Open
Abstract
Hepatitis A virus (HAV) is transmitted via the fecal-oral route from contaminated food or water. As part of the most recent survey of viral hepatitis burden in Thailand, we analyzed the current seroprevalence of HAV in the country and compared with data dating back to 1971. From March to October, 2014, a total of 4,260 individuals between one month and 71 years of age from different geographical regions (North = 961; Central = 1,125; Northeast = 1,109; South = 1,065) were screened for anti-HAV IgG antibody using an automated chemiluminescent microparticle immunoassay. Overall, 34.53% (1,471/4,260) possessed anti-HAV IgG antibody, and the age-standardized seroprevalence was 48.6%. Seroprevalence rates were 27.3% (North), 30.8% (Central), 33.8% (Northeast) and 45.8% (South) and were markedly lower than in the past studies especially among younger age groups. The overall trend showed an increase in the age by which 50% of the population were anti-HAV IgG antibody: 4.48 years (1971–1972), 6 (1976), 12.49 (1990), 36.02 (2004) and 42.03 (2014).This suggests that Thailand is transitioning from low to very low HAV endemicity. Lower prevalence of HAV correlated with improved healthcare system as measured by decreased infant mortality rate and improved national economy based on increased GDP per capita. The aging HAV immuno-naïve population may be rendered susceptible to potential HAV outbreaks similar to those in industrialized countries and may benefit from targeted vaccination of high-risk groups.
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206
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Taha TE, Rusie LK, Labrique A, Nyirenda M, Soko D, Kamanga M, Kumwenda J, Farazadegan H, Nelson K, Kumwenda N. Seroprevalence for Hepatitis E and Other Viral Hepatitides among Diverse Populations, Malawi. Emerg Infect Dis 2016; 21:1174-82. [PMID: 26079666 PMCID: PMC4480384 DOI: 10.3201/eid2107.141748] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Analysis of blood samples collected over 20 years suggests substantial underestimation of this virus in this country. Data on prevalence of hepatitis E virus (HEV) in Malawi is limited. We tested blood samples from HIV-uninfected and -infected populations of women and men enrolled in research studies in Malawi during 1989–2008 to determine the seroprevalence of HEV, hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Samples were tested for IgG against HEV, total antibodies against HAV and HCV, and presence of HBV surface antigens. Of 800 samples tested, 16.5% were positive for HEV IgG, 99.6% were positive for HAV antibodies, 7.5% were positive for HBV surface antigen, and 7.1% were positive for HCV antibodies. No clear trends over time were observed in the seroprevalence of HEV, and HIV status was not associated with hepatitis seroprevalence. These preliminary data suggest that the seroprevalence of HEV is high in Malawi; the clinical effects may be unrecognized or routinely misclassified.
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207
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Ogholikhan S, Schwarz KB. Hepatitis Vaccines. Vaccines (Basel) 2016; 4:E6. [PMID: 26978406 PMCID: PMC4810058 DOI: 10.3390/vaccines4010006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/11/2016] [Accepted: 01/14/2016] [Indexed: 12/22/2022] Open
Abstract
Viral hepatitis is a serious health problem all over the world. However, the reduction of the morbidity and mortality due to vaccinations against hepatitis A and hepatitis B has been a major component in the overall reduction in vaccine preventable diseases. We will discuss the epidemiology, vaccine development, and post-vaccination effects of the hepatitis A and B virus. In addition, we discuss attempts to provide hepatitis D vaccine for the 350 million individuals infected with hepatitis B globally. Given the lack of a hepatitis C vaccine, the many challenges facing the production of a hepatitis C vaccine will be shown, along with current and former vaccination trials. As there is no current FDA-approved hepatitis E vaccine, we will present vaccination data that is available in the rest of the world. Finally, we will discuss the existing challenges and questions facing future endeavors for each of the hepatitis viruses, with efforts continuing to focus on dramatically reducing the morbidity and mortality associated with these serious infections of the liver.
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Affiliation(s)
- Sina Ogholikhan
- Division of Pediatric Gastroenterology and Nutrition, Pediatric Liver Center, Johns Hopkins Medical Institutions, CMSC 2-125, 600 North Wolfe Street, Baltimore, MD 21287, USA.
| | - Kathleen B Schwarz
- Division of Pediatric Gastroenterology and Nutrition, Pediatric Liver Center, Johns Hopkins Medical Institutions, CMSC 2-125, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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208
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Weseslindtner L, Macheleidt I, Eischeid H, Strassl R, Hofer H, Popow-Kraupp T, Dienes HP, Holzmann H, Odenthal M. Micro RNAs mir-106a, mir-122 and mir-197 are increased in severe acute viral hepatitis with coagulopathy. Liver Int 2016; 36:353-60. [PMID: 26352910 DOI: 10.1111/liv.12961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/03/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The severity of acute viral hepatitis, which may be caused by several distinct viruses, varies among individual patients. In rare cases, severe hepatic injury with sudden loss of liver function may occur, which is clinically indicated by the occurrence of coagulopathy or encephalopathy. As the molecular mechanisms of this liver injury are largely unknown, we investigated extracellular micro RNA (miRNA) profiles in 54 patients acutely infected with one of four different hepatotropic viruses, in order to identify those miRNAs which indicate severe viral hepatitis associated with coagulopathy. METHODS First, the profile of miRNAs was extensively analysed using a microarray-based approach in highly characterized 24 patients, matched in terms of sex, age and level of liver enzymes, as well as in three healthy controls. The cohort included samples from 18 patients with moderate and six individuals with severe hepatitis, indicated by abnormal prothrombin time and higher alanine aminotransferase and bilirubin levels. miRNAs found to be upregulated in severe hepatitis were then quantified by real-time PCR in the expanded cohort of 54 patients. RESULTS Comprehensive microarray-based miRNA profiling identified upregulation of mir-106a, mir-122 and mir-197 in patients with severe acute viral hepatitis with coagulopathy, as compared to patients who did not develop coagulopathy. mir-106a, mir-122 and mir-197 were then proven to be significantly upregulated in patients with severe acute viral hepatitis by quantitative real-time PCR (P < 0.01, Mann-Whitney U-test). CONCLUSIONS mir-106a, mir-122 and mir-197 could be potential markers for severe acute viral hepatitis associated with coagulopathy.
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Affiliation(s)
| | - Iris Macheleidt
- Institute for Pathology, University Hospital of Cologne, Cologne, Germany
| | - Hannah Eischeid
- Institute for Pathology, University Hospital of Cologne, Cologne, Germany
| | - Robert Strassl
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Harald Hofer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Theresia Popow-Kraupp
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Hans-Peter Dienes
- Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | | | - Margarete Odenthal
- Institute for Pathology, University Hospital of Cologne, Cologne, Germany
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209
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Bessone F, Hernandez N, Lucena MI, Andrade RJ. The Latin American DILI Registry Experience: A Successful Ongoing Collaborative Strategic Initiative. Int J Mol Sci 2016; 17:313. [PMID: 26938524 PMCID: PMC4813176 DOI: 10.3390/ijms17030313] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 02/07/2023] Open
Abstract
Drug induced liver injury (DILI) is a rare but well recognized serious adverse reaction. Pre-marketing studies may not detect liver injury, and DILI becomes very often apparent after the drug is launched to the market. Specific biomarkers for DILI prediction or diagnosis are not available. Toxic liver reactions present with a wide spectrum of phenotypes and severity, and our knowledge on the mechanisms underlying idiosyncratic reactions and individual susceptibility is still limited. To overcome these limitations, country-based registries and multicenter research networks have been created in Europe and North America. Reliable epidemiological data on DILI in Latin America (LA), a region with a large variety of ethnic groups, were however lacking. Fortunately, a LA network of DILI was set up in 2011, with the support of the Spanish DILI Registry from the University of Malaga. The primary aim of the Latin DILI Network (LATINDILIN) Registry was to prospectively identify bona fide DILI cases and to collect biological samples to study genetic biomarkers. Physicians involved in the project must complete a structured report form describing the DILI case presentation and follow-up which is submitted to a Coordinator Center in each country, where it is further assessed for completeness. During the last four years, several LA countries (Argentina, Uruguay, Chile, Mexico, Paraguay, Brazil, Ecuador, Peru, Venezuela and Colombia) have joined the network and committed with this project. At that point, to identify both our strengths and weaknesses was a very important issue. In this review, we will describe how the LATINDILI Registry was created. The aims and methods to achieve these objectives will be discussed in depth. Additionally, both the difficulties we have faced and the strategies to solve them will be also pinpointed. Finally, we will report on our preliminary results, and discuss ideas to expand and to keep running this network.
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Affiliation(s)
- Fernando Bessone
- Hospital Provincial del Centenario, University of Rosario School of Medicine, Urquiza 3101, 2000 Rosario, Argentina.
| | - Nelia Hernandez
- Hospital de Clínicas, Facultad de Medicina, UdelaR, Av Italia s/n, 11600 Montevideo, Uruguay.
| | - M Isabel Lucena
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, CIBERehd, Blvd. L Pasteur 32, 29071 Málaga, Spain.
| | - Raúl J Andrade
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, CIBERehd, Blvd. L Pasteur 32, 29071 Málaga, Spain.
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210
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Yu JM, Li LL, Zhang CY, Lu S, Ao YY, Gao HC, Xie ZP, Xie GC, Sun XM, Pang LL, Xu JG, Lipkin WI, Duan ZJ. A novel hepatovirus identified in wild woodchuck Marmota himalayana. Sci Rep 2016; 6:22361. [PMID: 26924426 PMCID: PMC4770319 DOI: 10.1038/srep22361] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/12/2016] [Indexed: 12/31/2022] Open
Abstract
Hepatitis A virus (HAV) is a hepatotropic picornavirus that causes acute liver disease worldwide. Here, we report on the identification of a novel hepatovirus tentatively named Marmota Himalayana hepatovirus (MHHAV) in wild woodchucks (Marmota Himalayana) in China. The genomic and molecular characterization of MHHAV indicated that it is most closely related genetically to HAV. MHHAV has wide tissue distribution but shows tropism for the liver. The virus is morphologically and structurally similar to HAV. The pattern of its codon usage bias is also consistent with that of HAV. Phylogenetic analysis indicated that MHHAV groups with known HAVs but forms an independent branch, and represents a new species in the genus Hepatovirus within the family Picornaviridae. Antigenic site analysis suggested MHHAV has a new antigenic property to other HAVs. Further evolutionary analysis of MHHAV and primate HAVs led to a most recent common ancestor estimate of 1,000 years ago, while the common ancestor of all HAV-related viruses including phopivirus can be traced back to 1800 years ago. The discovery of MHHAV may provide new insights into the origin and evolution of HAV and a model system with which to explore the pathogenesis of HAV infection.
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Affiliation(s)
- Jie-mei Yu
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Li-li Li
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Cui-yuan Zhang
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Shan Lu
- National Institute for Communicable Disease Control and Prevention, China CDC, Beijing, China
| | - Yuan-yun Ao
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Han-chun Gao
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Zhi-ping Xie
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Guang-cheng Xie
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Xiao-man Sun
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Li-li Pang
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Jian-guo Xu
- National Institute for Communicable Disease Control and Prevention, China CDC, Beijing, China
| | - W Ian Lipkin
- Center for Infection and Immunity, Columbia University, New York, NY, USA
| | - Zhao-Jun Duan
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
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211
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Bruni R, Taffon S, Equestre M, Chionne P, Madonna E, Rizzo C, Tosti ME, Alfonsi V, Ricotta L, De Medici D, Di Pasquale S, Scavia G, Pavoni E, Losio MN, Romanò L, Zanetti AR, Morea A, Pacenti M, Palù G, Capobianchi MR, Chironna M, Pompa MG, Ciccaglione AR. Key Role of Sequencing to Trace Hepatitis A Viruses Circulating in Italy During a Large Multi-Country European Foodborne Outbreak in 2013. PLoS One 2016; 11:e0149642. [PMID: 26901877 PMCID: PMC4764681 DOI: 10.1371/journal.pone.0149642] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/03/2016] [Indexed: 12/15/2022] Open
Abstract
Background Foodborne Hepatitis A Virus (HAV) outbreaks are being recognized as an emerging public health problem in industrialized countries. In 2013 three foodborne HAV outbreaks occurred in Europe and one in USA. During the largest of the three European outbreaks, most cases occurred in Italy (>1,200 cases as of March 31, 2014). A national Task Force was established at the beginning of the outbreak by the Ministry of Health. Mixed frozen berries were early demonstrated to be the source of infection by the identity of viral sequences in patients and in food. In the present study the molecular characterization of HAV isolates from 355 Italian cases is reported. Methods Molecular characterization was carried out by PCR/sequencing (VP1/2A region), comparison with reference strains and phylogenetic analysis. Results A unique strain was responsible for most characterized cases (235/355, 66.1%). Molecular data had a key role in tracing this outbreak, allowing 110 out of the 235 outbreak cases (46.8%) to be recognized in absence of any other link. The data also showed background circulation of further unrelated strains, both autochthonous and travel related, whose sequence comparison highlighted minor outbreaks and small clusters, most of them unrecognized on the basis of epidemiological data. Phylogenetic analysis showed most isolates from travel related cases clustering with reference strains originating from the same geographical area of travel. Conclusions In conclusion, the study documents, in a real outbreak context, the crucial role of molecular analysis in investigating an old but re-emerging pathogen. Improving the molecular knowledge of HAV strains, both autochthonous and circulating in countries from which potentially contaminated foods are imported, will become increasingly important to control outbreaks by supporting trace back activities, aiming to identify the geographical source(s) of contaminated food, as well as public health interventions.
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Affiliation(s)
- Roberto Bruni
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
- * E-mail:
| | - Stefania Taffon
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Michele Equestre
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Paola Chionne
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Elisabetta Madonna
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Caterina Rizzo
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Maria Elena Tosti
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Valeria Alfonsi
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Lara Ricotta
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Dario De Medici
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Simona Di Pasquale
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Gaia Scavia
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Enrico Pavoni
- Reparto tecnologia acidi nucleici applicata agli alimenti, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, Brescia, Italy
| | - Marina Nadia Losio
- Reparto tecnologia acidi nucleici applicata agli alimenti, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, Brescia, Italy
| | - Luisa Romanò
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Anna Morea
- Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Monia Pacenti
- Microbiology and Virology Unit, Padua University Hospital, Padua, Italy
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | | | - Maria Chironna
- Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Maria Grazia Pompa
- Directorate General for Preventive Health Care, Ministry of Health, Rome, Italy
| | - Anna Rita Ciccaglione
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
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Abstract
PURPOSE OF REVIEW Transmission of hepatitis A virus (HAV) infection is primarily fecal-oral. Symptomatic hepatitis, severe disease, and death are more likely to occur when infection occurs at an older age. Improvements in socioeconomic and hygienic conditions have led to a change in its epidemiology worldwide. RECENT FINDINGS In the last two decades, improved hygiene in several resource-poor countries has led to reduced transmission of HAV, an increase in average age at infection, and, consequently, a paradoxical increase in morbidity and mortality because of hepatitis A. In Argentina, introduction of one dose (instead of the conventional two doses, to reduce costs) of inactivated HAV vaccine at 12-month age in a universal childhood immunization program during such 'epidemiologic transition' has markedly reduced the incidence of symptomatic hepatitis A, and of fulminant hepatitis and liver transplantation caused by HAV infection. The monetary value of medical and nonmedical benefits of this strategy outweighed the expenditure on vaccination. These excellent results were possibly contingent upon a high vaccination coverage. SUMMARY Resource-poor countries should closely monitor the epidemiology of HAV infection and periodically undertake cost-effectiveness analyses of HAV immunization strategies. This should allow timely identification of epidemiologic transition and introduction of preventive strategies before HAV infection becomes a public health problem.
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Murphy TV, Denniston MM, Hill HA, McDonald M, Klevens MR, Elam-Evans LD, Nelson NP, Iskander J, Ward JD. Progress Toward Eliminating Hepatitis A Disease in the United States. MMWR Suppl 2016; 65:29-41. [PMID: 26916458 DOI: 10.15585/mmwr.su6501a6] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Hepatitis A virus (HAV) disease disproportionately affects adolescents and young adults, American Indian/Alaska Native and Hispanic racial/ethnic groups, and disadvantaged populations. During 1996-2006, the Advisory Committee on Immunization Practices (ACIP) made incremental changes in hepatitis A (HepA) vaccination recommendations to increase coverage for children and persons at high risk for HAV infection. This report examines the temporal association of ACIP-recommended HepA vaccination and disparities (on the absolute scale) in cases of HAV disease and on seroprevalence of HAV-related protection (measured as antibody to HAV [anti-HAV]). ACIP-recommended childhood HepA vaccination in the United States has eliminated most absolute disparities in HAV disease by age, race/ethnicity, and geographic area with relatively modest ≥1-dose and ≥2-dose vaccine coverage. However, the increasing proportion of cases of HAV disease among adults with identified and unidentified sources of exposure underscores the importance of considering new strategies for preventing HAV infection among U.S. adults. For continued progress to be made toward elimination of HAV disease in the United States, additional strategies are needed to prevent HAV infection among an emerging population of susceptible adults. Notably, HAV infection remains endemic in much of the world, contributing to U.S. cases through international travel and the global food economy.
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Affiliation(s)
- Trudy V Murphy
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
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214
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Shimakawa Y, Njai HF, Takahashi K, Berg L, Ndow G, Jeng-Barry A, Ceesay A, Tamba S, Opoku E, Taal M, Akbar SMF, Arai M, D'Alessandro U, Taylor-Robinson SD, Njie R, Mishiro S, Thursz MR, Lemoine M. Hepatitis E virus infection and acute-on-chronic liver failure in West Africa: a case-control study from The Gambia. Aliment Pharmacol Ther 2016; 43:375-84. [PMID: 26623967 DOI: 10.1111/apt.13484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/17/2015] [Accepted: 11/04/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND In sub-Saharan Africa, it is unknown whether hepatitis E virus (HEV) infection is a common precipitating event of acute-on-chronic liver failure (ACLF). AIMS To estimate the prevalence of HEV infection in general population and assess whether HEV is a common trigger of ACLF in cirrhotic patients in The Gambia, West Africa. METHODS We first conducted an HEV sero-survey in healthy volunteers. We then tested cirrhotic patients with ACLF (cases) and compensated cirrhosis (controls) for anti-HEV IgG as a marker of exposure to HEV, and anti-HEV IgA and HEV RNA as a marker of recent infection. We also described the characteristics and survival of the ACLF cases and controls. RESULTS In the healthy volunteers (n = 204), 13.7% (95% CI: 9.6-19.2) were positive for anti-HEV IgG, and none had positive HEV viraemia. After adjusting for age and sex, the following were associated with positive anti-HEV IgG: being a Christian, a farmer, drinking water from wells, handling pigs and eating pork. In 40 cases (median age: 45 years, 72.5% male) and 71 controls (39 years, 74.6% male), ≥70% were infected with hepatitis B virus. Although hepatitis B flare and sepsis were important precipitating events of ACLF, none had marker of acute HEV. ACLF cases had high (70.0%) 28-day mortality. CONCLUSIONS Hepatitis E virus infection is endemic in The Gambia, where both faecal-oral route (contaminated water) and zoonotic transmission (pigs/pork meat) may be important. However, acute HEV was not a common cause of acute-on-chronic liver failure in The Gambia.
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Affiliation(s)
- Y Shimakawa
- MRC Unit The Gambia, Banjul, The Gambia.,Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - H F Njai
- MRC Unit The Gambia, Banjul, The Gambia
| | - K Takahashi
- Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan
| | - L Berg
- MRC Unit The Gambia, Banjul, The Gambia.,Hepatology Unit, Department of Medicine, Imperial College London, London, UK
| | - G Ndow
- MRC Unit The Gambia, Banjul, The Gambia.,Hepatology Unit, Department of Medicine, Imperial College London, London, UK
| | | | - A Ceesay
- MRC Unit The Gambia, Banjul, The Gambia
| | - S Tamba
- MRC Unit The Gambia, Banjul, The Gambia
| | - E Opoku
- MRC Unit The Gambia, Banjul, The Gambia.,Hepatology Unit, Department of Medicine, Imperial College London, London, UK
| | - M Taal
- Ministry of Health and Social Welfare, Banjul, The Gambia
| | - S M F Akbar
- Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan
| | - M Arai
- Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan
| | | | - S D Taylor-Robinson
- Hepatology Unit, Department of Medicine, Imperial College London, London, UK
| | - R Njie
- MRC Unit The Gambia, Banjul, The Gambia.,The Gambia Hepatitis Intervention Study, IARC, c/o MRC Unit, Banjul, The Gambia
| | - S Mishiro
- Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan
| | - M R Thursz
- Hepatology Unit, Department of Medicine, Imperial College London, London, UK
| | - M Lemoine
- MRC Unit The Gambia, Banjul, The Gambia.,Hepatology Unit, Department of Medicine, Imperial College London, London, UK
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215
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Hesamizadeh K, Sharafi H, Keyvani H, Alavian SM, Najafi-Tireh Shabankareh A, Sharifi Olyaie R, Keshvari M. Hepatitis A Virus and Hepatitis E Virus Seroprevalence Among Blood Donors in Tehran, Iran. HEPATITIS MONTHLY 2016; 16:e32215. [PMID: 27110256 PMCID: PMC4834187 DOI: 10.5812/hepatmon.32215] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/08/2015] [Accepted: 11/08/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are both transmitted by the fecal-oral route and are known as the leading causes of acute viral hepatitis in the world, especially in developing countries. There is a lack of updated data on HAV and HEV seroprevalence in Iran. OBJECTIVES The aim of this study was to determine the seroprevalence of HAV and HEV among a group of blood donors in Tehran, Iran. MATERIALS AND METHODS A cross-sectional study was performed from July 2014 to December 2014, on a total of 559 blood donors referred to the Tehran blood transfusion center. The serum samples were tested for antibodies to HAV and HEV, using the enzyme-linked immunosorbent assay. RESULTS In the present study, 536 (95.9%) cases were male and 23 (4.1%) female with mean age of 38 years. Out of 559 blood donors, 107 (19.1%) were first-time donors, 163 (29.2%) lapsed donors and 289 (51.7%) regular donors. Anti-HAV was found in 395 (70.7%) and anti-HEV in 45 (8.1%) of the blood donors. The HAV and HEV seroprevalence increased by age. There was no significant difference between genders in terms of anti-HAV and anti-HEV status. The HAV and HEV seroprevalence was significantly related to the level of education, where the donors with higher level of education had lower rate of HAV and HEV seroprevalence. The HAV and HEV seroprevalence was significantly higher in regular and lapsed donors than in first-time donors. CONCLUSIONS The present study showed that both HAV and HEV infections are still endemic in Iran.
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Affiliation(s)
- Khashayar Hesamizadeh
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Department of Medical Virology, Iran University of Medical Sciences, Tehran, IR Iran
| | - Heidar Sharafi
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Disease (MELD) Center, Tehran, IR Iran
| | - Hossein Keyvani
- Department of Medical Virology, Iran University of Medical Sciences, Tehran, IR Iran
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Disease (MELD) Center, Tehran, IR Iran
| | - Azar Najafi-Tireh Shabankareh
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Roghiyeh Sharifi Olyaie
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, IR Iran
| | - Maryam Keshvari
- Middle East Liver Disease (MELD) Center, Tehran, IR Iran
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, IR Iran
- Corresponding Author: Maryam Keshvari, Blood Transfusion Organization Research Center, Tehran, IR Iran. Tel: +98-218860150130, Fax: +98-2166900386, E-mail:
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216
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Yoon SH, Kim HW, Ahn JG, Kim IT, Kim JH, Kong KA, Kim KH. Reappraisal of the Immunogenicity and Safety of Three Hepatitis A Vaccines in Adolescents. J Korean Med Sci 2016; 31:73-9. [PMID: 26770041 PMCID: PMC4712583 DOI: 10.3346/jkms.2016.31.1.73] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/18/2015] [Indexed: 11/20/2022] Open
Abstract
Although the overall incidence of hepatitis A in Korea has been decreasing, adolescents remain highly vulnerable to its outbreaks. This study was conducted to compare the immunogenicity and safety of three hepatitis A vaccines in Korean adolescents. Healthy anti-hepatitis A virus seronegative subjects aged 13 to 19 yr were randomized in three equal groups to receive two doses of Avaxim™, Epaxal®, or Havrix®, 6 to 12 months apart. Seroconversion rates one month after the first dose were 98%, 95%, and 93% for Avaxim™, Epaxal®, and Havrix®, respectively. Seroconversion rates reached 100% for all vaccine groups one month after the second dose. Anti-HAV geometric mean concentrations (GMCs) were 7,207.7 mIU/mL (95% CI, 6023.1-8684.7), 1,750.5 mIU/mL (95% CI, 1362.9-2248.3), and 1,953.5 mIU/mL (95% CI, 1459.4-2614.7) after two doses of Avaxim™, Epaxal®, and Havrix® respectively. Avaxim™ was significantly more immunogenic than Epaxal® and Havrix®, whereas there were no significant differences in antibody responses between Epaxal® and Havrix®. Local and systemic solicited adverse events (AEs) were mostly of mild-to-moderate intensity and resolved within 5 days. No serious AEs were reported. In conclusion, all three vaccines are highly immunogenic and well-tolerated in Korean adolescents. (Clinical Trial Registry NCT00483470).
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Affiliation(s)
- Seo Hee Yoon
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
- Center for Vaccine Evaluation and Study, Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Han Wool Kim
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
- Center for Vaccine Evaluation and Study, Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jong Gyun Ahn
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
- Center for Vaccine Evaluation and Study, Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Korea
| | - In Tae Kim
- Seegene Medical Foundation, Seoul, Korea
| | - Jong-Hyun Kim
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | | | - Kyung-Hyo Kim
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
- Center for Vaccine Evaluation and Study, Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Korea
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217
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Van Effelterre T, Marano C, Jacobsen KH. Modeling the hepatitis A epidemiological transition in Thailand. Vaccine 2015; 34:555-562. [PMID: 26657185 DOI: 10.1016/j.vaccine.2015.11.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/26/2015] [Accepted: 11/19/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND In most low- and middle-income countries, hepatitis A virus (HAV) is shifting or expected to shift from high endemicity to intermediate or low endemicity. A decreased risk of HAV infection will cause an increase in the average age at infection and will therefore increase the proportion of infections that results in severe disease. Mathematical models can provide insights into the factors contributing to this epidemiological transition. METHODS An MSLIR compartmental dynamic transmission model stratified by age and setting (rural and urban) was developed and calibrated with demographic, environmental, and epidemiological data from Thailand. HAV transmission was modeled as a function of urbanization and access to clean drinking water. The model was used to project various epidemiological measures. RESULTS The age at midpoint of population immunity remains considerably younger in rural areas than in urban areas. The mean age of symptomatic hepatitis A infection in Thailand has shifted from childhood toward early adulthood in rural areas and is transitioning from early adulthood toward middle adulthood in urban areas. The model showed a significant decrease in incidence rates of total and symptomatic infections in rural and urban settings in Thailand over the past several decades as water access has increased, although the overall incidence rate of symptomatic HAV is projected to slightly increase in the coming decades. CONCLUSIONS Modeling the relationship between water, urbanization, and HAV endemicity is a novel approach in the estimation of HAV epidemiological trends and future projections. This approach provides insights about the shifting HAV epidemiology and could be used to evaluate the public health impact of vaccination and other interventions in a diversity of settings.
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Affiliation(s)
| | | | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
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218
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De Paschale M, Ceriani C, Romanò L, Cerulli T, Cagnin D, Cavallari S, Ndayake J, Zaongo D, Diombo K, Priuli G, Viganò P, Clerici P. Epidemiology of hepatitis E virus infection during pregnancy in Benin. Trop Med Int Health 2015; 21:108-113. [PMID: 26523476 DOI: 10.1111/tmi.12632] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Hepatitis E virus (HEV) is the cause of enterically transmitted non-A, non-C hepatitis (an infection that is particularly severe during pregnancy) in tropical and subtropical countries. As there are no published data concerning the prevalence of HEV antibodies in Benin, their presence was investigated in pregnant women undergoing routine HIV screening in a rural area in northern Benin and in pregnant women with acute non-A, non-C hepatitis. METHODS A total of 278 serum samples were collected from asymptomatic pregnant women in 2011 were tested for HEV and hepatitis A virus (HAV) antibodies, and the HEV IgM-positive samples were further tested for HEV-RNA. A further seven samples of pregnant women with acute non-A, non-C hepatitis collected during episodes of acute hepatitis in 2005 were also analysed. RESULTS Of the 278 samples collected in 2011, 16.19% were positive for HEV IgG and 1.44% for HEV IgM (none positive for HEV-RNA), and 99.64% were positive for total HAV antibodies (none positive for HAV IgM). Six of the seven samples collected in 2005 were positive for HEV IgG and IgM, and two were also positive for HEV-RNA. CONCLUSIONS The circulation of HEV infection is significant among pregnant women in Benin, in whom the consequences may be fatal.
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Affiliation(s)
| | | | - Luisa Romanò
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Debora Cagnin
- Microbiology Unit, Hospital of Legnano, Milan, Italy
| | | | | | | | | | | | - Paolo Viganò
- Infectious Diseases Department, Hospital of Legnano, Milan, Italy
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219
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Gupta E, Ballani N, Kumar M, Sarin SK. Role of non-hepatotropic viruses in acute sporadic viral hepatitis and acute-on-chronic liver failure in adults. Indian J Gastroenterol 2015; 34:448-52. [PMID: 26589230 DOI: 10.1007/s12664-015-0613-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/04/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acute viral hepatitis (AVH) is mostly caused by hepatitis E (HEV) and hepatitis A (HAV) viruses in India. This study was undertaken to find out the incidence of various hepatotropic and non-hepatotropic viruses in AVH and acute-on-chronic liver failure (ACLF) patients. METHODS Six-hundred and seventy-three adult patients of AVH and ACLF were screened for acute serological markers of hepatotropic (A, B, C, D, and E) and the non-hepatotropic cytomegalovirus (CMV) and Epstein-Barr virus (EBV). RESULTS Viral etiology profile in 295 samples with confirmed etiology were HEV in 155 (52.5 %); HAV in 43 (14.5 %); HBV in 35 (11.8 %); HCV in 1 (0.3 %); mixed viral etiology in 30 (10.1 %); and non-hepatotropic viruses, cytomegalovirus, and Epstein-Barr virus in 31 (10.5 %). Two-hundred and six patients (69.8 %) were AVH and 89 (30.1 %) ACLF. HEV was the commonest cause of infection in both the groups AVH (n = 95, 46.1 %) and ACLF (n = 60, 67.4 %). Twenty-nine (9.8 %) patients died on follow up; mortality was higher in ACLF (25/89, 28 %) than AVH group (4/206, 1.94 %; p < 0.001). The mortality was higher when HEV was the cause of acute event (20/29, 68.9 %). In AVH, mixed infection was more common as compared to ACLF (27 vs. 3, p < 0.001). Non-hepatotropic viruses contributed significantly higher infections in AVH as compared to ACLF (29 vs. 2, p = 0.002) patients. CONCLUSIONS HEV was an important cause of symptomatic hepatitis in both AVH and ACLF patients. Non-hepatotropic viruses like CMV and EBV were identified in a significant number of patients with AVH and much less frequently in ACLF.
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Affiliation(s)
- Ekta Gupta
- Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India.
| | - Neha Ballani
- Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Manoj Kumar
- Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Shiv Kumar Sarin
- Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
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220
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Tsatsralt-Od B, Baasanjav N, Nyamkhuu D, Ohnishi H, Takahashi M, Kobayashi T, Nagashima S, Nishizawa T, Okamoto H. Molecular analysis of hepatitis A virus strains obtained from patients with acute hepatitis A in Mongolia, 2004-2013. J Med Virol 2015; 88:622-30. [PMID: 26369542 DOI: 10.1002/jmv.24380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 01/22/2023]
Abstract
Despite the high endemicity of hepatitis A virus (HAV) in Mongolia, the genetic information on those HAV strains is limited. Serum samples obtained from 935 patients with acute hepatitis in Ulaanbaatar, Mongolia during 2004-2013 were tested for the presence of HAV RNA using reverse transcription-PCR with primers targeting the VP1-2B region (481 nucleotides, primer sequences at both ends excluded). Overall, 180 patients (19.3%) had detectable HAV RNA. These 180 isolates shared 94.6-100% identity and formed four phylogenetic clusters within subgenotype IA. One or three representative HAV isolates from each cluster exhibited 2.6-3.9% difference between clusters over the entire genome. Cluster 1 accounted for 65.0% of the total, followed by Cluster 2 (30.6%), Cluster 3 (3.3%), and Cluster 4 (1.1%). Clusters 1 and 2 were predominant throughout the observation period, whereas Cluster 3 was undetectable in 2009 and 2013 and Cluster 4 became undetectable after 2009. The Mongolian HAV isolates were closest to those of Chinese or Japanese origin (97.7-98.5% identities over the entire genome), suggesting the evolution from a common ancestor with those circulating in China and Japan. Further molecular epidemiological analyses of HAV infection are necessary to investigate the factors underlying the spread of HAV and to implement appropriate prevention measures in Mongolia.
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Affiliation(s)
- Bira Tsatsralt-Od
- National Institute of Medicine, Ministry of Health and Ministry of Science Education, Ulaanbaatar, Mongolia.,National Center for Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia
| | - Nachin Baasanjav
- National Institute of Medicine, Ministry of Health and Ministry of Science Education, Ulaanbaatar, Mongolia
| | - Dulmaa Nyamkhuu
- National Center for Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia
| | - Hiroshi Ohnishi
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Masaharu Takahashi
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Tominari Kobayashi
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Shigeo Nagashima
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Tsutomu Nishizawa
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiroaki Okamoto
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Tochigi, Japan
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221
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Kanyenda TJ, Abdullahi LH, Hussey GD, Kagina BM. Epidemiology of hepatitis A virus in Africa among persons aged 1-10 years: a systematic review protocol. Syst Rev 2015; 4:129. [PMID: 26419360 PMCID: PMC4589083 DOI: 10.1186/s13643-015-0112-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/08/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Africa is considered an area of high endemicity for hepatitis A virus infection. However, in the past two decades, tremendous progress has been made in improving water sources and sanitation which are risk factors for hepatitis A virus infection. Recent studies suggest that several African countries could be in epidemiological transitions due to the evident socio-economic development. As a result, there may be a decrease in the exposure to and infection with hepatitis A virus at an early age. Understanding and mapping the shifting epidemiology is vital in developing control measures against the disease. We are conducting a comprehensive systematic review study to document the current burden of hepatitis A virus infection in Africa. METHODS Our population of interest is children between 1 and 10 years in any African country. We will select cross-sectional, case-control, and cohort studies that have tested hepatitis A virus infection by serological confirmation of antibodies against the virus. We will search for eligible studies published without language restrictions from PubMed, Scopus, Africa-wide, Web of Science, and WHOLIS as well as the reference lists of the relevant articles. Two authors will independently review the search outputs, select eligible articles, and extract pre-defined study outcomes. Inconsistencies will be resolved by discussion and consensus among the authors. Data will be extracted using a standardised data collection form. Trends in the prevalence and/or incidence will be evaluated by urban and rural setting if sufficient data is available. Where there is sufficient homogeneity between studies, meta-analysis will also be conducted, otherwise the results will be presented in a narrative format. DISCUSSION The systematic review will generate up-to-date information on the current burden of hepatitis A virus in Africa. This information may have implications on policy for hepatitis A vaccination on individual African countries. SYSTEMATIC REVIEW REGISTRATION CRD42015023764.
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Affiliation(s)
- Tiwonge J Kanyenda
- Vaccines for Africa Initiative, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
| | - Leila H Abdullahi
- Vaccines for Africa Initiative, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
| | - Gregory D Hussey
- Vaccines for Africa Initiative, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
| | - Benjamin M Kagina
- Vaccines for Africa Initiative, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
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222
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Epidemiology of sexually transmitted viral hepatitis in human immunodeficiency virus-positive men who have sex with men in Asia. J Formos Med Assoc 2015; 114:1154-61. [PMID: 26375778 DOI: 10.1016/j.jfma.2015.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/02/2015] [Accepted: 08/11/2015] [Indexed: 01/10/2023] Open
Abstract
Both human immunodeficiency virus (HIV) and viral hepatitis constitute major disease burden globally. As with other parts of the world, the HIV epidemic in Asia impacts mainly on men who have sex with men, one of the at-risk populations for sexually transmitted viral hepatitis. With the increasing availability of effective antiretroviral therapy, HIV-related mortality of people living with HIV has markedly reduced. Liver disease has become an important cause of mortality and morbidity in the HIV-infected population. With the improvement of socioeconomic conditions and availability of healthcare in Asian countries in recent years, the epidemiology of sexually transmitted viral hepatitis among HIV-positive men who have sex with men has also evolved. This review updates the epidemiology of different types of sexually transmitted viral hepatitis in this defined population in Asia.
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223
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Hygiene and other early childhood influences on the subsequent function of the immune system. Brain Res 2015; 1617:47-62. [DOI: 10.1016/j.brainres.2014.04.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/17/2014] [Accepted: 04/05/2014] [Indexed: 02/08/2023]
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224
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Abstract
Hepatitis B and A account for considerable morbidity and mortality worldwide. Immunization is the most effective means of preventing hepatitis B and A. However, the immune response to both hepatitis vaccines seems to be reduced in HIV-infected subjects. The aim of this review was to analyze the immunogenicity, safety, long-term protection and current recommendations of hepatitis B and A vaccination among HIV-infected adults. The factors most frequently associated with a deficient level of anti-HBs or IgG anti-HAV after vaccination are those related to immunosuppression (CD4 level and HIV RNA viral load) and to the frequency of administration and/or the amount of antigenic load per dose. The duration of the response to both HBV and HAV vaccines is associated with suppression of the viral load at vaccination and, in the case of HBV vaccination, with a higher level of antibodies after vaccination. In terms of safety, there is no evidence of more, or different, adverse effects compared with HIV-free individuals. Despite literature-based advice on the administration of alternative schedules, revaccination after the failure of primary vaccination, and the need for periodic re-evaluation of antibody levels, few firm recommendations are found in the leading guidelines.
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Affiliation(s)
- G Mena
- a Department of Preventive Medicine & Care Quality ; Hospital General Universitario de Castellón ; Castellón de la Plana , Spain
| | - A L García-Basteiro
- b ISGlobal; Barcelona Ctr. Int. Health Res. (CRESIB); Hospital Clínic - Universitat de Barcelona ; Barcelona , Spain.,c Centro de Investigação em Saúde deg Manhiça (CISM) ; Manhiça, Maputo , Mozambique
| | - J M Bayas
- b ISGlobal; Barcelona Ctr. Int. Health Res. (CRESIB); Hospital Clínic - Universitat de Barcelona ; Barcelona , Spain.,d Department of Preventive Medicine & Epidemiology ; Hospital Clínic de Barcelona; Universitat de Barcelona ; Barcelona , Spain
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Suwantika AA, Beutels P, Postma MJ. Cost-effectiveness of hepatitis A vaccination in Indonesia. Hum Vaccin Immunother 2015; 10:2342-9. [PMID: 25424941 DOI: 10.4161/hv.29353] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This study aims to assess the cost-effectiveness of hepatitis A immunization in Indonesia, including an explicit comparison between one-dose and two-dose vaccines. METHODS An age-structured cohort model based on a decision tree was developed for the 2012 Indonesia birth cohort. Using the model, we made a comparison on the use of two-dose and one-dose vaccines. The model involved a 70-year time horizon with 1-month cycles for children less than 2 years old and annually thereafter. Monte Carlo simulations were used to examine the economic acceptability and affordability of the hepatitis A vaccination. RESULTS Vaccination would save US$ 3,795,148 and US$ 2,892,920 from the societal perspective, for the two-dose and one-dose vaccine schedules, respectively, in the context of hepatitis A treatment. It also would save 8917 and 6614 discounted quality-adjusted-life-years (QALYs), respectively. With the vaccine price of US$ 3.21 per dose, the implementation of single dose vaccine would yield an incremental cost-effectiveness ratio (ICER) of US$ 4933 per QALY gained versus no vaccination, whereas the two-dose versus one-dose schedule would cost US$ 14 568 per QALY gained. Considering the 2012 gross-domestic-product (GDP) per capita in Indonesia of US$ 3557, the results indicate that hepatitis A vaccination would be a cost-effective intervention, both for the two-dose and one-dose vaccine schedules in isolation, but two-dose vaccination would no longer be cost-effective if one-dose vaccination is a feasible option. Vaccination would be 100% affordable at budgets of US$ 71,408 000 and US$ 37,690,000 for the implementation of the two-dose and one-dose vaccine schedules, respectively. CONCLUSIONS The implementation of hepatitis A vaccination in Indonesia would be a cost-effective health intervention under the market vaccine price. Given the budget limitations, the use of a one-dose-vaccine schedule would be more realistic to be applied than a two-dose schedule. The vaccine price, mortality rate and discount rate were the most influential parameters impacting the ICERs.
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Affiliation(s)
- Auliya A Suwantika
- a Unit of PharmacoEpidemiology&PharmacoEconomics (PE2); Department of Pharmacy; University of Groningen; Groningen, The Netherlands
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Sequera VG, Valencia S, García-Basteiro AL, Marco A, Bayas JM. Vaccinations in prisons: A shot in the arm for community health. Hum Vaccin Immunother 2015; 11:2615-26. [PMID: 26158401 PMCID: PMC4685700 DOI: 10.1080/21645515.2015.1051269] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/27/2015] [Accepted: 05/10/2015] [Indexed: 02/08/2023] Open
Abstract
From the first day of imprisonment, prisoners are exposed to and expose other prisoners to various communicable diseases, many of which are vaccine-preventable. The risk of acquiring these diseases during the prison sentence exceeds that of the general population. This excess risk may be explained by various causes; some due to the structural and logistical problems of prisons and others to habitual or acquired behaviors during imprisonment. Prison is, for many inmates, an opportunity to access health care, and is therefore an ideal opportunity to update adult vaccination schedules. The traditional idea that prisons are intended to ensure public safety should be complemented by the contribution they can make in improving community health, providing a more comprehensive vision of safety that includes public health.
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Affiliation(s)
| | - Salomé Valencia
- Preventive Medicine and Epidemiology Service; Hospital Clínic of Barcelona; Barcelona, Spain
| | - Alberto L García-Basteiro
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB); Hospital Clínic - Universitat de Barcelona, Rossello, Barcelona, Spain
- Centro de Investigação em Saude de Manhiça (CISM); Maputo, Mozambique
| | - Andrés Marco
- Health Services of Barcelona Men's Penitentiary Center; Barcelona, Spain
| | - José M Bayas
- Preventive Medicine and Epidemiology Service; Hospital Clínic of Barcelona; Barcelona, Spain
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB); Hospital Clínic - Universitat de Barcelona, Rossello, Barcelona, Spain
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227
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Seroprevalence of hepatitis A in Iranian adolescents: is it time to introduce a vaccine? Epidemiol Infect 2015; 144:291-6. [PMID: 26083105 DOI: 10.1017/s0950268815001302] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Universal vaccination of children for hepatitis A virus (HAV) has emerged as a cost-effective strategy to prevent this infection in regions with high incidence of symptomatic disease. Age-specific seroprevalence surveys are practical and reliable methods to estimate the rate of susceptibility in populations, and to help the implementation of vaccination policies. We surveyed the age-specific HAV seroprevalence in a nationally representative sample of Iranian adolescent students aged 10-18 years. Serum samples (n = 2494) were tested by enzyme immunoassay for total anti-HAV antibody. The overall rate of HAV seropositivity was 64% [95% confidence interval (CI), 62-66), which increased sharply from 14·8% (95% CI 7-23) at age 10 years to 72·9% (95% CI 68-78) at age 13 years, without a significant increase up to age 18 years. No significant difference in HAV seroprevalence was observed between males and females (63% vs. 65·1%), or urban and rural areas (63·4% vs. 65·2%); the seropositivity rate was similar in four different socioeconomic regions of Iran. We conclude that the seroconversion rate of HAV is high in Iranian adolescents and therefore mass vaccination of children may be necessary and should be considered by national health authorities.
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228
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Estripeaut D, Contreras R, Tinajeros O, Castrejón MM, Shafi F, Ortega-Barria E, DeAntonio R. Impact of Hepatitis A vaccination with a two-dose schedule in Panama: Results of epidemiological surveillance and time trend analysis. Vaccine 2015; 33:3200-7. [PMID: 25981490 DOI: 10.1016/j.vaccine.2015.04.100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/25/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE In April 2007, Panama introduced Hepatitis A universal vaccination using a two-dose schedule (Havrix(®)junior; GSK Vaccines, Belgium). We assessed the impact of this hepatitis A vaccine three years after it was recommended for universal mass vaccination in Panama. MATERIALS AND METHODS Hepatitis A vaccination impact was assessed using two different approaches. The first approach used retrospective data (incidence and number of cases for all age groups), collected from the passive surveillance of the Epidemiologic Surveillance System of the Ministry of Health of hepatitis A and unspecified hepatitis before (2000-2006) and after (2008-2010) introduction of hepatitis A vaccine. The second approach was a prospective hospital-based active surveillance for hepatitis cases conducted in subjects (0-14 years) during 2009-2011 at three sentinel hospitals in Panama. RESULTS Overall, the annual incidence of hepatitis A and unspecified hepatitis in 2008, 2009 and 2010 were 13.1, 7.9 and 3.7 per 100,000 subjects, lower than the baseline incidence of 51.1 per 100,000 subjects. In comparison to the mean baseline period (2000-2006), there was an 82% mean reduction in the overall hepatitis-related outcomes (hepatitis A and unspecified hepatitis) after vaccine introduction (2008-2010) in all age groups. In the hospital-based surveillance (2009-2011), of the 42 probable viral hepatitis A cases, nine cases were confirmed as acute hepatitis A (8 in 2009, 1 in 2010). Of these confirmed cases, two belonged to the targeted vaccine group (1-4 years) but were not vaccinated. CONCLUSIONS Our study suggests that the introduction of two-dose hepatitis A vaccines in Panama has contributed to the reduction in the incidence of overall hepatitis-related outcomes for all age groups, suggesting herd protection. Additional monitoring is required to document a sustained long-term effect.
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Affiliation(s)
| | - Rodolfo Contreras
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama
| | - Olga Tinajeros
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT), Panama City, Panama
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Seropositivity of Antibodies Against Hepatitis A Virus in Mashhad, Northeast of Iran: A Cross-Sectional Community-Based Study During 2009. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2015. [DOI: 10.5812/rijm.3(2)2015.27082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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230
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Sane J, de Sousa R, van Pelt W, Petrignani M, Verhoef L, Koopmans M. Risk of hepatitis A decreased among Dutch travelers to endemic regions in 2003 to 2011. J Travel Med 2015; 22:208-11. [PMID: 25530483 DOI: 10.1111/jtm.12181] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/03/2014] [Indexed: 11/28/2022]
Abstract
We divided the number of travel-related hepatitis A cases notified in Dutch surveillance (2003-2011) by travel data obtained from an annual holiday survey to estimate the risk of hepatitis A among Dutch travelers. Of the 2,094 cases notified, 931 (44%) were imported. Morocco (n = 272, 29%), Turkey (n = 98, 11%), and Egypt (n = 87, 9%) accounted for the largest proportion of cases. Attack rates in returnees from high or intermediate endemic regions declined from 7.5 per 100,000 travelers (95% CI 6.7-8.4) in 2003-2005 to 3.5 (95% CI 3.0-4.0) in 2009-2011 (p < 0.01). Despite the decrease in risk, vaccination remains important, and routine risk monitoring should also be considered.
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Affiliation(s)
- Jussi Sane
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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231
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Navas Navas MC, Báez Triana PA. Infección por el virus de la hepatitis A: epidemiología y diversidad genética. IATREIA 2015. [DOI: 10.17533/udea.iatreia.v28n2a06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
The age-associated increased susceptibility to infectious disease would suggest that vaccination should be a route to promote healthy aging and keep our seniors autonomous and independent. While vaccination represents a cost-effective and efficient strategy at community level, the ability of the immune system to mount a protective immune response is still unpredictable at the level of the individual. Thus, at a similar age, some individuals, including the elderly, might still be 'good' responders while some other, even younger, would definitely fail to mount a protective response. In this review, the current burden of vaccine-preventable diseases in the aging and aged population will be detailed with the aim to identify the ideal vaccine candidates over the age of 50 years. This article will conclude with potential strategies to reduce, as best as possible, this burden and the imperative need to overcome barriers in extending current vaccine coverage towards to a lifelong vaccine schedule.
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Affiliation(s)
- Pierre-Olivier Lang
- Translational Medicine Research group, Cranfield Health, Cranfield University, Cranfield, England,
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233
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Head MG, Fitchett JR, Cooke GS, Foster GR, Atun R. Systematic analysis of funding awarded for viral hepatitis-related research to institutions in the United Kingdom, 1997-2010. J Viral Hepat 2015; 22:230-7. [PMID: 25146854 PMCID: PMC4344814 DOI: 10.1111/jvh.12300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/19/2014] [Indexed: 12/29/2022]
Abstract
Viral hepatitis is responsible for great health, social and economic burden both globally and in the UK. This study aimed to assess the research funding awarded to UK institutions for viral hepatitis research and the relationship of funded research to clinical and public health burden of viral hepatitis. Databases and websites were systematically searched for information on infectious disease research studies funded for the period 1997-2010. Studies specifically related to viral hepatitis research were identified and categorized in terms of funding by pathogen, disease and by a research and development value chain describing the type of science. The overall data set included 6165 studies (total investment £2.6 billion) of which £76.9 million (3.0%) was directed towards viral hepatitis across 323 studies (5.2%). By pathogen, there were four studies specifically investigating hepatitis A (£3.8 million), 69 studies for hepatitis B (21.4%) with total investment of £14.7 million (19.1%) and 236 (73.1%) hepatitis C studies (£62.7 million, 81.5%). There were 4 studies investigating hepatitis G, and none specifying hepatitis D or E. By associated area, viral hepatitis and therapeutics research received £17.0 million, vaccinology £3.1 million and diagnostics £2.9 million. Preclinical research received £50.3 million (65.4%) across 173 studies, whilst implementation and operational research received £19.4 million (25.3%) across 128 studies. The UK is engaged in much hepatology research, but there are areas where the burden is great and may require greater focus, such as hepatitis E, development of a vaccine for hepatitis C, and further research into hepatitis-associated cancers. Private sector data, and funding information from other countries, would also be useful in priority setting.
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Affiliation(s)
- M G Head
- Research Department of Infection and Population Health, University College LondonLondon, UK
| | - J R Fitchett
- Department for Infectious Diseases, King's College LondonLondon, UK
| | - G S Cooke
- Infectious Diseases, Imperial CollegeLondon, UK
| | - G R Foster
- Blizard Institute, Queen Marys University of LondonLondon, UK
| | - R Atun
- Harvard School of Public Health, Harvard UniversityBoston, MA, USA
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234
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Ikobah JM, Okpara HC, Ekanem EE, Udo JJ. Seroprevalence and predictors of hepatitis A infection in Nigerian children. Pan Afr Med J 2015; 20:120. [PMID: 26090068 PMCID: PMC4458321 DOI: 10.11604/pamj.2015.20.120.5501] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 02/03/2015] [Indexed: 02/01/2023] Open
Abstract
Introduction Hepatitis A infection is prevalent in developing countries where sanitation is still a public health issue. In Nigeria, there is no epidemiological data on children for this infection. A community based study was carried out to establish the seroprevalence and predictors of this infection in children. Methods A community based cross sectional study was carried out in Akpabuyo local Government Area of Cross River State in southern Nigeria. Multi-staged sampling technique was used to recruit 406 children aged 1-18 years. Blood samples were analysed for anti-HAV total antibody (IgM and IgG) using a commercial Enzyme-Linked Immunoassay Assay(ELISA). A multivariate logistic regression was used to identify factors that independently predicted the occurrence of anti-HAV total antibody. p value of < 0.05 was considered significant. Results Two hundred and twenty four subjects tested positive for anti-HAV total antibody giving a prevalence rate of 55.2%. The median age for those positive was 9 years and for those without evidence of HAV infection was 4 years. One hundred and one (45.1%) males and 123 (54.9%) females were positive. The study population was mainly of the low social class with 94.1%. After multivariate analysis, predictors of HAV infection were age and social class. Conclusion HAV infection was prevalent in the study population. Educational campaign is imperative and vaccine provision is advocated to further curb the spread of this infection.
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Affiliation(s)
- Joanah Moses Ikobah
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Cross River state, Nigeria
| | - Henry Chima Okpara
- Department of Chemical Pathology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Emmanuel Eyo Ekanem
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Cross River state, Nigeria
| | - Jacob Jackson Udo
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Cross River state, Nigeria
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235
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Migration pattern of hepatitis A virus genotype IA in North-Central Tunisia. Virol J 2015; 12:17. [PMID: 25886374 PMCID: PMC4327963 DOI: 10.1186/s12985-015-0249-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/28/2015] [Indexed: 01/20/2023] Open
Abstract
Background Hepatitis A virus (HAV) epidemiology in Tunisia has changed from high to intermediate endemicity in the last decades. However, several outbreaks continue to occur. The last reported sequences from Tunisian HAV strains date back to 2006. In order to provide an updated overview of the strains currently circulating in Tunisia, a large-scale molecular analysis of samples from hepatitis A cases was performed, the first in Tunisia. Results Biological samples were collected from patients with laboratory confirmed hepatitis A: 145 sera samples in Tunis, Monastir, Sousse and Kairouan from 2008 to 2013 and 45 stool samples in Mahdia in 2009. HAV isolates were characterised by nested RT-PCR (VP1/2A region) and sequencing. The sequences finally obtained from 81 samples showed 78 genotype IA and 3 genotype IB isolates. A Tunisian genotype IA sequence dataset, including both the 78 newly obtained IA sequences and 51 sequences retrieved from GenBank, was used for phylogenetic investigation, including analysis of migration pattern among six towns. Virus gene flow from Sfax and Monastir was directed to all other towns; in contrast, the gene flows from Sousse, Tunis, Mahdia and Kairouan were directed to three, two, one and no towns, respectively. Conclusions Several different HAV strains co-circulate in Tunisia, but the predominant genotype still continues to be IA (78/81, 96% isolates). A complex gene flow (migration) of HAV genotype IA was observed, with Sfax and Monastir showing gene flows to all other investigated towns. This approach coupled to a wider sampling can prove useful to investigate the factors underlying the spread of HAV in Tunisia and, thus, to implement appropriate preventing measures.
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236
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Hayajneh WA, Balbeesi A, Faouri S. Hepatitis A virus age-specific sero-prevalence and risk factors among Jordanian children. J Med Virol 2015; 87:569-74. [DOI: 10.1002/jmv.24137] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Wail A. Hayajneh
- Faculty of Medicine, Department of Pediatrics; Jordan University of Science and Technology; Irbid Jordan
| | - Adel Balbeesi
- Eastern Mediterranean Public Health Network (EMPHNET); Amman Jordan
| | - Samir Faouri
- Department of Pediatrics; Al Bashir Hospital, Ministry of Health; Amman Jordan
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237
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Sane J, MacDonald E, Vold L, Gossner C, Severi E. Multistate foodborne hepatitis A outbreak among European tourists returning from Egypt--need for reinforced vaccination recommendations, November 2012 to April 2013. ACTA ACUST UNITED AC 2015; 20. [PMID: 25655054 DOI: 10.2807/1560-7917.es2015.20.4.21018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- J Sane
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, the Netherlands
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238
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Nelson KE. The changing epidemiology of hepatitis A virus infections in the United States. J Infect Dis 2015; 212:171-2. [PMID: 25637351 DOI: 10.1093/infdis/jiu835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 12/19/2014] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kenrad E Nelson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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239
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Considerations on the current universal vaccination policy against hepatitis A in Greece after recent outbreaks. PLoS One 2015; 10:e0116939. [PMID: 25590132 PMCID: PMC4295885 DOI: 10.1371/journal.pone.0116939] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/17/2014] [Indexed: 12/16/2022] Open
Abstract
Greece is the only European Union member state that in 2008 included hepatitis A (HAV) vaccine in the routine national childhood immunization program (NCIP). Given that the resources allocated to public health have dramatically decreased since 2008 and that Greece is a low endemicity country for the disease, the benefit from universal vaccination has been questioned. The aim of this paper is to summarize the available epidemiological data of the disease for 1982-2013, and discuss the effects of universal vaccination on disease morbidity. Descriptive analysis, ARIMA modeling and time series intervention analysis were conducted using surveillance data of acute HAV. A decreasing trend of HAV notification rate over the years was identified (p<0.001). However, universal vaccination (~ 80% vaccine coverage of children) had no significant effect on the annual number of reported cases (p = 0.261) and has resulted to a progressive increase of the average age of infection in the general population. The mean age of cases before the inclusion of the vaccine to NCIP (24.1 years, SD = 1.5) was significantly lower than the mean age of cases after 2008 (31.7 years, SD = 2.1) (p<0.001). In the last decade, one third of all reported cases were Roma (a population accounting for 1.5% of the country’s total population) and in 2013 three outbreaks with 16, 9 and 25 Roma cases respectively, were recorded, indicating the decreased effectiveness of the current immunization strategy in this group. Data suggest that universal vaccination may need to be re-considered. Probably a more cost effective approach would be to implement a program that will include: a) vaccination of high risk groups, b) universal vaccination of Roma children and improving conditions at Roma camps, c) education of the population and travel advice, and d) enhancement of the control measures to increase safety of shellfish and other foods.
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240
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Castro-García FP, Corral-Jara KF, Escobedo-Melendez G, Sandoval-Hernandez MA, Rosenstein Y, Roman S, Panduro A, Fierro NA. Conjugated bilirubin affects cytokine profiles in hepatitis A virus infection by modulating function of signal transducer and activator of transcription factors. Immunology 2015; 143:578-87. [PMID: 24943111 DOI: 10.1111/imm.12336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/11/2014] [Accepted: 06/13/2014] [Indexed: 12/24/2022] Open
Abstract
Hepatitis A virus (HAV) infection is the major cause of acute liver failure in paediatric patients. The clinical spectrum of infection is variable, and liver injury is determined by altered hepatic enzyme function and bilirubin concentration. We recently reported differences in cytokine profiles between distinct HAV-induced clinical courses, and bilirubin has been recognized as a potential immune-modulator. However, how bilirubin may affect cytokine profiles underlying the variability in the course of infection has not been determined. Herein, we used a transcription factor (TF) binding site identification approach to retrospectively analyse cytokine expression in HAV-infected children and to predict the entire set of TFs associated with the expression of specific cytokine profiles. The results suggested that modulation of the activity of signal transducers and activators of transcription proteins (STATs) may play a central role during HAV infection. This led us to compare the degree of STAT phosphorylation in peripheral blood lymphoid cells (PBLCs) from paediatric patients with distinct levels of conjugated bilirubin (CB). Low CB levels in sera were associated with increased STAT-1 and STAT-5 phosphorylation. A positive correlation was observed between the serum interleukin-6 (IL-6) content and CB values, whereas higher levels of CB correlated with reduced serum IL-8 values and with a reduction in the proportion of PBLCs positive for STAT-5 phosphorylation. When CB was used to stimulate patients' PBLCs in vitro, the levels of IL-6 and tumour necrosis factor-α were increased. The data showed that bilirubin plays a role in STAT function and affects cytokine profile expression during HAV infection.
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Affiliation(s)
- Flor P Castro-García
- Unidad de Inmunovirología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
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241
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Mikati T, Griffin K, Lane D, Matasar M, Shah MK. International travel patterns and travel risks for stem cell transplant recipients. J Travel Med 2015; 22:39-47. [PMID: 25327693 DOI: 10.1111/jtm.12166] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/14/2014] [Accepted: 07/15/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stem cell transplantation (SCT) is being increasingly utilized for multiple medical illnesses. However, there is limited knowledge about international travel patterns and travel-related illnesses of stem cell transplant recipients (SCTRs). METHODS An observational cross-sectional study was conducted among 979 SCTRs at Memorial Sloan Kettering Cancer Center using a previously standardized and validated questionnaire. International travel post SCT, pre-travel health advice, exposure risks, and travel-related illnesses were queried. RESULTS A total of 516 SCTRs completed the survey (55% response rate); of these, 40% were allogeneic SCTRs. A total of 229 (44.3%) respondents reported international travel outside the United States and Canada post SCT. The international travel incidence was 32% [95% confidence interval CI 28-36] within 2 years after SCT. Using multivariable Cox regression analysis, variables significantly associated with international travel within first 2 years after SCT were history of international travel prior to SCT [hazard ratio (HR) = 5.3, 95% CI 2.3-12.0], autologous SCT (HR = 2.6, 95% CI 1.6-2.8), foreign birth (HR = 2.3, 95% CI 1.5-3.3), and high income (HR = 2.0, 95% CI 1.8-3.7). During their first trip, 64 travelers (28%) had traveled to destinations that may have required vaccination or malaria chemoprophylaxis. Only 56% reported seeking pre-travel health advice. Of those who traveled, 16 travelers (7%) became ill enough to require medical attention during their first trip after SCT. Ill travelers were more likely to have visited high-risk areas (60 vs 26%, p = 0.005), to have had a longer mean trip duration (24 vs 12 days, p = 0.0002), and to have visited friends and relatives (69 vs 21%, p < 0.0001). CONCLUSIONS International travel was common among SCTRs within 2 years after SCT and was mainly to low-risk destinations. Although the overall incidence of travel-related illnesses was low, certain subgroups of travelers were at a significantly higher risk. Pre-travel health counseling and interventions were suboptimal.
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Affiliation(s)
- Tarek Mikati
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Public Health, New York, NY, USA
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Melhem NM, Jaffa M, Zaatari M, Awada H, Salibi NE, Ramia S. The changing pattern of hepatitis A in Lebanese adults. Int J Infect Dis 2015; 30:87-90. [DOI: 10.1016/j.ijid.2014.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/21/2014] [Accepted: 10/25/2014] [Indexed: 11/28/2022] Open
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Petrignani M, Verhoef L, Vennema H, van Hunen R, Baas D, van Steenbergen JE, Koopmans MPG. Underdiagnosis of foodborne hepatitis A, The Netherlands, 2008-2010(1.). Emerg Infect Dis 2014; 20:596-602. [PMID: 24655539 PMCID: PMC3966399 DOI: 10.3201/eid2004.130753] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Outbreaks of foodborne hepatitis A are rarely recognized as such. Detection of these infections is challenging because of the infection’s long incubation period and patients’ recall bias. Nevertheless, the complex food market might lead to reemergence of hepatitis A virus outside of disease-endemic areas. To assess the role of food as a source of infection, we combined routine surveillance with real-time strain sequencing in the Netherlands during 2008–2010. Virus RNA from serum of 248 (59%) of 421 reported case-patients could be sequenced. Without typing, foodborne transmission was suspected for only 4% of reported case-patients. With typing, foodborne transmission increased to being the most probable source of infection for 16%. We recommend routine implementation of an enhanced surveillance system that includes prompt forwarding and typing of hepatitis A virus RNA isolated from serum, standard use of questionnaires, data sharing, and centralized interpretation of data.
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244
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Hepatitis A related acute liver failure by consumption of contaminated food. J Clin Virol 2014; 61:456-8. [DOI: 10.1016/j.jcv.2014.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 08/14/2014] [Accepted: 08/19/2014] [Indexed: 01/10/2023]
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245
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Waning of anti-HAV immunity in Shijiazhuang prefecture, Hebei province, China: A comparison of seroprevalence between 1992 and 2011. Vaccine 2014; 32:6227-32. [DOI: 10.1016/j.vaccine.2014.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/28/2014] [Accepted: 09/08/2014] [Indexed: 11/18/2022]
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246
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Microfluidic quantitative PCR for simultaneous quantification of multiple viruses in environmental water samples. Appl Environ Microbiol 2014; 80:7505-11. [PMID: 25261510 DOI: 10.1128/aem.02578-14] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
To secure food and water safety, quantitative information on multiple pathogens is important. In this study, we developed a microfluidic quantitative PCR (MFQPCR) system to simultaneously quantify 11 major human viral pathogens, including adenovirus, Aichi virus, astrovirus, enterovirus, human norovirus, rotavirus, sapovirus, and hepatitis A and E viruses. Murine norovirus and mengovirus were also quantified in our MFQPCR system as a sample processing control and an internal amplification control, respectively. River water contaminated with effluents from a wastewater treatment plant in Sapporo, Japan, was collected and used to validate our MFQPCR system for multiple viruses. High-throughput quantitative information was obtained with a quantification limit of 2 copies/μl of cDNA/DNA. Using this MFQPCR system, we could simultaneously quantify multiple viral pathogens in environmental water samples. The viral quantities obtained using MFQPCR were similar to those determined by conventional quantitative PCR. Thus, the MFQPCR system developed in this study can provide direct and quantitative information for viral pathogens, which is essential for risk assessments.
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247
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Itani T, Jacobsen KH, Nguyen T, Wiktor SZ. A new method for imputing country-level estimates of hepatitis A virus endemicity levels in the Eastern Mediterranean region. Vaccine 2014; 32:6067-74. [PMID: 25236586 DOI: 10.1016/j.vaccine.2014.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/28/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Few country-level estimates for hepatitis A virus (HAV) seroprevlance are available for the 23 countries in the Eastern Mediterranean region (EMRO) of the World Health Organization. METHODS We used a three-stage approach to assign an HAV endemicity level to each country in North Africa and the Middle East based on the age at midpoint of population immunity. First, we conducted a systematic review to identify all age-seroprevalence studies conducted within the past 10 years. Second, for countries without first-stage evidence we searched for incidence data and older seroprevalence data. Third, for countries with no hepatitis A data, we estimated HAV endemicity based on socioeconomic and water indicators. RESULTS This three-stage method allowed us to estimate country-specific endemicity levels for every country in EMRO even though first-stage evidence was only available for nine countries and for three countries only third-stage evidence was available. The region has a heterogeneous hepatitis A risk profile, with 13 countries having very high endemicity (an age at midpoint of population immunity in early childhood), three having high endemicity (late childhood), and seven having intermediate endemicity (early adulthood). CONCLUSIONS The three-stage estimation approach enables the creation of a complete country-level map of HAV risk in EMRO. Given the heterogeneity of HAV endemicity levels in the region and the likelihood of transitions to lower incidence rates and greater adult susceptibility in the near future, enhanced surveillance for hepatitis A would strengthen decisions about vaccination policy in the region.
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Affiliation(s)
- Taha Itani
- Global Hepatitis Programme, HIV/AIDS Department, World Health Organization, Geneva, Switzerland; Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Kathryn H Jacobsen
- Department of Global & Community Health, George Mason University, Fairfax, Virginia, USA.
| | - Tim Nguyen
- Global Hepatitis Programme, HIV/AIDS Department, World Health Organization, Geneva, Switzerland; Evidence and Information for Policy, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Stefan Z Wiktor
- Global Hepatitis Programme, HIV/AIDS Department, World Health Organization, Geneva, Switzerland
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248
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Hu Y, Arsov I. A rapid single-tube protocol for HAV detection by nested real-time PCR. FOOD AND ENVIRONMENTAL VIROLOGY 2014; 6:189-195. [PMID: 24902810 DOI: 10.1007/s12560-014-9152-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 05/20/2014] [Indexed: 06/03/2023]
Abstract
Infections by food-borne viruses such as hepatitis A virus (HAV) and norovirus are significant public health concerns worldwide. Since food-borne viruses are rarely confirmed through direct isolation from contaminated samples, highly sensitive molecular techniques remain the methods of choice for the detection of viral genetic material. Our group has previously developed a specific nested real-time PCR (NRT-PCR) assay for HAV detection that improved overall sensitivity. Furthermore in this study, we have developed a single-tube NRT-PCR approach for HAV detection in food samples that reduces the likelihood of cross contamination between tubes during sample manipulation. HAV RNA was isolated from HAV-spiked food samples and HAV-infected cell cultures. All reactions following HAV RNA isolation, including conventional reverse transcriptase PCR, nested-PCR, and RT-PCR were performed in a single tube. Our results demonstrated that all the samples tested positive by RT-PCR and nested-PCR were also positive by a single-tube NRT-PCR. The detection limits observed for HAV-infected cell cultures and HAV-spiked green onions were 0.1 and 1 PFU, respectively. This novel method retained the specificity and robustness of the original NRT-PCR method, while greatly reducing sample manipulation, turnaround time, and the risk of carry-over contamination. Single-tube NRT-PCR thus represents a promising new tool that can potentially facilitate the detection of HAV in foods thereby improving food safety and public health.
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Affiliation(s)
- Yuan Hu
- FDA, Northeast Regional Laboratory, 158-15 Liberty Avenue, Jamaica, NY, USA,
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Freeman E, Lawrence G, McAnulty J, Tobin S, MacIntyre CR, Torvaldsen S. Field effectiveness of hepatitis A vaccine and uptake of post exposure prophylaxis following a change to the Australian guidelines. Vaccine 2014; 32:5509-13. [DOI: 10.1016/j.vaccine.2014.07.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 06/06/2014] [Accepted: 07/15/2014] [Indexed: 12/29/2022]
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250
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Hepatitis A and E seroprevalence and associated risk factors: a community-based cross-sectional survey in rural Amazonia. BMC Infect Dis 2014; 14:458. [PMID: 25149658 PMCID: PMC4152586 DOI: 10.1186/1471-2334-14-458] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/18/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hepatitis A virus (HAV) and hepatitis E virus (HEV) are both transmitted by the faecal-oral route, and represent common causes of acute hepatitis in developing countries. The endemicity of HAV infection has shifted from high to moderate in Brazil. Human cases of HEV infection seem to be rare, although the virus has been detected in swine livestock and effluents of slaughterhouses. This study was to determine the epidemiology of hepatitis A and E in one of the largest agricultural settlements in the Amazon Basin of Brazil. METHODS Serum samples collected from 397 individuals aged between 5 and 90 years during a population-based cross-sectional survey were tested for anti-HAV and anti-HEV antibodies. Associated risk factors and spatial clustering of HAV and HEV seropositivity were also analyzed. RESULTS The overall rate of HAV seropositivity was 82.9% (95% confidence interval (CI), 79.2-86.6%). Multilevel logistic regression analysis identified increasing age (in years; odds ratio (OR), 1.097; 95% CI, 1.050-1.147; P < 0.001) and crowding (OR, 1.603; 95% CI, 1.054-2.440; P = 0.028) as significant risk factors for HAV seropositivity. Anti-HEV IgG was detected in 50/388 settlers (12.9%, 95% CI, 9.5-16.2%). Anti-HEV IgM was detected in 7/43 (16.3%) anti-IgG positive samples, and 4 of them had a confirmed result by immunoblot. Increasing age was the only significant determinant of HEV seropositivity (OR, 1.033; 95% CI, 1.016-1.050; P < 0.001). No significant spatial clustering of HAV and HEV seropositivity was detected in the area. CONCLUSIONS Both HAV and HEV are endemic, with differing rates of infection in children and adults in this rural setting of the Brazilian Amazon. Anti-HEV prevalence was considerably higher than those previously reported in Brazil. The detection of HEV- specific IgM antibodies in four asymptomatic individuals is highly suggestive of the circulation of HEV in this rural population.
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