Seroepidemiology of hepatitis A, B, C, and E viruses infection among preschool children in Taiwan

Cohort study of familial viral hepatitis and risks of paediatric cancers

BACKGROUND

Although viral hepatitis causes paediatric hepatocellular carcinoma and hepatic and extrahepatic cancers in adults, there are few epidemiologic studies on paediatric-cancer risks from parental viral hepatitis. In a nationwide study in a viral hepatitis endemic region and with confirmation in another population-based sample, we examined associations between parental hepatitis B (HBV) and C (HCV) infections and risks of cancers in offspring.

METHODS

We included all children born in Taiwan in 2004-2014 (N = 2 079 037) with 2160 cancer cases ascertained from the Cancer Registry. We estimated risks for paediatric cancers using Cox proportional-hazard regressions. We checked these associations in a nationwide case-control study in Denmark (6422 cases, 160 522 controls).

RESULTS

In Taiwan, paternal HBV was related to child's hepatoblastoma [hazard ratio (HR) = 1.77, 95% confidence interval (CI) = 1.05, 2.97] when identified at any time in the medical record, and when analyses were limited to hepatitis diagnoses occurring before the child's birth, risks increased (HR = 2.08, 95% CI = 1.13-3.80). Paternal HCV was related to child's non-Hodgkin lymphoma (HR = 2.06, 95% CI = 1.13-3.74). Maternal HCV was weakly related to increased risks of all childhood cancers [all types combined; HR = 1.45, 95% CI = 0.95-2.22]. The population-attributable fraction of hepatoblastoma for maternal, paternal and child HBV was 2.6%, 6.8% and 2.8%, respectively.

CONCLUSIONS

Parental HBV and HCV may be risk factors for hepatic and non-hepatic cancers in children. If associations are causal, then parental screening and treatment with antivirals may prevent some paediatric cancers.

Study of Hepatitis E Virus in Blood Donors

Introduction:

Hepatitis E (HEV) is a major health problem affecting around one third of the world population. The prevalence of antibodies to HEV among blood donors have been documented in several countries in Europe and Asia.

Objectives:

The aims of the study are to estimate the seroprevalence of hepatitis E antibodies among healthy blood donors and to explore the factors associated with positive HEV antibodies among healthy blood donors. Moreover, to detect HEV viremia by real time polymerase chain reaction among seropositive blood donors for HEV.

Methods:

The study included 200 apparent healthy blood donors from Dakahlia Governorate, Egypt. Blood samples were collected from the blood donors for serological determination for specific hepatitis E virus immunoglobulin G (anti-HEV IgG) and specific hepatitis E virus immunoglobulin M (anti- HEV IgM). Positive samples for anti-HEV IgM were further subjected for determination of HEV-RNA by real time Polymerase Chain Reaction (PCR). Anti-HEV-IgG was positive in 50 donor (25%) anti-HEV-IgM was positive in 10 donors (5%) and HEV-RNA was positive in 6 donors (3%).

Results and Discussion:

The comparison between blood donors positive for anti-HEV-IgG and negative blood donors negative reveals significant association between anti-HEV-IgG and donors with older age (42.0 ± 9.7,P = 0.001),rural residence (76%, P = 0.001), workers in agricultural works (92%, P = 0.035) and elevated AST (31.28±14.28, P = 0.04). Regarding viral markers, there was significant prevalance between positive anti-HCV-IgG and positive anti-HEV-IgG (P = 0.003). Univariate analysis for risk factors associated with positive anti-HEV IgG reveals significant prevalence with older age (P = 0.001), rural residence (P < 0.001), positive anti-HCV- IgG (P = 0.004) and increase in AST (P = 0.045). However, on Multivariate analysis HEV infection was independently prevalent with older age (P < 0.001) and rural residence (P = 0.002).

Conclusion:

The present study highlights that HEV seroprevalence in blood donors is common finding. Further finding is the statistically significant correlation between antibodies to HCV and serological markers for HEV and even HEV viremia. Longitudinal studies may be needed to explore the clinical significance and cost effectiveness of screening of the blood donors for hepatitis E virus by serological tests and/or detection of viremia by Molecular testing.

Seroprevalence of viral hepatitis A, B, C, D and E viruses in the Hormozgan province southern Iran

BACKGROUND

Viral hepatitis is a global public health problem affecting millions of people worldwide, causing thousands of deaths due to acute and persistent infection, cirrhosis, and liver cancer. Providing updated serologic data can improve both surveillance and disease control programs. This study is aimed to determine the seroprevalence of markers for viral hepatitis (A, B, C, D and E) and the epidemiology of such infections in the general population of southern Iran's Hormozgan province.

METHODS

Between 2016 and 2017, a total of 562 individuals with ages ranging from 1 to 86 years, who visited governmental public laboratories for routine check-ups, were tested for the presence of serological markers to hepatitis virus types A to E using enzyme-linked immunosorbent assays.

RESULTS

The overall anti-hepatitis A virus (HAV) antibody seroprevalence was 93.2% (524/562). The prevalence of anti-hepatitis E virus (HEV) antibodies was 15.8% (89/562) among which 1.6% (9/562) of the seropositive individuals also had evidence of recent exposure to the virus (IgM positivity). Two and a half percent (14/562) were positive for hepatitis B surface (HBs) antigen, whereas 11.6% (65/562) tested positive for anti-hepatitis B core (HBc) antibodies. Among anti-HBc positive patients, 11% (7/65) had HBs Ag and 5% (3/65) were positive for anti-hepatitis D virus (HDV) antibodies. The prevalence of anti-hepatitis C virus (HCV) antibodies was 0.7% (4/562). The seroprevalence of anti-HAV, HEV IgG, anti-HBc antibodies, and HBs Ag increased with age.

CONCLUSION

The present study confirms a high seroprevalence of HAV infection among the examined population and reveals high levels of endemicity for HEV in the region. Planned vaccination policies against HAV should be considered in all parts of Iran. In addition, improvements on public sanitation and hygiene management of drinking water sources for the studied area are recommended.

Host genetic factors in hepatitis B infection, liver cancer and vaccination response: a review with a focus on Africa

The disease burden due to hepatitis B virus (HBV) infection remains significant; 350 million people are infected world-wide, and around half a million deaths each year are due to HBV-related liver disease and hepatocellular carcinoma (HCC). Infant immunisation against infection was introduced in the early 1980s, the vaccine is routinely administered across regions where the disease is endemic and has been shown to be safe and effective. However, the large number of older individuals with persistent infection means that disease will not be reduced significantly for several decades. Furthermore, failure to respond to the vaccination has been observed in about 5% of vaccinees and to date we have limited information on the durability of vaccine protection against infection. Hepatitis B infection and disease pathogenesis are known to be influenced by a number of factors including host genetics factors. This review aims to give an overview of the role of genetic variation in persistent HBV infection and the development of liver disease including HCC. Vaccine-induced immunity is, at least in part, heritable and we also discuss findings on the genetic control of responses to HBV vaccination. The epidemiology of HBV infection differs by world region, as does the genetic makeup of individuals originating from different regions. This review focuses on the situation in Africa, where hepatitis B is highly endemic.

APASL consensus statements and management algorithms for hepatitis C virus infection

The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the "APASL Consensus Statements and Management Algorithms for Hepatitis C Virus Infection" in December, 2010, in order to revise "Asian Pacific Association for the Study of the Liver consensus statements on the diagnosis, management and treatment of hepatitis C virus infection (J Gastroenterol Hepatol 22:615-633, 2007)". The working party consisted of expert hepatologists from the Asian-Pacific region gathered at Makuhari, Chiba, Japan on 19 December 2010. New data were presented, discussed and debated to draft a revision. Participants of the consensus meeting assessed the quality of cited studies. Finalized recommendations are presented in this review.

Hepatitis A seroprevalence in a population of immigrants at a French vaccination center

BACKGROUND

Hepatitis A vaccination is recommended to people traveling to countries where the disease is endemic. Until recently, people originating from developing countries were considered to be "naturally" immunized. Because of improving socioeconomic conditions, hepatitis A incidence has decreased in most previously highly endemic countries during the last three decades, especially in the younger age groups.

METHODS

We analyzed hepatitis A seroprevalence of 989 travelers who had been born and lived at least 1 year in a developing country, wanted to travel to a hepatitis A endemic area, and consulted at the vaccination center of the Institut Pasteur of Paris between September 1, 2008 and February 28, 2010.

RESULTS

Hepatitis A serology results were available for 646 subjects. Overall seroprevalence was 82.4%. A total of 90, 82.6, 81.2, 68.4, 56.9, and 50% of people of sub-Saharan African, Near and Middle Eastern, North African, Asian, Latin American, and Eastern European origin had hepatitis A antibodies, respectively. The difference in seroprevalence according to the continent of origin, age, and length of stay in an endemic country was significant (p < 0.0001). More than 75% of seronegatives and less than 50% of seropositives were younger than 36 years. Almost three quarters of the positive group (while less than half of the negative group) lived longer than 18 years in a developing country. Multivariate analysis showed that seroprevalence increases with age, length of stay in a country at risk, and varies significantly from one continent to another.

CONCLUSION

We recommend extending serologic confirmation of immigrants' hepatitis A immunity. If time is lacking, vaccination should be considered.

Model of life expectancy of chronic hepatitis B carriers in an endemic region

Background

Chronic infection with hepatitis B (HBV) is a known risk factor for increased mortality from hepatocellular carcinoma (HCC) and chronic liver disease (CLD). However, the specific effects of chronic HBV infection on life expectancy have not been adequately studied. Taiwan is endemic for HBV infection, and thus provides sufficient information for such estimates.

Methods

Population mortality statistics, combined with data on the contribution of HBV to HCC and CLD deaths, were used to model carrier mortality by sex and e antigen status. An abridged life table was used to calculate carrier life expectancy.

Results

Among both males and females, those who are e antigen-positive are more likely to die from HCC than from CLD. When e antigen status remains positive, absolute liver mortality rates climb significantly after age 40 years. CLD is a proportionally higher threat for e antigen-negative females than for other subgroups. Males have higher liver-related mortality at all ages. A small decrease in life expectancy, from 82.0 to 80.1 years, was found for female noncarriers versus female carriers; a larger discrepancy was observed for males—from 76.2 to 71.8 years. In comparison to noncarriers, the lifetime relative risk of mortality is 1.35 for male carriers and 1.16 for female carriers.

Conclusions

These results indicate that chronic HBV infection results in significant liver-related mortality; however, carriers retain a satisfactory life expectancy.

Asthma symptoms and airway narrowing in children growing up in an urban versus rural environment

The development of asthma and allergy appears to be the result of gene-environment interaction. Potential environmental risk factors such as outdoor and indoor air pollution, infections, allergen exposure, diet, and lifestyle patterns may trigger respiratory symptoms and compromise lung function in children. Specific features of urban and rural lifestyle may constitute distinct risk factors but may also coexist within certain socioeconomic levels. Children of rural environments are at lower risk for asthma and aeroallergen sensitization. The protective effect has been associated with close contact with large animals, but the genetic factor also plays a contributory role. Children with prolonged exposure to urban environment are at increased risk of reduced lung function and those that reside in polluted areas exhibit slower lung growth. It is possible that polluted urban environment per se facilitates subclinical small airway disease. Evidence to date supports a strong relation between residential area as a potential risk factor for childhood asthma symptoms and airway obstruction and a western type of socioeconomic development.

Hepatitis C virus infection among children in aboriginal areas in Taiwan

The prevalence of hepatitis C virus (HCV) infection among adults in aboriginal areas has been shown to be higher than in urban areas in Taiwan. Whether the prevalence of HCV infection is also higher among children in aboriginal areas remains unclear. In total, 1176 schoolchildren in four aboriginal areas were invited to participate in the study. All children were tested for serum antibodies to HCV (anti-HCV) and liver enzymes. The age range of children was 6-13 years. Another 606 sex- and age-matched schoolchildren from an urban area served as controls. There was no statistically significant difference in prevalence of anti-HCV between aboriginal and Han Chinese students in aboriginal areas. The prevalence of anti-HCV was 0.3% (4/1176) in aboriginal areas, which was similar to the prevalence of 0% (0/606) in the urban area. The four anti-HCV seropositive aboriginal children were all negative for HCV RNA. Our data suggest that the high prevalence of anti-HCV among aboriginal adults might be due to subsequent exposure to risk factors after school age.

Distinct changing profiles of hepatitis A and E virus infection among patients with acute hepatitis, patients on maintenance hemodialysis and healthy individuals in Japan

To compare the epidemiologic profiles of hepatitis A virus (HAV) and hepatitis E virus (HEV) infections in Japan, the prevalence of clinical or subclinical HAV and HEV infections was investigated serologically and molecularly among 128 consecutive patients (age, mean +/- standard deviation, 37.5 +/- 14.7 years) who contracted acute hepatitis between 1989 and 2005 in a city hospital, and among 416 hemodialysis patients (60.1 +/- 12.6 years) and 266 medical staff members (34.6 +/- 11.4 years) at the same hospital, using stored periodic serum samples collected since the start of hemodialysis or employment, respectively. Between 1989 and 1995, among 93 patients with acute hepatitis, 51 (54.8%) were diagnosed with hepatitis A and only one patient with hepatitis E. Between 1996 and 2005, however, among 35 patients, only 3 (8.6%) were diagnosed with hepatitis A and 2 (5.7%) with hepatitis E. Although subclinical HEV infection was recognized in four hemodialysis patients (one each in 1979, 1980, 1988, and 2003) and two medical staff members (1978 and 2003) in previous studies, none of the 191 hemodialysis patients who had been negative for anti-HAV at the start of hemodialysis contracted HAV infection during the observation period of 7.6 +/- 6.4 years. Only one (0.4%) of the 246 medical staff members who had been negative for anti-HAV at the start of employment acquired hepatitis A during the observation period of 7.9 +/- 8.0 years: none had subclinical HAV infection. Clinical or subclinical HEV infection has occurred rarely during the last three decades, while HAV infection has markedly decreased at least since 1996.

Host susceptibility to persistent hepatitis B virus infection

Genetic epidemiology researches such as twin studies, family-clustering of hepatitis B virus (HBV) infection studies and ethnic difference studies have provided the evidence that host genetic factors play an important role in determining the outcome of HBV infection. The opening questions include which human genes are important in infection and how to find them. Though a number of studies have sought genetic associations between HBV infection/persistence and gene polymorphisms, the candidate gene-based approach is clearly inadequate to fully explain the genetic basis of the disease. With the advent of new genetic markers and automated genotyping, genetic mapping can be conducted extremely rapid. This approach has been successful in some infectious diseases. Linkage analysis can find host genes susceptible to HBV and is of great clinical importance.