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Silva RJS, do Nascimento RS, Oliveira-Neto JAJ, Silva FQ, Piauiense JNF, Gomes CM, Pinheiro LML, Resque RL, Pinho JRR, Kupek E, Fischer B, Machado LFA, Martins LC, Lemos JAR, Oliveira-Filho AB. Detection and Genetic Characterization of Hepatitis B and D Viruses: A Multi-Site Cross-Sectional Study of People Who Use Illicit Drugs in the Amazon Region. Viruses 2021; 13:v13071380. [PMID: 34372586 PMCID: PMC8310228 DOI: 10.3390/v13071380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B (HBV) and delta (HDV) viruses are endemic in the Amazon region, but vaccine coverage against HBV is still limited. People who use illicit drugs (PWUDs) represent a high-risk group due to common risk behavior and socioeconomic factors that facilitate the acquisition and transmission of pathogens. The present study assessed the presence of HBV and HBV-HDV co-infection, identified viral sub-genotypes, and verified the occurrence of mutations in coding regions for HBsAg and part of the polymerase in HBV-infected PWUDs in municipalities of the Brazilian states of Amapá and Pará, in the Amazon region. In total, 1074 PWUDs provided blood samples and personal data in 30 municipalities of the Brazilian Amazon. HBV and HDV were detected by enzyme-linked immunosorbent assay and polymerase chain reaction. Viral genotypes were identified by nucleotide sequencing followed by phylogenetic analysis, whereas viral mutations were analyzed by specialized software. High rates of serological (32.2%) and molecular (7.2%) markers for HBV were detected, including cases of occult HBV infection (2.5%). Sub-genotypes A1, A2, D4, and F2a were most frequently found. Escape mutations due to vaccine and antiviral resistance were identified. Among PWUDs with HBV DNA, serological (19.5%) and molecular (11.7%) HDV markers were detected, such as HDV genotypes 1 and 3. These are worrying findings, presenting clear implications for urgent prevention and treatment needs for the carriers of these viruses.
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Affiliation(s)
- Ronylson José S. Silva
- Programa de Pós-Graduação em Biologia Ambiental, Universidade Federal do Pará, Bragança 68600-000, PA, Brazil; (R.J.S.S.); (R.S.d.N.); (C.M.G.)
| | - Raquel Silva do Nascimento
- Programa de Pós-Graduação em Biologia Ambiental, Universidade Federal do Pará, Bragança 68600-000, PA, Brazil; (R.J.S.S.); (R.S.d.N.); (C.M.G.)
| | - José Augusto J. Oliveira-Neto
- Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, PA, Brazil; (J.A.J.O.-N.); (F.Q.S.)
| | - Fabricio Quaresma Silva
- Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, PA, Brazil; (J.A.J.O.-N.); (F.Q.S.)
| | - Juliana Nádia F. Piauiense
- Programa de Pós-Graduação em Saúde na Amazônia, Universidade Federal do Pará, Belém 66055-240, PA, Brazil; (J.N.F.P.); (L.C.M.)
| | - Camila Moraes Gomes
- Programa de Pós-Graduação em Biologia Ambiental, Universidade Federal do Pará, Bragança 68600-000, PA, Brazil; (R.J.S.S.); (R.S.d.N.); (C.M.G.)
| | - Luiz Marcelo L. Pinheiro
- Faculdade de Ciências Biológicas, Campus do Marajó, Universidade Federal do Pará, Soure 68870-000, PA, Brazil;
| | - Rafael Lima Resque
- Departamento de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Macapá 68903-419, AP, Brazil;
| | - João Renato R. Pinho
- Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo 05403-000, SP, Brazil;
| | - Emil Kupek
- Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis 88040-900, SC, Brazil;
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC V6B 5K3, Canada;
- Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo 04038-000, SP, Brazil
| | - Luiz Fernando A. Machado
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, PA, Brazil; (L.F.A.M.); (J.A.R.L.)
| | - Luísa Caricio Martins
- Programa de Pós-Graduação em Saúde na Amazônia, Universidade Federal do Pará, Belém 66055-240, PA, Brazil; (J.N.F.P.); (L.C.M.)
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém 66055-240, PA, Brazil
| | - José Alexandre R. Lemos
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, PA, Brazil; (L.F.A.M.); (J.A.R.L.)
| | - Aldemir B. Oliveira-Filho
- Programa de Pós-Graduação em Biologia Ambiental, Universidade Federal do Pará, Bragança 68600-000, PA, Brazil; (R.J.S.S.); (R.S.d.N.); (C.M.G.)
- Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, PA, Brazil; (J.A.J.O.-N.); (F.Q.S.)
- Correspondence: ; Tel.: +55-91-3425-1209
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Scarponi CFDO, Silva RDND, Souza Filho JAD, Guerra MRL, Pedrosa MAF, Mol MPG. Hepatitis Delta Prevalence in South America: A Systematic Review and Meta-Analysis. Rev Soc Bras Med Trop 2019; 52:e20180289. [PMID: 30698197 DOI: 10.1590/0037-8682-0289-2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/18/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatitis delta virus (HDV) has been associated with acute or chronic hepatitis in Latin America, but there is no prevalence study covering South American countries. This meta-analysis aimed to estimate anti-HDV prevalence through a systematic review of published articles in English, Portuguese and Spanish until December 2017. Searches were conducted in Health Virtual Library, Capes, Lilacs, PubMed, and SciELO, according to defined criteria regarding participant selection and geographical setting. Study quality was assessed using the GRADE guidelines. Pooled anti-HDV prevalence was calculated using the DerSimonian-Laird random-effects model with Freeman-Tukey double arcsine transformation. Out of the 405 identified articles, only 31 met the eligibility criteria for inclusion in the meta-analysis. In South America, pooled anti-HDV prevalence among hepatitis B virus carriers was 22.37% (95% confidence interval: 13.72-32.26), though it appeared less frequently in some countries and populations, according to the data collection date. The findings indicated significant successive reductions in anti-HDV prevalence over thirty years. However, there was a scarcity of HDV epidemiological studies outside the Amazon Basin, notably in the Southwest continent and absence of target population standardization. There was a high HDV prevalence in South American countries, despite differences in methodological characteristics and outcomes, highlighting a drastic decline in the last decades. Future studies should identify HDV prevalence estimates in other regions of the continent and identify risk factors.
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Affiliation(s)
| | | | | | | | | | - Marcos Paulo Gomes Mol
- Diretoria de Pesquisa e Desenvolvimento. Fundação Ezequiel Dias, Belo Horizonte, MG, Brasil
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de Castro Rocha DFN, da Cunha Rosa LR, de Almeida Silva C, de Oliveira BR, Martins TLS, Martins RMB, de Matos MA, Dos Santos Carneiro MA, Soares JP, de Oliveira E Silva AC, de Souza MM, Cook RL, Caetano KAA, Teles SA. Epidemiology of HIV, syphilis, and hepatitis B and C among manual cane cutters in low-income regions of Brazil. BMC Infect Dis 2018; 18:546. [PMID: 30390628 PMCID: PMC6215621 DOI: 10.1186/s12879-018-3439-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/09/2018] [Indexed: 01/04/2023] Open
Abstract
Background In recent decades the epidemic of asymptomatic sexually transmitted infections has extended deep into Brazil, including small towns and rural areas. The purpose of this study was to investigate the epidemiology of HIV, syphilis, and hepatitis B (HBV) and hepatitis C viruses (HCV), and to evaluate immunization coverage against hepatitis B in a group of rural workers in Brazil. Methods In 2016, a cross-sectional study was conducted with 937 manual sugarcane cutters of the Midwest and Northeast Regions of Brazil. All individuals were interviewed and screened for HIV, syphilis, HBV and HCV. Correlating factors with lifetime HBV infection were investigated using logistic regression. Positive Predictive Values, Negative Predictive Values, sensitivity and specificity were also calculated relative to vaccination against Hepatitis B, comparing anti-HBs titers to vaccination reports. Results Most reported previous hospitalization (55%), occupational injuries (54%), sharing of personal items (45.8%), alcohol consumption (77.2%), multiple sexual partners in previous 12 months (39.8%), and no condom use during sexual intercourse in last 12 months (46.5%). Only 0.2% reported using injection drugs. Anti-HIV-1 was detected in three individuals (0.3%). Serological markers of lifetime syphilis (treponemal test) were detected in 2.5% (95% CI: 1.6–3.6) of participants, and active syphilis (treponemal test and VDRL) present in 1.2%. No samples were positive for anti-HCV. The prevalence of lifetime HBV infection (current or past infection) was 15.9%, and 0.7% (95% CI 0.4 to 1.5) were HBsAg-positive. Previous hospitalization (OR 1.53, CI 1.05–2.24, p < 0.01) and multiple sexual partners in the last 12 months (OR 1.80, CI 1.25–2.60, p < 0.01) were predictors for lifetime HBV infection. Although 46.7% (95% CI 43.4–49.9) of individuals reported having been vaccinated against hepatitis B, only 20.6% (95% CI 18.1–23.3) showed serological evidence of previous hepatitis B vaccination (positive for anti-HBs alone). Conclusions The high prevalence of syphilis and HBV compared to the general population and the high frequency of risk behaviors show the potential for sexual and parenteral dissemination of these agents in this rural population. In addition, the low frequency of hepatitis B vaccinated individuals suggests a need for improved vaccination services.
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Affiliation(s)
| | | | - Carla de Almeida Silva
- Faculty of Nursing, Federal University of Goias/Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Brunna Rodrigues de Oliveira
- Institute of Tropical Pathology and Public Health, Federal University of Goias/Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | - Regina Maria Bringel Martins
- Institute of Tropical Pathology and Public Health, Federal University of Goias/Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Marcos André de Matos
- Faculty of Nursing, Federal University of Goias/Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | - Juliana Pontes Soares
- Faculty of Nursing, Federal University of Paraiba/Universidade Federal da Paraíba, João Pessoa, PB, Brazil
| | | | - Márcia Maria de Souza
- Faculty of Nursing, Federal University of Goias/Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Sheila Araujo Teles
- Faculty of Nursing, Federal University of Goias/Universidade Federal de Goiás, Goiânia, GO, Brazil.
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Oliveira MSD, Valle SDCND, Souza RMD, Silva RPM, Figueiredo END, Taminato M, Fram D. Evidências científicas sobre a hepatite Delta no Brasil: revisão integrativa da literatura. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Resumo Objetivo: Descrever o nível de evidência científica sobre a infecção por vírus da hepatite Delta (VHD) no Brasil. Métodos: Revisão integrativa da literatura, com buscas realizadas nas bases de dados do Medical Literature Analysis and Retrieval System Online, Literatura Latino-americana e do Caribe em Ciências da Saúde, Scientific Eletronic Library Online e Scopus, com análise centrada no nivelamento do rigor metodológico de acordo com o modelo de Melnyk e Fineout-Overholt. Resultados: A busca revelou uma média de duas publicações por ano no intervalo entre 1987 e 2017. Foram selecionados 33 artigos, tendo a maioria (91%) apresentado nível de evidência VI. As publicações ficaram concentradas em periódicos da área de medicina tropical (46%) e virologia (15%). Dos trabalhos, 85% tinha profissional médico com autor e o delineamento mais encontrado foi o descritivo/transversal (69,6%). Conclusão: A produção científica sobre a infecção por VHD no Brasil está centrada em estudos de prevalência, mostrando-se incipiente quanto à produção de estudos com delineamentos mais rígidos como ensaios clínicos.
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Lago BV, Mello FC, Kramvis A, Niel C, Gomes SA. Hepatitis B virus subgenotype A1: evolutionary relationships between Brazilian, African and Asian isolates. PLoS One 2014; 9:e105317. [PMID: 25122004 PMCID: PMC4133366 DOI: 10.1371/journal.pone.0105317] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/23/2014] [Indexed: 12/13/2022] Open
Abstract
Brazil is a country of low hepatitis B virus (HBV) endemicity in which the genotype A of HBV (HBV/A) is the most prevalent. The complete nucleotide sequences of 26 HBV/A isolates, originating from eight Brazilian states, were determined. All were adw2. Twenty-three belonged to subgenotype A1 and three to A2. By phylogenetic analysis, it was shown that all the 23 HBV/A1 isolates clustered together with isolates from Bangladesh, India, Japan, Nepal, the Philippines and United Arab Emirates, but not with those of Congo, Kenya, Malawi, Rwanda, South Africa, Tanzania, Uganda and Zimbabwe. Four amino acid residues in the polymerase (His138 in the terminal protein domain, Pro18 and His90 in the spacer, and Ser109 in the reverse transcriptase), and one (Phe17) in the precore region, predominated in Latin American and Asian HBV/A1 isolates, but were rarely encountered in African isolates, with the exception of those from Somalia. Specific variations of two adjacent amino acids in the C-terminal domain of the HBx protein, namely Ala146 and Pro147, were found in all the Brazilian, but rarely in the other HBV/A1 isolates. By Bayesian analysis, the existence of an 'Asian-American' clade within subgenotype A1 was supported by a posterior probability value of 0.996. The close relatedness of the Brazilian, Asian and Somalian isolates suggests that the HBV/A1 strains predominant in Brazil did not originate from the five million slaves who were imported from Central and Western Africa from 1551 to 1840, but rather from the 300-400,000 captives forcibly removed from southeast Africa at the middle of the 19th century.
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Affiliation(s)
- Bárbara V. Lago
- Laboratory of Molecular Virology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Francisco C. Mello
- Laboratory of Molecular Virology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Programme, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christian Niel
- Laboratory of Molecular Virology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Selma A. Gomes
- Laboratory of Molecular Virology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- * E-mail:
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Abstract
The hepatitis D virus (HDV), the smallest virus known to infect man, causes the most severe form of chronic viral hepatitis, hepatitis delta. It is estimated that about 15 to 20 million people are suffering from chronic HDV infection. HDV is a defective satellite virus depending on the hepatitis B surface antigen (HBsAg) for transmission. Chronic hepatitis delta is associated with a rapid progression of liver fibrosis and a high prevalence of liver cirrhosis, even in younger patients. Immunization against hepatitis B virus (HBV) protects from HDV infection, but there is no specific vaccine against HDV available for HBsAg-positive individuals. Treatment options for hepatitis delta patients are limited. So far, only interferon-alpha has shown an antiviral efficacy against HDV. Recent trials showed sustained virological response rates concerning HDV in 25 %-30 % of patients treated with pegylated interferons. HDV is dominant over HBV in the majority of cases, but HBV DNA-positive subjects should be treated with HBV polymerase inhibitors. Combination therapy of pegylated interferon-alpha and adefovir showed a more pronounced HBsAg decline, but the exact role of combination therapies in hepatitis delta requires further investigation. Alternative future treatment strategies may include prenylation inhibitors and HBV entry inhibitors, which are in early clinical development.
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Alvarado-Mora MV, Romano CM, Gomes-Gouvêa MS, Gutierrez MF, Carrilho FJ, Pinho JRR. Phylogenetic analysis of complete genome sequences of hepatitis B virus from an Afro-Colombian community: presence of HBV F3/A1 recombinant strain. Virol J 2012; 9:244. [PMID: 23092209 PMCID: PMC3499267 DOI: 10.1186/1743-422x-9-244] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 10/22/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is one of the most prevalent viral infections in humans and represents a serious public health problem. In Colombia, our group reported recently the presence of subgenotypes F3, A2 and genotype G in Bogotá. The aim of this study was to characterize the HBV genotypes circulating in Quibdó, the largest Afro-descendant community in Colombia. Sixty HBsAg-positive samples were studied. A fragment of 1306 bp (S/POL) was amplified by nested PCR. Positive samples to S/POL fragment were submitted to PCR amplification of the HBV complete genome. FINDINGS The distribution of HBV genotypes was: A1 (52.17%), E (39.13%), D3 (4.3%) and F3/A1 (4.3%). An HBV recombinant strain subgenotype F3/A1 was found for the first time. CONCLUSIONS This study is the first analysis of complete HBV genome sequences from Afro-Colombian population. It was found an important presence of HBV/A1 and HBV/E genotypes. A new recombinant strain of HBV genotype F3/A1 was reported in this population. This fact may be correlated with the introduction of these genotypes in the times of slavery.
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Affiliation(s)
- Mónica V Alvarado-Mora
- Laboratory of Gastroenterology and Hepatology, São Paulo Institute of Tropical Medicine and Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil.
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Castilho MDC, Oliveira CMCD, Gimaque JBDL, Leão JDT, Braga WSM. Epidemiology and molecular characterization of hepatitis B virus infection in isolated villages in the Western Brazilian Amazon. Am J Trop Med Hyg 2012; 87:768-74. [PMID: 22908032 PMCID: PMC3516333 DOI: 10.4269/ajtmh.2012.12-0083] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 07/21/2012] [Indexed: 12/15/2022] Open
Abstract
Individuals from three isolated, rural communities in the western Brazilian Amazon were evaluated for serological markers of hepatitis B virus (HBV) infection, HBV genotype, and the presence of risk factors for infection and transmission. Of the 225 individuals studied, 79.1% had serological evidence of HBV infection; 10.2% individuals were chronic carriers for HBV surface antigen (HBsAg-positive). Analysis of risk factors indicates that HBV is transmitted mainly horizontally within the family from a chronic "active" carrier for hepatitis B "e" antigen (HBeAg-positive), though a strong possibility of vertical transmission remains. The predominance of HBV genotype F, with a higher genomic similarity between the isolates, indicated a relatively recent introduction of HBV, from a common source, to the area. This study sheds light on the HBV epidemiology in the Brazilian Amazon region and highlights the need for greater emphasis on HBV control and immunization programs.
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Affiliation(s)
- Márcia da Costa Castilho
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Gerência de Virologia, Universidade do Estado do Amazonas, Programa de Pós-Graduação em Doenças Tropicais e Infecciosas Manaus, Amazonas, Brazil.
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Sbai A, Baha W, Ougabrai H, Allalia T, Dersi N, Lazaar F, Ennaji MM, Benjouad A, El Malki A, Hassar M, Benani A. [Hepatitis B prevalence and risk factors in Morocco]. ACTA ACUST UNITED AC 2011; 60:e65-9. [PMID: 21816547 DOI: 10.1016/j.patbio.2011.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 06/21/2011] [Indexed: 01/26/2023]
Abstract
AIM The aim of this study was to determine the prevalence of hepatitis B and the risk factors in Morocco. STUDY DESIGN A total number of 16,634 individuals were screened for HBsAg using the Murex HBsAg Version 3 assay and were interviewed using a structured standard questionnaire to collect information about risk factor. RESULTS Two hundred seventy-six subjects were positive for HBsAg, the prevalence of HBV infection was 1.66%. Using a structured standard questionnaire we reported that sexual behaviours (43.84%) are among the main risk factors for HBV transmission. CONCLUSION This study indicates that the prevalence of HBsAg in Morocco is currently estimated at 1.66% in the active population. The risk factors for HBV infection identified here indicate that prevention is the most cost-effective method for successfully controlling HBV infection, so vaccination remains the best way to control this infection and its related complications.
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Affiliation(s)
- A Sbai
- Laboratoire d'immunologie et de biochimie, faculté des sciences, 4, avenue Ibn Battouta, BP 1014 RP, Rabat, Maroc.
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Duarte MC, Cardona N, Poblete F, González K, García M, Pacheco M, Botto C, Pujol FH, Williams JR. A comparative epidemiological study of hepatitis B and hepatitis D virus infections in Yanomami and Piaroa Amerindians of Amazonas State, Venezuela. Trop Med Int Health 2010; 15:924-33. [PMID: 20561309 DOI: 10.1111/j.1365-3156.2010.02560.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To report the prevalences of hepatitis B (HBV) and hepatitis D (HDV) infections in remote and more accessible Yanomami and Piaroa Venezuelan Amazonian Amerindian populations; to estimate incidence per susceptible. METHODS Clinico-epidemiological evaluation was carried out in 9 Piaroa villages. Blood samples were tested for HBV core antibody (anti-HBc), surface antigen (HBsAg) and HDV antibody (anti-HDV). Results were analysed using logistic regression, and estimates made of HBV forces of infection (FOI). Prevalences and FOI were also estimated for 4 Yanomami villages. RESULTS Mean Piaroa anti-HBc and HBsAg prevalences were 27.4% and 5.1%, respectively (up to 53% and 19% in the remote Autana region). Mean Yanomami anti-HBc and HBsAg prevalences were, respectively, 58.0% (range 43-70%) and 14.3% (31% in the village with highest HBsAg). No significant difference was found between sexes, with age and maternal HBsAg the only risk factors for HBV identified in multivariate regression of Piaroa data. Only 4 Piaroa and 2 Yanomami individuals were anti-HDV positive. CONCLUSION Piaroa HBV prevalences were generally higher in remote villages than in less remote ones, with prevalences in Yanomami villages even higher. Anti-HBc prevalence was 47% in one Yanomami village with a history of HBV vaccination but no HBsAg cases were identified, suggestive of previously cleared or possibly transient infection or vaccine escape. Despite a past history of HDV epidemic outbreaks and HBsAg levels in some villages appearing sufficient to facilitate HDV transmission, anti-HDV prevalence was low; it remains to be established why no recent outbreaks have been reported.
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Affiliation(s)
- María Carolina Duarte
- Servicio Autónomo Centro Amazónico de Investigación y Control de Enfermedades Tropicales, Puerto Ayacucho, Venezuela
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Alam MM, Zaidi SZ, Shaukat S, Sharif S, Angez M, Naeem A, Saleha S, Butt JA, Malik SA. Common genotypes of Hepatitis B virus prevalent in injecting drug abusers (addicts) of North West Frontier Province of Pakistan. Virol J 2007; 4:63. [PMID: 17597548 PMCID: PMC1910598 DOI: 10.1186/1743-422x-4-63] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 06/28/2007] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The epidemiological significance of Hepatitis B virus genotypes has been well established and becoming an essential concern day by day however, much little is known about the mixed infection with more than one Hepatitis B virus genotypes and their clinical relevance. METHODS Intravenous drug abusers are considered as a major risk group for the acquisition and transmission of blood borne infections like hepatitis B, however, in Pakistan, no such data has ever been reported about the epidemiology of HBV and its genotypes in Injecting Drug Users. 250 individuals were analyzed for hepatitis B virus genotypes after prior screening with serological assay for the detection of HBsAg. RESULTS 56 (22.4%) individuals were found positive on ELSIA for HBsAg. The genotype distribution was found to be as: genotype D, 62.5%; genotype A, 8.92% while 28.57% individuals were found to be infected with a mixture of genotype A and D. CONCLUSION There is an urgent need of the time to develop public health care policies with special emphasis towards the control of HBV transmission through high risk groups especially Injecting Drug Users.
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Affiliation(s)
| | - Sohail Zahoor Zaidi
- Head of Department of Virology; Principal Investigator-WHO Regional Reference Laboratory for Polio Eradication Initiative, National Institute of Health, Islamabad, Pakistan
| | - Shehzad Shaukat
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Salmaan Sharif
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Mehar Angez
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Asif Naeem
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Shamim Saleha
- Research Student, Department of Virology, National Institute of Health, Islamabad Pakistan
| | - Javed Aslam Butt
- Head of Department of Gastroenterology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Salman Akbar Malik
- Head of Department of Biochemistry, Quaid-i-azam University, Islamabad, Pakistan
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de Almeida Pereira RAR, Hg Mussi AD, de Azevedo e Silva VC, Souto FJD. Hepatitis B Virus infection in HIV-positive population in Brazil: results of a survey in the state of Mato Grosso and a comparative analysis with other regions of Brazil. BMC Infect Dis 2006; 6:34. [PMID: 16504137 PMCID: PMC1421409 DOI: 10.1186/1471-2334-6-34] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Accepted: 02/25/2006] [Indexed: 11/17/2022] Open
Abstract
Background End-stage liver disease is currently a major concern among HIV-positive individuals due to co-infection with hepatotropic virus. Hepatitis C has been pointed out as a remarkable factor for that. More recently, hepatitis B virus (HBV) infection has also been found to play a role on liver disease in this population. HIV-HBV co-infection prevalence remains largely unknown in vast areas of Brazil. The objective of the present study was to estimate the prevalence of HBV and HDV infection in HIV-infected subjects living in the state of Mato Grosso, in the Central region of Brazil, and compare it to other Brazilian studies. We also assess epidemiologic data regarding risk factors and vaccinal status. Methods HIV-positive individuals followed at the Central Laboratory of the Department of Public Health of Mato Grosso in the city of Cuiabá composed the sample. Participants answered a specific questionnaire and had a blood sample taken and tested for serologic markers. Results A thousand individuals were interviewed and tested for HBsAg, anti-HBc, anti-HBs and anti-HDV if positive for HBsAg. Measurements of CD4 and viral load for HIV-1 were also performed. Overall prevalence of HBV exposure (anti-HBc +ve) was 40.0%, and 3.7% for HBsAg. This prevalence data was similar or slightly lower than for other Brazilian regions, which ranged from 40% and 3% to 71% and 24%, respectively. Testing for anti-HDV in the 37 HBsAg positive patients was positive in only one subject. Factors that showed independent association with HBV exposure, after adjustment, were: male gender, older age groups, tattooing, and reporting more than ten sexual partners throughout life (p < 0.01). Eighty-one (27.5%) out of 291 HBV-unexposed individuals who reported vaccination were anti-HBs positive. Anti-HBs prevalence was higher among those who had higher levels of CD4 by multivariate analysis. Conclusion Our data showed HBV infection prevalence similar or slightly lower than that reported in other regions of Brazil. In addition, our data revealed a less important role for drug injection in the spread of HIV and HBV in Mato Grosso compared to other regions of the country. The high rate of non-vaccinated subjects among this HBV-unexposed, HIV-infected population is a matter of considerable health concern in this region. The relationship between CD4 levels and HBV vaccine response found in the present study reinforces the need of keeping health care workers alert to this issue.
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Affiliation(s)
| | | | | | - Francisco José Dutra Souto
- Faculdade de Medicina da Universidade de Cuiabá, Cuiabá, MT, Brazil
- Faculdade de Ciências Médicas, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil
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Akhtar S, Younus M, Adil S, Hassan F, Jafri SH. Epidemiologic study of chronic hepatitis B virus infection in male volunteer blood donors in Karachi, Pakistan. BMC Gastroenterol 2005; 5:26. [PMID: 16086833 PMCID: PMC1208878 DOI: 10.1186/1471-230x-5-26] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2005] [Accepted: 08/08/2005] [Indexed: 11/26/2022] Open
Abstract
Background The magnitude of chronic infection with hepatitis B virus (HBV) varies substantially between the countries. A better understanding of incidence and/ or prevalence of HBV infection and associated risk factors provides insight into the transmission of this infection in the community. The purpose of this investigation was to estimate the prevalence of and to identify the risk factors associated with chronic infection with HBV, as assessed by HBV surface antigen (HBsAg) positivity, in asymptomatic volunteer male blood donors in Karachi, Pakistan. Methods Consecutive blood donations made at the two large blood banks between January 1, 1998 and December 31, 2002 were assessed to estimate the prevalence of HBsAg positivity. To evaluate the potential risk factors, a case-control study design was implemented; cases (HBsAg positives) and controls (HBsAg negatives), were recruited between October 15, 2001 and March 15, 2002. A pre-tested structured questionnaire was administered through trained interviewers to collect the data on hypothesized risk factors for HBV infection. Sera were tested for HBsAg using commercially available kits for enzyme linked Immunosorbant assay-III. Results HBsAg prevalence in the male volunteer blood donors was 2.0 % (7048/351309). Multivariate logistic regression analysis showed that after adjusting for age and ethnicity, cases were significantly more likely than controls to have received dental treatment from un-qualified dental care provider (adjusted odds ratio (OR) = 9.8; 95% confidence interval (CI): 2.1, 46.1), have received 1–5 injections (adjusted OR = 3.3; 95% CI: 1.1, 9.6), more than 5 injections (adjusted OR = 1.4; 95% CI: 1.4, 12.7) during the last five years or have received injection through a glass syringe (adjusted OR = 9.4; 95% CI: 2.6, 34.3). Injury resulted in bleeding during shaving from barbers (adjusted OR = 2.3; 95% CI: 1.1, 4.8) was also significant predictor of HBsAg positivity. Conclusion Prevalence of HBsAg positivity in the male volunteer blood donors in Karachi was 2%. Infection control measures in health-care settings including safe injection practices and proper sterilization techniques of medical instruments and education of barbers about the significance of sterilization of their instruments may reduce the burden of HBV infection in this and similar settings. There is also an urgent need of developing locally relevant guidelines for counseling and management of HBsAg positive blood donors.
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Affiliation(s)
- Saeed Akhtar
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University PO Box 24923, Safat 13110, Kuwait
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
| | - Muhammad Younus
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
| | - Salman Adil
- Department of Pathology and Microbiology, Aga Khan University, Karachi 74800, Pakistan
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Abstract
The hepatitis D virus (HDV), also called delta virus, is a small circular RNA virus. The HDV is dependent on the hepatitis B virus (HBV) and can cause infection in normal individuals with hepatitis B or yet, superinfect chronic HBV carriers. Three genotypes have already been cloned and sequenced. Infection with HDV has a worldwide distribution and a high HDV endemicity has been documented in the western Amazon region, in Brazil. It has been estimated that 18 million people are infected with this virus amongst the 350 million carriers of the HBV around the world. The HDV transmission and risk factors for infection are similar to those for HBV infection. The diagnosis is based on the immunohistological identification of HDAg in the liver and detection of IgM and IgG anti-HD in serum using RIA or EIA. The clinical course of hepatitis D is variable. Fulminant disease occurs more commonly in hepatitis B and D than in other forms of acute viral hepatitis. Chronic HDV infection is usually associated with severe histological changes in the liver and with a rapidly progressive course, that can lead to cirrhosis, liver failure and death. Treatment of chronic hepatitis D is currently unsatisfactory and interferon alpha is the only agent found to have some effect on the course of chronic hepatitis. Orthotopic liver transplantation is indicated for terminal cases of cirrhosis. Prophylaxis for HDV infection is possible by vaccination against the hepatitis B virus.
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de Paula VS, Arruda ME, Vitral CL, Gaspar AM. Seroprevalence of viral hepatitis in riverine communities from the Western Region of the Brazilian Amazon Basin. Mem Inst Oswaldo Cruz 2001; 96:1123-8. [PMID: 11784933 DOI: 10.1590/s0074-02762001000800016] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The western region of the Brazilian Amazon Basin has long been shown to be a highly endemic area for hepatitis B and hepatitis D viruses. Data concerning the prevalence of hepatitis C and E viruses in this region are still scarce. In this study we investigated the presence of hepatitis A, B, C, D and E viruses infection in communities that live along the Purus and Acre rivers in the states of Acre and Amazonas within the Amazon Basin. A total of 349 blood samples were collected and tested for hepatitis A-E serological markers (antibodies and/or antigens) using commercial enzyme linked immunosorbent assays. Anti-HCV positive sera were further assayed by an immunoblot. HBsAg positive sera were subtyped by immunodifusion. The overall prevalence for hepatitis A, B, C, and E were 93.7%, 66.1%, 1.7%, and 4%, respectively. A very high prevalence of delta hepatitis (66.6%) was found among HBsAg positive subjects. Hepatitis A, B and D viruses were shown to be largely disseminated in this population, while hepatitis C and E viruses infection presented low prevalence rates in this region. The analysis of risk factors for HBV infection demonstrated that transmission was closely associated with sexual activity.
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Affiliation(s)
- V S de Paula
- Departamento de Virologia, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brasil.
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Ribeiro LC, Souto FJ. [Hepatitis Delta in the State of Mato Grosso, Brazil: report of 5 cases]. Rev Soc Bras Med Trop 2000; 33:599-602. [PMID: 11175592 DOI: 10.1590/s0037-86822000000600013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Five cases of hepatitis B and D superinfection in teenagers from the northernmost region of Mato Grosso State are reported. Hepatitis B is high prevalent there, but not hepatitis D. The proximity to the States of Acre and Amazonas and intense migration may be introducing the virus into the region. Necessity for the surveillance of hepatitis D in northern Mato Grosso is emphasized.
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Affiliation(s)
- L C Ribeiro
- Departamento de Clínica Médica, Hospital Universitário Júlio Müller, Faculdade de Ciências Médicas, Universidade Federal de Mato Grosso, Brazil.
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Ferrari JO, Ferreira MU, Tanaka A, Mizokami M. The seroprevalence of hepatitis B and C in an Amerindian population in the southwestern Brazilian Amazon. Rev Soc Bras Med Trop 1999; 32:299-302. [PMID: 10380571 DOI: 10.1590/s0037-86821999000300013] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We have investigated the seroprevalence of hepatitis B and C among Karitiana Indians (n = 119) living in the State of Rondônia, southwestern Brazilian Amazon. The prevalences of anti-HBs and anti-HBc were 16.1% and 35.3%, respectively, with HBsAg being found in only four (3.4%) subjects. Anti-HCV antibodies were detected in two subjects (1.7%). Age-stratified prevalence data suggest that both vertical and horizontal (the last among adults) routes of HBV transmission are important in this community.
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Affiliation(s)
- J O Ferrari
- National Indian Foundation, Porto Velho, Rondônia, Brazil
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Souto FJ, Fontes CJ, Gaspar AM, Lyra LG. Hepatitis B virus infection in immigrants to the southern Brazilian Amazon. Trans R Soc Trop Med Hyg 1998; 92:282-4. [PMID: 9861397 DOI: 10.1016/s0035-9203(98)91012-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
To identify epidemiological patterns and risk factors associated with hepatitis B virus (HBV) infection in the southern Brazilian Amazon, a survey was performed in the county of Terra Nova do Norte in the northern part of the state of Mato Grosso. The population consists mainly of immigrants from the southern part of Brazil, where HBV prevalence is low. A random sample (n = 783) of the population was interviewed and tested for HBV markers. The overall prevalence of HBV infection was 54.7%. There were 31 hepatitis B surface antigen (HBsAg) carriers (3.9%), with a low rate of HBV e antigen positivity, and none with anti-hepatitis D virus. Subtypes ayw3 and ayw2 of HBsAg were predominant, suggesting that the immigrants carried HBV from their original region to the Amazon. Clustering of HBV infection within families was found. The association between HBV markers and having lived in a gold-miners' camp, even after adjusting for confounders, indicated that the gold-miners may play a role in HBV spread in areas of the Amazon where gold prospecting occurs.
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Affiliation(s)
- F J Souto
- Departamento de Clínica Médica, Hospital Universitário Júlio Müller, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil.
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