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Moonsamy S, Pillay P, Prabdial-Sing N. Hepatitis B infection status among South Africans attending public health facilities over a five-year period: 2015 to 2019. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000992. [PMID: 37747913 PMCID: PMC10519597 DOI: 10.1371/journal.pgph.0000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 06/07/2023] [Indexed: 09/27/2023]
Abstract
Hepatitis B, a potentially life-threatening viral infection of the liver, remains a global public health concern despite the availability of effective vaccines for over three decades. The aim of our study was to provide national data on active hepatitis B infections in the public health sector of South Africa. We conducted retrospective analyses on national laboratory data over the period 2015 to 2019. We identified 176,530 cases who tested positive for HBsAg (active infection) with a test positivity rate of 9.02%. Of these active infections, 11,355 (6.43%) were found to be chronically infected. We linked 24,839 (14.07%) and 2,461 (21.67%) HBeAg positive results to all active HBV infections and identified chronic infections respectively. Clearance of HBsAg was observed in 5,569 cases, inclusive of clearance in 135 chronic cases. Active HBV infections were significantly higher in men than women over the five years (p < 0.0001). Among individuals who were vaccine-eligible as infants (0 to 19 years old), we observed 4,981 active HBV infections, including 1,131 infections under five years old, majority of which (65.78%) were under one year old. In the under five-year age group, the HBsAg population positivity rate was 0.02% and test positivity rate was 4.83%. Among all women with active HBV infections (78,935), 85.17% were of reproductive age and of these, 13.73% were HBeAg positive. Without a birth dose of the HBV vaccine, lack of routine HBsAg screening at antenatal care, and HBsAg and HBeAg prevalence among women of reproductive age, it is likely that the majority of cases under five years old were vertically infected. Optimal HBV vaccine coverage, inclusive of a birth dose, is key to eliminating horizontal and vertical transmission of HBV. Early identification of HBV chronicity through real time data analysis is fundamental in reducing the risk of liver cirrhosis and hepatocellular carcinoma.
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Affiliation(s)
- Shelina Moonsamy
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Centre for Vaccines and Immunology, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Biomedical and Clinical Technology, Durban University of Technology, Durban, South Africa
| | - Pavitra Pillay
- Faculty of Health Sciences, Department of Biomedical and Clinical Technology, Durban University of Technology, Durban, South Africa
| | - Nishi Prabdial-Sing
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Centre for Vaccines and Immunology, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Medical Virology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
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Brown R, Goulder P, Matthews PC. Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts. Wellcome Open Res 2022; 7:32. [PMID: 36212217 PMCID: PMC9520633 DOI: 10.12688/wellcomeopenres.17601.3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/20/2022] Open
Abstract
Sexual dimorphism in infectious diseases refers to the different infection susceptibilities and outcomes between males and females, and has been described for many pathogens, including hepatitis B virus (HBV). HBV is a substantial global health problem, with close to 300 million people chronically infected, and accounting for a million deaths each year, with an urgent need for enhanced interventions to support progress towards elimination goals. Sexual dimorphism has a strong influence in HBV infection, with males more likely to be exposed, to develop chronic infection, and to suffer from complications including cirrhosis and hepatocellular carcinoma (HCC) compared to females. Different outcomes are driven by differential immune responses, sexual dimorphism of the liver, and androgen response elements in the HBV genome. The impact of sex may also vary with age, with changes at puberty and influences of menarche, pregnancy and menopause in females. In addition, gender has complex influences on education, beliefs, behaviour and access to / engagement with healthcare services, which may contribute to differences in diagnosis and treatment. Interplay between these complex factors, alongside other attributes of host, virus and the environment, accounts for different outcomes of infection. However, gaps remain in our understanding of sexual dimorphism in HBV, and little effort has previously been made to harness this knowledge for translational gains. In this review, we assimilate human and animal data to consider the mechanism, outcomes and impact of sexual dimorphism, and consider how these insights can be used to inform advances in surveillance, treatment and prevention for HBV infection.
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Affiliation(s)
- Robin Brown
- Harris Manchester College, University of Oxford, Oxford, Oxon, OX1 3TD, UK
| | - Philip Goulder
- Department of Paediatrics, University of Oxford, Oxford, Oxon, OX1 3SY, UK
| | - Philippa C. Matthews
- Harris Manchester College, University of Oxford, Oxford, Oxon, OX1 3TD, UK
- The Francis Crick Institute, London, London, NW1 1AT, UK
- Division of Infection and Immunity, University College London, London, WC1E 6BT, UK
- Department of Infectious Diseases, University College London Hospital, London, NW1 2BU, UK
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Brown R, Goulder P, Matthews PC. Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts. Wellcome Open Res 2022; 7:32. [PMID: 36212217 PMCID: PMC9520633 DOI: 10.12688/wellcomeopenres.17601.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 08/27/2024] Open
Abstract
Sexual dimorphism in infectious diseases refers to the different infection susceptibilities and outcomes between males and females, and has been described for many pathogens, including hepatitis B virus (HBV). HBV is a substantial global health problem, with close to 300 million people chronically infected, and accounting for a million deaths each year, with an urgent need for enhanced interventions to support progress towards elimination goals. Sexual dimorphism has a strong influence in HBV infection, with males more likely to be exposed, to develop chronic infection, and to suffer from complications including cirrhosis and hepatocellular carcinoma (HCC) compared to females. Different outcomes are driven by differential immune responses, sexual dimorphism of the liver, and androgen response elements in the HBV genome. The impact of sex may also vary with age, with changes at puberty and influences of menarche, pregnancy and menopause in females. In addition, gender has complex influences on education, beliefs, behaviour and access to / engagement with healthcare services, which may contribute to differences in diagnosis and treatment. Interplay between these complex factors, alongside other attributes of host, virus and the environment, accounts for different outcomes of infection. However, gaps remain in our understanding of sexual dimorphism in HBV, and little effort has previously been made to harness this knowledge for translational gains. In this review, we assimilate human and animal data to consider the mechanism, outcomes and impact of sexual dimorphism, and consider how these insights can be used to inform advances in surveillance, treatment and prevention for HBV infection.
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Affiliation(s)
- Robin Brown
- Harris Manchester College, University of Oxford, Oxford, Oxon, OX1 3TD, UK
| | - Philip Goulder
- Department of Paediatrics, University of Oxford, Oxford, Oxon, OX1 3SY, UK
| | - Philippa C. Matthews
- Harris Manchester College, University of Oxford, Oxford, Oxon, OX1 3TD, UK
- The Francis Crick Institute, London, London, NW1 1AT, UK
- Division of Infection and Immunity, University College London, London, WC1E 6BT, UK
- Department of Infectious Diseases, University College London Hospital, London, NW1 2BU, UK
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4
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Brown R, Goulder P, Matthews PC. Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts. Wellcome Open Res 2022; 7:32. [PMID: 36212217 PMCID: PMC9520633 DOI: 10.12688/wellcomeopenres.17601.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 09/06/2024] Open
Abstract
Sexual dimorphism in infectious diseases refers to the different infection susceptibilities and outcomes between males and females, and has been described for many pathogens, including hepatitis B virus (HBV) infection. HBV is a substantial global health problem, with close to 300 million people infected, and accounting for a million deaths each year, with an urgent need for enhanced interventions to support progress towards elimination goals. Sexual dimorphism has a strong influence in HBV infection, with males more likely to be exposed, to develop chronic infection, and to suffer from complications including cirrhosis and hepatocellular carcinoma (HCC) compared to females. Different outcomes are driven by differential immune responses, sexual dimorphism of the liver, and androgen response elements in the HBV genome. The impact of sex may also vary with age, with changes at puberty and influences of menarche, pregnancy and menopause in females. In addition, gender has complex influences on education, beliefs, behaviour and access to / engagement with healthcare services, which may contribute to differences in diagnosis and treatment. Interplay between these complex factors, alongside other attributes of host, virus and the environment, accounts for different outcomes of infection. However, gaps remain in our understanding of sexual dimorphism in HBV, and little effort has previously been made to harness this knowledge for translational gains. In this review, we assimilate human and animal data to consider the mechanism, outcomes and impact of sexual dimorphism, considering how these insights can be used to inform advances in surveillance, treatment and prevention for HBV infection.
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Affiliation(s)
- Robin Brown
- Harris Manchester College, University of Oxford, Oxford, Oxon, OX1 3TD, UK
| | - Philip Goulder
- Department of Paediatrics, University of Oxford, Oxford, Oxon, OX1 3SY, UK
| | - Philippa C. Matthews
- Harris Manchester College, University of Oxford, Oxford, Oxon, OX1 3TD, UK
- The Francis Crick Institute, London, London, NW1 1AT, UK
- Division of Infection and Immunity, University College London, London, WC1E 6BT, UK
- Department of Infectious Diseases, University College London Hospital, London, NW1 2BU, UK
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Prevalence and incidence rates of laboratory-confirmed hepatitis B infection in South Africa, 2015 to 2019. BMC Public Health 2022; 22:29. [PMID: 34991533 PMCID: PMC8739689 DOI: 10.1186/s12889-021-12391-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/07/2021] [Indexed: 12/17/2022] Open
Abstract
Background Hepatitis B virus (HBV), a global public health threat, is targeted for elimination by 2030. As national HBV prevalence and incidence is lacking for South Africa, our study aimed to provide such data in the public health sector. Methods We analysed laboratory-confirmed HBV data from 2015 to 2019 to determine annual prevalence and incidence rates of HBV infection per 100,000 population, HBsAg and anti-HBc IgM test positivity rates, and HBsAg and anti-HBc IgM testing rates per 100,000 population. Time trend and statistical analyses were performed on HBsAg and anti-HBc IgM test positivity rates. Results The national prevalence rate of HBV infection per 100,000 population increased from 56.14 in 2015 to 67.76 in 2019. Over the five years, the prevalence rate was higher in males than females, highest amongst individuals 25 to 49 years old and highest in Gauteng province. The HBsAg test positivity rate dropped from 9.77% in 2015 to 8.09% in 2019. Over the five years, the HBsAg test positivity rate was higher in males than females, amongst individuals 25 to 49 years old and amongst individuals of Limpopo province. Amongst HBsAg positive children under 5 years old, the majority (65.7%) were less than a year old. HBsAg testing rates per 100,000 population were higher in females under 45 years of age and in males 45 years and above. The national incidence rate of acute HBV infection per 100,000 population dropped from 3.17 in 2015 to 1.69 in 2019. Over the five-year period, incidence rates were similar between males and females, highest amongst individuals 20 to 39 years old and highest in Mpumalanga province. Amongst individuals 20 to 24 years old, there was a substantial decline in the incidence and anti-HBc IgM test positivity rates over time. Anti-HBc IgM testing rates per 100,000 population were higher in females under 40 years of age and in males 40 years and above. Conclusion Critical to hepatitis B elimination is strengthened infant vaccination coverage and interruption of vertical transmission. Transmission of HBV infection in adults may be reduced through heightened awareness of transmission routes and prevention measures. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12391-3.
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Prevalence of Hepatitis B Serum Markers in Young Military Recruits in Greece: A Comparison Study between 2005 and 2019 Cohorts. LIVERS 2021. [DOI: 10.3390/livers1040018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The prevalence of hepatitis B varies (HBV) among countries. Although an overall reduction has been described in Greece, data are limited. Methods: We reviewed the HBsAg/anti-HBc/anti-HBs seroprevalence among military recruits and compared data between 2005 and 2019. The study included 2001 (group 1) and 1629 (group 2) male recruits in 2019 and 2005, respectively. Age and descent were recorded. Results: The prevalence of HBsAg, anti-HBc and anti-HBs positivity in group1 vs. group 2 was estimated as: 0.2%, 1.3% and 67% vs. 0.4%, 1.6% and 62%, respectively. Only anti-HBs positivity achieved a statistically significant difference between the two groups (p = 0.007). HBsAg and anti-HBc were more frequently positive in non-Greeks than in Greeks (9/237 (4%) vs. 2/3393 (0.06%), p < 0.001), (26/237 (11%) vs. 26/3393 (0.8%), p < 0.001 respectively), while anti-HBs was more frequently positive in Greeks than in non-Greeks (84/164 (51%) vs. 1461/2213 (66%), p < 0.001). Conclusions: Our data suggest a further reduction in HBV prevalence in Greece about 20 years after the adoption of the National HBV Immunization Program, with Greek participants experiencing a more effective HBV Immunization Program than non-Greeks.
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Triantos C, Konstantakis C, Tselekouni P, Kalafateli M, Aggeletopoulou I, Manolakopoulos S. Epidemiology of hepatitis C in Greece. World J Gastroenterol 2016; 22:8094-8102. [PMID: 27688651 PMCID: PMC5037078 DOI: 10.3748/wjg.v22.i36.8094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/07/2016] [Accepted: 08/10/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C is a global health issue and constitutes a major cause of chronic liver disease worldwide. In this article, a comprehensive literature search was conducted for the prevalence of hepatitis C virus (HCV) infection in Greece, since data on the HCV prevalence, viremia and genotypes are important for developing strategies to manage or eliminate HCV infection. In addition, the pattern of HCV infection was analyzed according to the geographic region and the risk factors. These differences reflect not only distinct epidemiological characteristics among populations, but also differences on the strategy of data acquisition and quantification. Although there are not enough data, the estimation of the current prevalence of Hepatitis C in Greece ranges from 0.5% to 2%. The most important risk factors for HCV infection include blood product transfusion, intravenous drug use, chronic hemodialysis, organ transplantation, occupational exposure, sexual transmission, and vertical transmission. Because of lack of vaccine or effective post-exposure prophylaxis for HCV, the main focus of prevention is to recognize and control these risk factors. HCV infection in Greece is closely associated with the development of chronic liver disease, cirrhosis, and primary hepatocellular carcinoma. As far as the genotype distribution is concerned genotype 1 estimated to be 45%-47% and it constitutes the prevalent genotype in Greece, followed by genotype 3.
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8
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Sex differences in prophylaxis and therapeutic treatments for viral diseases. Handb Exp Pharmacol 2013:499-522. [PMID: 23027464 DOI: 10.1007/978-3-642-30726-3_22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The intensity and prevalence of viral infections are typically higher in males than in females. In contrast, disease outcome can be worse for females. Males and females also differ in their responses to prophylaxis and therapeutic treatments for viral diseases. In response to vaccines against herpes viruses, hepatitis viruses, influenza viruses, and others, females consistently mount higher humoral immune responses and experience more frequent and severe adverse reactions than males. Males and females also differ in the absorption, metabolism, and clearance of antiviral drugs. The pharmacological effects, including toxicity and adverse reactions, of antiviral drugs are typically greater in females than males. The efficacy of antiviral drugs at reducing viral load also differs between the sexes, with antiviral treatments being better at clearing HIV and hepatitis C virus in females, but showing greater reduction of herpes simplex virus and influenza A virus loads in males. Biological variables, including hormone and genes, as well as gender-specific factors related to access and compliance to drug regimens must be considered when evaluating male-female differences in responses to treatments for viral diseases. Clinicians, epidemiologists, and basic biomedical scientists should design experiments that include both males and females, develop a priori hypotheses that the sexes will differ in their responses to and the outcome of vaccines and antiviral treatments, and statistically analyze outcome data by sex. Knowledge that the sexes differ in response to prophylaxis and therapeutic treatments for viral diseases should influence the recommended course of treatment differently for males and females.
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9
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Hepatitis C Virus infections trends in Italy, 1996-2006. HEPATITIS MONTHLY 2011. [DOI: 10.5812/kowsar.1735143x.3751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Prevalence of Chronic Hepatitis B and Hepatitis C among First Time Blood Donors in Northeast Bosnia and Herzegovina: An Estimate of Prevalence in General Population. HEPATITIS MONTHLY 2011. [DOI: 10.5812/kowsar.1735143x.1506] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Cornberg M, Razavi HA, Alberti A, Bernasconi E, Buti M, Cooper C, Dalgard O, Dillion JF, Flisiak R, Forns X, Frankova S, Goldis A, Goulis I, Halota W, Hunyady B, Lagging M, Largen A, Makara M, Manolakopoulos S, Marcellin P, Marinho RT, Pol S, Poynard T, Puoti M, Sagalova O, Sibbel S, Simon K, Wallace C, Young K, Yurdaydin C, Zuckerman E, Negro F, Zeuzem S. A systematic review of hepatitis C virus epidemiology in Europe, Canada and Israel. Liver Int 2011; 31 Suppl 2:30-60. [PMID: 21651702 DOI: 10.1111/j.1478-3231.2011.02539.x] [Citation(s) in RCA: 304] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Decisions on public health issues are dependent on reliable epidemiological data. A comprehensive review of the literature was used to gather country-specific data on risk factors, prevalence, number of diagnosed individuals and genotype distribution of the hepatitis C virus (HCV) infection in selected European countries, Canada and Israel. METHODOLOGY Data references were identified through indexed journals and non-indexed sources. In this work, 13,000 articles were reviewed and 860 were selected based on their relevance. RESULTS Differences in prevalence were explained by local and regional variances in transmission routes or different public health measures. The lowest HCV prevalence (≤ 0.5%) estimates were from northern European countries and the highest (≥ 3%) were from Romania and rural areas in Greece, Italy and Russia. The main risk for HCV transmission in countries with well-established HCV screening programmes and lower HCV prevalence was injection drug use, which was associated with younger age at the time of infection and a higher infection rate among males. In other regions, contaminated glass syringes and nosocomial infections continue to play an important role in new infections. Immigration from endemic countries was another factor impacting the total number of infections and the genotype distribution. Approximately 70% of cases in Israel, 37% in Germany and 33% in Switzerland were not born in the country. In summary, HCV epidemiology shows a high variability across Europe, Canada and Israel. CONCLUSION Despite the eradication of transmission by blood products, HCV infection continues to be one of the leading blood-borne infections in the region.
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Affiliation(s)
- Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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New data concerning the epidemiology of Hepatitis B virus infection in Greece. Gastroenterol Res Pract 2009; 2008:580341. [PMID: 18795118 PMCID: PMC2533103 DOI: 10.1155/2008/580341] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Accepted: 02/21/2008] [Indexed: 12/31/2022] Open
Abstract
There is an obvious, significant, and diachronic reduction of the
prevalence of HBV infection in Greece, concerning the general population as
well as some traditionally high-risk groups, mainly as a result of constant
informing and the widespread initiation of preventive and prophylactic
measures, as well as the improvement of health care services. Nevertheless,
there are special groups and populations (economical refugees, religious
minorities, HIV-positive patients, abroad pregnant women, prostitutes, etc.) who
represent sacs of high HBV endemicity and need epidemiological supervision and intervention, in order to limit the spread of the infection and to further
improve the existing epidemiological data.
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Stefos A, Gatselis N, Zachou K, Rigopoulou E, Hadjichristodoulou C, Dalekos GN. Descriptive epidemiology of chronic hepatitis B by using data from a hepatitis registry in Central Greece. Eur J Intern Med 2009; 20:35-43. [PMID: 19237090 DOI: 10.1016/j.ejim.2008.04.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 03/18/2008] [Accepted: 04/25/2008] [Indexed: 01/11/2023]
Abstract
BACKGROUND In Greece, there are few data on the epidemiological characteristics of HBV. Our aim was to study the epidemiological patterns of HBV in Central Greece and identify the possible differences in HBV prevalence (clusters) among areas inside this region using data from the hepatitis registry. METHODS The study was performed in Thessaly, one out of the thirteen regions of Greece and covers most of the part of Central Greece. A total of 921 HBV patients were registered in the hepatitis registry during the period 1999-2004 while 303 were randomly selected to be studied further using a detailed questionnaire on several epidemiological factors. RESULTS 187/303 patients (61.7%) classified as chronic inactive HBV carriers, 78/303 (25.7%) had chronic hepatitis B, 29/303 (9.6%) had HBV-related cirrhosis and 9/303 (3%) HBV-related hepatocellular carcinoma (HCC). The route of HBV transmission was vertical in 103 (34%), sexual in 46 (15.1%) and intrafamilial in 98 (32.4%). Folk remedies were identified as the predisposing risk factor for contracting HBV infection in 38 (12.5%), previous transfusion in 9 (3%) and unknown mode of transmission in 9 patients (3%). Alcohol abuse was the only independent factor (OR: 2.5; p=0.01) associated with the progression to cirrhosis-HCC. There were specific areas (clusters) inside Thessaly region with increased ratio of HBV infection; Vertical and sexual modes of transmission were more prominent in some of these areas. CONCLUSIONS Vertical, intrafamilial and sexual modes of HBV transmission identified as the major routes of HBV infection in our study. We also identified cluster areas of HBV infection in Central Greece. Alcohol abuse is frequent among HBV patients and is acting as an effect modificator risk factor for the development of HBV-related cirrhosis and HCC. Extended population studies in Greece are needed to assess in detail the epidemiological patterns of HBV and evaluate control programmes.
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Affiliation(s)
- Aggelos Stefos
- Department of Medicine, Academic Liver Unit, Medical School, University of Thessaly, Larissa, Greece
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Sgourou A, Karakantza M, Theodori E, Papadimitriou C, Theodorou GL, Davanos N, Thymianou S, Zoumbos NC, Mouzaki A. Procleix Ultrio transcription-mediated amplification vs. serological blood screening in south-western Greece. Transfus Med 2008; 18:104-11. [DOI: 10.1111/j.1365-3148.2008.00847.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Salkic NN, Zildzic M, Muminhodzic K, Pavlovic-Calic N, Zerem E, Ahmetagic S, Mott-Divkovic S, Alibegovic E. Intrafamilial transmission of hepatitis B in Tuzla region of Bosnia and Herzegovina. Eur J Gastroenterol Hepatol 2007; 19:113-8. [PMID: 17272995 DOI: 10.1097/meg.0b013e32801290f7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine (i) the prevalence of HBV infection in families of confirmed chronic carriers, (ii) possible routes of transmission and risk factors for the intrafamilial transmission, (iii) vaccination rate among family members of chronic carriers and (iv) family members with highest risk for infection. METHODS A total of 172 family members of 67 hepatitis B surface antigen chronic carriers were tested for hepatitis B markers; 716 first-time blood donors from the same area were used as controls. RESULTS Prevalence of hepatitis B surface antigen was higher (P<0.001) among family members of index cases (12.2%; 21/172) than among controls (3.6%; 26/716) with relative risk of 3.3 (95% confidence Intervals=1.9-5.8; P<0.05). Rate of exposure among family members was 37.8% (65/172); only 8.7% (15/172) had been vaccinated for hepatitis B virus. Difference (P<0.001) in exposure existed among family members; exposure increased with age (rhos=0.34; P<0.001). Prevalences of hepatitis B surface antigen positivity and hepatitis B virus exposure were higher among parents of index cases (P<0.005) and among offspring of female index cases (P<0.001). There were more (P<0.001) hepatitis B surface antigen-positive family members among those with mother-children relationship with index case (13/31; 41.9%) than among those with father-children (19/85; 22.4%) and horizontal (siblings and spouses) relationship (2/56; 3.6%). Significantly more (P<0.001) hepatitis B surface antigen-positive and hepatitis B virus-exposed offspring were found in families where only mother was hepatitis B surface antigen positive. Among family members of HBeAg-positive cases more hepatitis B surface antigen-positive cases and hepatitis B virus-exposed cases have been found (P<0.001). Combination of HBeAg positivity and female sex of index case significantly increased risk for chronic carriage among family members (relative risk=24.06; 95% confidence interval=8.88-65.21; P<0.05). CONCLUSION In the area studied, both horizontal and vertical transmission exists, but maternal route is predominant. Female sex, HBeAg positivity of index carrier and presence of hepatitis B surface antigen-positive mother inside family increased risk for hepatitis B surface antigen positivity and exposure among family members. Vaccination rate of family members of index cases is alarmingly low.
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Affiliation(s)
- Nermin N Salkic
- Department of Gastroenterology, Internal Medicine Hospital, Bosnia and Herzegovina.
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16
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Gatselis NK, Rigopoulou E, Stefos A, Kardasi M, Dalekos GN. Risk factors associated with HCV infection in semi-rural areas of central Greece. Eur J Intern Med 2007; 18:48-55. [PMID: 17223043 DOI: 10.1016/j.ejim.2006.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Revised: 07/20/2006] [Accepted: 09/19/2006] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) appears to be endemic in most parts of the world, but there is considerable geographic variation. In order to assess the geographic distribution of HCV in Thessaly, in central Greece, we conducted a retrospective study in HCV-infected patients attending the Academic Liver Unit of Thessaly University from 1999 to 2003. We also investigated whether variation among regions could be attributed to differences in risk factors. METHODS We evaluated the records of 309 HCV patients whose origin and/or residence was in Thessaly. To identify risk factors that were independently associated with the place of birth and/or residence, adjusted odds ratios (OR) were calculated by logistic regression analysis. We also studied the medical records of 150 HCV-negative patients from the same areas in order to evaluate whether there are differences in risk factors reported by HCV-positive and HCV-negative patients. RESULTS We found three municipalities with a high HCV frequency. The use of non-disposable, multiple-use glass syringes for medical purposes in the past was the only potential risk factor more frequently identified in these areas than in other places (OR=2.3; p<0.05). This risk factor was significantly (p<0.001) associated with older age of the infected patients. CONCLUSIONS This study shows that the spread of HCV in the three regions may have occurred several years ago as a result of the use of multiple-use glass syringes. Differences in prevalence rates among different age groups, as well as among different areas, indicate the need for extensive studies to determine HCV epidemiology and to develop appropriate prevention programs.
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Affiliation(s)
- Nikolaos K Gatselis
- Department of Medicine, Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
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Altindis M, Yilmaz S, Dikengil T, Acemoglu H, Hosoglu S. Seroprevalence and genotyping of hepatitis B, hepatitis C and HIV among healthy population and Turkish soldiers in Northern Cyprus. World J Gastroenterol 2006; 12:6792-6. [PMID: 17106927 PMCID: PMC4087433 DOI: 10.3748/wjg.v12.i42.6792] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the prevalence of hepatitis viral markers among soldiers from Turkey, blood donors from Northern Cyprus, and soldiers from Northern Cyprus.
METHODS: Hepatitis B surface antigen (HBsAg), anti-HCV and anti-human immunodeficiency virus (HIV) seroprevalence, HBV DNA, HCV RNA and HCV genotyping among soldiers from Turkey (groupI), civil blood donors from Northern Cyprus (group II), and soldier candidates from Northern Cyprus (group III) were studied and compared to one another. In total, 17 545 cases (13 546 males and 3999 females with a mean age of 34.5 ± 10.3 year, groupI= 11 234, group II = 5057, and group III = 1254) were included into the study.
RESULTS: Among all cases, HBsAg positivity rates were 2.46%, anti-HCV was 0.46% and anti-HIV was 0.00%. HBV DNA was 2.25%, HCV RNA was 0.33% in all groups. HBsAg positivity rates were 2.16% in groupI, 3.00% in group II and 2.71% in group III. There was a significant difference between groupIand group II (χ2 = 6.11, P = 0.047 < 0.05). Anti-HCV positivity rates were 0.45% in groupI, 0.45% in group II, and 0.56% in group III. Genotypes of HCV were 1b and 1a in groupI, 1b, 1a and 2 in group II, and 1b, 1a in group III. HBsAg carrier rates were 2.20% in females and 2.53% in males. Anti-HCV prevalence was 0.38% in females and 0.48% in males. HBsAg positivity rates were 2.53% in individuals younger than 50, and 1.47% in older than 50. There was a significant difference between the two groups (χ2 = 23.48, P = 0.001).
CONCLUSION: Prevalences of HBsAg, HCV and HIV infections in Northern Cyprus population are similar to those of Turkey.
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Affiliation(s)
- Mustafa Altindis
- Department of Microbiology and Clinical Microbiology, Kocatepe University School of Medicine, Afyon, Turkey.
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Valente VB, Covas DT, Passos ADC. [Hepatitis B and C serologic markers in blood donors of the Ribeirão Preto Blood Center]. Rev Soc Bras Med Trop 2006; 38:488-92. [PMID: 16410924 DOI: 10.1590/s0037-86822005000600008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The investigation involved 25,891 blood donors who attended for the first time the Blood Center of Ribeirão Preto, Brazil, between Jun 23, 1996 and Jun 22, 2001. The objective was to study the proportion of positive serological markers for hepatitis B and C at the initial screening tests and to estimate the prevalence of such infections through the analysis of confirmatory tests, carried out at the University Hospital as a part of the patients evaluation. Data from the donors and laboratory results were obtained from the records of both the Blood Bank and the Hospital. The population of donors was mainly composed by males (83.6%) and by individuals between 26 and 45 (64%) years of age. The proportions of positive results in screening tests were 0.6% (CI95%: 0.54-0.72) for HBsAg and 1.2% (CI95%: 1.02-1.28) for anti-HCV. Confirmatory testes showed values of prevalence of 0.2% (CI95%: 0.16-0.28) for hepatitis B and 0.3% (IC95%: 0.24-0.38) for hepatitis C.
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Katsoulidou A, Sypsa V, Tassopoulos NC, Boletis J, Karafoulidou A, Ketikoglou I, Tsantoulas D, Vafiadi I, Hatzis G, Skoutelis A, Akriviadis E, Vasiliadis T, Kitis G, Magiorkinis G, Hatzakis A. Molecular epidemiology of hepatitis C virus (HCV) in Greece: temporal trends in HCV genotype-specific incidence and molecular characterization of genotype 4 isolates. J Viral Hepat 2006; 13:19-27. [PMID: 16364078 DOI: 10.1111/j.1365-2893.2005.00649.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study aimed to estimate the overall HCV genotype distribution and to reconstruct the HCV genotype-specific incidence in Greece during the recent decades. It also focused at the identification of genotype 4 subtype variability in Greek isolates. A total of 1686 chronically infected HCV patients with detectable serum HCV RNA by RT-PCR, belonging to different risk groups were studied. Amplified products from the 5'-noncoding region were typed using a commercially available assay based on the reverse hybridization principle. The HCV genotype-specific incidence was estimated using a previously described back calculation method. HCV genotype 1 was the most prevalent (46.9%) followed by genotype 3 (28.1%), 4 (13.2%), 2 (6.9%) and 5 (0.4%). A high prevalence of genotype 1 (66.3%) in haemophilia patients was recorded whereas HCV genotype 3 was found mainly among patients infected by I.V. drug use (58.2%). Data on the temporal patterns of HCV genotype-specific incidence in Greece revealed a moderate increase (1.3-1.6 times) for genotypes 1 and 4, and a decrease (1.5 times) for genotype 2 from 1970 to 1990, whereas there was a sharp (13-fold) increase for genotype 3. The molecular characterization of 41 genotype 4 HCV isolates belonging to various risk groups revealed that, subtype 4a was the most frequently detected (78%). Phylogenetic comparison of the Greek 4a isolates with all HCV-4a isolates reported worldwide so far revealed a topology which does not discriminate Greek isolates from the others. HCV-4 does not represent a recent introduction in Greece.
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Affiliation(s)
- A Katsoulidou
- Department of Hygiene and Epidemiology, Athens University Medical School, Athens, Greece
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20
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Zervou EK, Gatselis NK, Xanthi E, Ziciadis K, Georgiadou SP, Dalekos GN. Intrafamilial spread of hepatitis B virus infection in Greece. Eur J Gastroenterol Hepatol 2005; 17:911-5. [PMID: 16093867 DOI: 10.1097/00042737-200509000-00005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE No study has investigated the intrafamilial spread of hepatitis B virus (HBV) in Greece. We conducted a 9-year prospective study to determine the rate of HBV spread in family members when a member is identified as an HBV carrier, the possible routes and risk factors for transmission of HBV and the family members with the highest risk of infection according to kinship degrees. METHODS A total of 387 family members of 166 hepatitis B surface antigen (HBsAg) carriers were investigated for the detection of HBV infection markers using standard enzyme immunoassays; 6.696 blood donors from the same area were used as controls. RESULTS Serological markers of past or current HBV infection were detected significantly more frequently among family members of HBsAg carriers (23.2 and 15.8%, respectively) compared with blood donors (14.1 and 0.85%, respectively). The prevalence of the above markers was higher among siblings, husbands and parents of the carriers. Offspring of the female index cases had higher rates of current or past infection. HBV infection markers were significantly increased in family members who reported common use of syringes (P<0.001), birth in rural areas (P<0.001) and a low level of education (P<0.001). CONCLUSIONS We demonstrated a high risk of HBV transmission among family members of HBsAg carriers, which was associated with special risk factors for contracting HBV. Our findings indicate the need for strict adherence to the universal guidelines of vaccination against HBV and also the need for an immediate investigation of other potentially infected relatives among family members of HBsAg carriers.
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21
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Roussos A, Goritsas C, Pappas T, Spanaki M, Papadaki P, Ferti A. Prevalence of hepatitis B and C markers among refugees in Athens. World J Gastroenterol 2003; 9:993-5. [PMID: 12717844 PMCID: PMC4611411 DOI: 10.3748/wjg.v9.i5.993] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the prevalence of hepatitis B and C serological markers in a population of refugees living in Athens.
METHODS: One hundred and thirty refugees (81 males and 49 females, mean age ± SD: 31.7 ± 8 years) were included in the study. The hepatitis B virus surface antigen (HBsAg), the hepatitis B virus core antibody (anti-HBc) and the hepatitis C virus antibody (anti-HCV) were detected using a third-generation immunoassay.
RESULTS: Twenty individuals (15.4%) were HBsAg positive and 69 (53.1%) were anti-HBc positive. The prevalence of HBsAg and anti-HBc was higher among refugees from Albania and Asia (statistical significant difference, P < 0.008 and P < 0.001 respectively). The prevalence of these markers was found irrelevant to age or sex. Anti-HCV was detected in the serum of 3 individuals (2.3%). No differences among age, sex or ethnicity regarding anti-HCV prevalence were found.
CONCLUSION: It can be concluded that refugees living in Athens are an immigrant population characterized by a high incidence of HBV infection. The prevalence of HBV markers is higher among refugees from Albania and Asia. It is therefore believed that the adherence to general precautions and the initiation of HBV vaccination programs will be necessary in the future, especially in these communities. Although the prevalence of HCV infection seems to be relatively low, extended epidemiological surveys are needed to provide valid results.
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Affiliation(s)
- Anastasios Roussos
- Department of Internal Medicine, General Regional Hospital Sotiria, Athens, Greece.
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22
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Zervou EK, Boumba DS, Liaskos C, Georgiadou S, Tsianos EV, Dalekos GN. Low prevalence of HCV, HIV, and HTLV-I/II infection markers in northwestern Greece: results of a 3-year prospective donor study (1995-1997). Eur J Intern Med 2003; 14:39-44. [PMID: 12554009 DOI: 10.1016/s0953-6205(02)00185-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: The risk of infection with transfusion-transmitted viruses has been reduced remarkably. A zero-risk blood supply, however, remains a popular goal. A 3-year prospective donor study was conducted in the Epirus region of Greece to determine the prevalence of human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV), hepatitis B virus, and hepatitis C virus (HCV). Herein, we report the prevalence of HIV, HTLV, and HCV infection markers in this area. Methodology: Between January 1, 1995 and December 31, 1997, 6696 donors were investigated for the presence of anti-HIV, anti-HTLV, and anti-HCV antibodies using standard enzyme immunoassays (EIA). Every sample with anti-HCV reactivity by third-generation EIA was further investigated using a third-generation recombinant immunoblot assay (RIBA 3.0) and HCV-RNA by a combination of polymerase chain reaction (PCR) and DNA EIA. Results: None of the donors tested positive for anti-HIV or anti-HTLV antibodies. In contrast, anti-HCV was detected in 41 donors (0.61%). Using a RIBA 3.0 test, eight donors tested positive and eight had indeterminate results, while 25 tested negative. Seven of the eight donors with both EIA and RIBA 3.0 reactivity had increased levels of aminotransferases and detectable serum HCV-RNA. The remaining 34 donors had repeatedly normal aminotransferases and three times negative HCV-RNA. Liver biopsy was performed in anti-HCV/HCV-RNA-positive donors (7/41). The lesions were compatible with chronic hepatitis C in all of them. Conclusion: A zero prevalence of HIV and HTLV infection markers was found. Although the number of annual donations in this study was relatively low, the negative data for HIV and HTLV clearly indicate that rates of these infections are low in our region and that infected donors will be seen infrequently. HCV infection in blood donors remains very low in our region and is similar to the data reported in other industrialized countries. In fact, the prevalence of definite HCV infection seems to be very low (7/6696; 0.1%). However, a significant proportion of anti-HCV-reactive donors by third-generation EIA (33/41) had indeterminate or negative results by the RIBA 3.0. The latter donors were repeatedly negative for HCV-RNA. This finding may indicate that some donors tested false-positive for anti-HCV, although the possibility of true HCV infection contracted in the distant past cannot be excluded. In our opinion, close attention to mandatory principles of transfusion medicine, along with the screening of plasma donors using nucleic acid amplification technology, are the only methods that can further ensure the safety of our blood supply.
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Affiliation(s)
- E K. Zervou
- Blood Bank at the University Hospital of Ioannina, Ioannina, Greece
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23
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Koulentaki M, Ergazaki M, Moschandrea J, Spanoudakis S, Tzagarakis N, Drandakis PE, Spandidos DA, Kouroumalis EA. Prevalence of hepatitis B and C markers in high-risk hospitalised patients in Crete: a five-year observational study. BMC Public Health 2001; 1:17. [PMID: 11806759 PMCID: PMC64645 DOI: 10.1186/1471-2458-1-17] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2001] [Accepted: 12/21/2001] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND So far the prevalence of viral hepatitis infection in hospitalized patients has not been extensively studied. Therefore we conducted the present five-year observational study to evaluate the prevalence of HBV and HCV infection in high-risk hospitalized patients of Crete, the largest Greek island, Due to the homogeneous population, epidemiological studies can be accurately done. METHODS The study was carried out in two out of four District General Hospitals, and in the University Hospital of the island. Markers for HBV and HCV were studied and statistically evaluated according to age, sex and geographical area, in a well-defined hospitalized population. RESULTS The total prevalence of HBsAg and anti-HCV in the three prefectures during the five-year study is 2.66% and 4.75% respectively. Overall the relative risks were higher in males than females for each hepatitis marker (p < 0.001). Higher prevalence of HBcAb was found in the 41-60 years age group for both sexes (males 36.17%, females 27.38%). Peak HBsAg prevalence was found in the age group of 21-40 and 41-60 years for males (5.4%) and females (3.09%) respectively. Anti-HCV prevalence increases with age reaching the highest prevalence in the age group of 41-60 years for males (7.19%) and in the 61-90 years age group for females (7.16%). For both sexes significant differences between the three locations were identified. For HBsAg a higher prevalence in Heraklion (3.96%) compared to Chania (2.30%, males: p < 0.0001, females: p < 0.05) and Rethymnon (1.45%, males: p < 0.01, females: p < 0.0001) was detected. For HCV a significantly higher prevalence in Heraklion (6.54%) compared to Chania (2.39%, males: p < 0.001, females: p < 0.001) but not in Rethymnon (5.15%, NS). A lower prevalence rate of HBcAb in Heraklion compared to Chania (20.07% versus 23.05%, males: p < 0.001, females: p < 0.001) was found. CONCLUSIONS These results were possibly overestimated, but nevertheless reflect the situation of the general population within the island as shown by our previous publications in other study groups. Moreover they contribute to the mapping of viral hepatitis prevalence in a geographical area of Southern Europe and may be helpful in planning public health interventional strategies.
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Affiliation(s)
- Meri Koulentaki
- Dept of Gastroenterology, University Hospital of Heraklion, Crete, Greece
| | - Maria Ergazaki
- Dept of Virology, University Hospital of Heraklion, Crete, Greece
| | | | - Stelios Spanoudakis
- Department of Internal Medicine, District General Hospital of Rethymnon, Crete, Greece
| | | | - Pandelis E Drandakis
- Department of Internal Medicine, District General Hospital of Rethymnon, Crete, Greece
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Drygiannakis D, Lionis C, Drygiannakis I, Pappas G, Kouroumalis E. Low prevalence of liver-kidney microsomal autoantibodies of type 1 (LKM1) in hepatitis C seropositive subjects on Crete, Greece. BMC Gastroenterol 2001; 1:4. [PMID: 11418082 PMCID: PMC33343 DOI: 10.1186/1471-230x-1-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2001] [Accepted: 06/11/2001] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hepatitis C is a serious problem on the Greek island of Crete, where a high prevalence of antibodies against hepatitis C (anti-HCV) has recently been reported. This article reports the findings of a study carried out in Crete, which investigated the prevalence of serum autoantibodies in patients with chronic hepatitis C. PATIENTS AND METHODS One hundred and forty two patients (59 men and 83 women), who were found anti-HCV seropositive in two hospitals and two Primary Health Care Centres in Crete, were eligible. Sixty healthy blood donors (46 men, 14 women), which were negative to anti-HCV, were used as the control group. They were randomly selected from those attending Rethymnon Hospital. Autoantibodies were identified using the indirect immunofluorescence (IFL) technique on human epithelial cells from larynx cancer (HEp-2 cells), rat liver-kidney-stomach substrate (CT3) and Chrithidia Luciliae (CL). RESULTS Serum autoantibodies were detected in 104 HCV patients, yielding an overall prevalence of 73.2%. The most frequent autoantibodies were antinuclear antibodies (ANA), positive in 72 patients (50.7%). Anti-smooth muscle antibodies (ASMA) were detected in 33 patients (23.2%). Only one patient was positive for LKM1 autoantibodies. No autoantibodies were found in 38 patients (26.7%). Autoantibodies were also found in 5 out of the 60 examined healthy blood donors (8.3%). CONCLUSIONS Autoantibodies, mainly ANA and ASMA are very common in HCV seropositive patients from Crete. By contrast LKM1 autoantibodies are exceptionally rare in these patients.
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Affiliation(s)
| | - Christos Lionis
- Clinic of the Social and Family Medicine, School of Medicine, University of Crete, PO Box 1393, Heraklion, Crete, Greece
| | - Ioannis Drygiannakis
- Clinic of the Social and Family Medicine, School of Medicine, University of Crete, PO Box 1393, Heraklion, Crete, Greece
| | - Georgios Pappas
- General Hospital of Rethymnon, Trantallidou 17, Crete, Greece
| | - Elias Kouroumalis
- Department of Gastroenterology, University Hospital of Heraklion, PO Box 1393, Heraklion, Crete, Greece
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25
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Zervou EK, Dalekos GN, Boumba DS, Tsianos EV. Value of anti-HBc screening of blood donors for prevention of HBV infection: results of a 3-year prospective study in Northwestern Greece. Transfusion 2001; 41:652-8. [PMID: 11346702 DOI: 10.1046/j.1537-2995.2001.41050652.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The risk of infection with transfusion-transmitted viruses has been reduced remarkably. However, a zero-risk blood supply remains a popular goal. Some authorities have introduced the screening for antibody to HBc (anti-HBc) as a surrogate test for the presence of several infectious agents. A 3-year prospective study was conducted in the Epirus region of Greece to determine the prevalence of several blood-borne viruses. One component of the study was the prevalence of HBV infection markers and the potential value of anti-HBc testing of donors in this area. STUDY DESIGN AND METHODS Between January 1, 1995, and December 31, 1997, some 6696 donors were investigated for the presence of HBV infection markers by standard EIAS: Every sample that tested HBsAg-negative but anti-HBc-reactive alone or in combination with either or both antibodies to HBV e antigen (anti-HBe) and low-titered antibodies to HBsAg (anti-HBs <20 mIU/mL) was further investigated for the presence of HBV DNA by a combination of PCR and DNA EIA. RESULTS Of these 6696 donors, 15.8 percent tested positive for at least one serologic marker of HBV infection (HBsAg prevalence, 0.85%). Anti-HBc reactivity alone or in combination with either or both anti-HBe and low-titered anti-HBs was found in 282 donors (4.2%). None tested HBV-DNA positive. No transfusion-associated HBV infections were recorded in the recipients of the above 282 blood units. CONCLUSION A moderate prevalence of HBV infection markers was found. However, taking into account previous studies from this region, it appears that the HBsAg prevalence has declined. In addition, the present study cannot recommend the introduction of anti-HBc screening as a surrogate marker of occult HBV infection. The adoption of this exclusion criterion in this region would result in unacceptably high rejection rates among otherwise healthy donors. The absence of any case of transfusion-associated HBV infection after the transfusion of all HBsAg-negative, anti-HBc-positive units appears to provide further support for the negative HBV DNA results. Before a consideration of screening donors, efforts must be focused on reducing the number of false-positive anti-HBc results.
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Affiliation(s)
- E K Zervou
- Blood Bank at the University Hospital of Ioannina, Greece
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Lionis C, Vlachonikolis IG, Skliros S, Symeonidis A, Merkouris BP, Kouroumalis E. Do undefined sources of hepatitis C transmission exist? The Greek study in General Practice. J Viral Hepat 2000; 7:218-24. [PMID: 10849264 DOI: 10.1046/j.1365-2893.2000.00217.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A seroepidemiological study was carried out in 15 primary health care (PHC) centres in rural Greece to determine the prevalence of hepatitis C virus (HCV) in the surgeries of Greek General Practitioners (GPs) and to further clarify the transmission of hepatitis C in Greece. Serum samples were obtained from 1961 subjects (1259 females) aged >/= 15 years, who visited GP surgeries between July 1996 and February 1997 in 15 PHC centres located in three large Greek regions (Macedonia, Attika and Crete). Subjects who participated in the study fulfilled the following criteria: history of blood transfusion; hospital admission of > 7 days' duration without surgical or other intervention; use of intravenous drugs (current or previous); or women with a history of medical or paramedical abortion. Nearly 65% (1263 subjects) of the participants in this study reported hospital admission with a length of stay > 7 days. Antibodies to HCV (anti-HCV) were found in 67 participants (3. 5%), 41 of whom were females and 44 of whom were aged >/= 61 years. The highest prevalence (4.8%) of anti-HCV was found in Crete, and differences among the Greek regions were statistically significant (P < 0.05). Multivariate statistical analysis showed that in addition to regional differences, the following variables had a statistically significant effect on the prevalence of anti-HCV: history of dental surgery; use of intravenous drugs; hospital admission for > 7 days; and the high consumption of alcoholic drinks. Hence there is a significant variability in the prevalence of hepatitis C in well-defined PHC areas of Greece. Several risk factors for acquiring HCV infection have been identified. Screening for HCV risk factors may enable Greek GPs to identify HCV-infected patients.
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Affiliation(s)
- C Lionis
- Greek Association of General Practitioners, Koundourioti, Thessaloniki, Greece
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