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Hepatitis A: Epidemiology, Natural History, Unusual Clinical Manifestations, and Prevention. Gastroenterol Clin North Am 2020; 49:191-199. [PMID: 32389358 PMCID: PMC7883407 DOI: 10.1016/j.gtc.2020.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis A virus (HAV) is a positive-strand RNA virus that is transmitted feco-orally through person-to-person contact. Outbreaks are often linked to poor sanitation, overcrowding, or food and water contamination. Infection is often asymptomatic in children, but adults present with jaundice, abdominal pain, hepatitis, and hyperbilirubinemia. Diagnosis is through detection of immunoglobulin M antibodies against HAV, and treatment is supportive. Vaccination is the mainstay of prevention and should be given before exposure whenever possible.
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Cardoso AM, Resende PC, Paixao ES, Tavares FG, Farias YN, Barreto CTG, Pantoja LN, Ferreira FL, Martins AL, Lima ÂB, Fernandes DA, Sanches PM, Almeida WAF, Rodrigues LC, Siqueira MM. Investigation of an outbreak of acute respiratory disease in an indigenous village in Brazil: Contribution of Influenza A(H1N1)pdm09 and human respiratory syncytial viruses. PLoS One 2019; 14:e0218925. [PMID: 31283762 PMCID: PMC6613774 DOI: 10.1371/journal.pone.0218925] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 06/13/2019] [Indexed: 11/18/2022] Open
Abstract
Analyses of the 2009 H1N1 influenza pandemic and post-pandemic years showed high attack rates and severity among indigenous populations. This study presents the characteristics of the first documented influenza outbreak in indigenous peoples in Brazil, that occurred from 30th March to 14th April 2016 in a Guarani village in Southeast Region. Acute respiratory infections were prospectively investigated. The majority of the 73 cases were influenza-like illness (ILI) (63.0%) or severe acute respiratory infection (SARI) (20.5%). The ILI+SARI attack rate (35.9%) decreased with increasing age. There was a high influenza vaccination rate (86.3%), but no statistically significant difference in vaccination rates between severe and non-severe cases was seen (p = 0.334). Molecular analyses of 19.2% of the cases showed 100% positivity for influenza A(H1N1)pdm09 and/or hRSV. Influenza A(H1N1)pdm09 was included in the 6B.1 genetic group, a distinct cluster with 13 amino acid substitutions of A/California/07/2009-like. The hRSV were clustered in the BA-like genetic group. The early arrival of the influenza season overlapping usual hRSV season, the circulation of a drifted influenza virus not covered by vaccine and the high prevalence of risk factors for infection and severity in the village jointly can explain the high attack rate of ARI, even with a high rate of influenza vaccination. The results reinforce the importance of surveillance of respiratory viruses, timely vaccination and controlling risk factors for infection and severity of in the indigenous populations in order to preventing disease and related deaths, particularly in children.
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Affiliation(s)
- Andrey Moreira Cardoso
- Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | | | - Enny S. Paixao
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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O'Brien TR. Editorial: epidemic-assistance investigations by the centers for disease control and prevention: the first 60 years. Am J Epidemiol 2011; 174:1211-2. [PMID: 22120937 DOI: 10.1093/aje/kwr336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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