Prevalence of hepatitis A virus infection in Goiânia, Goiás, Brazil, by molecular and serological procedures, 1995-2002

Declining prevalence of hepatitis A virus antibodies among children from low socioeconomic groups reinforces the need for the implementation of hepatitis A vaccination in Brazil

Age-related seroprevalence studies that have been conducted in Brazil have indicated a transition from a high to a medium endemicity of hepatitis A virus (HAV) infection in the population. However, most of these studies have focused on urban populations that experience lower incidence rates of HAV infection. In the current study, the prevalence of anti-HAV antibodies was investigated in children with a low socioeconomic status (SES) that live on the periphery of three capital cities in Brazil. A total of 1,162 dried blood spot samples were collected from individuals whose ages ranged from one-18 years and tested for anti-HAV antibodies. A large number of children under five years old (74.1-90%) were identified to be susceptible to HAV infection. The anti-HAV antibody prevalence reached ≥ 50% among those that were 10-14 years of age or older. The anti-HAV prevalence rates observed were characteristics of regions with intermediate level of hepatitis A endemicity. These data indicated that a large proportion of children with a low SES that live at the periphery of urban cities might be at risk of contracting an HAV infection. The hepatitis A vaccine that is currently offered in Brazil is only available for high-risk groups or at private clinics and is unaffordable for individuals with a lower SES. The results from this study suggest that the hepatitis A vaccine should be included in the Brazilian National Program for Immunisation.

Hepatite A: soroprevalência e fatores associados em escolares de São Luís (MA), Brasil

OBJETIVOS: Estimar a prevalência de anticorpos contra o vírus da hepatite A (antiVHA-IgG) em escolares de 7 a 14 anos de escolas públicas e privadas e identificar fatores demográficos, socioeconômicos e sanitários associados à prevalência de antiVHA-IgG. MÉTODOS: Estudo soroepidemiológico para detecção de antiVHA-IgG, de abril de 2002 a abril de 2004, em 462 escolares de São Luís, com idades compreendidas entre 7 e 14 anos, do ensino fundamental. Participaram 30 escolas aleatoriamente selecionadas, com probabilidade proporcional ao número de alunos matriculados, sendo 23 públicas e 7 privadas. Os dados foram obtidos por meio de questionário estruturado. Para se identificar variáveis independentemente associadas à prevalência do antiVHA-IgG, foi realizada análise de regressão de Poisson múltipla, sendo estimadas as RPs ajustadas e respectivos intervalos de confiança de 95%. Somente permaneceram no modelo final aquelas variáveis associadas com a prevalência da hepatite A com p < 0,10. Foi adotado o nível de significância de 0,05 (α = 0,05). RESULTADOS: A prevalência de antiVHA-IgG foi de 64%, sendo de 71,5% nas escolas públicas e de 36,5% nas privadas. Após análise multivariável, idade de 11 a 14 anos, mais de uma pessoa por dormitório e menos de dois banheiros por domicílio foi associada a maiores prevalências de antiVHA-IgG. Maior escolaridade dos pais esteve associada à menor prevalência de antiVHA-IgG. CONCLUSÕES: A hepatite A é endêmica nos escolares de São Luís, com taxa de prevalência semelhante àquela encontrada em outras regiões do país com condições socioeconômicas e sanitárias similares. Fatores historicamente associados à maior prevalência da hepatite A foram também identificados nesta população.

Exposure to multiple subgenotypes of hepatitis A virus during an outbreak using matched serum and saliva specimens

Matched serum and saliva samples were collected simultaneously from 124 subjects exposed during a hepatitis A virus (HAV) outbreak at a daycare center in Rio de Janeiro, Brazil. All samples were tested for IgM and total anti-HAV antibodies by enzyme immunoassay (EIA). HAV was detected by nested PCR in serum, saliva, and water samples employing primers for the VP1/2A region of the viral RNA; all positive products were then sequenced. The viral load of the matched samples was determined by real-time PCR using the TaqMan system. HAV-RNA was identified by nested PCR in 37.7% of the saliva samples, 29% of the serum samples, and one drinking water sample. The mean HAV viral load was similar in the serum and saliva specimens (10(3)  copies/ml). HAV genotypes IA and IB were detected in both specimen types, and the water sample isolate was classified as genotype IB, indicating the existence of more than one source of infection at the daycare center. In six infected patients, a different HAV subgenotype was found in their serum than in their saliva, and this unusual pattern of mixed HAV infection was investigated further by molecular cloning followed by nucleotide sequencing. All clones derived from the saliva samples belonged to subgenotype IB and shared 96.5-100% identity. However, clones derived from their corresponding serum sample belonged to subgenotype IA and shared 90.5-100% identity. This study showed the important role that non-invasive saliva samples can play in the molecular epidemiological analysis of a hepatitis A outbreak.

Molecular characterization of hepatitis A virus isolates from Goiânia, Gioás, Brazil

Hepatitis A virus (HAV) infection is a public health problem worldwide and the virus has been classified into six genotypes. In Brazil, the only genotype that has been found is genotype I, predominately from subgenotype IA. Here, the HAV genotypes were analyzed of 18 isolates circulating between 1996-2001 in Goiânia, state of Goiás, Brazil. Viral RNA was extracted from 18 serum samples and amplified (RT-PCR/nested-PCR), followed by the genomic sequencing of the VP1/2A junction region of the HAV genome. Sequences of 168 nucleotides were compared and analyzed using the BLAST N, Clustal X and PAUP v. 4.10b programs. All samples were classified as genotype I, with 10 belonging to subgenotype IA and eight to subgenotype IB. The subgenotype IA isolates showed greater diversity than the subgenotype IB isolates at the nucleotide level. Elevated identity values were found between isolates obtained in this study and those from other regions of the world, including Brazil, highlighting the high conservation among different isolates of this virus. However, changes in the HAV subgenotype circulation could also be observed during the evaluated period.

Inactivation of hepatitis A HM-175/18f, reovirus T1 Lang and MS2 during alkaline stabilization of human biosolids

Aim:  To compare the inactivation rates of male‐specific bacteriophage‐2 (MS2), hepatitis A HM‐175/18f (HM‐175) and reovirus T1 Lang (T1 L) during alkaline stabilization of wastewater residues.

Methods and Results:  A bench scale alkaline stabilization model was used to evaluate the inactivation of MS2 seeded into raw sludge simultaneously with HM‐175 or T1 L. Stabilization was performed in triplicate at 28 and 4°C for both viral combinations. During stabilization at 28 and 4°C, MS2 and T1 L concentrations were similar at each time point (t = 0·1, 2, 12 and 24 h). MS2 and HM‐175 concentrations were also similar at each time point during stabilization at 28°C. At 4°C, MS2 and HM‐175 concentrations were not similar at the first two time points (t = 0·1 and 2 h), but were similar at later time points (t = 12 and 24 h).

Conclusions:  The inactivation rates of T1 L at 4°C and both T1 L and HM‐175 at 28°C were similar to the inactivation rate of MS2 at all time points. At 4°C, MS2 was inactivated at a faster rate during the first two time points (t = 0·1 and 2 h) than HM‐175, but was inactivated similarly at later time points (t = 12 and 24 h).

Significance and Impact of the Study:  Phages, such as MS2, would be ideal indicators for the presence of enteric viruses in wastewater residues because of their ubiquity, nonpathogenic nature, low cost and time associated with their detection. The findings of this study suggest that MS2 could serve as an indicator for monitoring the persistence of enteric viruses, such as HM‐175 and T1 L, during alkaline stabilization performed at moderate temperatures (28°C), but may not serve as an indicator for HM‐175 at reduced temperature (4°C). The utility of MS2 as an indicator of viral persistence during biosolids treatment should be further evaluated, as the increased efficiency and frequency of pathogen monitoring associated with their use may reduce the potential public health risk associated with biosolids, facilitating a greater acceptance for their land application.