Impact of 10 years of hepatitis B vaccination on the frequency of acute symptomatic hepatitis B at a major urban referral center in Egypt

This study aimed to determine the impact of 10 years of universal hepatitis B immunization on the prevalence of acute symptomatic viral hepatitis B in Egypt compared with previous results reported by the same authors in 1983. Two hundred consecutive patients with acute symptomatic viral hepatitis, diagnosed clinically and biochemically, were enrolled from Embaba Fever Hospital [EFH], Giza Governorate, Egypt in the period from December 2001 to September 2002. Serological tests were done using ABBOTT AXSYM [Abbott laboratory, Abbott Park, III] for hepatitis A virus [anti-HAV IgM], hepatitis B virus [HBsAg, anti-HBc total and IgM, anti HBs], hepatitis C virus [anti-HCV IgM and total, in addition to PCR], hepatitis D virus [anti-HDV IgM] and hepatitis E [anti-HEV IgM]. In addition, the patients were screened for IgM Ab of cytomegalovirus [CMV], Ebstein barr virus [EBV] and PCR for HGV and transfusion transmitted virus [TTV]. In the present study, the overall acute HBV infection was accounted for 31.5% of the acute viral hepatitis cases, with a male predominance of 62.4% and a significant increased prevalence in adolescent and adults. Although the clinical presentation of HBV did not differ from those of the various causes of hepatitis, the mean ALT levels were significantly higher in acute HBV when compared with acute HAV infection. The frequency of acute hepatitis B was decreased from 43.4% in 1983 to 31.5% in 2002, which was particularly evident in children and there were no significant changes in the rate of acute hepatitis among HBsAg carriers [12.3% and 9%, respectively]. Despite the lower coverage rate of hepatitis vaccination in those <9 years [37.9%], there was virtual absence of acute hepatitis B. The use of multiple seromarkers decreased the prevalence of the undiagnosed cases in those suffering from acute hepatitis to 6.5%

Possible role of endotoxin and tumor necrosis factor-alpha in maintaining chronicity of otitis media with effusion in children

In this study, endotoxin, a lipopolysaccharide complex present on the outer surface of Gram-negative bacteria, was demonstrated with a substantial level in MEEs from children with chronic otitis media with effusion [OME]. Being a potent inflammatory mediator, it promotes the release of cytokine 1 TNF-alpha, which was also detected in MEEs from children with chronic OME. Forty samples from 20 children with chronic OMEs were aspirated during the introduction of tympanostomy tubes. The samples were studied for culture and Gram stain to detect viable bacteria, assayed for endotoxin utilizing limulus assay and TNF-alpha level utilizing ELISA. The results showed that 33 out of the 40 specimens exhibited an endotoxin activity ranging from 13 to 445 ng/ml and 27 out of the specimens showed TNF-alpha ranging from 2 to 97 pg/ml TP; the levels were higher among specimens with positive H. Influenza culture. Substantial levels of both endotoxin and TNF- alpha were also detected among specimens growing S. Pneum and culture negative specimens, suggesting the possibility of previously existing Gram-negative bacteria nonviable at the time of culture. Thus, it was hypothesized that the persistence of endotoxin and TNF-alpha, in spite of the non-existing viable bacteria, might play a role in sustaining the chronicity of OME in children