Sobre la hepatitis aguda grave de etiología desconocida: la situación en México / About severe acute hepatitis of unknown etiology: the situation in Mexico

Introducción: en México, las hepatitis virales son de notificación epidemiológica obligatoria, pero no existe un sistema especial de vigilancia. La información disponible se limita a la distribución por edad y sexo. Ante la alerta de casos de hepatitis aguda grave de etiología desconocida, en la Unión Europea el Consejo Nacional de Vigilancia Epidemiológica (CONAVE) alertó al Sistema Nacional de Salud (SNS) para la atención y vigilancia de estos casos. Desarrollo: la hipótesis más convincente sobre la etiología está relacionada con una respuesta inmunitaria exacerbada que es mediada por superantígenos relacionados con la proteína espiga del SARS-CoV-2, activados por una infección por adenovirus que desencadena una respuesta de linfocitos T que provoca apoptosis de hepatocitos. Con base en la presentación clínica (niños menores de 16 años, con diarrea, dolor abdominal, ictericia, vómito e hipertransaminasemia) se han diseñado definiciones operacionales para su identificación y notificación al Sistema Nacional de Vigilancia Epidemiológica (SINAVE). Hasta junio del 2022, se han identificado 56 casos en México. Conclusiones: este brote de hepatitis representa un reto para el SINAVE. Es necesario incluir la identificación de adenovirus en el algoritmo diagnóstico de enfermedad respiratoria viral, implementar un sistema especial de vigilancia epidemiológica de hepatitis virales y sensibilizar a los profesionales sanitarios en el tema.

Introduction: In Mexico viral hepatitis requires mandatory epidemiological notification, but there is no special surveillance system. Available information is limited to distribution of cases by age and sex. Given the alert of cases of severe acute hepatitis of unknown etiology in the European Union, the National Council for Epidemiological Surveillance (Consejo Nacional de Vigilancia Epidemiológica) alerted the entire National Health System to care for and monitor these cases in Mexico. Development: The most convincing hypothesis is an exacerbated immune response mediated by superantigens related to the spike protein of SARS-CoV-2, activated by adenovirus infection that ends in a response of T lymphocytes that causes apoptosis of hepatocytes. Based on clinical presentation (children under 16 years of age, with diarrhoea, abdominal pain, jaundice, vomiting and increase in transaminases) the operational case definitions have been designed for their timely identification and notification to the National System of Epidemiological Surveillance (Sistema Nacional de Vigilancia Epidemiológica). Until June 2022, 56 cases have been identified in Mexico. Conclusions: This hepatitis outbreak represents a challenge for the National System of Epidemiological Surveillance. It is necessary to include the identification of adenovirus in the diagnostic algorithm for viral respiratory disease, to implement a special epidemiological surveillance system for viral hepatitis, and to sensitize health professionals on this subject.

Prévision de la séroprévalence de l'hépatite A dans la Wilaya de Setif en 2024 / Forecast of hepatitis a seroprevalence in the Wilaya of Setif in 2024

La séroprévalence des anticorps anti hépatite A (correspondant au taux d'immunisation) était de 100% à Sétif (Algérie), chez les personnes âgées entre 10 et 14 ans en 1986. Elle est passée à 70,4% en 2011. Partant de ce fait, les auteurs se proposent de prévoir cette séroprévalence, dans la même wilaya en 2024, à travers le modèle 'Logit binaire multiple', sur la base des données d'une enquête réalisée en 2011. La séroprévalence globale chez les sujets âgés entre 5 et 19 ans serait, selon les résultats de ce modèle, de 67% en 2024; les principaux facteurs associés à cette séroprévalence seraient l'âge, l'habitat, la taille des ménageset l'antécédent d'ictère. En conséquence, un programme de vaccination pourrait s'imposer comme une nouvelle stratégie de lutte contre la maladie dans la wilaya de Sétif.

The seroprevalence of anti-hepatitis A antibodies (corresponding to the immunization rate) was 100% in Sétif, in people aged between 10 and 14 years in 1986. It has declined to 70.4% in 2011. Starting from this fact, the authors propose to predict this seroprevalence, in the same wilaya (district) in 2024, through the 'multiple binary logit' model, based on data from a survey carried out in 2011. The overall seroprevalence in subjects aged between 5 and 19 years would be, according to the results of this model, 67% in 2024; the main factors associated with this seroprevalence would be age, habitat, household size and a history of jaundice. As a result, a vaccination program could establish itself as a new disease control strategy in Sétif.

Ten-year changes in clinical characteristics and antiviral treatment patterns of chronic hepatitis B in China: a CR-HepB-based real-world study / 中华肝脏病杂志

Objective: To understand ten-year changes in clinical characteristics and antiviral treatment patterns of chronic hepatitis B in China. Methods: Patients with chronic HBV infection:demographic, virologic, hematologic, blood biochemistry, and antiviral treatment data were extracted from the China Registry of Hepatitis B (CR-HepB) database between 2012 and 2022 for descriptive statistics and change trend analysis. Multiple group comparisons were conducted using the Kruskal Wallis H test, while counting data was compared between groups using χ (2) test. Results: A total of 180 012 patients with chronic HBV infection were included, with a median age of 40 years old, and a male proportion accounting for 60.2%. The HBeAg positive rate was 43.3%. Over time, the median age of new patients each year increased from 39 to 47 years, while the HBeAg positive rate decreased from 51.3% to 32.8%. The initial diagnosis of patients was mainly CHB (71.4%), followed by hepatitis B cirrhosis (11.8%), inactive HBsAg carrier status (10.6%), and chronic HBV carrier status (6.2%). Among the newly registered patients every year from 2012 to 2022, the proportion of hepatitis B cirrhosis remained stable, but after 2019, the proportion of CHB increased and the proportion of other diagnoses decreased. The proportion of patients with cirrhosis increased with age in different age groups, with 3.5%, 19.3%, and 30.4% in the < 40, 40-69, and≥70 age groups, respectively. The proportion of women in patients with cirrhosis also increased with age, from 16.1% in those < 30 years old to 44.3% in those≥80 years old. From 2012 to 2022, the proportion of patients receiving first-line nucleos(t)ide analog antiviral treatment increased year by year, from 51.0% in 2012-2013 to 99.8% in 2022. Conclusion: The CR-HepB registration data reflect the changes in clinical characteristics and antiviral treatment patterns in patients with chronic HBV infection in China over the past ten years and can thus provide a reference to promote hepatitis B diagnosis and treatment practice, as well as scientific research.

Epidemiological profile of viral hepatitis infection in the population treated at a reference hospital in Alagoas / Perfil epidemiológico da infecção por hepatite viral na população atendida em hospital de referência em Alagoas

Viral hepatitis are widely spread infectious diseases caused by a variety of etiological agents that displays liver tropism as a common characteristic. A descriptive, cross-sectional, observational and retrospective study was conducted through the analysis of viral hepatitis medical records treated and diagnosed from 2010 to 2015. The relationship between the variables were made through the chi-square test. 632 viral hepatitis medical records were analyzed. The highest number of cases happened in 2011. Hepatitis A virus (HAV) infection was predominant. The most affected age group was < 20 years and the highest number of cases observed in this age group was related to HAV (p<0.001). The acute clinical form was predominant, with 70.2% of the cases. 92.3% of which corresponded to HAV infection (p<0.001). Most of the cases occurred in the brown race and male gender. Moreover, regarding the probable source/mechanism of infection, the contact with suspicious water/food for hepatitis A cases was highlighted. The sexual form predominated in HBV infection and previous history of blood transfusion in cases of hepatitis C. Most cases were spotted in the mesoregion of Eastern Alagoas, especially in the capital Maceió. It must be observed the importance of knowing the profile of this disease in order to understand its dissemination and thus have subsidies for the creation of actions and strategies to combat the infection.

A hepatite viral é uma doença infecciosa amplamente difundida causada por uma variedade de agentes etiológicos que exibem o tropismo hepático como uma característica comum. Um estudo descritivo, transversal, observacional e retrospectivo foi realizado por meio da análise de prontuários de hepatites virais tratados e diagnosticados de 2010 a 2015. A relação entre as variáveis foi feita através do teste qui-quadrado. Foram analisados 632 prontuários de hepatite sustero. O maior número de casos aconteceu em 2011. A infecção pelo vírus da hepatite A (HAV) foi predominante. A faixa etária mais atingida foi < 20 anos e o maior número de casos observados nessa faixa etária foi relacionado ao HAV (p<0,001). A forma clínica aguda foi predominante, com 70,2% dos casos. 92,3% dos quais corresponderam à infecção por HAV (p<0,001). A maioria dos casos ocorreu na raça parda e no sexo masculino. Além disso, quanto à provável fonte/mecanismo de infecção, foi destacado o contato com água/alimento suspeitos para os casos de hepatite A. A forma sexual predominou na infecção pelo HbV e histórico anterior de transfusão de sangue em casos de hepatite C. A maioria dos casos foi avistada na mesorregião do Leste de Alagoas, especialmente na capital Maceió. Deve-se observar a importância de conhecer o perfil dessa doença para entender sua disseminação e, assim, contar com subsídios para a criação de ações e estratégias de combate à infecção.

Guideline for the investigation of viral hepatitis A outbreak (version 2021) / 中华预防医学杂志

In China, the incidence rate of Hepatitis A has decreased from 56/100 000 in 1991 to 1.05/100 000 in 2020. The number of Hepatitis A outbreaks in China has decreased significantly, however, it has also happened in the last 5 years, and the risk still remains. In order to strengthen the technical guidance for the investigation and control of Hepatitis A outbreak, the Chinese Center for Disease Control and Prevention (China CDC) organized experts in related fields to compile this guideline. The main contents included outbreak definition, outbreak detecting and reporting, outbreak investigation and response, making conclusion and communication. This guideline is intended for use by staff at public health administrative departments, medical and health institutions, centers for disease control and prevention, health supervision agencies at different levels, and other relevant institutions, units and individuals. China CDC will update this guideline periodically based on the progress in this field and feedbacks during the implementation of this guideline.

Epidemiological profile of viral hepatitis infection in the population treated at a reference hospital in Alagoas / Perfil epidemiológico da infecção por hepatite viral na população atendida em hospital de referência em Alagoas

Viral hepatitis are widely spread infectious diseases caused by a variety of etiological agents that displays liver tropism as a common characteristic. A descriptive, cross-sectional, observational and retrospective study was conducted through the analysis of viral hepatitis medical records treated and diagnosed from 2010 to 2015. The relationship between the variables were made through the chi-square test. 632 viral hepatitis medical records were analyzed. The highest number of cases happened in 2011. Hepatitis A virus (HAV) infection was predominant. The most affected age group was < 20 years and the highest number of cases observed in this age group was related to HAV (p<0.001). The acute clinical form was predominant, with 70.2% of the cases. 92.3% of which corresponded to HAV infection (p<0.001). Most of the cases occurred in the brown race and male gender. Moreover, regarding the probable source/mechanism of infection, the contact with suspicious water/food for hepatitis A cases was highlighted. The sexual form predominated in HBV infection and previous history of blood transfusion in cases of hepatitis C. Most cases were spotted in the mesoregion of Eastern Alagoas, especially in the capital Maceió. It must be observed the importance of knowing the profile of this disease in order to understand its dissemination and thus have subsidies for the creation of actions and strategies to combat the infection.

A hepatite viral é uma doença infecciosa amplamente difundida causada por uma variedade de agentes etiológicos que exibem o tropismo hepático como uma característica comum. Um estudo descritivo, transversal, observacional e retrospectivo foi realizado por meio da análise de prontuários de hepatites virais tratados e diagnosticados de 2010 a 2015. A relação entre as variáveis foi feita através do teste qui-quadrado. Foram analisados 632 prontuários de hepatite sustero. O maior número de casos aconteceu em 2011. A infecção pelo vírus da hepatite A (HAV) foi predominante. A faixa etária mais atingida foi < 20 anos e o maior número de casos observados nessa faixa etária foi relacionado ao HAV (p<0,001). A forma clínica aguda foi predominante, com 70,2% dos casos. 92,3% dos quais corresponderam à infecção por HAV (p<0,001). A maioria dos casos ocorreu na raça parda e no sexo masculino. Além disso, quanto à provável fonte/mecanismo de infecção, foi destacado o contato com água/alimento suspeitos para os casos de hepatite A. A forma sexual predominou na infecção pelo HbV e histórico anterior de transfusão de sangue em casos de hepatite C. A maioria dos casos foi avistada na mesorregião do Leste de Alagoas, especialmente na capital Maceió. Deve-se observar a importância de conhecer o perfil dessa doença para entender sua disseminação e, assim, contar com subsídios para a criação de ações e estratégias de combate à infecção.

Epidemiological characteristics and spatiotemporal clustering of hepatitis A in Zhejiang Province from 2010 to 2019 / 中华预防医学杂志

Objective: To analyze the epidemiological characteristics and spatiotemporal clustering of hepatitis A in Zhejiang Province from 2010 to 2019. Methods: The data of hepatitis A incidence in Zhejiang Province from 2010 to 2019 were collected from the infectious disease surveillance system of China Information System for Disease Control and Prevention. ArcGIS 10.7 software was used for spatial autocorrelation analysis. SaTScan 9.6 software was used for spatiotemporal scanning analysis. SPSS 25.0 software was used for additional analysis. Results: Zhejiang Province has reported 5 465 cases of hepatitis A in 2010-2019 years, with an average annual incidence rate of 1.00/100 000, and periodicity and seasonality are not obvious. The incidence of male was higher than that of female (P=0.023), and the highest incidence rate was 50-59 years old. Spatial autocorrelation analysis showed that there was a positive spatial correlation between the incidence of hepatitis A in Zhejiang Province from 2010 to 2017, with the weakest correlation in 2010 (Moran's I =0.103, Z=1.769, P=0.049), and the strongest correlation in 2016 (Moran's I=0.328, Z=4.979, P=0.001). Spatiotemporal scanning analysis showed that there was spatial aggregation of hepatitis A in Zhejiang Province from 2010 to 2019, with a total of three aggregation areas identified. Among them, the mostly aggregation area was concentrated in Xiangshan county of Ningbo city, which covered 10 counties (cities and districts), including Ninghai county and Yinzhou district, and appeared from January 1 to June 30, 2012. Conclusion: The incidence level of hepatitis A in Zhejiang Province shows a stable fluctuation trend from 2010 to 2019, and the seasonal regularity is not obvious. The population group aged 50-59 years old is the key population. There is spatial aggregation in the epidemic situation of hepatitis A. Targeted prevention and control measures of hepatitis A should be done based on the law of spatiotemporal aggregation and local incidence.

Hepatitis A and E among immigrants and refugees in Central Brazil

ABSTRACT OBJECTIVE To estimate the prevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) among immigrants and refugees in Goiás, Central Brazil. METHODS Overall, 355 individuals were interviewed, and blood samples were tested for anti-HAV and anti-HEV IgG. Anti-HEV-positive samples were similarly tested for HEV RNA. RESULTS All participants were from Latin American countries, most of whom, young adult males. The overall anti-HAV IgG prevalence was 87.4% (95%CI: 83.5-90.4), of whom 94.9%, 75.6%, and 60% were from Haiti, Venezuela, and other Latin American countries, respectively (p < 0.001). Age above 19 years and more than 36 months residing in Brazil were associated with a higher prevalence of previous HAV and HEV infection, respectively. Of the children eligible for HAV vaccination according to the National Immunization Program, only eight (44%) had been vaccinated. The overall anti-HEV IgG prevalence was 6.5% (95%CI: 4.4-9.5). All anti-HEV IgG-positive individuals were Haitians, including a child born in Brazil. HEV RNA was detected in two of the anti-HEV IgG-positive samples. CONCLUSION The survey detected a high prevalence of anti-HAV and anti-HEV IgG among immigrants and refugees, and active HEV infection among some Haitian participants. Prevention measures are urgently required to interrupt enteric virus transmission in this emergent and vulnerable population.

Identification of enteric viruses from raw water using fluoro-immuno-magnetic separation coupled to RT-PCR / Identificación de virus entéricos en aguas crudas usando separación inmuno-magnética acoplada a RT-PCR

Abstract | Introduction: Enteric viruses have been associated with the production of a variety of diseases transmitted by the fecal-oral route and carried through contaminated food and water. Given their structure and composition, they are highly resistant to environmental conditions and most of the chemical agents used in the purification processes. Therefore, the systematic monitoring of raw water is necessary to ensure its quality especially when it is used for producing drinking water for human consumption. Objective: We identified the presence of rotavirus and hepatitis A virus by means of the fluoro-immuno-magnetic separation technique (FIMS) in raw water taken from four purification plants and their water supplies in the department of Norte de Santander. Materials and methods: The viruses were captured and separated from the water samples using magnetic microparticles functionalized with monoclonal anti-Hepatitis A and anti-Rotavirus antibodies. Confocal microscopy was used to monitor the viral concentration process and transmission electron microscopy for the morphological visualization of the separated viruses. The reverse transcriptase-coupled polymerase chain reaction (RT-PCR) was applied to confirm the presence of pathogens. Results: The two enteric viruses were identified in the majority of the analyzed water samples including water supply sources. Conclusion: We determined that the FIMS technique together with RT-PCR is highly effective for the detection of viral pathogens in complex matrices such as raw water.

Resumen | Introducción. Los virus entéricos se asocian con una serie de enfermedades transmitidas por vía fecal-oral en alimentos o agua contaminada. Dada su estructura y composición, son muy resistentes a las condiciones ambientales y a la mayoría de los agentes químicos empleados en los procesos de potabilización, por lo cual es necesario un monitoreo sistemático del agua cruda para asegurar su calidad, máxime cuando se emplea como materia prima en la producción de agua potable para consumo humano. Objetivo. Determinar la presencia de rotavirus y del virus de la hepatitis A mediante la técnica de separación fluoro-inmuno-magnética en agua cruda procedente de cuatro plantas de potabilización y sus fuentes hídricas en el departamento de Norte de Santander. Materiales y métodos. Los virus fueron capturados y separados a partir de las muestras de agua, empleando micropartículas magnéticas funcionalizadas con anticuerpos monoclonales anti-hepatitis A y anti-rotavirus. Se empleó microscopía confocal para hacer el seguimiento del proceso de concentración viral y, microscopía electrónica de transmisión, para la visualización morfológica de los virus separados. La reacción en cadena de la polimerasa acoplada a transcriptasa inversa (RT-PCR) se utilizó para confirmar la presencia de los patógenos. Resultados. Los dos virus entéricos se detectaron en la mayoría de las muestras de agua analizadas, incluidas las de sus fuentes hídricas. Conclusión. La técnica de separación fluoro-inmuno-magnética acoplada a RT-PCR fue altamente efectiva en la detección de patógenos virales en matrices complejas como el agua cruda.

Perfil dos portadores de hepatite A no Estado do Rio de Janeiro, no período de 2010 a 2018 / Profile of hepatitis carriers in the State of Rio de Janeiro, from 2010 to 2018

Objetivo: Este estudo busca caracterizar o perfil dos indivíduos com hepatite A, no Estado do Rio de Janeiro, no período de 2010 a 2018. Metodologia: Trata-se de uma pesquisa transversal desenvolvida na abordagem quantitativa. Foram utilizados dados secundários provenientes da Ficha de Notificação das Hepatites Virais do banco do Sistema de Informação de Agravos de Notificação, cedida pela Secretaria Estadual de Saúde do Rio de Janeiro. Resultados: Foram analisados 48672 notificações, sendo que 3734 foram notificações confirmadas de portadores exclusivo da hepatite A, 28719 referentes a outras hepatites, 614 de co-infecção por mais de uma hepatite viral e 15605 ignoradas. A maior prevalência da hepatite A foi encontrada nos indivíduos com 4 a 8 anos de estudo, da raça negra, faixa ≤ 24 anos e sendo água e alimentos contaminados a principal fonte de contágio. Conclusão: A notificação dos casos e o preenchimento adequado é importante para definições de ações sanitárias capazes de mitigar os danos à saúde pública. Palavras-chave: Hepatite A; Notificação; Prevalência.

Objective: To characterize the profile of individuals with hepatitis A in the State of Rio de Janeiro, from 2010 to 2018. Methodology: This is a cross-sectional research developed in the quantitative approach. Secondary data from the Viral Hepatitis Notification Form of the Bank of the Notifiable Diseases Information System, provided by the State Health Secretariat of Rio de Janeiro, were used. Results: 48672 notifications were analyzed, of which 3734 were confirmed notifications of hepatitis A carriers only, 28719 were related to other hepatitis, 614 were co-infected with more than one viral hepatitis and 15605 were ignored. The highest prevalence of hepatitis A was found in individuals with 4 to 8 years of study, black, aged ≤ 24 years and with contaminated water and food being the main source of contagion. Conclusion: Notification of cases and proper completion is important for the definition of health actions capable of mitigating damage to public health. Keywords: Hepatitis A; Notification; Prevalence.

Objetivo: Este estudio busca caracterizar el perfil de individuos con hepatitis A, en el estado de Río de Janeiro, de 2010 a 2018. Metodología: Se trata de una investigación transversal desarrollada en el enfoque cuantitativo. Se utilizaron datos secundarios del Formulario de Notificación de Hepatitis Virales del Banco del Sistema de Información de Enfermedades Notificables, proporcionado por la Secretaría de Salud del Estado de Río de Janeiro. Resultados: Se analizaron 48672 notificaciones, de las cuales 3734 fueron notificaciones confirmadas de solo portadores de hepatitis A, 28719 estaban relacionadas con otras hepatitis, 614 estaban coinfectadas con más de una hepatitis viral y 15605 fueron ignoradas. La mayor prevalencia de hepatitis A se encontró en individuos de 4 a 8 años de estudio, negros, ≤ 24 años y con agua y alimentos contaminados como la principal fuente de contagio. Conclusión: La notificación de casos y su debida cumplimentación es importante para la definición de acciones de salud capaces de mitigar los daños a la salud pública. Palabra clave: Hepatitis A; Notificación; Prevalencia.

Relação entre casos de hepatite A e áreas de inundação, município de Encantado, Rio Grande do Sul, Brasil / Relationship between cases of hepatitis A and flood areas, municipality of Encantado, Rio Grande do Sul, Brazil

Resumo A relação entre os desastres de origem hidrometeorológicos e a saúde das populações atingidas ainda é pouco abordada no Rio Grande do Sul (RS), Brasil. A Hepatite A é uma doença que envolve questões sanitárias e do meio urbano, sendo uma doença do tipo evitável. Esse estudo tem como objetivo analisar a relação entre áreas de inundação e a ocorrência de doenças de veiculação hídrica, neste caso, a Hepatite A. Foi estruturado um banco de dados dos casos confirmados de Hepatite A e de eventos de inundações no município de Encantado-RS entre os anos de 2012 e 2014. Esses dados foram analisados espacialmente a partir do estimador Kernel dos pontos de ocorrência de casos de Hepatite A e correlacionados para o perímetro urbano. Verificou-se que nos três meses posteriores à ocorrência de inundação, foram registrados 44 casos, um aumento de quase 300%, no registro de casos de Hepatite A. Os resultados identificaram que todos os casos confirmados estão na área urbana localizada na planície de inundação. O que reafirma a importância de incentivo a formulação e implementação de políticas de prevenção a surtos de doenças pós-desastres hidrometeorológicos.

Abstract The relationship between hydrometeorological disasters and the health of affected populations is still hardly discussed in Rio Grande do Sul (RS), Brazil. Hepatitis A is a disease that involves health and urban environment issue and is an avoidable disease. This study aims to analyze the relationship between flood areas and waterborne diseases, in this case, Hepatitis A. A database of confirmed cases of Hepatitis A and flood events in the municipality of Encantado-RS, Brazil between 2012 and 2014 was structured. These data were analyzed spatially from the kernel estimator of the occurrence points of Hepatitis A cases and correlated to the urban perimeter. It was verified that 44 cases were registered in the three months following the occurrence of flood, an increase of almost 300% in the records of Hepatitis A. The results identified that all the confirmed cases are in the urban area located in the floodplain. This reaffirms the importance of encouraging the formulation and implementation of policies to prevent outbreaks of waterborne diseases post hydrometeorological disaster.

Incidence of hepatitis A and hepatitis E viruses and norovirus and rotavirus in fish and shrimp samples caught from the Persian Gulf / [Incidência de vírus da hepatite A e hepatite E e norovírus e rotavírus em amostras de peixes e camarões capturados no Golfo Pérsico]

Foodborne viruses including hepatitis A virus (HAV), norovirus (NoV), rotavirus (RoV) and hepatitis E virus (HEV) are easily transmitted through contaminated seafoods. The current research was done to assess the incidence of RoV, NoV GI and GII,hAV and hEV in fish and shrimp samples caught from the Persian Gulf, Iran. Three-hundred and twenty fish and shrimp samples were collected. The presence of foodborne viruses were assessed by the real-time PCR. Forty-nine out of 320 (15.31%) fish and shrimp samples were positive for foodborne viruses. Distribution of hAV, NoV GI and NoV GII amongst all studied samples were 0.93%, 5.93% and 8.43%, respectively. hEV and RoV viruses were not found in studied samples. Parastromateus niger and Scomberomorus commerson fish and Penaeus monodon shrimp were the most frequently contaminated samples. Simultaneous incidence of hAV and NoV GI and hAV and NoV GII were 0.31% and 0.93%, respectively. Distribution of foodborne viruses in samples collected through spring, summer, autumn and winter seasons were 14.28%, 9.33%, 11.76% and 24.44%, respectively. Findings revealed that the incidence of foodborne viruses was significantly associated with seafood species and also season of sampling.(AU)

Vírus transmitidos por alimentos, incluindo hepatite A (HAV), norovírus (NoV), rotavírus (RoV) e hepatite E (HEV) são facilmente transmitidos através de frutos do mar contaminados. Esta pesquisa foi realizada para avaliar a incidência de RoV, NoV GI e GII, hAV e hEV em amostras de peixes e camarões capturadas no Golfo Pérsico, Irã. Foram coletadas 300 amostras de peixes e camarões. A presença de vírus transmitidos por alimentos foi avaliada por PCR em tempo real. Quarenta e nove das 320 amostras de peixes e camarões (15,31%) foram positivas para vírus transmitidos por alimentos. A distribuição de hAV, NoV GI e NoV GII entre as amostras estudadas foi 0,93%, 5,93% e 8,43%, respectivamente. Os vírus hEV e RoV não foram encontrados nas amostras estudadas. Os peixes Parastromateus niger e Scomberomorus commerson e o camarão Penaeus monodon foram as amostras mais frequentemente contaminadas. A incidência simultânea de hAV e NoV GI, e hAV e NoV GII foi de 0,31% e 0,93%, respectivamente. A distribuição dos vírus transmitidos por alimentos nas amostras coletadas na primavera, verão, outono e inverno foi de 14,28%, 9,33%, 11,76% e 24,44%, respectivamente. Os resultados demonstram que a incidência de vírus transmitidos por alimentos foi significativamente associada às espécies de frutos do mar e também à época da amostragem.(AU)

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: hepatites virais / Brazilian Protocol for Sexually Transmitted Infections 2020: viral hepatitis / Protocolo Brasileño para las Infecciones de Transmisión Sexual 2020: hepatitis virales

Este artigo aborda as hepatites virais, tema tratado no Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis e, mais precisamente, nos Protocolos Clínicos e Diretrizes Terapêuticas para Hepatite B e para Hepatite C e Coinfecções, publicados pelo Ministério da Saúde do Brasil. Além do espectro ampliado de acometimento da saúde, os vírus das hepatites A, B e C também apresentam diferentes formas de transmissão, seja parenteral, sexual, vertical ou oral. Entre as estratégias sugeridas para o controle das hepatites virais, além das medidas comportamentais, estão o diagnóstico ampliado, a vacinação precoce contra os vírus da hepatite A e hepatite B e o acesso aos recursos terapêuticos disponíveis. Considerando a transmissão vertical dos vírus da hepatite B e hepatite C, a triagem das gestantes portadoras crônicas desses vírus é uma importante estratégia de saúde perinatal, indicando com precisão quem pode se beneficiar das intervenções profiláticas disponíveis.

This article discusses viral hepatitis, a theme addressed by the Clinical Protocol and Therapeutic Guidelines to Comprehensive Care for People with Sexually Transmitted Infections and, more precisely, by the Clinical Protocols and Therapeutic Guidelines for Hepatitis B and Hepatitis C and Coinfections, published by the Brazilian Ministry of Health. Besides the broad spectrum of health impairment, hepatitis A, B and C viruses also present different forms of transmission, whether parenteral, sexual, vertical or oral. Among the strategies suggested for the control of viral hepatitis, in addition to behavioral measures, are expanded diagnosis, early vaccination against hepatitis A and hepatitis B viruses, and access to available therapeutic resources. Considering vertical transmission of the hepatitis B and hepatitis C viruses, screening for pregnant women with chronic hepatitis B and C is an important perinatal health strategy, indicating with precision those who can benefit from the prophylactic interventions.

Este artículo aborda las hepatitis virales, tema que hace parte del Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a Personas con Infecciones de Transmisión Sexual y más precisamente de los Protocolos Clínicos y Guías Terapéuticas para Hepatitis B, Hepatitis C y Coinfecciones, publicados por el Ministerio de Salud. Además del amplio espectro de deterioro de la salud, los virus de las hepatitis A, B y C presentan diferentes formas de transmisión, como parenteral, sexual, vertical u oral. Entre las estrategias sugeridas para el control de las hepatitis virales, están las medidas conductuales, el diagnóstico ampliado, la vacunación precoz contra los virus de las hepatitis A y B y el acceso facilitado a los recursos terapéuticos disponibles. Considerando la transmisión vertical de los virus de la hepatitis B y C, la identificación de embarazadas portadoras crónicas de estos virus es importante estrategia de salud perinatal, indicando quiénes pueden beneficiarse de las intervenciones profilácticas.

Anormalidades de la vesícula biliar en hepatitis A: a propósito de un caso / Gallbladder abnormalities in hepatitis A: a case report

El virus de hepatitis A es la causa más común de hepatitis viral aguda en el mundo. La infección en adultos produce un cuadro sintomático, agudo y autolimitado, pero se pueden presentar alteraciones extrahepáticas, como anormalidades en la vesícula biliar y pancreatitis aguda. Se presenta el caso de un hombre de 49 años con engrosamiento de las paredes de la vesícula biliar, atribuido en un principio a una neoplasia de la vesícula, cuya etiología ulterior fue la hepatitis A. Las anormalidades de la vesícula son un hallazgo frecuente en las hepatitis virales agudas, en especial por virus de hepatitis A. Los médicos deben estar familiarizados con esta manifestación extrahepática de la infección para no incurrir en exámenes innecesarios o tratamientos invasivos como la colecistectomía.

Hepatitis A virus is the most common cause of acute viral hepatitis in the world. Infection in adults produces an acute, self-limited symptomatic disease, but extrahepatic manifestations may occur, such as gallbladder abnormalities and acute pancreatitis. The case of a 49-year-old man with gallbladder wall thickening, initially attributed to gallbladder cancer, whose subsequent etiology was hepatitis A, is presented. Abnormalities of the gallbladder are common in patients with acute viral hepatitis, especially due to hepatitis A. Physicians caring for adults with hepatitis A virus infection should be aware that such disease manifestations may occur, in order to avoid unnecessary clinical investigations or invasive treatments such as cholecystectomy.

Hepatitis A and hepatitis E virus co-infection with right pleural effusion, ascites and acute acalculous cholecystitis. A case report / Coinfección por el virus de la hepatitis A y la hepatitis E con derrame pleural derecho, ascitis y colecistitis acalculosa aguda. Reporte de caso

ABSTRACT Hepatitis A and hepatitis E are the leading causes of acute viral hepatitis in developing countries due to our poor sanitary conditions, both spread by fecal-oral route or through contaminated water and food. Being both self-limiting diseases, they are usually benign but may present with atypical clinical findings. A 32 year-old female with right pleural effusion, ascites and acalculous cholecystitis during the course of HAV and HEV co-infection is reported. Clinical improvement was observed with conservative management. As far as we know, this is the first case described of a patient with these three complications in the background of a hepatitis A virus and hepatitis E virus co-infection.

RESUMEN Hepatits A y hepatitis E son las principales causas de hepatitis viral en países en desarrollo debido a las limitadas condiciones sanitarias. Son condiciones usualmente benignas y autolimitadas, pero pueden presentarse de forma atípica. Se reporta una paciente de 32 años con efusión pleural derecha, colecistitis acalculosa y ascitis en el curso de una co-infección por el virus de Hepatitis A y hepatitis E. Hasta donde tenemos conocimiento, este es el primer caso de una paciente con estas tres complicaciones como resultado de una infección por el virus de hepatitis A y hepatitis E.

Vacinação universal contra hepatite A no Brasil: análise da cobertura vacinal e da incidência cinco anos após a implantação do programa / Universal hepatitis A vaccination in Brazil: analysis of vaccination coverage and incidence five years after program implementation

RESUMO: Introdução: Em 2014, o Brasil introduziu programa de imunização universal contra o vírus da hepatite A (HAV) para crianças no segundo ano de vida, por meio de dose única da vacina de vírus inativado. Este estudo teve como objetivo avaliar a cobertura vacinal (CV) contra o HAV no Brasil, diante da incidência de casos notificados cinco anos após a implantação do programa. Metodologia: Dados secundários foram obtidos pesquisando-se sítios eletrônicos de acesso livre do Ministério da Saúde, Departamento de Informática do Sistema Único de Saúde (DATASUS), para análise de incidência e CV. Resultados: A CV variou entre 60,13 e 97,07%. A homogeneidade da CV contra hepatite A nos estados ficou aquém da meta estabelecida. Após 2015, houve queda da CV em todas as regiões do país. Apesar da cobertura insuficiente, houve redução concomitante da incidência da hepatite A em todo o Brasil. A taxa de incidência caiu de 3,29 para 0,80/100 mil entre 2014 e 2018. No entanto, ocorreu diminuição da velocidade de queda da incidência entre 2017 e 2018, o que pode ser consequência dos percentuais insuficientes de CV. Esse fenômeno parece acompanhar tendência geral de enfraquecimento do esforço vacinal no país, verificado também para outras vacinas, como poliomielite e tríplice viral. Conclusão: Esses números sugerem a necessidade de esforços para melhorar as taxas de CV da hepatite A no país.

ABSTRACT: Introduction: In 2014, Brazil introduced a universal immunization program against the hepatitis A virus (HAV) for children in the second year of life, using a single dose of inactivated virus vaccine. The objective of this study was to evaluate the vaccination coverage (VC) against HAV in Brazil, against the incidence of cases reported five years after the implementation of the program. Methodology: Secondary data were obtained by searching free access electronic sites of the Ministry of Health, Department of Informatics of the Unified Health System (Departamento de Informática do Sistema Único de Saúde - DATASUS), for incidence analysis and VC from 2014 to 2018. Results: VC ranged from 60.13 to 97.07%. The homogeneity of VC against hepatitis A did not reach the established goal throughout all states but for a few exceptions. After 2015, CV decreased in all regions of the country. Despite insufficient coverage, a concomitant reduction in the incidence of Hepatitis A took place throughout the country. The incidence rate fell from 3.29 to 0.80/100,000 between 2014 and 2018. However, there was an interruption in the pace of incidence fall between 2017 and 2018, which may be a consequence of insufficient VC. This phenomenon seems to be part of a widespread downward trend in vaccination effort across the country, also verified for other vaccines, such as poliomyelitis and measles, mumps and rubella vaccine. Conclusion: These figures suggest the need for implementing efforts to improve hepatitis A VC rates in the country.

Análise Epidemiológica e Molecular do vírus Hepatite A em Pacientes Atendidos entre 2013 a 2019 no Ambulatório de Hepatites Virais do Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro / Epidemiological and Molecular Analysis of the Hepatitis A Virus in Patients Attended Between 2013 and 2019 at the Viral Hepatitis Outpatient Clinic of the Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro

Ao longo dos anos vem se observando um declínio do número de casos de infecção pelo vírus da hepatite A (HAV) em crianças, relacionado ao investimento nos programas de vacinação e a melhorias sanitárias. Porém, nota se a mudança desse perfil de infecção, onde indivíduos jovens/adultos vêm sendo mais acometidos. Apesar do vírus ser transmitido principalmente pelo consumo de água e alimentos contaminados, diversos surtos têm ocorrido ao redor do mundo em adultos e sendo relacionados a práticas sexuais. Em nosso país, um aumento no número de casos nos últimos três anos foi observado após um período de declínio de notificações. Assim, este estudo teve como objetivo avaliar os comportamentos de risco e os aspectos moleculares associados à transmissão do HAV em indivíduos atendidos no Ambulatório de Hepatites Virais do Instituto Oswaldo Cruz/FIOCRUZ, Rio de Janeiro, entre os anos de 2017 e 2019. Para tal, foram coletadas amostras de soro e informações socioepidemiológicas de 52 pacientes com anti-HAV IgM reagente, que chegaram ao ambulatório. Posteriormente, essas amostras tiveram o genoma viral extraído e analisado através da técnica de RTPCR. Após detecção, o RNA foi sequenciado e analisado filogeneticamente. Em seguida, foram realizadas análises filogeográficas para obter a rota de dispersão e período de introdução das estirpes virais no país. (AU)

Com a análise dos dados dos prontuários, observou-se que 78,9% (41/52) pacientes eram do sexo masculino, nas faixas etárias 20 a 29 anos (n=24/52) e de 30 a 39 anos (n=20/52) com media 32,1 anos, sendo 63,5% (n=33) dele(a)s homens/mulheres que fazem sexo com homens/mulheres (HSH/MSM), e 89,9% eram residentes na região norte da cidade do Rio de Janeiro. Observou-se uma baixa frequência de exposição a fatores hídricos, alimentares e parenterais na população estudada, sendo 42,3%, 42,3%, 34,7%, respectivamente. Já algumas práticas sexuais apresentaram elevada frequência, destacando o sexo oral (75%) e sexo anal (65,3%). Através das análises filogenéticas, foi identificado um único subgenótipo IA da população estudada. Quatro clados deste subgenótipo foram formados, dos quais, três agruparamse as sequências dos estirpes virais provenientes de surtos Europeus/Asiáticos, e um clado, formado por estirpes virais previamente circulantes no Brasil. Através da filogeografia, foi possível inferir o ano e país de introdução, além da data de origem das estirpes virais no Brasil. A estirpe VRD_521_2016 foi possivelmente introduzida entre 2016-2017 pela Espanha com provável origem em 2013, a RIVM-HAV16-090 europeia/asiática e V16-25801, possivelmente introduzida pela Alemanha, entre 20142015 e 2015-2016 respectivamente, com provável origem em 2000 e 2011. Nossos achados reforçam a necessidade de ampliação do acesso à vacina contra o HAV a grupos adultos de risco e do monitoramento da entrada de novos patógenos no Brasil. Além disso, medidas educativas são úteis para impedir a disseminação do HAV em populações-chave como os HSH. (AU)

Modeling the Long-term Antibody Response and Duration of Immune Protection Induced by an Inactivated, Preservative-free Hepatitis A Vaccine (Healive) in Children / 生物医学与环境科学（英文）

Objective@#Long-term seroprotection the hepatitis A vaccine is essential for the prevention of disease from the hepatitis A virus (HAV). Due to documented difficulties during decade-long follow-ups after receiving vaccines, statistical-modeling approaches have been applied to predict the duration of immune protection.@*Methods@#Based on five-year follow-up data from a randomized positive-controlled trial among Chinese children (1-8 years old) following a 0, 6 months vaccination schedule, a power-law model accounting for the kinetics of B-cell turnover, as well as a modified power-law model considering a memory-B-cell subpopulation, were fitted to predict the long-term immune responses induced by HAV vaccination (Healive or Havrix). Anti-HAV levels of each individual and seroconversion rates up to 30 years after vaccination were predicted.@*Results@#A total of 375 participants who completed the two-dose vaccination were included in the analysis. Both models predicted that, over a life-long period, participants vaccinated with Healive would have close but slightly higher antibody titers than those of participants vaccinated with Havrix. Additionally, consistent with previous studies, more than 90% of participants were predicted to maintain seroconversion for at least 30 years. Moreover, the modified power-law model predicted that the antibody titers would reach a plateau level after nearly 15 years post-vaccination.@*Conclusions@#Based on the results of our modeling, Healive may adequately induce long-term immune responses following a 0, 6 months vaccination schedule in children induction of memory B cells to provide stable and durable immune protection.

Development of an Indirect ELISA Featuring Plates Coated with Column Chromatographically Purified Canine Adenovirus Type-1 Antigen

Canine adenovirus type 1 (CAV-1) causes infectious hepatitis in members of the family Canidae, including dogs. An indirect enzyme-linked immunosorbent assay (I-ELISA) that detects CAV-1 antibodies is required for large-throughput tests of dog sera. We collected 165 serum samples from dogs of Chungbuk and Gyeongbuk provinces between February 2016 and October 2018. The Korean CAV-1 vaccine strain CAV1V was propagated in Madin-Darby canine kidney (MDCK) cells and purified via Nuvia cPrime anion-exchange chromatography; the virus served as an I-ELISA antigen. Virus-neutralizing anti-CAV-1 titers in dog sera were measured using the virus neutralization (VN) method. The I-ELISA was optimized using purified CAV-1 antigen and serum samples. This kit was used to evaluate dog sera. The VN and I-ELISA data were compared. The sensitivity, specificity, and accuracy of the I-ELISA were 97.0%, 74.2%, and 92.7% compared to the VN assay, respectively. The I-ELISA data significantly correlated with those of VN (r = 0.88). These results suggest that the I-ELISA is useful for serosurveillance of CAV-1 in dog sera.

Autoimmune Hepatic Failure Following Acute Hepatitis A is Accompanied by Inflammatory Conversion of Regulatory T Cells