Comparative Analysis of Liver Injury-Associated Cytokines in Acute Hepatitis A and B

PURPOSE: Acute hepatitis A (AHA) and acute hepatitis B (AHB) are caused by an acute infection of the hepatitis A virus and the hepatitis B virus, respectively. In both AHA and AHB, liver injury is known to be mediated by immune cells and cytokines. In this study, we measured serum levels of various cytokines and T-cell cytotoxic proteins in patients with AHA or AHB to identify liver injury-associated cytokines. MATERIALS AND METHODS: Forty-six patients with AHA, 16 patients with AHB, and 14 healthy adults were enrolled in the study. Serum levels of 17 cytokines and T-cell cytotoxic proteins were measured by enzyme-linked immunosorbent assays or cytometric bead arrays and analyzed for correlation with serum alanine aminotransferase (ALT) levels. RESULTS: Interleukin (IL)-18, IL-8, CXCL9, and CXCL10 were significantly elevated in both AHA and AHB. IL-6, IL-22, granzyme B, and soluble Fas ligand (sFasL) were elevated in AHA but not in AHB. In both AHA and AHB, the serum level of CXCL10 significantly correlated with the peak ALT level. Additionally, the serum level of granzyme B in AHA and the serum level of sFasL in AHB correlated with the peak ALT level. CONCLUSION: We identified cytokines and T-cell cytotoxic proteins associated with liver injury in AHA and AHB. These findings deepen the existing understanding of immunological mechanisms responsible for liver injury in acute viral hepatitis.

Hepatite A: soroprevalência e fatores associados em escolares de São Luís (MA), Brasil / Hepatitis A: seroprevalence and associated factors among schoolchildren of São Luís (MA), Brazil

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 por cento. 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 por cento, sendo de 71,5 por cento nas escolas públicas e de 36,5 por cento 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.

OBJECTIVES: To estimate the prevalence of antibodies to hepatitis A virus (antiVHA-IgG) in children aged 7-14 years from public and private schools, and to identify demographic, socioeconomic and sanitation factors associated with the prevalence of antiVHA-IgG. METHODS: Seroepidemiological study for the detection of IgG antiVHA. It was conducted from April 2002 to April 2004 with 462 elementary school students from São Luis, ranging from 7 to 14-years of age. Thirty schools randomly selected took part in the study, with a probability proportional to the number of students enrolled; 23 schools were public and 7 were private. Data was obtained through a structured questionnaire. In order to identify the variables independently associated with IgG antiVHA, the Poisson multiple regression analysis was performed, estimating the adjusted PRs and their 95 percent confidence intervals. The variables associated with the prevalence of hepatitis A with p < 0 were the only ones that remained in the final model. The level of significance of 0.05 (α = 0.05) was adopted. RESULTS: The prevalence of antiVHA-IgG was 64 percent, 71.5 percent in public and 36.5 percent in private schools. After multivariate analysis, age 11 to 14 years, more than one person per bedroom, and less than two bathrooms per household were associated with a higher prevalence of antiVHA-IgG. Higher parental education was associated with lower prevalence of antiVHA-IgG. CONCLUSIONS: Hepatitis A is endemic among schoolchildren in São Luís. The prevalence rate was similar to those found in other regions of the country with similar socio-economic and health conditions. Factors historically associated with a higher prevalence of hepatitis A were also identified in this population.

Hepatitis A bifásica en niños colombianos: reporte de nueve casos y revisión de la literatura / Biphasic hepatitis A in colombian children: report of nine cases and literature review

La hepatitis A tiene una prevalencia o incidencia en los países en desarrollo de 50 a 100 por cada 100000 personas. La presentación atípica de la hepatitis A bifásica, es rara. El objetivo es presentar 9 casos de niños con hepatitis A bifásica. Se estudiaron nueve niños de edades comprendidas entre los 7 y 13 años (edad media 8,6 años); 5 varones con antecedentes de fiebre, vómito, ictericia, dolor abdominal y coluria de 3 a 5 días de evolución, e IgM para la hepatitis A (IgM VHA) positivo. Después de un mes de evolución asintomáticos, se volvieron a presentar iguales manifestaciones clínicas del primer episodio, con la presencia de IgM VHA positiva otra vez. La media de las pruebas de función hepática en el segundo cuadro fueron: ALT 1258 U/L,AST 986 U/l, bilirrubina directa 5,87 mg/dl, y fosfatasa alcalina 580 U/L. En ninguno se informó anomalías a la ecografía abdominal y la serología de hepatitis autoinmune fue negativa. No hubo morbilidad en los niños. La hepatitis agudaApuede tener entre un 3% a 20% de casos con más de un pico de aminotransferasas, que se eleva entre las 2 y 8 semanas después del primer cuadro. Las hipótesis para explicar ello, son fenómenos de reinfección y autoinmunes. En general, la evolución es satisfactoria.

Hepatitis A has a prevalence or incidence in developing countries from 50 to 100 per 100,000 people. The atypical presentation of biphasic hepatitis A, is rare. The objective was to report 9 cases of children with biphasic hepatitis A. We studied 9 children aged between 7 and 13 years (mean age 8.6 years), including 5 males with a history of fever, vomiting, jaundice, abdominal pain, and coluria for about 3 to 5 days of evolution, and IgM to hepatitisA(IgMVHA) positive. After a mean month evolution asymptomatic, again showed the same clinic manifestations for the second time in the presence of IgM VHA positive again. The median liver function tests in the second frame were ALT 1258 U/L, AST 986 U/L, direct bilirubin 5.87 mg/dL, FA 580 U/L. In all reported no abdominal ultrasound abnormalities and autoimmune hepatitis serology was negative. There was no morbidity in children. Acute hepatitisAcan take on 3%-20% of cases with more than 1 peak of aminotransferases, which can be raised between 2 and 8 weeks after the first frame. Hypotheses to explain this, are reinfection and autoimmune phenomena. In general, evolution is satisfactory.

A Case of Acute Hepatitis with Mycoplasma pneumoniae Infection and Transient Depression of Multiple Coagulation Factors

We report a case of acute severe hepatitis with Mycoplasma pneumoniae (M. pneumoniae) infection and transient depression of multiple coagulation factors. A 5-year-old boy, previously healthy, was admitted with pneumonia. M. pneumoniae infection was confirmed by serology testing. Liver enzymes were elevated on admission without any past medical history. After treatment with azithromycin for 3 days, pneumonia improved, but the hepatitis was acutely aggravated. Partial thromboplastin time (PTT) was prolonged and depression of multiple coagulation factors developed. Liver biopsy revealed features consistent with acute hepatitis. A week later, liver enzymes were nearly normalized spontaneously. Normalization of prolonged PTT and coagulation factors were also observed several months later. This may be the first case of transient depression of multiple coagulation factors associated with M. pneumoniae infection.

Incidence and Seroprevalence of Hepatitis A Virus Infections among Young Korean Soldiers

This study was performed to determine the incidence and seroprevalence of hepatitis A virus (HAV) infections in young soldiers in the Republic of Korea Army. From January 2000 through December 2004, a total of 147 hepatitis A cases were reported to the Armed Forces Medical Command. The annual incidence rates were 7.4 per 100,000 persons in 2000, 1.6 in 2001, 4.4 in 2002, 9.8 in 2003, and 6.2 in 2004, based on the reported cases among approximately 500,000 soldiers. All patients were males with a median age of 21 yr (range, 19-27). The most common symptom was nausea (86.5%), and all patients had recovered without complications. In addition, in order to evaluate the seroprevalence of HAV infection in young adults, serum samples were obtained from randomly selected young subjects among those who had been admitted to the Armed Forces Capital Hospital from September 2005 to February 2006. A total of 200 subjects were enrolled in the study to analyze the anti-HAV immune status. The overall anti-HAV IgG seropositive rate was 2% (4/200, 95% CI, 0.60-5.21%). Given the changing epidemiology of the disease and the associated increase in morbidity, it was suggested that the routine HAV vaccination for Korean military personnel might be necessary.

Prevalencia de enfermedades hepáticas en una población rural de alta montaña: estudio clínico, bioquímico y ecográfico / Prevalence of liver diseases in a small rural community isolated in tne mountain heights: clinical, biochemical and ultrasonographic study

En este estudio clínico, bioquímico y ecográfico se evaluó la prevalencia de hepatopatías en Lara, una comunidad rural aislada de alta montaña en Tucumán, provincia con la máxima prevalencia de infección por HAV en niños de Argentina. Lara carece de agua potable, electricidad y cloacas. Se estudiaron 102 habitantes, lo que representa el 41% de la población. El anti-HBc y anti-HCV fueron negativos en todos los casos. Ningún niño presentó anormalidades hepáticas. El 41% de los adultos refirió ingesta alcohólica y el 12% transfusiones. Se observó incremento leve de ALT en 3 casos (6%). La ecografía demostró esteatosis en 8 individuos (16%), litiasis vesicular en 7 (14%), microcalcificaciones en 5 (10%) y quistes de aspecto parasitario en 4 (8%). La prevalencia de infección por HAV en Lara fue de 89% en adultos y 35% en niños, siendo significativamente menor que la de los niños de la ciudad de Tucumán con nivel socioeconómico medio / alto (53%, p = 0.05) o bajo (74%, p = 0.0006). La diferencia fue más evidente en niños menores de 5 años (0%, 53% y 75% respectivamente). La serología para hidatidosis fue positiva en 3/4 individuos con quistes, 2/5 con microcalcificaciones y 17/85 (20%) con ecografía normal, lo que sugiere que la técnica de Elisa utilizada se asocia a frecuentes resultados falsos positivos. El estudio poblacional de Lara demostró una elevada prevalencia de esteatosis, litiasis vesicular e hidatidosis en adultos, ausencia de infección por HBV y HCV, y una baja exposición al HAV en niños, especialmente en menores de 5 años.

The goal of this population-based clinical, biochemical and ultrasonographic study was to assess the prevalence of liver diseases in Lara, a small rural community isolated in the mountain heights of Tucumán, a Province of Argentina with the highest reported rates of HAV infection in children. Inhabitants of Lara lack electricity, potable water and a sewer system. The study included 102 individuals representing 41% of the total population. Anti-HBc and anti-HCV were negative in all cases. No children showed clinical, biochemical or ecographic abnormalities. Among adults, 41% referred alcohol consumption and 12% blood transfusions. Only 3 adults (6%) had mildly elevated ALT. Ultrasound showed steatosis in 8 individuals (16%), gallstones in 7 (14%), parenchymal micro-calcifications in 5 (10%) and parasitic cysts in 4 (8%). Prevalence of HAV infection in Lara was 89% in adults and 35% in children, being significantly lower than that of children of medium/high (53%, p=0.05) and low (74%, p=0.0006) socioeconomic level from the city of Tucumán (control groups). These differences were more marked in children aged <5 years (anti-HAV in 0%, 53% y 75% respectively). Serologic tests for echinoccocal disease were positive in 3/4 individuals with parasitic cysts, 2/5 with micro-calcifications and 17/85 (20%) with normal ultrasound, thus suggesting a high rate of false-positive results of the Elisa test utilized. This study showed that in Lara there is a high prevalence of steatosis, gallstones and equinoccocal disease in adults, absenceof HBV and HCV infection and low exposure to HAV in children especially in those aged <5 years.

Serum leptin levels in children with acute viral hepatitis A / Niveles de leptina en plasma en niños con hepatitis viral a aguda

OBJECTIVES: In acute viral hepatitis A (AVH-A), involvement of the liver is through cytotoxic cells and cytokine levels are increased Immune response of the host determines the severity of the disease. Leptin stimulates cytokines, therefore, the authors hypothesized that the relationship between leptin and cellular immunity might cause different clinical presentations of the disease. METHODS: Twenty-eight children with AVH-A and 10 healthy children formed the basis of the study. Serum leptin, C-reactive protein (CRP) and alpha-1-antitrypsin (A1AT) levels were determined RESULTS: There was significant positive correlation between body mass index (BMI) and leptin levels both in patients and controls (p = 0.003 and p = 0.001 respectively). No significant difference in serum leptin, CRP or A1AT levels between patients and controls was detected (p > 0.05). Presence of icterus or fulminant hepatic failure (FHF) did not affect serum leptin level (p > 0.05). Mean A1AT level was significantly higher in children with FHF (p < 0.05). On the 30th day of admission, mean BMI, weight and leptin levels increased (p < 0.01, p < 0.01 and p < 0.05 respectively) and mean A1AT level decreased (p < 0.01). CONCLUSION: Leptin levels are not altered in children with AVH-A. In the convalescence period, leptin increased parallel to BMI. It is suggested that expected increment in leptin due to inflammation might be balanced with the decrease due to loss of appetite during acute illness or it might be entirely due to loss of production.

Pancytopenia in a child associated with hepatitis A infection.

Pancytopenia is a very rare condition associated with hepatitis A infection. We managed a 12 year old boy who had hepatitis A infection with anemia. His hemogram and bone marrow examination were suggestive of pancytopenia. Pancytopenia recovered without any specific therapy. There are case reports of severe aplastic anemia with hepatitis A infection that required immunosuppressive therapy. The present case did not require any aggressive therapy and recovered. In a young child with hepatitis A infection and anemia, bone marrow depression should be suspected. The pancytopenia may be transient as exemplified by the present case.

Field performance of VAQTA (inactivated, purified hepatitis a vaccine) in Chinese children in Jiangsu.

In Jiangsu, 30% of children between the ages of 5 and 8 years test seropositive for hepatitis A. The safety, tolerability, and immunogenicity of a 2-dose regimen (0, 6 months) of VAQTA (0.5 ml of 25U) administered IM in 50 healthy children aged 5 to 8 years without prior serological screening was evaluated. Blood samples were collected prior to the first dose and after each additional dose of VAQTA to determine the initial anti-HAV serostatus and response rates to the vaccine. Twelve children (24%) were initially seropositive and 38 (76%) were initially seronegative. Four weeks after the primary dose of VAQTA, 34 of the 38 subjects (89.5%, 95% CI 75 to 97) were anti-HAV seropositive. The geometric mean titer was 33.1 mIU/ml (95% CI 22.4 to 49.0). After the booster dose at 6 months, all the subjects were seropositive (37/37), giving a seroconversion of 100% (95% CI: 90, 100). The geometric mean titer was 7585.8 mIU/ml (95% CI: 5623.4 to 10,471.3). Adverse experiences were generally mild and transient. Results of this study are consistent with results from a previous double-blind randomized trial of this vaccine and confirm that VAQTA is highly immunogenic, and generally well-tolerated.

Serological survey of viral hepatitis A, B, and C at Thai Central Region and Bangkok: a population base study.

Hepatitis A, B, and C are important viral hepatitis infections in the Thai population. Hepatitis B vaccination was included in the Thai Expanded Program on Immunization (EPI) 10 years ago. In addition, the seroprevalence of hepatitis A has significantly changed in the last two decades. This study was done to evaluate current risk groups for hepatitis A and B infections and identify the magnitude of hepatitis C infection in the general population of Bangkok and six provinces in the Central Region of Thailand, during the period October 2000 to January 2002. This study revealed that the prevalence of anti-HAV in people younger than 25 years was low but very high in people older than 25 years. The prevalence of anti-HAV was 1.95% in Bangkok and 12.7% in other provinces in people younger than 25 years (p<0.001) while 90.9% in Bangkok and 88.2% in other provinces among people older than 25 years. Therefore, people who are older than 25 years should have a blood test for anti-HAV before getting a hepatitis A vaccination. Approximately 80% of people who are not covered by hepatitis B vaccination from EPI are at risk of hepatitis B infection and its complications. This group of people should receive hepatitis B vaccination. For hepatitis C, the prevalence is lower than 2% across age groups and areas. Therefore, current good primary prevention via blood donor screening and health education must be maintained.

Declining hepatitis A seroprevalence among medical students in Bangkok, Thailand, 1981-2001.

The severity of clinical symptoms following hepatitis A virus (HAV) infection is age dependent. Hepatitis A in children is mostly an asymptomatic disease while adolescents and adults usually show symptoms of clinical hepatitis. Improved personal hygiene and environmental sanitation has led to a decline in natural immunity acquired in childhood, creating a population of susceptible adults. In the past decade, the incidence and prevalence of hepatitis A disease in Thailand have decreased significantly. In this study, we used enzyme-linked immunosorbent assay to determine the prevalence of anti-HAV antibodies among medical students at two different time points in 1996 and 2001. We then compared these results with data from previous studies in 1981 and 1992. The seroprevalence was 73.01%, 30.23%, 16.67% and 6.67% in 1981, 1992, 1996 and 2001, respectively. A significant decline has happened over the past two decades (p < 0.001). Considering the decreasing immunity to HAV in the younger generations, more cases of symptomatic HAV infection could be anticipated. Further seroprevalence studies in other adolescence groups from different socioeconomic status are needed to elucidate the current situation of HAV infection in the young generation more comprehensively and to develop an appropriate prevention program.

Serological study of hepatitis A virus infection amongst the students of a medical college in Delhi & evaluation of the need of vaccination.

BACKGROUND & OBJECTIVES: Recent seroepidemiological studies have demonstrated a decrease in the seroprevalence of hepatitis A virus (HAV) infection, thereby increasing the pool of susceptible adult population. Health care workers, especially those working in paediatric wards and nurseries, are at an increased risk of developing HAV infection. The present study was undertaken to determine the prevalence of antibody against HAV (IgG anti-HAV) among a batch of medical students of the Maulana Azad Medical College, New Delhi, so as to identify the proportion of students who would be susceptible to HAV infection and hence would benefit from a vaccination programme against HAV. METHODS: A total of 91 medical students were enrolled and divided into groups on the basis of sex. The serum samples were evaluated for the presence of immunoglobulin (IgG) against HAV (IgG anti-HAV) using a commercially available enzyme linked immunosorbent assay (ELISA) kit. RESULTS: The mean age of all the subjects was 19.9 +/- 1.5 yr and the male: female ratio was 1.2: 1. Fifty seven (62.6 +/- 5.1%) students were positive for IgG anti-HAV while 34 (37.4%) were seronegative and hence susceptible to HAV infection. No statistically significant difference was observed in the seroprevalence of HAV between males and females [64 +/- 6.7% (32/50) versus 60.9 +/- 7.6% (25/41)]. INTERPRETATION & CONCLUSION: our results indicate that more than one-third of the medical students were seronegative for IgG anti-HAV and hence at an increased risk of developing HAV infection as a result of occupational exposure. Therefore, we suggest that students in a health care set up should undergo vaccination against HAV after pre-vaccination immunity screening.

Use of filter paper disks for hepatitis A surveillance.

BACKGROUND: Venous blood collection is a cumbersome and uncomfortable procedure during hepatitis A surveillance. Collection of capillary blood by finger prick is an alternative method. AIM: To evaluate the reactivity of capillary blood/anti-hepatitis A virus (HAV) IgG stored on filter paper disks for detection of anti-HAV antibody. METHODS: Venous blood specimens were collected from healthy individuals. Simultaneous capillary blood specimens obtained by finger prick were stored on filter paper disks. A reference standard of anti-HAV IgG in known concentrations was spotted on filter paper disks. The reactivities of anti-HAV IgG and capillary blood specimens eluted from filter paper disks were tested by blocking ELISA for detection of anti-HAV antibody. The results were evaluated by comparing optical density (OD) and neutralization values with those obtained for WHO anti-HAV IgG stored in liquid phase and homologous venous blood specimens, respectively. RESULTS: Among both venous and capillary-blood specimens stored for 10 days, percent neutralization shown by the same 46 specimens was > 50 and that of the same 3 specimens was < 50, indicating anti-HAV positivity and negativity, respectively. There was significant correlation between the OD values displayed by anti-HAV IgG from liquid phase and that eluted from filter paper disk (p < 0.01). Sixteen serum specimens stored for a period of 2 months showed results similar to those of the corresponding filter paper disk elutes. CONCLUSION: Use of filter paper disks could be a suitable choice for pre- and post-immunization collection of blood specimens during hepatitis A surveillance.

Susceptibility to hepatitis A virus infection among chronic liver disease patients and healthy blood donors in Thailand.

Due to improvements in socio-economic and sanitation conditions, Thailand has undergone a change from hyperendemicity to intermediate endemicity for hepatitis A virus infection, leaving a large part of the adult population without immunity. At the same time, the country is still highly endemic for hepatitis B and especially in the northeast, hepatitis C virus infection both of which when acquired during infancy or early childhood exhibit a strong tendency to turn towards chronic liver disease, although in particular with hepatitis B virus the asymptomatic carrier state is also rather common. As no cross-immunity exists between any of these viruses, double or triple infections do occur, a situation where previously acquired immunity to HAV becomes crucial as double infections have been shown to take a more severe or even fatal course. In the present study, we investigated 820 HBV- and/or HCV-related chronic liver disease (CLD) patients and 195 blood donors, both groups divided by 10-year age intervals, for the prevalence of anti-HAV. The results showed the same age dependence of immunity for all groups tested as can be expected for an area of intermediate endemicity, in that approximately 50% of those between 21 and 30 years of age had acquired anti-HAV. These findings indicate the immune response to HAV infection not to be altered by chronic infection with either HBV or HCV. Hence, vaccination against HAV should be considered, particularly in anti-HAV-negative patients with CLD.

Hepatitis A virus: declining seroprevalence in children and adolescents in Southeast Asia.

The prevalence of hepatitis A virus (HAV) in a country largely reflects its standards of hygiene and socioeconomic conditions. Countries which undergo socioeconomic development show major change in HAV prevalence from high to low endemicity, and this is largely reflected in patterns of age-related seroprevalence. This paper presents age-related HAV seroprevalence patterns of SE Asian countries, and highlights how these patterns have changed over recent decades. Singapore, Thailand and Malaysia have experienced a decline in childhood and adolescent HAV seroprevalence, typical of countries which undergo socioeconomic development. By contrast, India has remained a country of high endemicity, with almost universal seroconversion in childhood. The Philippines and Vietnam show age-related seroprevalence patterns typical of high to moderate endemicity, while Indonesia shows significant regional variation in HAV seroprevalence. Populations within countries which exhibit major improvements in endemicity and age related HAV seroprevalence patterns are at risk of HAV epidemics, and a paradoxical increase in incidence tends to occur as seroconversion shifts from children to adults. The residents of these countries, a significant number of whom are at-risk, would benefit from a program of vaccination, as would non-infected individuals visiting high-risk areas.

Soroepidemiologia da infecçäo pelo vírus da hepatite A em meninos de/na rua de Goiânia-Goiás / Seroepidemiology of hepatitis A virus infection in street children of Goiânia-Goiás

Um estudo soro epidemiológico, para anticorpos contra o virus da hepatite A (anti-VHA total-IgM e IgG), foi realizado no período de 1991-1992, em 397 "meninos de/na rua" em Goiânia. Destes, 313 apresentavam vínculo familiar e desenvolviam, em sua maioria, atividades de trabalho informal, enquanto que 84 nao possuiam vínculo familiar e se encontravam na rua ou em Instituiçoes do Governo Estadual. A taxa média de prevalência foi de 90,4 por cento, variando de 80,0 por cento a 92,9 por cento, sem contudo apresentar diferença estatística significante relativa à idade (7-21). Também nao se evidenciou qualquer diferença quando este grupo foi estratificado para presença ou ausência de vínculo familiar ou mesmo quando analisado em relaçao a outras variáveis sócio-demográficas. Estes dados sugerem que a hepatite A é endêmica na populaçao de baixa condiçao sócio-econômica da regiao e que nesta faixa etária a maioria dos indivíduos já adquiriu a infecçao. Outras investigaçoes em grupos e camadas sociais diferentes sao necessárias a fim de parametrar estratégias vacinais em países subdesenvolvidos.

Intragastric infection induced in marmosets (Callithrix jacchus) by a Brazilian hepatitis A virus (HAF-203)

Several specied of non-human primates have been used in studies on experimental infection with hepatitis A virus (HAV). Attempts to infect a South-American marmoset (Callithrix jacchus) with a Brazilian HAV isolate (HAF-203) are described here. Four seronegative animals were inoculated intragastrically and one was sacrificed on day 11,20,47 and 62 after infection. One uninfected animal was included as control. Liver, small intestine, lymph node, spleen and kidney samples were collected for histological diagnosis and immunocytochemistry studies. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) serum enzymes and anti-HAV antibodies were monitored by a colorimetric procedure (Abbott) and an enzyme immunoassay (ELISA), respectively. Feces were collected daily for HAV antigen (HAVAg) detection by ELISA. Increased levels of HAVAg were detected in hepatocytes 11 days after infection, with a gradual decrease during the course of infection. Shedding of HAVAg in feces was observed from the late incubation to the early acute phase (20th day to 47th day after infection). The end of the incubation period was indicated by the initial increases in serum ALT and AST. Severe hepatic lesions such as piecemeal necrosis and bridging necrosis were detected during the acute phase, coinciding with the maximum transaminase levels and the appearance of anti-HAV antibodies. On the 62nd day (convalescent phase), the hepatic tissue showed evidence of regeneration and the transaminase values had returned to baselines. The serological, biochemical, antigenic and histological evidence of hepatitis A was similar to that observed in several primate models inoculated with other HAV isolates. The data suggest that C. jacchus can be a valuable model for the study of hepatitis A and for the evaluation of HAV vaccines

An outbreak of hepatitis A in school children at Nakhon Si Thammarat, southern Thailand.

Hepatitis A antibody prevalence in Southeast Asia has markedly declined among children and adolescents. Therefore increasing a number of susceptible populations could result in an outbreak or epidemic. This paper reports an intensive study of an outbreak of hepatitis A in a primary school children during an endemic at Nakhon Si Thammarat, Southern Thailand. Eighty-nine children were inspected randomly from the total of 269 students, age ranged from 7-12 years old. The school children and parents were interviewed for their illness. Serological tests for antiHAV IgM and antiHAV (total antibody) were performed by ELISA. There were 36 cases of clinical acute hepatitis were positive for antiHAV IgM because of serological tests were performed nearly 4 months later. Seventy of 89 children tested were positive for antiHAV and 16 of them were positive for IgM class. Seven of 16 children with antiHAV IgM positive were asymptomatic. The significant risk factors for children with positive antiHAV were occurrence of hepatitis patients in the family and no latrine (p < 0.01). Endemic transmission in this outbreak occurred rapidly. Therefore preventive measures are essential in reducing the infection rate. In addition to personal hygiene, immunoprophylaxis with either immunoglobulin or HAV vaccine is recommended.

Hepatitis A, B and C seroprevalence in Pakistan.

A cross sectional study was conducted to determine the seroprevalence of Hepatitis A, B, and C virus in healthy Pakistani children. HAV IgG antibody was assayed in 258 subjects and it was found that 94% children by 5 years of age had HAV IgG-antibody. The overall seroprevalence of HAV IgG antibody was 55.8% and IgM 5.3%. HBVsAb levels assayed in 236 healthy children showed a seroprevalence of 2.97%. Similarly, HCV antibody seroprevalence was found to be a low 0.44% in healthy children. HAV is a major cause of Hepatitis, as compared to HBV and HCV which are of low endemicity.