Reducción en la infección por VHB y VHD en dos poblaciones indígenas de la Amazonia peruana después de la vacunación contra la hepatitis B / Reduction of HBV and HDV infection in two indigenous peoples of Peruvian Amazon after the vaccination against hepatitis B

Resumen: Objetivo: Conocer el resultado de la vacunación contra la hepatitis B en las comunidades hiperendémicas Kandozi y Chapra de la Amazonia Peruana a partir de la prevalencia de infecciones por los virus de la hepatitis B (VHB) y Delta (VHD), ocho años después de iniciada la vacunación. Material y métodos: Se realizó un estudio transversal en 2 944 pobladores de 67 comunidades indígenas Kandozi y Chapra en abril de 2010. El tamizaje serológico para el antígeno de superficie del VHB (HBsAg), anticuerpos anti-HBc IgM e IgG, anticuerpos anti-HBs y anti-VHD se determinaron mediante pruebas de ELISA. Resultados: Las tasas de prevalencia del HBsAg, anti-HBc IgG, anti-HBs ≥10 mlUI/ml y anti-VHD fueron 2.3, 39.13, 50.95 y 2.11%, respectivamente. La prevalencia del HBsAg en niños <11 años fue cero. Entre los portadores del HBsAg, las tasas de prevalencia de sobreinfeccion por el VHD e infección aguda por el VHB fueron 2.11% (todos fueron >14 años) y 11.94%, respectivamente. Conclusiones: Estos hallazgos muestran la eliminación de portadores de VHB en niños <11 años, ocho años después de iniciada la vacunación contra el VHB.

Abstract: Objective: To determine the outcome of the vaccination against hepatitis, we determined the prevalence of hepatitis B virus (HBV) and hepatitis D virus (HDV) infections, eight years after introduction of the vaccination. Materials and methods: A cross-sectional study was performed in 2 944 participants of 67 Kandozi and Chapra indigenous peoples in April 2010. Serological screening for hepatitis B surface antigen (HBsAg), antibody anti-HBc IgM and IgG, antibody anti-HBs and anti-HDV were determined by ELISA tests. Results: The prevalence rates of HBsAg, anti-HBc total, anti-HBs ≥10 mlUI/ml and anti-HDV were 2.3, 39.13, 50.95 and 2.11%, respectively. The prevalence rate of HBsAg in children <11 years was 0%. Among carriers of HBsAg, the prevalence rates of HDV and acute HBV infections were 2.11% (all were >14 years) and 11.94%, respectively. HBsAg and anti-HBc total were associated with individuals ≥10 years (p<0.001). Conclusions: These findings show the elimination of HBV carriers in children <11 years, eight years following introduction of the vaccination against HBV.

Hepatitis delta prevalence in South America: a systematic review and meta-analysis

Abstract Hepatitis delta virus (HDV) has been associated with acute or chronic hepatitis in Latin America, but there is no prevalence study covering South American countries. This meta-analysis aimed to estimate anti-HDV prevalence through a systematic review of published articles in English, Portuguese and Spanish until December 2017. Searches were conducted in Health Virtual Library, Capes, Lilacs, PubMed, and SciELO, according to defined criteria regarding participant selection and geographical setting. Study quality was assessed using the GRADE guidelines. Pooled anti-HDV prevalence was calculated using the DerSimonian-Laird random-effects model with Freeman-Tukey double arcsine transformation. Out of the 405 identified articles, only 31 met the eligibility criteria for inclusion in the meta-analysis. In South America, pooled anti-HDV prevalence among hepatitis B virus carriers was 22.37% (95% confidence interval: 13.72-32.26), though it appeared less frequently in some countries and populations, according to the data collection date. The findings indicated significant successive reductions in anti-HDV prevalence over thirty years. However, there was a scarcity of HDV epidemiological studies outside the Amazon Basin, notably in the Southwest continent and absence of target population standardization. There was a high HDV prevalence in South American countries, despite differences in methodological characteristics and outcomes, highlighting a drastic decline in the last decades. Future studies should identify HDV prevalence estimates in other regions of the continent and identify risk factors.

Inactive hepatitis B surface antigen carriers and intrafamilial tramsmission: results of a 10-year study

BACKGROUND/AIMS: The aims of the present study were to determine the outcomes of inactive hepatitis B virus (HBV) surface antigen (HBsAg) carriers over a 10-year study period and to elucidate the HBV serological profile of their family members. METHODS: We retrospectively analyzed the medical files of inactive HBsAg carriers followed up at the Department of Infectious Diseases of Kocatepe University Medical Faculty Hospital between March 2001 and January 2011. RESULTS: In total, 438 inactive HBsAg carriers were enrolled in this trial. The follow-up period was 33.7+/-22.5 months (mean+/-SD). Anti-hepatitis-B surface antibody seroconversion occurred in 0.7% of cases, while chronic hepatitis B was found in 0.5%. The anti-hepatitis-D virus (HDV) status was evaluated in 400 patients and anti-hepatitis C virus (HCV) in 430. It was found that 1% and 0.2% were positive for anti-HDV and anti-HCV, respectively. HBV serology was investigated in at least 1 family member of 334/438 (76.3%) patients. The HBsAg positivity rate was 34.6% in 625 family members of 334 patients. A comparison of the HBsAg positivity rates in terms of HBV DNA levels in index cases revealed that HBsAg seropositivity rates were higher in family members of HBV DNA-negative patients than in family members of HBV DNA-positive cases (P=0.0001). CONCLUSIONS: The HBsAg positivity rate was higher in family members of inactive HBsAg carriers than in the general population; these family members therefore have a higher risk of HBV transmission. Furthermore, despite negative HBV DNA levels, transmission risk was not reduced in these patients, and horizontal transmission seems to be independent of the HBV DNA value.

Hepatitis D virus infection in the Western Brazilian Amazon - far from a vanishing disease / Infecção pelo vírus da hepatite D na Amazônia brasileira - longe de uma doença em declínio

INTRODUCTION: A decline in hepatitis D virus (HDV) occurrence was described in Europe and Asia. We estimated HDV prevalence in the Brazilian Amazon following hepatitis B vaccination. METHODS: This is a cross-sectional survey of HDV measured by total antibodies to HDV (anti-HD T). RESULTS: HDV prevalence was 41.9% whiting HBsAg carries and was associated with age (PR = 1.96; 95% CI 1.12-3.42; p = 0.01), hepatitis B virus (HBV) infection (PR = 4.38; 95% CI 3.12-6.13; p < 0.001), and clinical hepatitis (PR =1.44; 95% CI 1.03-2.00; p = 0.03). Risk factors were related to HDV biology, clinical or demographic aspects such as underlying HBV infection, clinical hepatitis and age. CONCLUSIONS: Our study demonstrated that HDV infection continues to be an important health issue in the Brazilian Amazon and that the implementation of the HBV vaccination in rural Lábrea had little or no impact on the spread of HDV. This shows that HDV has not yet disappeared from HBV hyperendemic areas and reminding that it is far from being a vanishing disease in the Amazon basin.

INTRODUÇÃO: É descrito declínio na ocorrência do vírus da hepatite D (VHD) na Europa e Ásia. Estimamos a prevalência de infecção pelo VHD na Amazônia Ocidental, após a introdução da vacinação contra hepatite B. MÉTODOS: Este é um estudo de corte transversal da prevalência do VHD medido pela ocorrência de anticorpos totais (anti-HD T). RESULTADOS: A prevalência do VHD encontrada foi 41,9% entre os portadores do HBsAg, e esteve associado à idade (RP = 1,96; IC 95% 1,12-3,42; p = 0,01), infecção pelo HBV (RP = 4,38; IC 95% 3,12-6,13; p < 0,001) e história clínica de hepatite (RP =1,44; IC 95% 1,03-2,00; p = 0,03). Fatores de risco mostraram-se associados à biologia do HDV, aspectos clínicos e demográficos como infecção prévia pelo VHB e idade. CONCLUSÕES: O estudo demonstra que a infecção pelo VHD continua sendo um importante problema de saúde pública na região, e que a implantação da vacinação contra o VHB na área rural de Lábrea teve um impacto pouco significativo no controle do VHD, percebe-se que este ainda não desapareceu de áreas hiperendêmicas do VHB, e está longe de poder ser classificado como uma doença em declínio na bacia Amazônica.

Prevalência dos marcadores sorológicos dos vírus das hepatites B e D na área indígena Apyterewa, do grupo Parakanã, Pará, Brasil / Prevalence of hepatitis B and D serological markers in the Parakanã, Apyterewa Indian Reservation, Pará State, Brazil

Com o objetivo de estudar a prevalência dos vírus das hepatites B (HBV) e D (HDV), nas aldeias Apyterewa e Xingu, do grupo Parakanã, e avaliar o impacto da vacinação contra a hepatite B, iniciada nessas aldeias em 1995, foram coletadas, em 2004, 258 amostras de soro para análise dos marcadores sorológicos das hepatites B e D, por técnicas imunoenzimáticas; cujos resultados revelaram padrão de endemicidade moderada com prevalência total de infecção pelo HBV de 55,7 por cento, com 5,4 por cento de portadores do vírus, na aldeia Apyterewa, e de 49,5 por cento, com 1,1 por cento de portadores, na Xingu; 31,4 por cento de anti-HBs+ como marcador isolado nas duas aldeias, e não foi detectada sorologia positiva para o HDV entre portadores do HBV. Caracterizamos, em base laboratorial, a presença de portadores crônicos do HBV, ausência de portadores do HDV e emergência de perfil vacinal entre os susceptíveis, confirmando a efetividade e a necessidade de manter a vacinação, principalmente no primeiro ano de vida, e, ainda, a necessidade de desenvolver vigilância epidemiológica efetiva para detecção precoce da infecção pelo HDV, entre os portadores do HBV.

In order to study the prevalence of hepatitis B (HBV) and D (HDV) viruses in the Parakanã Indians and to evaluate the impact of hepatitis B vaccination beginning there in 1995, 258 serum samples were analyzed in the year 2004 for hepatitis B and D serological markers using immunoenzymatic techniques; the results showed a moderate endemic pattern, with a total prevalence of HBV infection of 55.7 percent and 5.4 percent of virus carriers in the Apyterewa village and 49.5 percent with 1.1 percent of HBV carriers in the Xingu village; 31.4 percent of anti-HBs+ as an isolated marker in both villages and no detection of positive serological tests for HDV among HBV carriers. The laboratory analysis thus showed the presence of chronic HBV carriers, absence of HDV carriers, and an emerging vaccine profile among susceptibles, confirming the effectiveness and need to maintain vaccination, especially in the first year of life, and the need to implement effective epidemiological surveillance for early detection of HDV infection among HBV carriers.

The Prevalence and Clinical Characteristics of Hepatitis-delta Infection in Korea / 대한간학회지

BACKGROUND/AIMS: The prevalence of hepatitis delta virus (HDV) infection has been estimated as being approximately 5% among global HBsAg carriers. The anti-delta positive rate in Koreans had been reported as being 0.85% in 1985. While the prevalence of HBV has been decreased from nearly 10% to 5% during the past twenty years, there have been no more studies on the anti-delta prevalence in Koreans. The aim of this study was to estimate the anti-delta prevalence in Koreans and to study the clinical characteristics of anti-delta positive patients in a single center. METHODS: Serum anti-delta was measured in one hundred ninety four HBsAg-positive patients who were admitted to our hospital from February 2003 to August 2003. We checked the genotypes of the HBV in the anti-delta positive patients. The clinical features of the anti-delta positive patients were compared to those clinical features of the anti-delta negative patients from the aspect of age, gender, mode of transmission, the positivity of HBeAg and serum HBV DNA. RESULTS: Serum anti-delta was positive in seven patients among the 194 subjects, giving a 3.6% positive rate. Among these seven patients, six had hepatocellular carcinoma (HCC) and the other one had cholangiocarcinoma. All of the anti-delta positive patients had the C genotype of HBV. The anti-delta positive patients showed significantly suppressed HBV DNA replication compared to the anti-delta negative patients. CONCLUSIONS: In Koreans, anti-delta was positive mainly in HCC patients with an approximate prevalence of 4%, and this rate has not changed much for the past twenty years. HBV DNA replication was suppressed by HDV infection.

Infecção pelos vírus das hepatites B e D entre grupos indígenas da Amazônia Brasileira: aspectos epidemiológicos / Hepatitis B and D virus infection within amerindians ethnic groups in the Brazilian Amazon: epidemiological aspects

Entre populações autóctones da América, estudos relatam altos índices de infecção e doença pelos vírus das hepatites B e D. Esta é uma revisão do que já foi descrito entre indígenas da Amazônia brasileira. Em alguns grupos a prevalência do AgHBs é muito baixa, enquanto que outros da mesma região, apresentam padrão de elevada endemicidade, presente inclusive entre menores de 10 anos. O VHD só foi encontrado entre etnias no estado do Amazonas. É descrito a importância da transmissão horizontal familiar, e do contato sexual entre adultos jovens. Fatores socioculturais, genéticos, ecológicos, e a formação histórica desses povos, são apontados como determinantes deste padrão. Entretanto, a origem do VHB e VHD na Amazônia é ainda obscura. Populações indígenas com sua memória genética são, na verdade, o experimento ao vivo, o que demanda investigação abrangente, avaliando a influência dos aspectos históricos, ecológicos, médicos e antropológicos envolvidos, utilizando inclusive técnicas modernas de biologia molecular.

Several studies describe very high prevalence rates of infection and disease of hepatitis B and D within Native American population. This is a review of what has been described among Amerindians of Brazilian Amazon. Some groups show low prevalence rates of HBsAg, whereas, others of the same region reveal high endemic pattern, even among individuals less then 10 years of age. HDV is only found in groups of Amazonas province. Transmission may occur by interfamilial dissemination or sexual contact among young adults. Socio-cultural, genetic, and ecological factors are described as determinants of this unique pattern. Nevertheless, the origin of these two viruses is yet to be disclosed. Amerindians population and their genetic memory are a live experiment, which demands a broad investigation, weighting with modern tools, as molecular biology, the influence of historical, genetic, medical and anthropological factors.

Fulminant hepatic failure: etiology, viral markers and outcome.

OBJECTIVE: To investigate the etiology and outcome of fulminant hepatic failure (FHF) in children. SETTING: Hospital based descriptive. METHODS: 36 children (22 males and 14 females) presenting with FHF over a period of one year were investigated. The ages ranged from 1.5 to 9 years. FHF was defined as occurrence of encephalopathy within eight weeks of onset of jaundice with no evidence of pre-existing liver disease. Detailed history, clinical examination, routine biochemical parameters and relevant diagnostic tests were carried out. Viral markers studied were anti HAV-IgM, HBsAg, anti HBc-IgM, anti-HCV and anti HEV-IgM. RESULTS: A viral etiology could be established in 22 children (61.1%). Hepatitis A (n = 12), Hepatitis B (n = 3), Hepatitis A and B (n = 2), and Hepatitis A and E (n = 4). Two children had enteric fever (1 with associated HEV), 2 children had Wilson's disease, 1 child had Indian Childhood Cirrhosis (ICC) and 2 children had drug induced hepatitis. Etiological diagnosis was not possible in 8 children (22%). Fourteen children (39%) died. Poor outcome was associated with spontaneous bleeding, raised prothrombin time, lower transaminases and higher bilirubin on admission. CONCLUSION: Viral hepatitis is the commonest cause of FHF in children. HAV alone or in combination is responsible for upto 50% of all FHF in children. Chronic liver disease can also present as FHF. Etiological diagnosis is not possible to upto one-fourth of all cases.

Hepatitis B virus surface antigen (HBsAg) and antibody (anti-HBs) forming immune complexes in fulminant hepatits

Este trabalho relata um padräo sorológico näo usual para o HBV e a presença de imunocomplexos HBsAg/anti-HBs em amostras de soro provenientes de dois pacientes com hepatite fulminante procedentes da Amazônia Ocidental Brasileira. O diagnóstico foi estabelecido por meio de testes sorológicos e pela demonstraçäo de complexos antígeno/anticorpo por técnicas de microscopia eletrônica de transmissäo. A concomitante superinfecçäo pelo vírus da hepatite Delta também é discutida

Prevalence of anti-delta antibodies in central India.

A total of 238 sera samples from cases of hepatitis, renal failure, thalassaemia, healthy health care workers (HCWs) & asymptomatic HBsAG carriers coming from central India from July 1992 to June 1998, were screened for anti-delta antibodies. Among 238 subjects, 206 were reactive for hepatitis B surface antigen (HBsAg) while 32 were HBsAg non-reactive. The prevalence of anti-delta antibodies was low (1.9%) among 54 patients of acute viral hepatitis (AVH) while it was higher (5.7%) among 52 patients of chronic liver disease (CLD). The anti-delta antibodies positivity among 34 patients with hepatic failure was around 15% and all of them were FHF patients. Among multitransfused subjects such as chronic renal failure (CRF) the prevalence of anti-delta antibodies was low (2.3%). None of the apparently healthy HBsAg reactive HCWs and asymptomatic HBV carriers were reactive for anti-delta antibodies. Similarly anti-delta antibodies could not be detected in HBsAg negative viral hepatitis patients. There is a wide variation in the prevalence of anti-delta antibodies in different parts of India. However, overall prevalence of anti-delta antibodies appears to be lower in the Indian population in comparision to western countries.

Hepatitis D infectivity profile among hepatitis B infected hospitalised patients in Calcutta.

450 hospitalised cases of hepatic and non hepatic disorders and 100 normal individuals were examined for serum Hepatitis B Surface antigen and Delta Virus antigen by ELISA to find out its association with different clinical disorders. 105 patients (23.3%) and 2 control (2%) were positive for HBsAG. 60 cases with jaundice (26%) were HBsAg positive. 65% of HBsAg positive jaundiced patients had serum bilirubin level more than 2 mg per dl with a mean SGPT level of 488 iu/L. Only two cases were positive for HDV antigen among 60 HBsAg positive jaundice patients indicating a lower rate of prevalence of infection (3.3%). 62 (59%) out of 105 HBsAg positive cases did not show any history of blood transfusion or surgical interference indicating a positive HBV transmission through needle prick during investigative procedures.

Prevalence of markers of hepatitis viruses A, B, C and of HIV in healthy individuals and patients of a Cambodian province.

So far little was known on the epidemiology of hepatitis A, B, C and of AIDS in Cambodia and especially not in the rural area of Takeo. Therefore serological markers for past or ongoing infections with the disease causing viruses were measured in 559 healthy individuals (305 adults, 200 children and 54 mothers of children with liver disorders) and in 185 individuals (103 adults and 82 children) with liver or kidney diseases. In none of the 744 samples tested was anti-HIV detected. 10-37% of the children and 73% of the adults showed HBV-markers, HBsAg being detectable in 2-14% of the children and in 8% of the adults. The prevalence for anti-HCV was 6.5% in the adults with a predilection in males (9%). No markers for HCV infections were found in children. Growing, age related proportions of children (27-97%) and 100% of the adults were anti-HAV IgG positive. HBsAg was detected in 46% of the adults with acute hepatitis, in 45% of those with chronic hepatitis/liver cirrhosis and in 90% of patients with hepato-cellular carcinoma (HCC). In children the corresponding figures were 18% for acute hepatitis and 18% for chronic hepatitis. Patients with acute hepatitis or HCC had a similar prevalence of anti-HCV as healthy individuals. However, 34% of the adult patients with chronic hepatitis/cirrhosis showed signs of a HCV-infection. When the data were analysed with respect to modes of viral transmission, crowding, transmission by unsafe sexual practice or contaminated injection material, and to a lesser extent vertical transmission, seem to be relevant for HBV. The main mode of acquiring HCV infection is probably through medical injections of all sorts, a habit which is very popular in Takeo. Prophylactic measures should concentrate on the prevention of HBV and HCV infections by hygienic means. HBV mass vaccination should be considered in the future.

Markers of HBV, HCV and HDV among multitransfused children

In order to study the profile of distribution of hepatitis B virus [HBV], hepatitis C virus [HCV], and hepatitis Delta virus [HDV] markers among multitransfused children, this study was carried out on 94 polytransfused cases [84 males and 10 females, their ages ranged from 2 to 13 years], as well as 25 apparently healthy children with matchable age and sex as controls. The studied cases included 51 patients with malignant disease [38 with acute leukemia and 13 with lymphoma], 33 with thalassemia major, and 10 hemophiliaes. All cases and controls were screened for the following HBV markers: hepatitis B surface antigen [HBsAg] antibodies to hepatitis B core antigen [Anti-HBc] and antibodies to hepatitis B surface antigen [Anti-HBs], as well as for antibodies to HCV [Anti-HCV]. Fifty cases were randomly studied for antibodies to HDV [Anti-HDV]. Serum levels of alanine amino-transferase [ALT] were evaluated in all the patients and controls. All cases and controls were subjected to study of human immunodeficiency virus [HIV] with negative results. Among the polytransfused cases, 45.74% were positive for one or more of the studied HBV markers while 27.66% were positive for Anti-HCV. As regards the controls, only one of them [4%] showed HBsAg while none of them was positive for Anti-HCV. The prevalence rate of one or more of HBV markers was significantly higher than that of Anti-HCV [p<0.01]. Also, the prevalence of both HBV and HCV markers increased significantly with the increase in frequency of blood transfusion. In relation to the underlying disease, both thalassemic patients and hemophiliacs showed significantly higher prevalence rates than cases with malignant disease regarding either one or more of HBV markers [p<0.001 and p<0.05 respectively] and regarding Anti-HCV [p<0.02 and p< 0.01 respectively]. Hepatitis B surface antigen and Anti-HBc were significantly more common in patients seropositive for Anti-HCV than in those without Anti-HCV [p < 0.05 for each]. Out of the 50 polytransfused cases screened for Anti-HDV, 6 cases showed this marker [12%], all of them exposed to blood transfusion for more than 5 times. Non of them was positive for Anti-HCV. The prevalence of Anti-HBc among cases positive for Anti-HDV was significantly higher than that among cases without Anti-HDV [p<0.05]. Serum levels of ALT were significantly higher among cases than controls irrespective of the presence or absence of HBV or HCV markers [p< 0.001]. Cases positive for markers of HBV or HCV or both showed significantly higher serum ALT levels than cases negative for these markers [p<0.05, p< 0.005, and p< 0.001 respectively]. In relation to the underlying disease, cases with either malignant disease or thalassemia showed significantly higher serum levels of ALT than hemophiliacs [p < 0.005 and p< 0.05 respectively]. However, all the 3 disease groups showed significantly higher serum ALT levels than controls [p< 0.001 for each]. Finally serum ALT exhibit significant elevation among cases simultaneously positive for both HBV and HDV markers than among those positive for HBV markers only [p < 0.05]. We concluded that because of the presence of cases showing Anti-HBc without HBsAg, screening of blood donors for Anti-HBc and HBsAg is desirable to decrease the incidence of hepatitis B viral infection among the poly transfused patients. Moreover, to decrease the incidence of hepatitis C viral infection, blood donors should be also screened for Anti-HCV combined with measurement of serum ALT until more than one marker for HCV is available, as the time of appearance of Anti-HCV is variable. In addition, we recommend early vaccination of children at risk of repeated blood transfusion against HBV to protect them from both HBV and HD V infections. Owing to the presence of cases showing Anti-HDV with HBV markers other than HBsAg, accurate estimation of the incidence and prevalence rates of HDV infection needs screening for Anti-HDV whether HBsAg is present or not

Hepatitis viral delta

The etiologic agent of this severe form of hepatitis was identified by Rizzetto et al in Italy in 1977. The Delta virus resembles satellite viruses of plants which can not replicate without another specific virus. In this particular case hepatitis B virus is the helper agent. Clinically this form of hepatitis is characterized by two presentations: coinfeccion, which means simultaneous infection of a host with hepatitis B virus and hepatitis D virus. This variety of hepatitis can present with two distinct peaks of transaminases and usually resolves completely in most of the cases, however 0-4 percent can evolve to chronic hepatitis and 25 percent of the cases of fulminant hepatitis are due to this viral association. The diagnosis can be established demonstrating anti-HDV IgM or HDV-RNA or HDV antigen in the serum. In essence coinfection makers acute hepatic failure more common and the mortality is significantly higher than hepatitis B infections by itself. The second type of clinical presentation is superinfection, which means infection with the Delta virus of a patient previously infected with the hepatitis B virus (healthy carrier). Initially the patient develop a typical acute viral hepatitis in 50-70 percent of the cases, and 30-50 percent can have asymptomatic infection. The real problem with this presentation is that 20-90 percent of the cases evolved to chronicity: chronic active hepatitis and cirrhosis. The diagnosis can be made demonstrating anti-HDB IgM and anti-HDV IfG, although this last one is usually transitory. A liver biopsy can show HDV RNA or HDV antigen using special immunostainings...

Prevalence of delta virus infection in high risk population and hepatitis B virus related liver diseases.

Two hundred and fifty four high risk persons or patients with hepatitis B virus related liver disease (209 men, 45 women; age range 1-78 years) were tested for anti-delta antibody and IgM anti-HBc to determine the prevalence of delta agent coinfection and superinfection. The prevalence of delta infection was as follows: acute viral hepatitis 23/148 (16%) and chronic liver disease 17/92 (19%), and asymptomatic HBsAg carriers 1/6 (17%). In the high risk population, the delta antibody prevalence was as follows: multiple transfusion recipients 3/8 (38%), patients with chronic renal failure 1/5 (20%) and medical professionals 2/7 (29%). Of 44 patients (34 men, 10 women; age 3-63 years) with delta infection, 26 (59%) had coinfection and 18 (41%) had superinfection. Six patients with anti-delta antibody had received blood transfusion(s) and six others gave history of parenteral exposure.

Hepatitis delta virus infection in Nepal.

Hepatitis Delta Virus (HDV) infection is very rare in Nepal. Anti-HDV antibody was detected in none of the 110 HBsAg sero-positive persons with different profile of HBV infection. It was however detected in only one patient of liver cirrhosis and hepatocellular carcinoma who were sero-negative for HBsAg but had serological evidence of past infection with HBV and HCV.

Marcadores virales en la hepatitis A, B y Delta / Viral markers in hepatitis A, B and Delta

Se describen los marcadores virales de la hepatitis A, B y la provocada por el agente Delta. así como la interpretación clínica de los mismos. Se señala la importancia de aquellos que indican replicación viral e inmunidad a la infección, también con los que resultan imprescindibles para establecer el agente causal de una hepatitis viral

Band delta hepatitis virus infection in a population of West Africa

Em 424 amostras de soros examinadas, a prevalência da infecçäo pelo vírus da hepatite B foi de 89,6% com 15,6% de positividade para o HBsAg. Algumas das amostras pertenciam a uma populaçäo aferente e outras a pessoas trabalhando em hospital rural situado na Africa Ocidental (República Popular de Benin). Vinte e sete por cento dos indivíduos soro-positivos evidenciaram replicaçäo do vírus como demonstrado pela presença do HBcAg. Nos indivíduos HBcAb positivos, os anticorpos anti-delta foram positivos em uma freqüência de 19,7%. A presença de HBsAg em 15% das mulheres gestantes eleva a importância da transmissäo de HBV, da mäe para o filho, nesta regiäo. Os resultados apresentados podem ser comparados com aqueles obtidos em outra áreas da Africa, com condiçöes sócio-econômicas semelhantes

HIV; HBV; delta-agent and Treponema pallidum infections in two rural African areas

In order to compare the seroepidemiology of human immunodeficiency virus (HIV); hepatitis B virus; delta agent and Treponema pallidum infections in two rural populations living in north Uganda (Kitgum district) and in central Burundi (Butezi; Ruyigi region); 448 sera were tested for HBS-Ag; HBS-Ab; and anti-HIV antibodies and screened for syphilis using the T. pallidum haemagglutination (TPHA) test. HBS-Ag positive sera were also tested for anti-delta antibodies. Overall seropositivity rates in healthy subjects; outpatients and inpatients (non-AIDS) were 14.2pc and 9.5pc in Kitgum district and Butezi; respectively. The prevalence of HBS-Ag and HBS-Ab ranged from 10.0pc to 15.6pc and from 66.2pc to 68.9pc; respectively. In north Uganda the rates of anti-delta positivity were 3.1pc in the overall population and 30.6pc in the HBS-Ag positive subjects. No serum obtained in Butezi was anti-delta positive. In Ugandan people; 64.0pc of anti-HIV positive and 25.8pc of anti-HIV negative patients were also TPHA-positive (P less than 0.01). For Butezi the corresponding figures were 21.4pc and 1.6pc respectively (P less than 0.04). On the contrary; no correlation was found between either anti-HIV or TPHA positives and seropositivity for B and delta hepatitis serological markers. The study demonstrated an association between seropositivities for HIV and T. pallidum (TPHA); suggesting common patterns of transmission. On the contrary; no association seemed to exist between HBV and HIV infections