Ecological study of viral hepatitis in Brazil: a geographical and temporal analysis

Introduction: Viral hepatitis is a group of diseases that present high hepatotropism and are related to liver dysfunctions, having either an acute or a chronic course. Their worldwide epidemiology is diverse, with several endemic places, such as South America. The objective of this study was to analyze the epidemiology of viral hepatitis in Brazil, in order to better understand its pattern of distribution and evolution. Method: A temporal aggregation study was conducted using the Viral Hepatitis Database of the Brazilian Ministry of Health. The serological markers used were HBsAg and anti-HCV for hepatitis B and C, respectively. Mortality data were collected from the Mortality Information System for deaths attributed to viral hepatitis. The period analyzed was from 2007 to 2016/17. Results: The incidence was 7.88 (95% CI, 7.30-8.45) for hepatitis B and 11.9 (95% CI, 11.15-12.65) for hepatitis C. Mortality attributed to viral hepatitis was 1.61 (95% CI, 1.35-1.87) deaths per 100,000 people. An analysis of municipal distribution data showed several endemic areas. The Brazilian regions most affected by hepatitis B virus were the northern and southern borders, Santa Catarina coast and Espírito Santo state, while hepatitis C virus was mostly present in metropolitan areas such as Porto Alegre and São Paulo. Conclusions: Viral hepatitis has a diverse geographic distribution in the Brazilian territory, with highly endemic areas. The distribution differs between hepatitis B and hepatitis C viruses. (AU)

Determining seroprevalence of Hepatitis B and C virus infections and associated risk factors among apparently healthy mothers in Addis Ababa, Ethiopia

Introduction: Viral hepatitis is a global public health problem affecting millions of people every year, causing disability and death. Hepatitis B (HBV) and hepatitis C (HCV) viruses spread horizontally, mainly through sexual contact and contaminated needles, and vertically. Both cause considerable morbidity and mortality worldwide. Maternal infection is a risk factor for vertical transmission. Objective: To determine the sero-prevalence of HBsAg and anti-HCV antibody among non-pregnant, apparently healthy mothers and to identify potential risk factors associated with HBV or HCV infection. Methods: A community based cross sectional study was conducted on 454 apparently healthy women, in Addis Ababa, Ethiopia from May 2016 to June 2017. A systematic random sampling method was used to recruit participants. Result: A total of 454 mothers were enrolled. Sero-prevalence of HBsAg and HCV was found to be 3.7% and 2.0%, respectively. HBc antibody was detected in 36.3% of the mothers. None of the participants were co-infected with both viruses. Previous history of liver disease, history of jaundice, HIV infection, and family history of liver disease were significantly associated with HBV infection. Marital status, caring for hepatitis patients, and a history of liver disease were factors significantly associated with HCV infection. Conclusion: Apparently healthy mothers in Addis Ababa had intermediate level of endemicity for hepatitis B and C infections Routine screening and vaccination of high risk reproductive mothers against HBV is advisable. Emphasis should be given to health education and promotion of infection control practices. Population based studies are strongly recommended to help monitor disease transmission patterns and to design evidence-based interventions against the spread of hepatitis infections in Ethiopia

Epidemiological profile of viral hepatitis in Rio Grande do Sul and its health macro-regions

Introduction: Viral hepatitis comprises a group of viruses characterized by high global prevalence and hepatic tropism. Its epidemiology is extremely variable throughout the world, and South America is an endemic place. A better understanding of the regional reality is fundamental for proposing new public health measures. Methods: We conducted an aggregate temporal study of the Viral Hepatitis Database of the Ministry of Health of the state of Rio Grande do Sul (RS), with an epidemiological profile of the reactive results of HBsAg and Anti-HCV tests, together with data on mortality from acute Hepatitis B and chronic viral hepatitis from the respective Health Macro-Regions from 2007 to 2015. Results: The incidence of new cases of hepatitis B in RS during the analyzed period was 11 (95% CI, 9.7-12.1) cases per 100,000 inhabitants. Meanwhile, the Northern region of the state, represented by the municipality of Passo Fundo, had 32.7 (95% CI, 28.3-37) and 22.8 (95% CI, 19.5-26) new cases of hepatitis B per 100,000 inhabitants for men and women, respectively. The incidence of new cases of hepatitis C in the State of Rio Grande do Sul was 29.2 (95% CI, 24.5-34.9 in 100,000 inhabitants). Conclusion: Viral hepatitis remains an important pathology in the context of Rio Grande do Sul and its Macro-Regions. (AU)

molecular and antigenic tissue impact of viral infections on liver transplant patients with neonatal hepatitis

Pathogenesis of neonatal hepatitis relates to various underlying causes including viral infections. Both hepatotropic and non-hepatotropic viruses may induce liver failures in infants before birth, during delivery, or shortly after birth. The tissue impact of HCMV, HSV, HBV, HCV, and rotavirus and adenovirus infections was evaluated in studied infants with neonatal hepatitis. The history of viral infections was analyzed in paraffin-embedded biopsy and autopsy tissues of 22 infants with neonatal hepatitis between years 1996 and 2007, retrospectively. The tissue molecular presentation of HBV, HCV, HCMV, HSV, adenovirus, and rotavirus was evaluated by different qualitative simple and nested PCR and RT-PCR protocols. Immunohistochemistry [IHC] method was used for studying the antigenic prevalence of HSV-1, 2; HBV, HCMV and adenovirus infections. Also the laboratory liver indices of all patients with neonatal hepatitis were analyzed. The HBV and HSV genomes were detected in 3 [14%] of 22 infants. The rotavirus and HCV-RNA and also the HCMV-DNA were detected separately in 1 [4%] of 26 paraffin-embedded autopsy and biopsy tissues. The HBV and HSV-1 specific antigens were separately diagnosed in 1 [4%] of 26 neonatal samples by IHC protocols. Also the HSV-2 antigen was seen in 5 [23%] of 22 liver autopsy and biopsy specimens. Co-infections with HCMV, HSV, HBV, HCV, and rotavirus were detected in these infants with hepatitis. Diagnosis of single and mixed molecular and antigenic traces of HCMV, HSV, HBV, HCV and rotavirus underlines the etiologic role of these viruses in clinical pathogenesis of neonatal hepatitis

Acute liver failure in children: observations in Vitória, Espírito Santo State, Brazil

In this communication we report 46 cases of acute liver failure in children diagnosed at the Hospital Infantil Nossa Senhora da Glória in Vitória, E Santo. Serology for IgM anti-HAV, IgM anti-HBc, HbsAg, anti-HCV and biochemical tests were performed in all cases in a routine laboratory. The M/F ratio was 1.1:1 and the mean age was 4.7±3.2 years, without gender difference. Anti-HAV IgM+ in 38 (82.6 percent) cases, anti-HbcIgM+ in two (4.3 percent) cases and 6 (13.1 percent) cases were negative for all viral markers investigated. Anti- HCV+ in one anti-HAV IgM+ case. HbsAg+ in two anti-HbcIgM+ and in two HAVIgM+ cases. Among the six A, B and C negative cases, four (8.6 percent) did not have the suspected exogenous intoxication. Mortality was 50 percent, without gender or age differences. These results demonstrate that HAV infection is the main etiology of acute liver failure in children in Brazil, confirming that, although it is a self limited, relatively mild illness, it can cause serious and even fatal disease. The observation of four cases without A, B and C viral markers and no history of exogenous intoxication, agree with the observation of non A-E acute sporadic hepatitis in Northeastern Brazil

Hepatitis aguda fulminante no A no B en el embarazo: un caso clínico de probable hepatitis esporádica producida por virus E / Fulminating acute non A non B hepatitis in pregnancy: a clinical case of probably sporadic hepatitis produced by E virus

Se destaca la mayor gravedad de la hepatitis E en la embarazada y la alta mortalidad materna y fetal en la hepatitis aguda fulminante. Se presneta el caso clínico de una paciente de 19 años, primigesta, embarazo de 29 semanas con diagnóstico de hepatitis aguda fulminante no A no B, probable E por el cuadro clínico, que evoluciona con muerte fetal y ante la gravedad del cuadro se planteó un transplante hepático que no se logra por falta de donante; la paciente fallece el día 16 desde su ingreso. En el estudio histopatológico de hígado destaca una necrosis hepática masiva y un shock terminal