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.

High-risk behaviors for hepatitis B and C infections among female sex workers

Abstract INTRODUCTION: The prevalence of hepatitis B and hepatitis C and risk behaviors among 402 female sex workers in Central Brazil were investigated by respondent-driven sampling. METHODS: Blood samples were tested for hepatitis B and C markers by enzyme-linked immunosorbent assay. Two hepatitis B vaccination schedules were performed. RESULTS: The prevalence of hepatitis B and C infections were 9.3% and 0.5%, respectively. Susceptibility to hepatitis B infection was observed in 61.5% of subjects. There was no significant difference in adherence index (p=0.52) between vaccination schedules and all participants had protective antibody titers. CONCLUSIONS: This hard-to-reach population requires hepatitis B and C surveillance.

Induction of antibody and interferon-gamma production in mice immunized with virus-like particles of swine hepatitis E virus

Virus-like particles (VLPs) composed of the truncated capsid protein of swine hepatitis E virus (HEV) were developed and immune responses of mice immunized with the VLPs were evaluated. IgG titers specific for the capsid protein of swine HEV were significantly higher for all groups of mice immunized with the VLPs than those of the negative control mice. Splenocytes from mice immunized with the VLPs also produced significantly greater quantities of interferon (IFN)-gamma than interleukin (IL)-4 and IL-10. These newly developed swine HEV VLPs have the capacity to induce antigen-specific antibody and IFN-gamma production in immunized mice.

Exposure of Indian children to hepatitis A virus & vaccination age.

It is known that 90 per cent of children in India are exposed to hepatitis A virus (HAV) by the age of six years. The aim of the study was to determine when in early childhood maximum HAV infections take place and to deduce an appropriate age for vaccination against HAV. Blood samples of 499 children between the ages of three days and six years were collected and tested for the presence of antibodies against hepatitis A. A statistically significant negative correlation between IgG anti-HAV and age was observed (P < 0.01) up to 11.67 months when IgG anti-HAV positivity was found to be minimum (9.25%). Subsequently a significant positive correlation was noted (P < 0.01). Exposure to HAV was 28.9 per cent soon after the waning of maternal antibodies in the 13-15 month age group which increased to 52.5 per cent by two years of age and 90.9 per cent by 6 yr. It is concluded that in addition to other preventive measures, if children in India are to be vaccinated against hepatitis A they should be immunised against HAV by 9-10 months of age when the maternal antibodies disappear.

Respuesta de sujetos sanos a la vacuna anti-hepatitis B plasmo-derivada / Response of healthy subjects to plasma - derived antihepatitis B vaccine -derived

Se presenta una serie de 71 sujetos sanos vacunados con 60 mcgrs de antígeno de superficie del virus B de hepatitis, extraido de plasma de portadores crónicos e inactivado con formalina y calor. La vacuna produjo niveles protectores de anticuerpos contra el antígeno de superficie (> 10 mUl/ml) en el 94.4 de los vacunados. Los efectos colaterales fueron escasos e irrelevantes (15.4%). El grupo de vacuandos que alcanzó títulos de anticuerpos superiores a 100 ml/ml tuvo una media de edad signficativamente menor que el de respuesta inferior a 100 mUl/ml. No hubo diferencia significativa entre las medias de superficie corporal de ambos grupos. Esto indica que el grado de respuesta se asocia con la edad y no con la superficie corporal

Immunogenicity of yeast-derived hepatitis B vaccine in Pakistani adults.

A study of the immunogenicity and safety of 20 micrograms recombinant DNA yeast derived hepatitis B vaccine was conducted in 153 Pakistani adults. All participants were in good physical condition, had negative hepatitis B serological markers (HBsAg, anti-HBs, anti-HBc) and normal ALT. Anti-HBs developed in 33%, 81% and 98% of subjects one month after the first, second and third dose respectively. Minor systemic and local side-effects were observed in 39% of individuals. We conclude that yeast derived hepatitis B vaccine is safe, effective and immunogenic in Pakistani adults.

Prevalencia de los marcadores serológicos del virus de la hepatitis B y respuesta a la inmunización activa en un instituto de personas subnormales / Prevalence of serological hepatitis B markers and response to active immunization in an institution for mentally subnormal patients

En un instituto para personas con diversos niveles de deficiencia mental, y el personal encargado de su cuidado, se estudia la prevalencia de la infección con virus de hepatitis B (HBV). Un 70 por ciento de los internados mostró uno o más marcadores indicadores de infección con HBV, mientras que el personal mostró un nivel de prevalencia del 12 por ciento que compara con el de la población de donantes de sangre en la Argentina. Los resultados obtenidos en el personal de atención indican que éste tiene inclusive menor riesgo que los empleados hospitalarios tomados globalmente. Los indicadores epidemiológicos observados y el encuadre de la experiencia documentada muestran el alto riesgo de infección por Hepatitis en este sistema de interacción. En forma inmediata se instaló un programa de vacunación de los susceptibles (sin ningún marcador positivo) lográndose una respuesta de anticuerpos a los 330 días en el 100 por ciento de los internados. Como corolario se propone ajustar las normas nacionales de vacunación actuales, incluyendo en primera prioridad a los internos en asilos de este tipo, que actualmente figuran en segunda

Carcinoma hepatocelular / Hepatocellular carcinoma

O carcinoma hepatocelular (CHC) é um dos tumores malignos mais freqüentes no mundo, sendo considerado pela OMS como problema de Saúde Pública em áreas de grande incidência do tumor, como Africa e Sudeste Asiático. Nesta revisäo seräo discutidos alguns aspectos do CHC, especialmente: a) a estreita relaçäo etiológica com o vírus da hepatite B, o mais universal agente etiológico, mas näo o único, havendo outros carcinogénicos e co-carcinogénicos que participam da gênese do tumor; b) a grande variaçäo na distribuiçäo geográfica do tumor, inclusive no Brasil, onde ele é mais freqüente no Norte e Nordeste; c) a singular associaçäo com a cirrose hepática, observada em todas as regiöes onde o tumor é diagnosticado; d) aspectos morfológicos do CHC, incluindo a nova classificaçäo macroscópica baseada nos padröes de crescimento do tumor e as características dos CHC pequenos; e) as manifestaçöes clínicas e alteraçöes laboratoriais, dando ênfase à avaliaçäo da alfa-feto-proteína, nem sempre elevada nos pacientes com CHC e aos métodos de imagenologia, especialmente a ultra-sonografia, como métodos para o diagnóstico precoce do CHC, o que melhora o prognóstico, sendo importante o seguimento de pacientes de alto risco (cirróticos HBsAg positivos) com aqueles métodos. Finalmente seräo feitos comentários sobre terapêutica, quando esta é possível, e sobre a perspectiva de prevençäo da ocorrência do tumor pelo aumento na utilizaçäo da vacina contra o VHB

Clinical experience with a recombinant DNA hepatitis B vaccine.

The clinical testing of EngerixR-B, the hepatitis B vaccine produced by SmithKline Biologicals using recombinant DNA technology, started in February 1984. Since extensive pre-clinical laboratory work had established that the polypeptide (HBsAg) expressed in genetically engineered yeast cells was after purification--physically, chemically and antigenically similar to the viral surface antigen particles found in the blood of chronic carriers, the aims of the clinical trials were to compare the safety, reactogenicity, immunogenicity and protective efficacy of yeast-derived (YDV) and plasma-derived (PDV) vaccines. By September 1987, 89 studies had been initiated involving a total of 10,545 subjects aged from birth to 82 years. This extensive experience has established that the risk of hypersensitivity to yeast-derived contaminants is negligible since no hypersensitivity reaction has been observed in any vaccinee, the incidence and severity of local reactions have not increased after repeated inoculations and no anti-yeast antibodies were produced by vaccination. Reactogenicity has been comparable to that of PDV's consisting essentially of transient mild irritation at the site of injection presumably caused by the aluminium hydroxide used as adjuvant. The anti-HBs responses to YDV and PDV's were quantitatively (seroconversion rates, peak antibody levels and persistence) as well as qualitatively (epitope specificity and affinity) similar. The expected protective effect of the immune response to the vaccine was confirmed in a challenge study in chimpanzees and in vaccinated human populations (male homosexuals, institutionalized mentally retarded patients, neonates of carrier women) with historically a high infection rate.

Active pre-exposure immunisation against hepatitis B virus: immunogenicity of hepatitis B vaccine in healthy Thai adults and children.

The immunogenicity of plasma derived hepatitis B vaccine (Hevac B) was studied for active pre-exposure immunisation in 176 healthy volunteer adults and 162 randomised children who had no hepatitis B virus markers. All subjects received three injections of 5 micrograms of hepatitis B vaccine intramuscularly at one month intervals. Seroconversion at 2 months after the third dose of vaccine was 96.30 percent in the children and 92.00 percent in the adults with mean anti-HBs titres of 800 mlU/ml and 353 mlU/ml respectively. The difference of anti-HBs levels between these two groups was statistically significant (p less than 0.05). Female adults had exhibited higher immune response to HB vaccine than male adults but there was no seroconversion difference between boys and girls. There were no serious local or systemic side effects of hepatitis B vaccination. It was concluded that active immunisation with plasma derived hepatitis B vaccine in non-immune children and adults is highly effective without any serious side effects or complications. The prevention of horizontal transmission of hepatitis B virus should be done by vaccination in children since they have a much better immune response to hepatitis B vaccine than adults.