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.

Mudança na suscetibilidade à hepatite A em crianças e adolescentes na última década / Shifting susceptibility to hepatitis A among children and adolescents over the past decade

OBJETIVOS: Estimar a prevalência de anticorpos contra hepatite A (anti-VHA) em grupo de crianças e adolescentes de laboratório público e privado em Porto Alegre e comparar com estudo realizado na década anterior. MÉTODOS: Entre 2007 e 2008 foi realizado estudo transversal onde foram incluídas, consecutivamente, 465 amostras de soros de crianças e adolescentes entre 1 e 19 anos de idade para determinar a prevalência de anticorpos anti-VHA total. As amostras foram fornecidas por laboratório público (grupo 1), que atende somente Sistema Único de Saúde, e por laboratório privado (grupo 2), representando os estratos socioeconômicos mais baixo e mais alto, respectivamente. O teste foi realizado em único laboratório (eletroquimioluminescência, Roche Diagnostics). Resultados > 20 UI/L foram considerados positivos. RESULTADOS: A soroprevalência de anti-VHA no grupo 1 foi de 37,6 por cento e o percentual de positividade aumentou conforme a idade, variando de 19,4 por cento entre 1-4 anos a 54,1 por cento entre 15-19 anos. No grupo 2, a frequência de anti-VHA foi de 46,1 por cento e foi inversamente relacionada à idade, caindo de cerca de 50,0 por cento nas faixas etárias menores para 29,1 por cento aos 15-19 anos. Houve diminuição significativa na prevalência do anti-VHA nas crianças de 5-9 anos do grupo 1 (p = 0,03), quando comparadas com estudo realizado na década de 1990. CONCLUSÕES: Os resultados sugerem queda na endemicidade da hepatite A em Porto Alegre na última década e indicam maior suscetibilidade à doença em crianças e adolescentes, principalmente no estrato socioeconômico mais baixo.

OBJECTIVES: To estimate the prevalence of anti-hepatitis A virus (anti-HAV) antibodies in serum samples from children and adolescents obtained at two clinical pathology laboratories in the city of Porto Alegre, south of Brazil, and to compare findings to those of a study carried out in the 1990s. METHODS: In this cross-sectional study conducted between 2007 and 2008, 465 serum samples obtained from subjects aged 1-19 years were consecutively tested to determine the prevalence of total anti-HAV antibodies. Samples were provided by a public laboratory (group 1) that serves the Unified Health System exclusively, meant to represent the lowest socioeconomic strata, and by a private laboratory (group 2), meant to represent the higher socioeconomic classes. Tests were performed at a single laboratory using commercially available electrochemiluminescence kits. Antibody levels > 20 UI/L were considered positive. RESULTS: The seroprevalence of anti-HAV in Group 1 was 37.6 percent. The percentage of anti-HAV reactivity increased from 19.4 percent in the 1-to-4 group to 54.1 percent in the 15-to-19 group. In Group 2, overall anti-HAV positivity was 46.1 percent and was inversely correlated with age, declining from roughly 50 percent in the youngest groups to 29.1 percent in the 15-to-19 group. Comparison of sample findings to those reported in a 1990s study showed a significant reduction in anti-HAV prevalence among 5-to-9-year-olds in group 1 (p = 0.03). CONCLUSIONS: The results suggest that the endemicity of hepatitis A in Porto Alegre has been declining over the past decade, and that children and adolescents, particularly those in the lowest socioeconomic strata, are more susceptible to the disease.

Hepatite A: avaliação do custo-beneficio da prevenção pela vacina - Paraná, Brasil / Hepatitis A: an assessment of the cost-benefit ratio of prevention by the vaccine - Paraná, Brazil

Objetivos: conhecer a magnitude do problema da Hepatite A no Parana. , Brasil, e avaliar custo-beneficio da vacinação. Materiais e métodos: o estudo é descritivo e de farmacoeconomia. Para avaliar a magnitude do problema, foram coletados dados sobre os casos de hepatite A do Sistema de Informação de Agravos de Notificação, (SIN AN), Sistema de Informação em Mortalidade (SIM) e Autorização de Internação Hospitalar (A114) da Secretaria de Estado da Saúde do Paraná ao período de 2000 a 2003. Foi estimada a probabilidade de uma coorte de crianças adquirir Hepatite A durante a vida e os custos dos tratamentos. Esses gastos foram comparados corn o custo da acinação. Resultados: foram 14.682 notificações das quais 12.102 (82,4%) ocorreram em menores de 15 anos. A incidência napopulação foi de 37,5/100000. Ocorreram 20 óbitos, sendo sete por insuficiência hepática. O custo com a doença foi comprovaciamente alto. 0 investimento para a vacinação de crianças, com duas doses (10 LTSD/dose), também foi estimado. Observou-se uma relação custo-beneficio positiva da vacinação. Para cada dólar investido na vacinação, 2,26 LTSD sic) economizados no tratamento. Conclusões: os resultados confirmam a relação custo-beneficio positiva da vacina. Sendo esse o primeiro estudo farmacoeconOmico sobre a vacinação contra hepatite A em nosso meio, apontasse para a necessidade de pesquisas mais aprofundadas e abrangentes, com o intuito de complementar alguns aspectos ainda não explorados.

Objectives: know the mqgniulde of the problem of Hepatitis A in Parana, Brazil, and assess the cost-benefit ratio of vaccination. Materials and methods: the study is descriptive and pharmacoeconomical. To assess the magnitude of the problem, data were collected on cases of hepatitis A from the Information System of Worsening Notification (SINAN), Information System in Mortality (SIM) and Hospitalization Authorization (AIH) of the State Secretariat of I Health of Paraná referring to the period from 2000 to 2003. The probability of one tenth of children acquiring Hepatitis A during their lifetime was estimated along with the costs of the treatments. These expenses were compared with the cost of vaccination. Results: there were 14,682 notices of which 12,102 (82.4%) occurred in children under 15 years of age. The incidence on the population was 37.5/100000. There were 20 deaths, being 7 due to liver failure. Costs with the disease were truly high.. The investment in children vaccination, with two doses (10 USD / dose), was also estimated. A positive cost-benefit relation of the vaccination was observed. For each dollar invested in vaccination, US$ 2.26 are saved on the treatment. Conclusions: the results confirm the positive cost-benefit relation of the vaccine. Since this is the first pharmacoeconomic study on vaccination against hepatitis A in our environment, the need for more in-depth and encompassing studies is highlighted with the goal of complementing a few aspects not explored yet.