Overdose Deaths and Acute Hepatitis Infections among American Indians in North Carolina.

BACKGROUND Like the rest of the nation, North Carolina is experiencing the worst drug crisis in United States history, as deaths related to medication and drug overdoses are at an all-time high. Although the absolute numbers of deaths are highest among white populations, American Indians (AIs) experience disproportionally high rates.METHOD Using death certificate data, death rates due to unintentional medication and drug overdose were calculated for various races and ethnicities. Acute hepatitis B (HBV) and acute hepatitis C (HCV) rates were also calculated across racial and ethnic groups using data from the North Carolina Electronic Disease Surveillance System.RESULTS After adjusting for population size, AIs have as high or higher overdose death rates for all types of drugs except heroin, compared to other racial and ethnic groups. During the most recent 5 years of data (2012-2016), the highest rate of acute HCV infection occurred among AIs.LIMITATIONS Race/ethnicity data recorded on death certificates is often provided by family members and is difficult to verify independently. Another potential limitation is use of small numbers to calculate rates. Additionally, HBV and HCV are thought to be underreported.CONCLUSION Overdose death rates and rates of communicable diseases associated with injection drug use among AIs residing in North Carolina are as high as or higher than the overall North Carolina population. It is important to recognize and address these differences and provide prevention, harm reduction, and treatment services to all groups being impacted by the overdose epidemic.

Infectious Diseases in Immigrant Population Related to the Time of Residence in Spain.

The aim of this study was to evaluate the data on the main imported infectious diseases and public health issues arising from the risk of transmission of tropical and common diseases in the immigrant population. During the period of study, 2,426 immigrants were attended in the Tropical Medicine Unit of the Hospital of Poniente. For each patient, a complete screening for common and tropical diseases was performed. The prevalence and main features of intestinal and urinary parasites, microfilarias, Chagas disease, malaria, hepatitis B (HBV) and C (HCV) viruses, extrapulmonary tuberculosis and syphilis was investigated taking into account the length of stay in Spain. Sub-Saharan Africa patients who had lived for <3 years in Spain had a high significantly number of infections produced by hookworms, Ascaris lumbricoides, Trichuris trichiura, Schistosoma mansoni, Giardia lamblia, Entamoeba histolytica/dispar and Plasmodium spp. In patients who had lived for more than 3 years, there were significantly high rates of HBV infections, although HBV rates in sub-Saharan African patients are high even if the patients have been in Spain for <3 years. However, patients with large stays in Spain had also an important number of parasitological diseases. The main objective of the diagnosis is to avoid important public health problems and further complications in patients. It is advisable to carry out a screening of the main transmissible infections in all immigrant population regardless of the time outside their country. This screening should be individualized according to the geographical area of origin.

Using data linkage to improve the completeness of Aboriginal and Torres Strait Islander status in communicable disease notifications in Victoria.

OBJECTIVE: The burden of notifiable diseases in Aboriginal and Torres Strait Islander Victorians cannot be accurately estimated due to under-reporting of Indigenous status. We used data linkage to improve completeness of Indigenous status in people notified with viral hepatitis and gonococcal infection. METHODS: Notifications made between 2009 and 2010 were linked with Victorian hospitalisation data (1997-2011). Notification rates by Indigenous status and rate ratios were calculated before and after linkage. RESULTS: There were 12,448 cases of hepatitis B, hepatitis C and gonococcal infection notified in Victoria in 2009-2010, with Indigenous status missing in 61.6%, 67.8%, 33.1% of these conditions, respectively. Of the total notified cases, 82% were able to be linked. Following linkage, the proportion of notifications with missing Indigenous status decreased to less than 0.2% for all conditions. Age-standardised notification rates among both Aboriginal people and non-Aboriginal people increased for all conditions. CONCLUSIONS: Data linkage improved completeness of Indigenous status in notifications for viral hepatitis and gonococcal infection in Victoria. Completeness of these data is integral to monitoring progress in closing the Indigenous life expectancy gap. IMPLICATIONS: Greater emphasis is needed on addressing prevention, treatment and care for viral hepatitis and sexually transmissible infections for Indigenous Victorians.

Viral Hepatitis Among Non-Hispanic Asian Adults in the United States, 2011-2014.

KEY FINDINGS: Hepatitis A (HAV), B (HBV), and C (HCV) viruses are common types of viral hepatitis. HBV and HCV infection can lead to liver disease, cancer, and serious health consequences. HAV and HBV infections are high among Asian persons, especially those born outside the United States (1-3). This report provides 2011- 2014 National Health and Nutrition Examination Survey (NHANES) estimates on prevalence of antibody to HAV (from infection or immunization), past or current HBV infection, and current HCV infection, by race and Hispanic origin.

How do economic crises affect migrants' risk of infectious disease? A systematic-narrative review.

BACKGROUND: It is not well understood how economic crises affect infectious disease incidence and prevalence, particularly among vulnerable groups. Using a susceptible-infected-recovered framework, we systematically reviewed literature on the impact of the economic crises on infectious disease risks in migrants in Europe, focusing principally on HIV, TB, hepatitis and other STIs. METHODS: We conducted two searches in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar, websites of key organizations and grey literature to identify how economic changes affect migrant populations and infectious disease. We perform a narrative synthesis in order to map critical pathways and identify hypotheses for subsequent research. RESULTS: The systematic review on links between economic crises and migrant health identified 653 studies through database searching; only seven met the inclusion criteria. Fourteen items were identified through further searches. The systematic review on links between economic crises and infectious disease identified 480 studies through database searching; 19 met the inclusion criteria. Eight items were identified through further searches. The reviews show that migrant populations in Europe appear disproportionately at risk of specific infectious diseases, and that economic crises and subsequent responses have tended to exacerbate such risks. Recessions lead to unemployment, impoverishment and other risk factors that can be linked to the transmissibility of disease among migrants. Austerity measures that lead to cuts in prevention and treatment programmes further exacerbate infectious disease risks among migrants. Non-governmental health service providers occasionally stepped in to cater to specific populations that include migrants. CONCLUSIONS: There is evidence that migrants are especially vulnerable to infectious disease during economic crises. Ring-fenced funding of prevention programs, including screening and treatment, is important for addressing this vulnerability.

BREADTH SPREADING OF VIRAL HEPATITIS MARKERS IN THE RISK GROUPS IN THE REPUBLIC OF SAKHA (YAKUTIA).

INTRODUCTION: Republic of Sakha (Yakutia) is a hyperendemic region of Russian Federation for spreading of parenteral viral hepatitis B, C and D. In risk groups of these diseases are firstly medical personnel, who contacting with infection carriers including latent infections family and members of families of chronic viral hepatitis carriers. AIM: To reveal the breadth of spreading of viral hepatitis markers in the risk groups. MATERIALS AND METHODS: The level of HBV- and HC- infection were determined in medical staff of large multi specialty hospital and family members of people with viral hepatitis B and C. Epidemiological, clinical, serological and molecular biology methods of viral hepatitis diagnostics were applied in this study. RESULTS: Results of this study showed that the staff at surgery and hematology departments and all nursing staff belong to the high-risk of HBV-infection groups. Therefore, they are a priority for active immunization. Attention is paid on the fact that infectivity of medical staff is not equally distributed in dependence on type of department and position of medical staff. Rate HBV-marker detecting in "family hearths" was dependent on degree of interrelationship with infection source. According received information, in families of patientwith chronic hepatitis B spreading of infection was higher (77.6%) then in families of patients with acute hepatitis B (39.7%). At primary examination of families an anti-HCV was detected in 9.3 ± 1.8% cases, i.e. the spreading of HCV was at low-activity. CONCLUSIONS: Results of our study on spreading of hepatitis B and C in Yakutia showed the high rate of appearance of HCV and HBV markers in the risk groups.

Association of apolipoprotein E polymorphisms in patients with non-alcoholic steatohepatitis.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of abnormal hepatic steatosis in the absence of alcohol abuse worldwide. Non-alcoholic steatohepatitis (NASH) is the most progressive form of NAFLD. The aim of this study was to investigate the role of apolipoprotein E (APOE) polymorphisms in the development of NASH. We analysed 57 NASH patients and 245 healthy controls using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in a case-control study. The diagnosis of the patients was based on liver biopsy. The serum levels of glucose, lipids, vitamin B12, folic acid, homocysteine, insulin, total biluribin, total protein, albumin, ferritin, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were determined in all of the subjects. Body mass index (BMI), waist circumference (WC), AST, ALT, fasting blood sugar (FBS), total cholesterol, triglyceride (TG), low-density lipoprotein (LDL) cholesterol, very low-density lipoprotein (VLDL) cholesterol, insulin and ferritin levels were significantly higher in the 57 patients with NASH compared with the 245 healthy controls. The APOE epsilon3 allele was overrepresented in the whole group of NASH patients (epsilon3=97.37% in NASH versus 82.45% in controls). The APOE polymorphism was statistically significantly associated with NASH (chi(2)=15.741; p=0.008). The APOE3/3 genotype (odds ratio [OR]=7.941; p=0.000) was strongly associated with increased risk for NASH in all NASH patients. Consequently, the APOE3/3 genotype may play a role in the aetiopathogenesis of NASH.

Independent associations of alanine aminotransferase (ALT) levels with cardiovascular risk factor clustering in Chinese adolescents.

BACKGROUND/AIMS: To establish the prevalence of elevated serum alanine aminotransferase (ALT) concentrations in Chinese adolescents, and to explore the nature of associations amongst ALT, obesity and cardiovascular risk factors. METHODS: Anthropometric measurements and fasting plasma glucose, insulin, lipids and ALT were measured in 2102 Chinese adolescents, aged 12-18 years, randomly selected from 14 secondary schools in Hong Kong. RESULTS: The prevalence of elevated ALT levels was 3.2% and 5.9% if abnormal ALT levels were defined as >40 IU/L and >30 IU/L respectively. Using the <25th, 25-75th and >75th percentile values of ALT, all subjects were divided into 3 ALT strata. Using the lowest ALT stratum as referent, the top ALT stratum was associated with obesity and clustering of cardiometabolic-inflammatory risk markers in both genders. After adjusting for age and body mass index (BMI), the highest ALT stratum remained independently associated with diastolic blood pressure and insulin resistance (fasting insulin and Homeostasis Model Assessment, HOMA-IR, HOMA-beta) in boys (p<0.05); and serum triglyceride and HOMA-beta (p=0.008 and 0.014, respectively) in girls. Repeat analysis after excluding subjects with ALT>30 (n=123) or >40 IU/L (n=67) yielded comparable results. CONCLUSIONS: In adolescents, top ALT stratum, albeit within normal range, is associated with clustering of cardiovascular risk factors, independent of obesity.

Lay beliefs about hepatitis among North American Chinese: implications for hepatitis prevention.

The objective was to learn about the hepatitis prevention behavior of relatively unacculturated North American Chinese adults, along with their knowledge, beliefs, and perceptions with regard to hepatitis, screening, and vaccination. Forty Chinese men and women, aged 18-64, were recruited from immigrant communities in Seattle, Washington, and Vancouver, British Columbia. Semi-structured interviews (Cantonese or Mandarin) were audiotaped, translated, transcribed verbatim, and coded. Open coding, axial coding, constant comparison methods, and QSR NUD*IST 5 software was used for analysis. Findings were validated using eight focus groups. Findings indicated that many interviewees lack accurate knowledge with regard to hepatitis, often confusing the different types. Perceived causes of hepatitis included potentially harmful food (e.g., fried foods or potentially contaminated foods), alcohol, contact with infected individuals, stress, and inadequate rest. Preventive strategies associated with Chinese health beliefs included the use of Chinese herbal medicine, maintaining a stress-free mind, strengthening the body's natural defenses, and getting enough sleep. Other preventive strategies were the practice of good hygiene, vaccination, and the avoidance of contact with infected persons. Vaccination was not seen as primary, as 65% of those who had heard of hepatitis vaccination did not cite it as a means for hepatitis prevention until asked. Also, participants lacked information about the types and purposes of hepatitis vaccination and were worried about side effects. In conclusion, any attempt to promote hepatitis testing and vaccination among the North American Chinese should take traditional beliefs and practices into consideration.

Routine testing for IgG antibodies against hepatitis A virus in Israel.

BACKGROUND: Viral hepatitis is highly endemic in Israel, with the hepatitis A virus (HAV) responsible for most cases. Improved socioeconomic factors, as well as the universal vaccination of infants (introduced in 1999) has resulted in a decline in infection rates in Israel. This study examines the benefits of routine testing for anti-HAV IgG in high-risk population. METHODS: A retrospective examination of the files of teenage and adult patients (aged 16-99 years; mean 33.9) in two primary care clinics found 1,017 patients who had been tested for anti-HAV IgG antibodies for either general healthcare screening or ongoing follow-up for chronic illness. Seropositive patients were then asked regarding recall of past hepatitis (i.e. jaundice, regardless of viral etiology); post-exposure prophylaxis with immune serum immunoglobulin (ISG); and active immunization with inactivated virus. Seronegative patients were subsequently sent for active immunization. RESULTS: Of the 1,017 patient records studied (503 male, 514 female), a total of 692 were seropositive (354 males, 338 females; P = 0.113). Seropositivity rates increased with age (p < 0.005), and were highest among those born in Middle Eastern countries other than Israel (91.3%) and lowest among immigrants from South America (44.1%; P < 0.005). 456 of the seropositive patients were interviewed, of whom only 91 recalled past illness while 103 remembered receiving post-exposure prophylaxis (ISG) and 8 active vaccination. Those who were unaware of past infection were more likely to have been vaccinated with ISG than those who were aware (26.3% vs. 7.7%; p < 0.005). CONCLUSION: The relatively high prevalence rate of anti-HAV seropositivity in our study may me due to the fact that the study was conducted in a primary care clinic or that it took place in Jerusalem, a relatively poor and densely populated Israeli city. Most of the seropostive patients had no recollection of prior infection, which can be explained by the fact that most hepatitis A infections occur during childhood and are asymptomatic. Routine testing for anti-HAV IgG in societies endemic for HAV would help prevent seropositive patients from receiving either post-exposure or preventive immunization and target seronegative patients for preventive vaccination.

Clinical and histological features of non-alcoholic fatty liver disease in Hong Kong Chinese.

BACKGROUND: Non-alcoholic fatty liver disease is prevalent in affluent countries and is a cause of cirrhosis and possibly hepatocellular carcinoma. AIM: To examine the clinical and histological features of biopsy-proven non-alcoholic fatty liver disease and investigate the predictors of severe histological disease in Chinese patients. METHODS: Electronic records of all patients (n = 247) who underwent liver biopsy between 1996 and 2003 in our hospital were retrieved. Patients who had histological features of non-alcoholic fatty liver disease were identified. The demographic, clinical, laboratory and histological (Brunt's criteria) parameters of these patients were analysed. RESULTS: Forty-two patients had histology-proven non-alcoholic fatty liver disease. The median age was 47 years (range 23-69). All except one patient had features of metabolic syndrome. The median alanine aminotransferase was 93 (range 24-270) IU/L. Thirty-six (85.7%) patients had steatohepatitis and 11 (26.1%) also had fibrosis. Only one patient had stage 3 fibrosis. The presence of diabetes mellitus predicted higher grade steatohepatitis and fibrosis (P = 0.019) whereas alanine aminotransferase level had no correlation with histological severity of steatohepatitis. After a median follow-up of 42 months, no patient developed hepatic decompensation. CONCLUSIONS: Most Chinese patients with non-alcoholic fatty liver disease had features of the metabolic syndrome. Histological activity was generally mild. Diabetes mellitus was the most important predictor of severe histological disease.

Acute hepatitis and renal failure following ingestion of raw carp gallbladders--Maryland and Pennsylvania, 1991 and 1994.

In some cultures, eating gallbladders from certain species of snakes, birds, or fish is believed to improve health. A syndrome of acute hepatitis and renal failure following the ingestion of raw carp gallbladders has been described previously among persons living in Asia (1-4). This report summarizes two cases of this syndrome that occurred in residents of Pennsylvania who had eaten the raw bile and gallbladders of carp caught in Maryland.

Acute hepatitis in recurrent hereditary polyserositis (familial Mediterranean fever).

The clinical features of two cases of Hereditary Recurrent Polyserositis HRP (Familial Mediterranean Fever) in related Yemeni children resident in Saudi Arabia are described. One presented with recurrent acute hepatitis, which has not been previously documented. These are the first cases of HRP reported in Arabs originating from the Arabian Peninsula.

Human leukocyte antigen A1-B8-DR3-DQ2-DPB1*0401 extended haplotype in autoimmune hepatitis.

Genetic susceptibility to autoimmune hepatitis is associated with the human leukocyte antigen haplotype A1-B8-DR3 and DR4. To date, only one study in Japan has considered the human leukocyte antigen DP locus in this disease, and no studies have been reported in whites. In this study we used a series of sequence-specific oligonucleotide probes to determine human leukocyte antigen DPB1 genotypes in 101 unrelated white northern European patients and 105 racially and geographically matched controls. The aims of the study were twofold: first, to determine the degree of DPB-encoded susceptibility to autoimmune hepatitis, and, second, to establish whether susceptibility can be extended to include human leukocyte antigen DPB. None of 17 DPB1 alleles was significantly associated with the susceptibility to autoimmune hepatitis. Although one particular seven-locus haplotype A1-B8-DRB3*0101-DRB1*0301-DQA1*0501-DQB1*0201-++ +DPB1*0401 was significantly associated with the disease (27% vs. 7%, relative risk = 5.14, p < 0.0005), the association with this haplotype was weaker than that for the six-locus haplotype excluding DPB (40% vs. 11%, RR = 5.52, p < 0.0005). When the patients first seen at ages younger than 16 yr (pediatric patients) were considered separately, the greatest relative risk was for the seven-locus haplotype (41% vs. 7%; relative risk = 9.60, p < 0.0005). The results of this study further confirm that major histocompatibility complex-encoded susceptibility to autoimmune hepatitis is located at or close to the human leukocyte antigen DR locus; however, the A1-B8-DR3-DQ2-DPB1*0401 extended haplotype may be important in determining the age of onset and severity of disease.

Infections among pygmies in the Eastern Province of Cameroon.

The health requirements of pygmies is poorly understood because of their continued isolation from the other tribes in Central Africa. This study was undertaken among the Baka pygmies of the Eastern Province of Cameroon to generate basic health data among them. A total of 141 adults (18-45 years) were tested for the hepatitis B surface antigen (HBsAg), antibody to the surface antigen (anti-HBs), antibody to the core antigen (anti-HBc) and antibody to the hepatitis C virus (anti-HCV). All HBsAg-positive sera were tested for the hepatitis B e antigen (HBeAg) and antibody (anti-HBe). The presence of antibodies to the hepatitis D virus was determined in most of the anti-Hbs-positive sera, and some of the HBsAg-positive sera. In addition to these, previous infection with syphilis, measles, HIV 1/2 and HTLV were determined by looking for the specific antibodies. We found HBsAg in 14.2% (20/141), anti-HBs in 93.6% (132/141), anti-HBs in 52.2% (73/140), anti-HCV in 7.9% (11/139, measles antibody in 99.3% (139/140), antibody to Treponema pallidum in 13.4% (18/134), antibody to HTLV-1 in 10.9% (15/138) and antibody to HIV-1 in 0.7% (1/140) of the sera tested.

PIP: Pygmies remain isolated from other tribes and urban communities in central Africa. This study was undertaken among the Baka pygmies of the Eastern Province of Cameroon in an effort to redress the lack of published information on the health needs of that population. 141 adults aged 18-45 years were tested for the hepatitis B surface antigen (HBsAg), antibody to the surface antigen (anti-HBs), antibody to the core antigen (anti-HBc), and antibody to the hepatitis C virus (anti-HCV). HBsAg-positive sera were tested for the hepatitis B e antigen and antibody, while the presence of antibodies to the hepatitis D virus was determined in most of the anti-HBs-positive sera and some of the HBsAg-positive sera. Furthermore, previous infection with syphilis, measles, HIV-1 and HIV-2, and HTLV were determined by looking for the specific antibodies. Test results identified HBsAg in 14.2%, anti-HBc in 93.6%, anti-HBs in 52.2%, anti-HCV in 7.9%, hepatitis D in 46%, measles antibody in 99.3%, antibody to Treponema pallidum in 13.4%, antibody to HTLV-1 in 10.9%, and antibody to HIV-1 in 0.7% of sera tested. This prevalence of HIV-1 infection is lower than the estimated 1-1.5% projected for the sexually active general population.

Familial granulomatous hepatitis: a hitherto unrecognized entity.

Two West Indian parents and three of their seven offspring presented over a 12-yr period with identical systemic illnesses characterized by the development of granulomatous hepatitis. Granulomata were variably also found in muscle, lymph nodes, and pleura in some of these affected individuals. The usual causes of granulomatous hepatitis were absent, and this familial disease represents a hitherto undescribed entity.

Familial granulomatous hepatitis: a hitherto unrecognized entity

Two West Indian parents and three of their seven offspring presented over a 12 yr period with identical systemic illnesses characterized by the development of granulomatous hepatitis. Granulomata were variably also found in muscle, lymph nodes, and pleura in some of these affected individuals. The usual causes of granulomatous hepatitis were absent, and this familial disease represents a hitherto undescribed entity. (AU)