Boletim epidemiológico: perfil epidemiológico de hepatites b e c no Estado de Goiás, 2019 a 2023 / Epidemiological bulletin: epidemiological profile of hepatitis b and c in the state of Goiás, 2019 to 2023

Boletim com o objetivo de demonstrar o perfil epidemiológico dos casos que foram notificados entre 2019 a 2023, apresentando os indicadores epidemiológicos e operacionais de relevância do estado, para fins de tomada de decisão em relação às ações do Programa para Eliminação das Hepatites Virais até 2030. Trata-se de uma análise de dados secundários obtidos do Sistema de Informação de Agravos de Notificações (SINAN), referentes aos casos diagnosticados e notificados, por município de residência entre 2019 e 2023 pelos serviços de saúde do Estado de Goiás

Bulletin with the aim of demonstrating the epidemiological profile of cases that were reported between 2019 and 2023, presenting epidemiological and operational indicators of relevance to the state, for decision-making purposes in relation to the actions of the Program for the Elimination of Viral Hepatitis by 2030. This is an analysis of secondary data obtained from the Notifiable Diseases Information System (SINAN), referring to cases diagnosed and notified, by municipality of residence between 2019 and 2023 by the health services of the State of Goiás

Hepatitis mortality in Brazil and regions, 2001-2020: temporal trend and spatial analysis.

OBJECTIVE: To analyze the spatial distribution and the temporal trend of the hepatitis mortality rate in Brazil from 2001 to 2020. METHODS: Ecological, temporal, and spatial study on mortality from hepatitis in Brazil with data from the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM/DATASUS). Information was stratified by year of diagnosis, region of the country, municipalities (of residence). Standardized mortality rates (SMR) were calculated. The temporal trend was estimated by Prais-Winsten regression and the spatial distribution by the Global Moran Index (GMI). RESULTS: The highest SMR means in Brazil were for Chronic viral hepatitis with 0.88 deaths per 100,000 inhabitants (SD=0.16), followed by Other viral hepatitis with 0.22/100,000 (SD=0.11). In Brazil, the temporal trend of mortality from Hepatitis A was -8.11% per year (95%CI -9.38; -6.82), while for Hepatitis B it was -4.13% (95%CI -6.03; -2.20), of Other viral hepatitis of -7.84% (95%CI -14.11; -1.11) and of Unspecified Hepatitis -5.67% per year (95%CI -6.22; -5.10). Mortality due to chronic viral hepatitis increased by 5.74% (95%CI 3.47; 8.06) in the North and 4.95% in the Northeast (95%CI 0.27; 9.85). The Moran Index (I) for Hepatitis A was 0.470 (p<0.001), for Hepatitis B 0.846 (p<0.001), Chronic viral hepatitis=0.666 (p<0.001), other viral hepatitis=0.713 (p<0.001), and Unspecified Hepatitis=0.712 (p<0.001). CONCLUSION: The temporal trend of hepatitis A, B, other viral, and unspecified hepatitis was decreasing in Brazil, while mortality from chronic hepatitis was increasing in the North and Northeast.

Adoption of Euvax-B vaccine in Nineveh

Hepatitis B infection is one of the most important health problems around the world. The high mortality rate of the hepatitis B encouraged research that led to the finding of an effective vaccine against it. The aim of the present study was to find out the use of the Euvax-B vaccine in sectors of Nineveh province. According to the results obtained in this study, in the next five years, the vaccination coverage for the second and third doses needs to improve(AU)

La infección por hepatitis B es uno de los más importantes problemas de salud del mundo. La alta tasa de mortalidad de la hepatitis B impulsó las investigaciones que llevaron a encontrar una vacuna eficaz contra la misma. El objetivo del presente estudio fue conocer el uso de la vacuna Euvax-B en sectores de la provincia de Nínive. De acuerdo con los resultados obtenidos, en los próximos cinco años, se debe incrementar la cobertura de inmunización de la segunda y tercera dosis de la vacuna(AU)

Mortality trend due to Hepatitis B and C in the city of São Paulo, 2002-2016.

OBJECTIVE: To describe mortality due to hepatitis B and C as underlying cause in the municipality of São Paulo, verifying the trend of these rates, and to assess the association of these diseases with others, from 2002 to 2016. METHODS: This is a time series study on mortality due to hepatitis B and C according to sex, with data from the Sistema de Informação de Mortalidade (SIM - Mortality Information Sistem). Prais Winsten regression was used in rate trend analysis. RESULTS: The findings of this study showed a trend of decline of mortality from hepatitis B and C in recent years, particularly among males. These infections were important associated causes of liver cell carcinoma and HIV. The proportion of deaths under 70 years of age stands out. CONCLUSIONS: The study provides a baseline for research on mortality trend and the impact of interventions, given the history of expanded detection and supply of treatments, including the most recent antivirals in Brazil, since 2015.

Hepatitis B virus among hematopoietic stem cell transplant recipients: Antiviral impact in seroconversion, engraftment, and mortality in a Latin American center.

BACKGROUND: Hepatitis B virus (HBV) infection is a worldwide concern with a broad distribution. In immunosuppressed populations, such as solid organ and hematopoietic stem cell transplant (HSCT) recipients, it can reactivate leading to acute hepatic failure. Different risk factors are known for higher rates of reactivation, and entecavir, tenofovir, and lamivudine are often used for prophylaxis and treatment. However, data regarding the impact of antiviral drugs in neutrophil and platelet engraftment are still unknown and concern the management of viral hepatitis post-HSCT. METHODS: We performed a single-center, retrospective, observational study reviewing medical records of patients referred for hematopoietic stem cell transplant from 2010 to 2017, which were also HBV infected, aiming to describe outcomes related to antiviral treatment and also the impact on platelet and neutrophil recovery after transplant. A secondary goal consisted of analyzing the impact of HBV infection in early and late mortality post-HSCT. The study included patients with positive blood bank screening for hepatitis B infection (HBsAg, Anti-HBc or HBV-NAT), confirmed later on by a laboratory routine serology. RESULTS: A total of 1132 hematopoietic stem cell recipients were assessed between 2010 and 2017. Eighty-six patients were confirmed to have HBV infection, of which six were HBsAg-positive, 20 were isolated anti-HBc-positive, and 60 had resolved infection (anti-HBc-positive and anti-HBs-positive). With regard to prophylaxis, 19 patients underwent HSCT on HBV antiviral therapy or prophylaxis: two were HBeAg-positive, three were HBeAg-negative and HBV-DNA was only detectable in three of them. Moreover, one patient had an occult HBV infection. Regarding therapy, 9 patients were on entecavir, 6 patients on lamivudine, two on tenofovir, and two of them on a combination of tenofovir + lamivudine due to HIV co-infection. Reverse seroconversion was not identified in any patients receiving antiviral therapy or prophylaxis, but it was detected in one patient with occult hepatitis B and another with resolved infection. No severe side effects led to therapy discontinuation in the treated group, which also did not have any significant delay in neutrophil or platelet engraftment when compared to patients without antiviral therapy. In addition, the only factors associated with increased mortality were transplant onset after 50 years, allogeneic transplant and myeloablative conditioning regimens. Interestingly, the presence of HBsAg or detectable HBV-DNA was not related to worse outcomes, neither the use of rituximab. In multivariate analysis, the use of antiviral therapy, the occurrence of graft-versus-host disease or CMV reactivation also was not linked to increased mortality. CONCLUSIONS: To sum up, HBV serology, ALT, and HBV-DNA monitoring are essential to detect hepatic flares earlier, even in populations with chronic inactive hepatitis, due to the possibility of later seroconversion. HBV infection was not related to increased 2-year mortality post-transplant. Antiviral prophylaxis did not cause any important clinical or laboratory side effects that could demand discontinuation, and its use was not associated with later neutrophil and platelet engraftments.

Mortality trend due to Hepatitis B and C in the city of São Paulo, 2002-2016 / Tendência de mortalidade por hepatites B e C no município de São Paulo, 2002-2016

ABSTRACT OBJECTIVE: To describe mortality due to hepatitis B and C as underlying cause in the municipality of São Paulo, verifying the trend of these rates, and to assess the association of these diseases with others, from 2002 to 2016. METHODS: This is a time series study on mortality due to hepatitis B and C according to sex, with data from the Sistema de Informação de Mortalidade (SIM - Mortality Information Sistem). Prais Winsten regression was used in rate trend analysis. RESULTS: The findings of this study showed a trend of decline of mortality from hepatitis B and C in recent years, particularly among males. These infections were important associated causes of liver cell carcinoma and HIV. The proportion of deaths under 70 years of age stands out. CONCLUSIONS: The study provides a baseline for research on mortality trend and the impact of interventions, given the history of expanded detection and supply of treatments, including the most recent antivirals in Brazil, since 2015.

RESUMO OBJETIVO: Descrever a mortalidade por hepatites B e C como causa básica no município de São Paulo, verificando a tendência dessas taxas, e avaliar a associação dessas doenças a outras no período de 2002 a 2016. MÉTODOS: Trata-se de um estudo de série temporal sobre mortalidade por hepatites B e C segundo sexo, com dados do Sistema de Informação de Mortalidade. A regressão de Prais Winsten foi usada na análise de tendência das taxas. RESULTADOS: Os achados do presente estudo mostraram tendência de declínio da mortalidade por hepatites B e C nos últimos anos, particularmente entre pessoas do sexo masculino. Essas infecções foram causas associadas importantes ao carcinoma de células hepáticas e ao HIV. Destaca-se a proporção de óbitos com menos de 70 anos de idade. CONCLUSÕES: O estudo fornece uma linha de base para pesquisas de tendência de mortalidade e de impacto de intervenções, visto o histórico de ampliação da detecção e oferta de tratamentos, incluindo os mais recentes antivirais no Brasil, desde 2015.

Exploratory spatial analysis of HBV cases in Brazil between 2005 and 2017.

OBJECTIVE: To analyze the pattern of spatial distribution of hepatitis B virus (HBV) cases and the mortality attributed to this disease throughout the Brazilian territory, in 2005, 2016 and 2017. METHODS: This is an ecological study of spatial analysis, using data from the Information System for Notifiable Diseases and the Brazilian Mortality Information System. HBV detection and mortality rates were analyzed. The spatial analysis from 2005 to 2017 was held through the Global Moran's Index (I) for global data and the Local Indicators of Spatial Association (LISA) for the 5,564 municipalities of the country. RESULTS: The North region stands out with the highest HBV detection and mortality rates in the country. The Global Moran's I showed a spatial correlation of HBV cases in Brazil, and the LISA Map evidenced the presence of hotspots or spatial clusters (high-high type), mainly in the North region and also in some municipalities of Santa Catarina, Paraná, Rio Grande do Sul, Espírito Santo, São Paulo and Rio de Janeiro. CONCLUSION: The spatial analysis of the HBV distribution pattern in Brazil shows areas with a large concentration of cases, particularly in the North of the country and in other points distributed throughout the national territory. These data reinforce the urgency of intervention actions related to prevention, diagnosis and treatment of hepatitis B.

Exploratory spatial analysis of HBV cases in Brazil between 2005 and 2017 / Análise exploratória espacial de casos de HBV no Brasil entre 2005 e 2017

ABSTRACT Objective: To analyze the pattern of spatial distribution of hepatitis B virus (HBV) cases and the mortality attributed to this disease throughout the Brazilian territory, in 2005, 2016 and 2017. Methods: This is an ecological study of spatial analysis, using data from the Information System for Notifiable Diseases and the Brazilian Mortality Information System. HBV detection and mortality rates were analyzed. The spatial analysis from 2005 to 2017 was held through the Global Moran's Index (I) for global data and the Local Indicators of Spatial Association (LISA) for the 5,564 municipalities of the country. Results: The North region stands out with the highest HBV detection and mortality rates in the country. The Global Moran's I showed a spatial correlation of HBV cases in Brazil, and the LISA Map evidenced the presence of hotspots or spatial clusters (high-high type), mainly in the North region and also in some municipalities of Santa Catarina, Paraná, Rio Grande do Sul, Espírito Santo, São Paulo and Rio de Janeiro. Conclusion: The spatial analysis of the HBV distribution pattern in Brazil shows areas with a large concentration of cases, particularly in the North of the country and in other points distributed throughout the national territory. These data reinforce the urgency of intervention actions related to prevention, diagnosis and treatment of hepatitis B.

RESUMO Objetivo: Analisar o padrão de distribuição espacial dos casos de hepatite causada pelo vírus B (HBV) e a mortalidade atribuída a esse agravo em todo o território nacional, nos anos de 2005, 2016 e 2017. Métodos : Trata-se de um estudo ecológico de análise espacial, utilizando dados do Sistema de Informação de Agravos de Notificação e do Sistema Nacional de Mortalidade. Analisaram-se as taxas de detecção e mortalidade de HBV. A análise espacial no período de 2005 a 2017 foi realizada por meio do Índice Global de Moran para os dados globais e dos Indicadores Locais de Associação Espacial (Lisa) para os 5.564 municípios do país. Resultados : A região Norte destaca-se pelas maiores taxas de detecção e mortalidade de HBV do país. O Índice Global de Moran revelou uma correlação espacial dos casos de HBV no Brasil, e o Lisa Map evidenciou a presença de bolsões (tipo high-high), principalmente na região Norte e também em alguns municípios de Santa Catarina, Paraná, Rio Grande do Sul, Espírito Santo, São Paulo e Rio de Janeiro. Conclusão : A análise espacial do padrão de distribuição do HBV no Brasil revela áreas com grande concentração de casos, particularmente no Norte do país e em outros pontos distribuídos pelo território nacional. Esses dados reforçam a urgência de ações de intervenção relativas a prevenção, diagnóstico e tratamento da hepatite B.

Comparison of Dynamic Changes Among Various Prognostic Scores in Viral Hepatitis-Related Acute Liver Failure.

INTRODUCTION AND AIM: Multiple prognostic scores are available for acute liver failure (ALF). Our objective was to compare the dynamicity of model for end stage liver disease (MELD), MELD-sodium, acute liver failure early dynamic model (ALFED), chronic liver failure (CLIF)-consortium ACLF score and King's College Hospital Criteria (KCH) for predicting outcome in ALF. MATERIALS AND METHODS: All consecutive patients with ALF at a tertiary care centre in India were included. MELD, MELD-Na, ALFED, CLIF-C ACLF scores and KCH criteria were calculated at admission and day 3 of admission. Area under receiver operator characteristic curves (AUROC) were compared with DeLong method. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) and diagnostic accuracy (DA) were reported. RESULTS: Of the 115 patients included in the study, 73 (63.5%) died. The discrimination of mortality with baseline values of prognostic scores (MELD, MELD-Na, ALFED, CLIF-C ACLF and KCH) was modest (AUROC: 0.65-0.77). The AUROC increased on day 3 for all scores, except KCH criteria. On day 3 of admission, ALFED score had the highest AUROC 0.95, followed by CLIF-C ACLF 0.88, MELD 0.81, MELD-Na 0.77 and KCH 0.52. The AUROC for ALFED was significantly higher than MELD, MELD-Na and KCH (P < 0.001 for all) and CLIF-C ACLF (P = 0.05). ALFED score ≥ 4 on day 3 had the best sensitivity (87.1%), specificity (89.5%), PPV (93.8%), NPV (79.1%), LR positive (8.3) and DA (87.9%) for predicting mortality. CONCLUSIONS: Dynamic assessment of prognostic scores better predicts outcome. ALFED model performs better than MELD, MELD, MELD-Na, CLIF-C ACLF scores and KCH criteria for predicting outcome in viral hepatitis- related ALF.

Prognostic factors of the short-term outcomes of patients with hepatitis B virus-associated acute-on-chronic liver failure.

OBJECTIVE: To investigate the impact of the baseline status of patients with hepatitis B virus-associated acute-on-chronic liver failure on short-term outcomes. METHODS: A retrospective study was conducted that included a total of 138 patients with hepatitis B virus-associated acute-on-chronic liver failure admitted to the Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, from November 2013 to October 2016. The patients were divided into a poor prognosis group (74 patients) and a good prognosis group (64 patients) based on the disease outcome. General information, clinical indicators and prognostic scores of the patients' baseline status were analyzed, and a prediction model was established accordingly. RESULTS: Elder age, treatment with artificial liver support systems and the frequency of such treatments, high levels of white blood cells, neutrophils, neutrophil count/lymphocyte count ratio, alanine aminotransferase, gamma-glutamyl transferase, total bilirubin, urea, and prognostic scores as well as low levels of albumin and sodium were all significantly associated with the short-term outcomes of hepatitis B virus-associated acute-on-chronic liver failure. The predictive model showed that logit (p) = 3.068 + 1.003 × neutrophil count/lymphocyte count ratio - 0.892 × gamma-glutamyl transferase - 1.138 × albumin - 1.364 × sodium + 1.651 × artificial liver support therapy. CONCLUSION: The neutrophil count/lymphocyte count ratio and serum levels of gamma-glutamyl transferase, albumin and sodium were independent risk factors predicting short-term outcomes of hepatitis B virus-associated acute-on-chronic liver failure, and the administration of multiple treatments with artificial liver support therapy during the early stage is conducive to improved short-term outcomes.

Prognostic factors of the short-term outcomes of patients with hepatitis B virus-associated acute-on-chronic liver failure

OBJECTIVE: To investigate the impact of the baseline status of patients with hepatitis B virus-associated acute-on-chronic liver failure on short-term outcomes. METHODS: A retrospective study was conducted that included a total of 138 patients with hepatitis B virus-associated acute-on-chronic liver failure admitted to the Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, from November 2013 to October 2016. The patients were divided into a poor prognosis group (74 patients) and a good prognosis group (64 patients) based on the disease outcome. General information, clinical indicators and prognostic scores of the patients' baseline status were analyzed, and a prediction model was established accordingly. RESULTS: Elder age, treatment with artificial liver support systems and the frequency of such treatments, high levels of white blood cells, neutrophils, neutrophil count/lymphocyte count ratio, alanine aminotransferase, gamma-glutamyl transferase, total bilirubin, urea, and prognostic scores as well as low levels of albumin and sodium were all significantly associated with the short-term outcomes of hepatitis B virus-associated acute-on-chronic liver failure. The predictive model showed that logit (p) = 3.068 + 1.003 × neutrophil count/lymphocyte count ratio - 0.892 × gamma-glutamyl transferase - 1.138 × albumin - 1.364 × sodium + 1.651 × artificial liver support therapy. CONCLUSION: The neutrophil count/lymphocyte count ratio and serum levels of gamma-glutamyl transferase, albumin and sodium were independent risk factors predicting short-term outcomes of hepatitis B virus-associated acute-on-chronic liver failure, and the administration of multiple treatments with artificial liver support therapy during the early stage is conducive to improved short-term outcomes.

Análise do perfil sociodemográfico de notificados para hepatite B e imunização contra a doença / Análisis sociodemográfico del reportado hepatitis B y la inmunización contra la enfermedad / Sociodemographic analysis of reported hepatitis B and immunization against the disease

Objective: To analyze the socio-demographic profile of reported hepatitis B and immunization against the disease. Methods: Study Hepatitis B notification data in the surveillance of a Minas Gerais’ municipality, from 2007 to 2015, conducted at the Labor Education Program for Health descriptive and analytical statistics, with significance level of p < 0.05. Results: 132 cases and two deaths were notified. The age of the reported cases ranged from zero to 87 years, average 35.8 (± 14.0) years. More frequently for men (52.3%) and with low education (64.8%). Most of them did not vaccinate (81.8%) and had positive result of HSBsAg serology (90.1%); immunization was not linked to the socio-demographic profile (p > 0.05). Conclusion: Age, education and gender were not associated with immunization, vaccination schedule and the HSBsAg test. The absence of vaccination among the notified suggests need for health education among the population, orienting the possibility of protection by immunization.

Objetivo: Analisar o perfil sociodemográfico dos notificados para hepatite B e a imunização contra a doença. Métodos: Estudo com dados de notificação de hepatite B na vigilância epidemiológica do município de Minas Gerais, entre 2007 a 2015, conduzido no Programa de Educação pelo Trabalho para a Saúde. Estatística descritiva e analítica, com nível de significância p < 0,05. Resultados: Notificaram-se 132 casos e dois óbitos. A idade dos notificados variou de zero a 87 anos, média de 35,8 (± 14,0) anos. Maior frequência para homens (52,3%) e baixa escolaridade (64,8%). A maioria não vacinou (81,8%) e teve resultado da sorologia HSBsAg positivo (90,1%); a imunização não se associou ao perfil sociodemográfico (p > 0,05). Conclusão: Idade, escolaridade e sexo não foram associados à imunização, ao esquema vacinal ou ao teste HSBsAg. A ausência de vacinação entre os notificados sugere a necessidade de educação em saúde junto à população, orientando-a sobre possibilidade de proteção pela imunização.

Objetivo: Analizar el perfil sociodemográfico reportado de hepatitis B y la inmunización contra la enfermedad. Métodos: Estudio de datos de notificación de la hepatitis B en la vigilancia del municipio de Minas Gerais, de 2007 a 2015, realizadas en el Programa de Educación para el Trabajo de estadística descriptiva y analítica de la Salud, con un nivel de significación de p<0,05. Resultados: 132 casos fueron notificados; dos muertes. La edad del reportado varió de cero a 87 años, con una media de 35,8 (± 14,0) años. Con mayor frecuencia entre los hombres (52,3%) y baja educación (64,8%). La mayoría no vacunados (81,8%) y tuvo resultado positivo de HSBsAg serología (90,1%); la inmunización no vinculado al perfil sociodemográfico (p > 0,05). Conclusión: La edad, la educación y el sexo no se asociaron con la inmunización, calendario de vacunación y la prueba HSBsAg. La ausencia de vacunación entre los notificados sugiere la necesidad de educación para la salud entre la población, orientando la posibilidad de protección mediante la vacunación.

Independent Predictors of Mortality and Resource Utilization in Viral Hepatitis Related Hepatocellular Carcinoma.

INTRODUCTION: Hepatitis B (HBV) and C viruses (HCV) are important causes of hepatocellular carcinoma (HCC). Our aim was to assess mortality and resource utilization of patients with HCC-related to HBV and HCV. MATERIAL AND METHODS: National Cancer Institute's Surveillance, Epidemiology and End Results (SEER)-Medicare linked database (2001-2009) was used. Medicare claims included patient demographic information, diagnoses, treatment, procedures, ICD-9 codes, service dates, payments, coverage status, survival data, carrier claims, and Medicare Provider Analysis and Review (MEDPAR) data. HCC related to HBV/HCV and non-cancer controls with HBV/HCV were included. Pair-wise comparisons were made by t-tests and chi-square tests. Logistic regression models to estimate odds ratios (ORs) with 95% confidence intervals (CIs) were used. RESULTS: We included 2,711 cases of HCC (518 HBV, 2,193 HCV-related) and 5,130 non-cancer controls (1,321 HBV, 3,809 HCV). Between 2001-2009, HCC cases related to HBV and HCV increased. Compared to controls, HBV and HCV patients with HCC were older, more likely to be male (73.2% vs 48.9% and 57.1% vs. 50.5%), die within one-year (49.3% vs. 20.3% and 52.2% vs. 19.2%), have decompensated cirrhosis (44.8% vs. 6.9% and 53.9% vs. 10.4%) and have higher inpatient ($60.471 vs. $47.223 and $56.033 vs. $41.005) and outpatient charges ($3,840 vs. $3,328 and $3,251 vs. $2,096) (all P < 0.05). In two separate multivariate analyses, independent predictors of one-year mortality were older age, being male and the presence of decompensated cirrhosis. CONCLUSIONS: The rate of viral hepatitis-related HCC is increasing. Mortality and resource utilization related to HBV and HCV-related HCC is substantial.

Trends in mortality burden of hepatocellular carcinoma, cirrhosis, and fulminant hepatitis before and after roll-out of the first pilot vaccination program against hepatitis B in Peru: An analysis of death certificate data.

The first pilot vaccination program against hepatitis B in Peru was implemented in the hyperendemic Abancay province in 1991. To assess the impact of vaccination on mortality rates of hepatitis B-related hepatocellular carcinoma (HCC), cirrhosis, and fulminant hepatitis, we compared mortality trends before (1960-1990) and after (1991-2012) roll-out of the vaccination program, using death certificate data from the Municipalidad Provincial de Abancay. Our results showed that, following program roll-out, the overall mortality rates (per 100,000 population) decreased from 9.20 to 3.30 for HCC (95% CI, 1.28-10.48%; P<0.014), from 16.0 to 6.3 for cirrhosis (95% CI, 3.20-16.10%; P<0.004), and from 34.80 to 1.28 for fulminant hepatitis (95% CI, 16.70-50.30%; P<0.001). The absolute number of deaths attributable to cirrhosis (10 [8.80%] vs. 0.0%; P<0.001) and fulminant hepatitis (83 [40.0%] vs. 5 [19.20%]; P<0.026) decreased in 5-14-year-old children following vaccination. These findings showed reduced mortality rates of hepatitis B-related liver diseases, particularly cirrhosis and fulminant hepatitis in children under 15years, following implementation of the vaccination program against hepatitis B.

The efficacy and safety of nucleos(t)ide analogues in the treatment of HBV-related acute-on-chronic liver failure: a meta-analysis.

BACKGROUND AND PURPOSE: The application of nucleos(t)ide analogues in hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) has not yet been widely accepted. Therefore, we conducted a metaanalysis of prospective and retrospective studies to examine the efficacy and safety of nucleos(t)ide analogues in treating HBV-related ACLF. MATERIAL AND METHODS: Two independent reviewers identified eligible studies through electronic, and manual searches, and contact with experts. Three-month mortality was defined as the primary efficacy measure. ACLF reactivation and HBV DNA inhibition were secondary efficacy measures. Quantitative meta-analyses were performed to compare differences between nucleos(t)ide analogue and control groups. RESULTS: Five eligible studies were identified. Antiviral treatment with nucleos(t)ide analogues led to significant reduction of HBV DNA [HBV DNA reduction > 2 log: 70.4 vs. 29%, RR = 2.29, 95%CI (1.49, 3.53), P < 0.01]. ACLF patients receiving nucleos(t)ide analogue had significantly lower 3-month mortality [44.8 vs. 73.3%, RR = 0.68, 95%CI (0.54, 0.84), P < 0.01] as well as incidence of reactivation [1.80 vs. 18.4%, RR = 0.11, 95%CI (0.03, 0.43), P < 0.01] compared to those who did not. There was no significant difference in the prognosis of patients treated with entecavir or lamivudine [36.4 vs. 40.5%, RR = 0.77, 95%CI (0.45, 1.32), P = 0.35]. No drug-related adverse events were reported during follow-up. CONCLUSION: Our findings suggest that nucleos(t)ide analogue treatment reduces short-term mortality as well as reactivation of HBV-related ACLF patients. Nucleos(t)ide analogues are well-tolerated during therapy, and suggestive evidence indicates that entecavir and lamivudine confer comparable.

Comparison of prognosis by viral etiology in patients with hepatocellular carcinoma after radiofrequency ablation.

UNLABELLED: BACKGROUND; Radiofrequency ablation (RFA) has been performed as a first line curative treatment modality for patients with hepatocellular carcinoma (HCC) within the Milan criteria currently. However, prognosis of hepatitis B- and hepatitis C-related HCC after RFA remains debatable. This study aimed to assess the impact of viral etiology on the prognosis of HCC patients undergoing RFA. MATERIAL AND METHODS: One hundred and ninety-two patients with positive serum HBV surface antigen (HBsAg) and negative serum antibody against HCV (anti-HCV) were enrolled as the B-HCC group and 165 patients with negative serum HBsAg and positive anti-HCV as the C-HCC group. Post-RFA prognoses were compared between the two groups using multivariate and propensity score matching analyses. RESULTS: The B-HCC group had higher male-to-female ratio and better liver functional reserve than the C-HCC group. After a median follow-up of 23.0 ± 22.7 months, 55 patients died and 189 patients had tumor recurrence after RFA. The cumulative five-year survival rate was 75.9% and 69.5% in the B-HCC and C-HCC groups, respectively (p = 0.312), while the five-year recurrence-free survival rate was 19.0% and 26.6%, respectively (p = 0.490). After propensity-score matching, the B-HCC group still had comparable overall survival rate (p = 0.679) and recurrence-free survival rate (p = 0.689) to the C-HCC group. For 132 patients with Barcelona-Clinic Liver Cancer stage 0, the five-year overall survival and recurrence-free survival rates were also comparable between the two groups (p = 0.559 and p = 0.872, respectively). CONCLUSION: Viral etiology is not essential for determining outcome in HCC patients undergoing RFA.

Mortalidad por hepatocarcinoma y cirrosis hepática en Apurímac: 2007-2010 / Mortality for hepatocarcinoma and liver cirrhosis in Apurímac: 2007-2010

Objetivo: Determinar las tasas de mortalidad por hepatocarcinoma, cirrosis hepática y hepatitis B aguda, en cinco provincias de Apurímac. Realizamos un estudio descriptivo retrospectivo, donde se revisó 2840 diagnósticos Métodos: de fallecimientos de la Oficina de Estadística e Informática de la DIRESA-Apurímac, entre enero del 2007 a diciembre de 2010. Primero se determinó las frecuencias de muerte por patologías y sexo, luego se calculó las tasas de mortalidad (TM) por cada 100 000 habitantes/año y mortalidad proporcional (MP) por cada 100 fallecidos/año. El 5.7% de los Resultados: fallecimientos fue por cirrosis hepática, 1.62% por hepatocarcinoma y 0.42% por hepatitis B aguda. La causa de mayor mortalidad es por cirrosis con una TM según provincia entre 13.2 a 21.0/100 000 y una MP entre 5.3 a 6.3%, seguido del hepatocarcinoma con una TM entre 3.0 a MP entre 0.9 a 2.2%, con 6.9/100 000 y una y finalmente la hepatitis B aguda una TM entre 0.4 a MP entre 0.1 a 1.0%. Las tasas más altas de mortalidad se registran la provincia de 3.5/100 000 y una Abancay y se presenta con mayor frecuencia a partir de los 50 años de edad. En la región Apurímac existen Conclusión: importantes tasas de mortalidad por cirrosis hepática, hepatocarcinoma y hepatitis B aguda.

Objective: to determine mortality rates for liver cancer, liver cirrhosis and acute hepatitis B in five provinces in Apurimac. Methods: A retrospective descriptive study, we reviewed 2 840 deaths diagnoses of the Apurimac Office of Statistics and Informatics, from January 2007 to December 2010. First we determined the frequency of death according to disease and genre, then we calculated the rates of mortality (MR) per 100 000 population/year and proportionate mortality (PM) per 100 deaths/year. 5.7% of the deaths were from liver cirrhosis, 1.62% from hepatocarcinoma and 0.42% due to hepatitis Results: B infection. The cause of higher mortality was cirrhosis with a MR by province from 13.2 to 21.0/100 000 and a MP from 5.3 to 6.3%, followed by hepatocellular carcinoma with a MR from 3.0 to 6.9/100 000 and a MP from 0.9 to 2.2% , finally acute hepatitis B account for a MR from 0.4 to 3.5/100 000 and a MP from 0.1 to 1.0%. The highest mortality rates were recorded in the province of Abancay and occurred most often after 50 years of age. there are significant rates of mortality Conclusion: from liver cirrhosis, hepatocellular carcinoma and hepatitis B infection in the Apurimac region.

[Hepatitis B mortality in Brazil, 2000-2009]. / Mortalidade por hepatite viral B no Brasil, 2000-2009.

This descriptive study focused on the mortality profile associated with hepatitis B virus (HBV) in Brazil as a whole and by region, based on data from the Mortality Information System (MIS). The study sample consisted of deaths from HBV recorded in the MIS from January 1, 2000, to December 31, 2009. The crude mortality rate remained constant in the country; the proportion of hepatocellular carcinoma with HBV as the associated cause was no greater than 7%. The standardized mortality rate was highest in the North of Brazil, and the proportional mortality rate was higher in males. In 2009, the potential years of life lost (PYLL) were highest in males in the 50-59-year age bracket and in females in the 40-49-year bracket. The largest increase in PYLL occurred in males 60 to 69 years of age. The study emphasizes the importance of scaling up preventive measures against HBV, in addition to expanding access to early diagnosis in order to reduce HBV mortality in the coming decades.