anti-HAV IgM Research Articles

Hepatitis A Seroprevalence Among HIV-Exposed and Unexposed Pediatric Populations in South Africa

Background: There is limited evidence comparing hepatitis A seroprevalence among HIV-exposed uninfected (HEU), HIV-infected (HIV), and unexposed uninfected (HUU) children. This compromises rational vaccine decision-making. Methods: This study comprised a retrospective health facility-based population of children aged 1 month–12 years. Archival sera were tested for markers of acute (anti-HAV IgM) or past (total anti-HAV) HAV infection. Subgroup analysis was conducted based on perinatal HIV exposure or infection status. Results: Among 513 children, the median age was 10 (IQR: 4–25) months. The median maternal age was 29 (IQR: 25–34) years. An anti-HAV seropositivity of 95.1% (117/122 [95% CI 90.2–98.4]) was found among those ≤6 months of age, indicative of the rate of transplacental antibody transfer. Among 1–12-year-olds, hepatitis A seroprevalence was 19.3% (37/192 [95% CI 14.1–25.7]), while 1.1% (2/188 [95% CI 0.12–2.76]) had evidence of acute infection. Compared to HIV-exposed subgroups (HIV = 60%, 6/10 [95% CI 27.4–86.3] and HEU = 45%, 9/20 [95% CI 23.8–68]), hepatitis A seroprevalence among HUU children was low (29.2%, 47/161 [95% CI 22.4–37.0]). Conclusions: Natural immunity among HIV-exposed and unexposed children in South Africa is insufficient to protect against severe liver complications associated with HAV infection later in adulthood.

A-258 Hepatitis A infections among patients suspected of acute hepatitis attended in Brazilian health services

Abstract Background Millions of people worldwide are infected with Hepatitis A Virus (HAV) annually - the leading widely spread causes of acute viral hepatitis in developing countries across all continents. Objective To evaluate the prevalence of anti-HAV antibodies; to determine HAV genotypes by nucleotide sequencing in patients suspected of acute hepatitis at public healthcare institutions; and to assess the association between this infection with age, gender, region, and other risk factors Methods Between October 2019 and May 2023, we analyzed 1,562 patients with more than 18 years old with clinical suspected acute hepatitis. Results Out of the 1,562 individuals, 1,244 were seropositive for Anti-HAV IgG, a median age of 45 years (IQR: 35 to 56) vs. 31 years (IQR: 25 to 39) in non-reactive individuals (p<0.001). A higher seropositivity was found in men compared to women (p=0.002). North region showed the highest seropositivity (p<0.001). There was also an association between poor sanitation conditions and seropositivity, such as lack of sewage collection and consumption of untreated water (p<0.001), as well as an association between heterosexual orientation and higher likelihood of seropositivity (p=0.015). In the logistic regression analysis for anti-HAV IgG seropositivity, age and male sex were significantly associated with seropositivity (OR = 1.09, 95% CI: 1.08 to 1.11, p<0.001; OR = 1.56, 95% CI: 1.16 to 2.11, p=0.004). North region showed a significant increase in the odds for seropositivity compared to all other regions. For anti-HAV IgM, out of the 1,562 individuals, 97 were seropositive, significantly higher in younger individuals [median age of 34 years (IQR: 28 to 40) vs. 42 years (IQR: 32 to 54) in non-reactive individuals (p<0.001)] and in males (p<0.001). South and Southeast regions had higher seropositivity (p<0.001). Non-heterosexual orientation and more than 2 sexual partners significantly correlated with seropositivity (p<0.001). In the logistic regression analysis for anti-HAV IgM, age showed an inverse association with seropositivity (OR = 0.96, 95% CI: 0.94 to 0.98, p<0.001), being more frequent in men (OR = 1.86, 95% CI: 1.11 to 3.21, p=0.021). Consumption of seafood was significantly associated with increased odds of seropositivity for anti-HAV IgM (OR = 2.26, 95% CI: 1.43 to 3.56, p<0.001). South and Southeast regions showed more IgM positive cases than North, Northeast and Midwest regions. Among the 1,562 cases, 35 complete (or almost complete) HAV genomes were successfully recovered from metagenomics sequencing data. These genomes range from 6,625 to 7,462 bp in length (89-100% completeness), sequences were fairly similar in pairwise nucleotide alignment, classified as genotype I.A, and displaying identities ranging from 94.7 to 99.7%. Conclusions Hepatitis A infection was found among 6.2% acute hepatitis cases attended in public services in Brazil while previous infections or vaccinated patients were found in 78.9% patients. While anti-HAV IgG positive patients where most frequent in the North region of Brazil, acute hepatitis A (IgM-positive) were more frequent in South and Southeast regions. Our results reinforce the need to implement vaccination against hepatitis A among individuals with more than 18 years in our country.

IL-10 and IL-18: Key players in liver damage associated with hepatitis A virus infection.

Hepatitis A virus infection is a health threat with multiple transmission patterns across areas, It is evaluated using immune response markers IL-10 and IL-18, along with molecular and biochemical diagnostic methods for accurate diagnosis. The association between liver damage and interleukin-10 and interleukin-18 levels in people with hepatitis A virus infection as indications of the risk of acute liver failure. 110 samples were collected from Iraqi individuals from both sexes and different age groups ⩽ 1 to ⩾ 25, including 60 patients and 50 healthy people. All samples were collected from a hospital in Diwaniyah city, and the infection was confirmed by antiHAV IgM titers and One-Step RT-PCR. ELISA was used to determine the levels of IL-10 and IL-18, while Biochemical tests measured for alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total serum Bilirubin (TSB) in serum. In this study, IL-10 levels were higher in HAV patients (0.12 ± 0.06 ng/L) compared to controls (0.11 ± 0.04 ng/L), but the difference was not significant (p= 0.17). Conversely, IL-18 levels were significantly elevated in patients (1.41 ± 0.71) versus controls (0.58 ± 0.35) (p= 0.00). Biochemical tests showed significantly elevated levels in HAV patients: ALT (170.18 ± 117.67 vs. 21.25 ± 7.41), AST (183.05 ± 128.13 vs. 26.00 ± 7.69), ALP (607.68 ± 214.93 vs. 202.02 ± 121.35), and TSB (2.77 ± 2.5 vs. 0.55 ± 0.14) (all p< 0.001). These findings underscore the potential of IL-10 and IL-18 as biomarkers for HAV severity and highlight their role in liver injury. Our study highlights the important roles of IL-10 and IL-18 in acute hepatitis A and reveals their impact on the immune response and liver damage. Elevated levels of IL-10, IL-18 and Biochemical tests are associated with disease severity, suggesting their potential as biomarkers and therapeutic targets to improve the management of HAV infection.

Rising trend of symptomatic infections due to Hepatitis A virus infection in adolescent and adult age group: An observational study from a tertiary care liver institute in India

BackgroundHepatitis A Virus (HAV) is the most common cause of Acute Viral Hepatitis (AVH) in children. It causes self-limiting illness and rarely acute liver failure. The shifting pattern in HAV endemicity is rendering adolescents and adults vulnerable to infection. MethodsIn this retrospective study, samples received from 14,807 patients with acute onset icteric illness from January 2014–December 2022 were analyzed. HAV infection was detected by anti-HAV IgM positivity. The cases were divided into 3 age groups, pediatric, adolescents and adults, and clinical presentations were compared. ResultsOverall, 7.72%(1144) were positive for anti-HAV IgM. Of these, 60%(690) were finally included in the study. The positive cases were divided into adults, ≥18 years (44%, 304); pediatric, <12 years (31%, 212) and adolescents (25%,174) age groups. Overall males were predominant [72.4%(500)], with a median age of 16 (IQR:9–21) years. Cases were characterised into AVH (68.1%, 470/690), Acute Liver Failure (ALF) (31.4%, 217/690) and Acute-on-Chronic Liver Failure (0.43%, 3/690).AVH in the pediatric age group was 69%(146/212), adolescents was 67%(117/174), and adults was 68%(207/304). ALF cases among the 3 groups were 30%(65/212), 33%(57/174), and 31%(95/304) respectively. Overall mortality was seen in 6.52%(45/690), maximum in adolescents with ALF presentation [10.3%(18/174)]. On molecular characterization of infection, viremia was seen in 28.9%(200/690) and all the isolates were Genotype IIIA. ConclusionsThe number of adults experiencing symptomatic HAV infection was seen to increase over the years in the present study. Infection in adolescents was associated with higher mortality and ALF as the clinical presentation.

A retrospective analysis on seroprevalence of acute viral hepatitis observed among dengue patients attending a tertiary care centre in central India

PurposeThe present study was conducted retrospectively to assess the frequency of acute viral hepatitis among the clinically suspected dengue cases presented at our tertiary care centre during 2021. MethodsTo determine the presence of acute viral hepatitis; Hepatitis A virus (HAV) and Hepatitis E virus (HEV) infections, 104 specimens were selected from the dengue-suspected clinical specimens received during 2021 on the basis of acute viral hepatitis symptoms. Following this, serological diagnosis was performed on those samples using anti-HAV IgM and anti-HEV IgM ELISA kits. ResultsBased on sero-positivity for IgM antibodies, 3 (5.3%) dengue virus (DENV) seropositive samples were positive for both HAV and HEV, while among DENV seronegative cases, 11 (22.91%) samples were positive for HEV and 1 (2.08%) sample was positive for HAV, pointing towards misdiagnosis due to overlapping symptoms. Additionally, co-infection of HAV & HEV in 1 sample was also observed in this study. ConclusionsThis study revealed the presence of acute hepatitis infections among the dengue cases during monsoon and post-monsoon season. Overlapping of the clinical manifestations of these diseases can create misdiagnosis incidences raising risk for underreporting of the true cases of acute viral hepatitis infection. Dengue-suspected patients with selected symptoms during the monsoon and post-monsoon season should additionally be screened for acute hepatitis infections, as suggested in this study.

Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among the fulminant hepatitis A virus infection patients.

Hepatitis A is a widespread viral infection with significant public health implications. Assessing glucose 6-phosphate dehydrogenase (G6PD) deficiency in hepatitis A patients is essential for various reasons, including prognosis, disease severity evaluation, encephalopathy risk identification, tailored management, and advancing scientific understanding. This study aimed to investigate the prevalence and clinical implications of G6PD impairment in individuals with fulminant hepatitis A. A cross-sectional descriptive analysis was conducted, involving hospitalized patients with fulminant hepatitis A. Demographic data, prevalence rates, and clinical findings were recorded in a database. The diagnosis of hepatitis A infection was confirmed using an anti-HAV IgM antibody test, and G6PD enzyme activity was measured with a fluorescent spot assay. Out of 81 patients with hepatitis A, 57 (70.4%) were males, and 24 (29.5%) were females, with an average age of 24.6 years. Dark yellow urine and anorexia were the most common clinical symptoms. Notably, 30 (37%) patients lacked G6PD. The group with G6PD deficiency showed significantly higher rates of encephalopathy and mortality (P<0.01), along with elevated bilirubin (P=0.00), abnormal coagulation parameters, and low hemoglobin levels (P=0.00). In light of these findings, the present study proposes the implementation of routine G6PD level assessments and the evaluation of other relevant markers in regions where hepatitis A is endemic. Furthermore, the study underscores the need for vigilant monitoring of hemolysis and encephalopathy in affected patients to optimize clinical management and reduce morbidity and mortality associated with this condition.

Prevalence of Rotavirus, Adenovirus, and Hepatitis A Virus in a Tertiary Care Hospital in Somalia

Rotavirus, one of the viral infectious agents that is transmitted mainly through the fecal-oral route and spreads easily in regions with poor sanitation conditions, is the most common causative agent of acute gastroenteritis in children under five years of age worldwide, and enteric adenoviruses are other frequently encountered causative agents of gastroenteritis in childhood. Hepatitis A virus (HAV) is also transmitted in similar routes and is endemic in regions with poor sanitation conditions and limited access to clean water and is usually acquired in early childhood in these regions. In this study conducted in Mogadishu Somalia, rotavirus and adenovirus antigen test (immunochromatographic rapid test) results in patients admitted to a tertiary hospital in the 9-month period between February 2019 and October 2019 and ELISA based HAV antibody test results studied in 2018-2019 were retrospectively examined and it was aimed to determine the distribution of positivity rates of these viruses by age, gender, and year. During the study period, 1136 patients (mean age 6.33±12.36) were tested for rotavirus and adenovirus antigens, and 362 patients (mean age 21.26±18.45) were tested for anti-HAV IgM/IgG antibodies. The positivity rates of rotavirus and adenovirus were found as 17.8% and 5.1%, respectively. The positivity rates of anti-HAV IgM and IgG antibodies were 26.5% and 85.4%. The age group with the highest rotavirus test positivity was babies under one year old (27.3%), positivity rate was also high in children aged 1-2 years old (20.9%), and this distribution was similar for adenovirus. Although a small number of patients were tested in under five years of age, anti-HAV IgG seropositivity was 60% and above in all age groups. The highest anti-HAV IgM positivity rates were observed in children 2-&lt;5 and 5-15 years of age, 52.9% and 44% respectively. Rotavirus antigen positivity was found at high levels in the three-month period covering June, July, and August 2019. In July (2019), it was observed that the number of rotavirus and adenovirus antigen test requests were increased, and also, at the same time the highest positivity rates for both viruses were observed; 31.2% and 9.5% for rotavirus and adenovirus. Rotavirus and enteric adenovirus co-infection was detected in 2.4% (27/1136) of the patients, and 23 (85.2%) of these were under five years of age children. Our study results show that children under the age of two are especially affected by rotavirus and adenovirus infections in Somalia and indicate that HAV infections are acquired at an early childhood. We can say that it may be useful to review vaccination programs as an important public health measure to reduce the burden of mortality and morbidity associated with HAV and rotavirus, which have a high prevalence and also have protective vaccines.

Neurological Uniqueness: A Case Study of Hepatitis A-Induced Acute Inflammatory Demyelinating Polyneuropathy

Acute inflammatory Demyelinating Polyneuropathy (AIDP) with hepatitis A (HA) is more likely to affect men, develop at a younger age, and have a better prognosis overall. The progression of the Hepatitis A Virus (HAV)-caused liver inflammation and the neurological difficulties could lead to AIDP in the early stages of the hepatitis signs and symptoms. The World Health Organization (WHO) estimates 1.5 million clinical HAV cases annually. Extrahepatic complications of this disease are rare. The etiology of HA associated AIDP remains unclear, with cross-reactive HA epitopes between the peripheral nervous system and other authors have hypothesized that the presence of CSF antibodies reflects direct entry into the central nervous system. Our patient presentations favored AIDP most commonly in HA. A 22-year-old man, with no prior significant medical history, presented to neurology emergency with a 3-day history of acute onset, had been complaining of nausea, general weakness, yellowing of the sclera and history of fever for 5 days. Further investigation revealed marked elevation of liver enzymes in a pattern suggestive of hepatocellular processes. Serum titres of hepatitis B, C, and E were negative, but IgM anti-HAV was positive (enzyme immunoassay). Elevation of Cerebrospinal fluid (CSF) protein and myelitis transversa shown by magnetic resonance imaging were established. The diagnosis as AIDP was taken and treated by symptomatic and neurology treatment. However, the patient regained strength and underwent physiotherapy during two weeks. Approximately 3 months after discharged, the patient's gait had nearly returned to baseline at follow-up and the symptoms slowly improved.

Seroprevalence of HAV and Mandatory Markers of Transfusion- Transmitted Infections in Blood Donors from Chiapas, Mexico: an Exploratory Study

Introduction: Blood transfusion saves millions of lives annually. However, blood transfusion is one of the leading risk factors for Transfusion-Transmitted Infections (TTIs). Therefore, the objective of this study was to explore the seroprevalence of both HAV and mandatory markers of TTIs in blood donors from Chiapas, Mexico. Materials and Methods: The study included 3,067 blood donors from the Dr. Domingo Chanona Rodríguez Blood Bank located in Tuxtla Gutiérrez, Chiapas, and from 9 collection centers located in different regions of Chiapas. Screening was performed using Enzyme immunoassay (anti-HAV IgM) or Chemiluminescent microparticle immunoassay (HBV HBsAg, anti-HCV IgG/IgM, HIV Ag/Ab, anti-T. pallidum IgG/IgM, and anti-T. cruzi IgG). Results: The seroprevalence of T. pallidum was the highest at 1.3%, followed by the seroprevalence of HAV and T. cruzi, both with 0.7%. Regions X and XV of the state of Chiapas presented the six markers of the analyzed TTIs. Blood donors at risk of being TTI reactive donated in regions IX and X. However, donors with qualified and unqualified employment and those who have donated more than 2 times are considered protective factors against TTIs. Conclusion: We observed a high seroprevalence of HAV in this exploratory study. It is indispensable to increase the sample size of blood donors from the state of Chiapas because HAV is endemic to Mexico and it is probably transmitted through blood transfusion. Also, it is necessary to augment voluntary non-remunerated blood donations in the state of Chiapas, mainly in the Southern border regions, to decrease the risk of TTIs.

Hepatitis A virus infection in Brazilian correctional facilities.

Hepatitis A virus (HAV) infection is transmitted by the fecal-oral route, through interpersonal contact and ingestion of contaminated food or water. Prisoners are at higher risk of acquiring HAV infection mainly due to the environment of closed penal institutions and socioeconomic conditions. This study aims to determine the seroprevalence of anti-HAV and its associated risk factors among inmates from twelve prisons in Central Brazil. A cross-sectional study was conducted between March 2013 and March 2014. A total of 580 prisoners participated in the study. The participant's samples were tested for Total and IgM anti-HAV antibodies by electrochemiluminescence immunoassay (ECLIA). Risk factors associated with anti-HAV seropositivity were also analyzed. The prevalence rate of HAV exposure was 88.1% (95% CI: 85.5-90.7). No sample had a positive reaction to IgM anti-HAV. Increasing age, low level of education, and being imprisoned in Corumbá city were independently associated with HAV exposure among prisoners. To prevent the burden of the disease, vaccination strategies should be considered for susceptible prisoners in Central Brazil.

Acute Acalculous Cholecystitis Associated with Hepatitis A Viral Infection: A Case Report

Most hepatitis A infections are acute, self-limiting, and asymptomatic. In rare instances, extra hepatic complication, such as acute cholecystitis, may emerge. Acute cholecystitis is inflammation of the gallbladder wall and is classified into calculus and acalculus. About 90–95% of cases are brought on by bile duct stones. Acute acalculous cholecystitis can be brought on by structural and functional abnormalities in the gallbladder brought on by viral hepatitis infection. Here we present a 20 years old female patient with acute acalculous cholecystitis associated with hepatitis A infection. Gallbladder distention, thickening of the gallbladder wall, absence of acoustic shadow or biliary sludge, perivesical liquid buildup, and absence of dilatation of the intra- and extrahepatic bile ducts are among the ultrasonographic criteria for diagnosing acute acalculous cholecystitis. The viral hepatitis serology revealed acute hepatitis A infection with positive anti-HAV IgM. Hepatitis A testing should be considered in patients suspected with acalculous cholecystitis of undefined etiology in markedly deranged liver function test adult patients.

Frequency of Hepatitis a Virus as a Cause of Anicteric Hepatitis in Children Under 5 Years

Background and Aim: Globally, Acute viral hepatitis A is the widespread type of hepatitis particularly in developing countries. Children under 5 year of age are at greater risk of asymptomatic infections, and if they do develop symptoms, they are likely to experience anicteric illnesses. The present study aimed to determine the incidence of hepatitis A virus as anicteric hepatitis cause among children under 5 years. Methodology: A cross-sectional study was carried out on 380 children (&lt;5 years) in the Pediatric Medicine Department of Qazi Hussain Ahmad Medical Complex Nowshera for the duration from 1st July 2021 to 30th June 2022. Study protocol was approved by the institute ethical committee. Children with normal-colored urine, diarrhea, abdominal pain, vomiting, malaise, nausea, and low-grade fever (&lt; 38.5 °C) were investigated. Demographic details and physical examination were recorded from children with elevated transaminase levels (ALT). Children with elevated transaminases were only enrolled and categorized into two groups: Group-I HAV-positive and Group-II HAV negative groups. Children with transaminases were the only ones who had IgM antibodies against HAV virus. ELISA was used to test for anti-HAV IgM. Results: Of the total 380 children, the incidence of elevated transaminases (ALT, AST) were 42.6% (n=162). The frequency of HAV positive and HAV negative was 13.6% (n=22) and 86.4% (n=140) respectively. Out of 162 children, there 84 (51.9%) male and 78 (48.1%) females. Age-wise distribution of patients were as follows: Age≥3 years 92 (56.8%) and age≤ 70 (43.2%). HAV infection rates were significantly higher among children over 2 years old (p &lt;0.05). Abdominal pain, vomiting, diarrhea, nausea, Right hypochondrial tenderness, Arthralgia, and Hepatomegaly were different clinical manifestation of HAV negative and HAV positive found in 20.7% (n=29) versus 13.6% (n=3), 97.1% (n=136) versus 81.8% (n=18), 87.1% (n=122) vs 81.8% (n=18), 81.4% (n=114) versus 95.5% (n=21), 32.9% (n=46) versus 86.4% (n=19), 38.6% (n=54) versus 59.1% (n=13), 4.3% (n=6) versus 18.2% (n=4) respectively. Conclusion: Children with anicteric hepatitis under the age of 5 years were found to have 13.6% HAV infection. Diarrhea and vomiting were the most prevalent clinical manifestation of children &lt; 5 years. A higher level of maternal education, older age, and poor sanitary conditions were various risk factors related to HAV infection. Keywords: Hepatitis A, Anicteric hepatitis, Children

Prevalence of HIV and Viral Hepatitis Markers among Healthcare Workers in the Republic of Guinea.

Healthcare workers are much more likely to be infected with HIV and hepatitis viruses compared to the general population. Although healthcare workers are more aware of HIV and hepatitis viruses, several countries in Africa lack a comprehensive grasp of disease routes and transmission risks. The aim of this study was to assess the prevalence of the serological and molecular biological markers of HIV and viral hepatitis among healthcare workers in the Republic of Guinea. The study material was 74 blood serum samples collected from healthcare workers who received additional training at the Institute of Applied Biological Research of Guinea (IRBAG, Kindia, Republic of Guinea). The markers examined included HBsAg, HBeAg, anti-HBs IgG, anti-HBcore IgG, anti-HCV qualitative determination, anti-HEV IgM and IgG, anti-HAV IgM and IgG, and anti-HIV. For viral DNA and RNA detection, nucleic acids were extracted from blood serum, and viral presence was inferred using real-time PCR with hybridization fluorescence detection. A high prevalence of viral hepatitis B markers was shown, and significantly fewer cases of viral hepatitis C and HIV were detected. Almost all examined medical workers had anti-HAV IgG antibodies, but no antibodies to hepatitis E virus. Apparently, the identified markers depend on the general prevalence of certain pathogens in the region and are associated with the traditions and characteristics of the country's residents.

Acute viral hepatitis a in children an epidemiological and clinical course in Babylon

The hepatitis A virus, a picornavirus, is a common cause of hepatitis worldwide. Spread of infection is generally by feco-oral route. Hepatitis A is endemic in developing countries, and most residents are exposed in childhood. The aim of study is to evaluate epidemiology, clinical course, and laboratory profile of hepatitis A in children. Method: In this cross-sectional investigation, 250 children identified with acute viral hepatitis A by IgM antiHAV were hospitalized to our infectious unit from March 2018 to December 2018. The child’s location of residence, source of drinking water, manner of fecal sewage, nursery attendance, eating outside the house, fever, gastrointestinal symptoms, and history of contact with a hepatitis patient were recorded. Total serum bilirubin, blood urea nitrogen, liver functions test (AST, ALT), bleeding profile, complete blood count, and abdominal ultrasound were performed. Results: (7.3 2.6) year-olds averaged. The study included 128 women (51.20%) and 122 men (48.80%). 238 (95.2%) patients reported yellow sclera, fever in 181 (72.4%), vomiting in 180 (72%), and stomach pain in 171 (67.41%). 168 individuals had hepatomegaly, 34 had splenomegaly, and 6 had ascites. 72 (28.8%) patients had anemia, 15 (6%), leucopenia, 41 (16.4%), and 9 (3.6%) had thrombocytopenia. Rural areas exhibited greater ALT, TSB, PT, PTT, and blood urea (P-values = 0.006, 0.020, 0.027, 0.010, and 0.003). 17 (6.8%) people experienced hepatic encephalopathy (8.3%), ascites (6.4%), and pleural effusion (3.2%) 233 (96%) had good results, while 3% needed tertiary care. One patient died from the illness (0.4%). Conclusion: Although hepatitis A is a self-limiting disease, it’s have low rate of complications. hepatitis A is one of important health problems but, still affected large numbers of children.

Improving the accuracy of clinical interpretation of serological testing for the diagnosis of acute hepatitis a infection.

Hepatitis A (HA) remains a common infection globally that results in a self-limiting hepatitis with gastrointestinal and systemic symptoms. Direct detection of the virus in blood or stool is often not possible once symptomatic. Serological testing is frequently performed to investigate abnormal liver function tests - and interpretation of equivocal and low-level positive anti-hepatitis A virus (HAV) IgM is difficult even in the context of accurate epidemiological and clinical information. The aim of this project was to characterise the association between low-level reactive anti-HAV IgM results and clinical disease. Anti-HAV serology results recorded over 22 months were analysed. Equivocal and positive Architect anti-HAV IgM results were matched with available clinical and demographical data to identify confirmed and probable cases of acute HAV infection. Reactive anti-HAV IgM results were recorded for 88/7661 (1.15%) samples. Using clinical and laboratory data, 35 patients were confirmed to have acute HAV infection. Acute HA was associated with a mean Architect anti-HAV IgM value of 9.4 (SD 6.8-12.0). Cases of HA had a mean peak ALT value of 1920 (SD 682-3158). All confirmed cases (35/35) of acute HAV were associated with at least one clinical indicator, with 28/31 cases (90%) having a documented jaundice. All 35 (100%) cases of acute HAV infection had anti-HAV IgM > 4.0. A diagnosis other than acute HA was identified in 7/11 (63.6%) of low-level reactive anti-HAV IgM results (clinical data unavailable for further 4/11, 36.3%). Where clinical information was available, acute HA was excluded in all 31 patients with equivocal or low-level reactive anti-HAV IgM results. The accuracy of reports sent out to the clinician showed room for improvement. An interpretive algorithm is proposed including a clinically significant cut-off value for anti-HAV IgM.

Kastamonu İlinde Hepatit A Seroprevalansının Değerlendirilmesi i

Aim: Hepatitis A disease is a contagious liver infection caused by the hepatitis A virus (HAV). This study aimed to decide the hepatitis A seroprevalence in all age groups in Kastamonu province, Turkey.&#x0D; Material and Method: The current study analyzed the anti-HAV antibodies test results of the patients who applied to Kastamonu Training and Research Hospital for various reasons between 2018-2022. The most up-to-date test results of patients sent more than one serum sample were evaluated. The patients were separated into eight age groups: 0-10,11-20, 21-30, 31-40, 41-50, 51-60, 61-70, and ≥71. The anti-HAV IgM and anti-HAV IgG values were determined using the chemiluminescence microparticle immunoassay method in the Abbott Architect i2000SR. The results were evaluated based on the manufacturer’s instructions. &#x0D; Results: There was positivity in 27 (1.3%) of 2083 patients in whom anti-HAV IgM was studied and in 837 (58.2%) of 1439 patients in whom anti-HAV IgG was studied. The anti-HAV IgG positivity in females and males was 55.9% and 61.0%, respectively; anti-HAV IgM positivity was 1.7% and 0.8%. The anti-HAV IgG positivity rate increased with increasing age (p

Çocuklarda On Yıllık Hepatit A, B ve C Seroprevalans Trendi: Tek Merkez Sonuçları

Aim: Hepatitis B vaccination since 1998 and hepatitis A vaccination since 2012 is available in the childhood routine vaccination program in Turkey. There is no vaccine for hepatitis C yet. The seroprevalence of hepatitis A, B, and C differs between regions. For this reason, each region should assemble its own rates. Therefore, this study aimed to determine the seroprevalence of hepatitis A, B, and C in children in Kastamonu province, to evaluate whether there is a change in prevalence according to years and patient age, and to review whether there is a change in hepatitis A virus seroprevalence with hepatitis A vaccination.&#x0D; Material and Methods: File records of all patients under 18 whose hepatitis serology was studied at Kastamonu Training and Research Hospital between 01.01.2012 and 21.12.2021 were reviewed retrospectively.&#x0D; Results: A total of 19885 patients and 55738 test results were included in the study. Accordingly, hepatitis A seroprevalence increased year by year. Anti-HAV IgG positivity was higher in the vaccinated group, whereas anti-HAV IgM positivity was higher in the unvaccinated group (p

Seroprevalence of Hepatitis A Marker among Food Handlers Receiving Periodical Health Examination in Tainan Area

&lt;p&gt;目的：台灣近數十年來因環境衛生改善A型肝炎盛行率逐年降低，1982年以後出生者大多無保護性抗體。供膳作業人員若感染急性A型肝炎，可能經由其製備之食物傳播造成A型肝炎群聚感染。本研究目的在探討2019-2021年於台灣南部某醫院進行週期性體檢之供膳作業人員A型肝炎血清偵測結果分析。&lt;/p&gt; &lt;p&gt;方法：本研究採用化學冷光微粒免疫分析法Chemiluminescent Microparticle Immunoassay (CMIA)測定檢體，定義anti-HAV IgM Signal/Cutoff (S/CO) &amp;ge;1.2為陽性、0.8&amp;le;S/CO&lt;1.2為邊緣陽性、S/CO&lt;0.8為陰性。並進一步將陽性及邊緣陽性定義為anti-HAV IgM異常（IgM異常）。將個案年齡分為三組：20歲以下、21-40歲及41歲以上。進行羅吉斯迴歸分析性別及年齡分組與IgM異常之相關性。&lt;/p&gt; &lt;p&gt;結果：2019-2021年共收案4,798件anti-HAV IgM檢體，其中供膳體檢佔4,532件(94%)。供膳體檢4,532件中，陽性12件(0.3%)，邊緣陽性27件(0.6%)。IgM異常者以女性及41歲以上組較多（女性30件 vs. 男性9件 [p=0.012]；41歲以上組31件 vs. 21-40歲組8件 [p&lt;0.001]）。20歲以下組243人檢體皆為陰性。羅吉斯迴歸分析發現女性(AOR 2.66 [CI 1.26-5.63])及41歲以上組(AOR 5.23 [CI 2.40-11.42])是IgM異常的獨立影響因子。在IgM異常者之次分析中，檢體呈邊緣陽性之個案肝指數皆正常。檢體呈陽性之個案中有兩位肝指數異常，但這兩位供膳作業者並無臨床症狀且後續病毒檢測(HAV RT-PCR)皆為陰性，排除急性A型肝炎感染。&lt;/p&gt; &lt;p&gt;結論：自2019至2021年週期性供膳作業人員體檢anti-HAV IgM篩檢陽性率為0.9%，但絕大多數排除急性A型肝炎。其中女性及41歲以上者較易有偽陽性之情形。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Purpose: In Taiwan, the prevalence of hepatitis A has decreased since 1982 thanks to improved sanitation. Most of the citizens born after 1982 do not have protective antibodies against hepatitis A. Protection is of crucial importance for food handlers as hepatitis A in this population cause cluster infection. The study aims to evaluate the seroprevalence of hepatitis A among food handlers receiving periodical health examinations during the period from 2019 to 2021 in our hospital in Tainan.&lt;/p&gt; &lt;p&gt;Method: We collected 4,798 anti-HAV IgM specimens during the study period, of 4,532 specimens (94%) were from food handlers receiving health examinations. Chemiluminescent microparticle immunoassay (CMIA) method was used to analyze anti-HAV IgM. We defined anti-HAV IgM signal/cutoff (S/CO)&amp;ge;1.2 as positive, 0.8&amp;le;S/CO&lt;1.2 as borderline, and S/CO&lt;0.8 as negative. Positive and borderline results were further defined as abnormal anti-HAV IgM. We separated the participants into 3 age groups, &lt;20 years old; 21-40 years old, and &gt;41 years old. Multivariate logistic regression model was applied to evaluate the association between sex, age groups, and abnormal anti-HAV IgM.&lt;/p&gt; &lt;p&gt;Results: Among the 4,532 anti-HAV IgM specimens, 12 positive results (0.3%) and 27 borderline results (0.6%) were detected. A greater cases of abnormal anti-HAV IgM was detected in the female group and the &gt;41 years old group (30 in the female group vs. 9 in the male group [p=0.012]; 31 in the &gt;41 years old group vs. 8 in the 21-40 years old group [p&lt;0.001]). There was no abnormal anti-HAV IgM in the &lt;20 years old group. Adjusting for multiple covariates, we found that being female and an aged over 41 years old were independent risk factors for abnormal anti-HAV IgM. Results of subgroup analysis indicated that all subjects in the borderline group had normal liver enzymes. In the positive group, two subjects had abnormal liver enzymes. However, they received HAV RT-PCR and the results were negative, suggesting the absence of acute hepatitis A.&lt;/p&gt; &lt;p&gt; Conclusion: Our survey on anti-HAV IgM among food handlers receiving health examinations during the period from 2019 to 2021 indicated a 0.9% abnormality rate. However, acute hepatitis A was excluded in most of the examined cases. Females and those aged over 41 years old were identified to be more likely to have anti-HAV IgM false positive.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

An Asymptomatic Patient with Persistent Anti-HAV IgM and Anti-HAV IgG: A Case Report and Literature Review

&lt;p&gt;?一名61歲女性，因職業為供膳人員而需要每年健檢，2015年於本院健檢時意外發現A型肝炎病毒IgM抗體(anti-HAV IgM)呈現陽性反應，懷疑是急性A型肝炎感染，因而轉至胃腸肝膽科門診檢查。個案本身並無症狀，實驗室報告顯示並無異常。隔年健康檢查仍發現anti-HAV IgM呈現陽性，再次安排實驗室檢查及理學檢查，也無顯示任何異常，隨後入院接受肝臟切片病理檢驗，但報告亦無特異性表現，且個案於住院期間也無任何不適。本次入院前，個案在外院也檢查了A型肝炎病毒IgG抗體(anti-HAV IgG)，發現也呈現陽性反應，且後續追蹤直至2020年期間，個案的anti-HAV IgM及anti-HAV IgG皆持續呈現陽性反應。持續性anti-HAV IgM陽性並不常見，本文針對造成持續性anti-HAV IgM陽性的原因，進行文獻回顧，並分析此案例可能的原因及後續適當之處理程序。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;A 61-year-old female restaurant caterer had received regular annual health examinations. In 2015, hepatitis A virus immunoglobulin M antibody (anti-HAV IgM) was detected, though she showed no symptom or sign of HAV infection. She was then transferred to the gastroenterology (GI) outpatient clinic where she underwent further laboratory tests that revealed no specific findings. Medical certificates were therefore issued and regular follow-ups arranged. However, reactive anti-HAV IgM persisted with reactive result of anti-HAV IgG in 2016, and laboratory tests again showed negative findings. She was accordingly admitted for liver biopsy. Nevertheless, the pathology report also revealed no sign or symptom of infection, and she did not report any symptoms of HAV infection. As a result, she was discharged for annual monitoring. During the period from 2017 to 2020, she had visited our family medicine outpatient clinic for regular follow-ups; anti-HAV IgM and anti-HAV IgG were followed and revealed reactive findings. Persistent anti-HAV IgM is rare in the literature, and concurrent persistent anti-HAV IgG is even more unusual. In this article, we present a rare case of the above condition while the literature of persistent anti-HAV IgM is also reviewed.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Comparative evaluation of four commercial analyzers for the serological screening of hepatitis A, B, C and HIV.

Independent evaluations that deploy clinical patient samples are important in assessing the performance of commercial tests used for serological screening of viral hepatitis and HIV in clinical laboratories. We compared the analytical performance of Abbott Architect i2000SR, Abbott Alinity i, DiaSorin Liaison XL, and Siemens Atellica for the following analytes: anti-HAV IgG/anti-HAV total, anti-HAV IgM, HBsAg, anti-HBc IgM, Anti-HBc, HBeAg, anti-HBe, anti-HBs, anti-HCV, and HIV Ag/Ab. In addition, anti-HBc IgM, HBeAg, and anti-HBe were evaluated for Abbott Architect, Abbott Alinity and DiaSorin Liaison. Pseudonymized clinical serum specimens (N=98-200 for each analyte) were selected for the analysis according to their reactivity on the Abbott Architect. The results were compared against Abbott Architect and against consensus. A generally high agreement was observed between the tests. Abbott Alinity had the lowest anti-HAV IgG/total specificity (75.9% against Abbott Architect and 83.0% against consensus). The comparatively low sensitivity of Siemens Atellica (78.2%), Abbott Alinity (87.5%) and DiaSorin Liaison (89.3%) for anti-HAV IgM against Abbott Architect may reflect a higher false-positive rate of Abbott Architect. Particular variation was observed in the sensitivity values of anti-HBc, HBsAg and HIV Ag/Ab between the test methods. DiaSorin Liaison anti-HBs gave consistently higher values as compared to the other tests. The serodiagnostic methods for HIV and viral hepatitis of Abbott Architect, Abbott Alinity, DiaSorin Liaison, and Siemens Atellica performed well in comparison with each other. The observed differences between the tests will provide useful information for clinical laboratories in planning their workflows for screening and confirmation.