Epidemiology Of Viral Hepatitis Research Articles

Epidemiology of Viral Hepatitis in the Indigenous Populations of the Arctic Zone of the Republic of Sakha (Yakutia).

The indigenous populations of the Arctic regions of Russia experience the lowest coverage of health-related services. We assessed the prevalence of hepatitis A, B, C, D and E viruses (HAV, HBV, HCV, HDV and HEV) among 367 healthy adult Native people of the Arctic zone of Yakutia. The HAV seroprevalence was above and increased with age. The anti-HEV IgM and IgG antibody detection rates were 4.1% and 2.5%, respectively. The average HBsAg detection rate was 4.6%, with no positive cases identified in participants aged under 30 years, confirming the effectiveness of the newborn vaccination program that began in 1998. Anti-HDV antibodies were detected in 29.4% of HBsAg-positive cases. The anti-HCV and HCV RNA detection rates peaked in the age cohort of 50-59 years (10.8% and 3.9%). No statistically significant gender differences in the prevalence of different viral hepatitis were observed. The time-scaled phylogenetic analysis demonstrated that all HBV genotype A and D strains isolated in this study were autochthonous and had an estimated most common recent ancestor (MCRA) age of around the 11th to 14th century. Unlike HBV, the HCV strains of subtypes 1b, 2a and 2k/1b were introduced from other regions of Russia in the 1980s and 1990s. The HCV 1b sequence analysis revealed a series of transmission events. In conclusion, these data emphasize the urgent need for expanded viral hepatitis screening and care programs in the indigenous populations of the Arctic zone of Yakutia.

Study of the stability of dental implants on the background of the hepatobiliary system pathology

Annotation. Today, dental implantation is one of the most important methods for restoring dental defects. This method allows restoration of tooth row defects without preparation of hard tooth tissues. Endoosseous dental implantation in patients with concomitant pathology requires special attention, among which pathology of the hepatobiliary system stands out, which has recently tended to increase. This is primarily due to the epidemiology of viral hepatitis, deterioration of the external environment, and complex social conditions of life. The purpose of our work was to investigate the stability of dental implants using the analysis of frequency-resonance indicators in patients with hepatobiliary system pathology. A study of the stability coefficient was conducted in 26 patients who had intraosseous dental implants installed. All patients were divided into 2 groups: the first – main (14 patients) – without pathology of the hepatobiliary system; the second – comparative (12 patients) - included patients who had disorders of the hepatobiliary system, which were established on the basis of the collected anamnesis and violations of biochemical indicators. There were equal numbers of men and women in each group. There were 8 (57.2%) women and 6 (42.8%) men in the first group, and 5 (41.7%) men and 7 (58.3%) women in the second group. For all patients, dental intraosseous implantation was performed in one or two zones of included defects. After the installation of dental intraosseous implants, the stability of the dental implant was determined using a frequency-resonance study. Similar studies were also conducted after the opening of the dental implants before the installation of the orthopedic structure after 6 months. The results. We found a significant difference in the coefficient of stability of dental implants in patients with hepatobiliary system pathology and without liver pathology (p<0.05). In the main research group, the following coefficients of stability of dental implants were obtained: immediately after the installation of dental implants intraoperatively, a study of indicators was carried out, which corresponded to the level of 70,41±2,97 points, and already after 6 months this indicator of the stability coefficient in±creased and was fixed at the level 75,41±2,59 points. In the patients of the second research group (comparison), immediately after the installation of dental implants, the stability coefficient was at the level of 42.56±3.53 points, and 6 months after the installation of dental implants – 44,39±3,26 points. Liver pathology negatively affects the coefficient of stability of dental implants and their osseointegration, worsening them by 1,7 times. With liver pathology, osteopenia is observed, which requires preoperative and postoperative hepatoprotective correction and osteotropic therapy.

The Changing Epidemiology of Viral Hepatitis in a Post-Soviet Country-The Case of Kyrgyzstan.

Historically, viral hepatitis has been a considerable public health problem in Central Asian countries, which may have worsened after the dissolution of the Soviet Union. However, up-to-date seroepidemiological studies are lacking. The aim of the present study was, therefore, to provide current estimates of the seroprevalence of viral hepatitis in Kyrgyzstan, one of the economically least developed countries in the region. We conducted a population-based cross-sectional study in 2018 in the capital of Kyrgyzstan, Bishkek (n = 1075). Participants, children and adults, were recruited from an outpatient clinic. The data were collected during face-to-face interviews. A blood sample (6 mL) was collected from each participant and tested with ELISA for the presence of serological markers for five viral hepatitides (A, B, C, D, and E). Post-stratification weighing was performed to obtain nationally representative findings. The overwhelming majority of the study participants were positive for anti-HAV (estimated seroprevalence, 75.3%; 95% confidence interval, 72.5-77.9%). The weighted seroprevalence estimates of HBsAg, anti-HCV, and anti-HDV were 2.2% (1.5-3.3%), 3.8% (2.8-5.1%), and 0.40% (0.15-1.01%), respectively. Anti-HEV seropositivity was 3.3% (2.4-4.5%). Of the 33 HBsAg-positive participants, five (15%) were anti-HDV-positive. Our study confirms that Kyrgyzstan remains a highly endemic country for hepatitis virus A and C infections. However, seroprevalences of HBV and HDV were lower than previously reported, and based on these data, the country could potentially be reclassified from high to (lower) intermediate endemicity. The observed anti-HEV seroprevalence resembles the low endemicity pattern characteristic of high-income countries.

MO834: The Epidemiology of Hepatitis B And C Infection in Hemodialysis Patients in Kazakhstan

Abstract BACKGROUND AND AIMS Hemodialysis patients are more likely than the general population to contract hepatitis B virus and hepatitis C virus. In Kazakhstan, there is no research on HBV and HCV in this population. The major goal of this study is to find out how common HBV and HCV infections are among hemodialysis patients in Kazakhstan, as well as their risk factors, the impact of hepatitis on the survival of patients with ESRD undergoing hemodialysis survival analysis was conducted using Kaplan–Meier method and Cox proportional hazards regression modelling. Data from the Unified National Electronic Health System (UNEHS) for the period of 2014–9 were used to study the epidemiology of viral hepatitis in patients with ESRD receiving hemodialysis in Kazakhstan. METHOD The study population consisted of 9310 patients with ESRD undergoing hemodialysis, whose individual records were obtained from the ‘Registry of Chronic Kidney Disease’ (RCKD) within UNEHS for the period of 2014–8. This cohort was cross-referenced with a cohort of hepatitis patients based on population registry number (RPN) for the purpose of identifying ESRD patients undergoing hemodialysis who had been diagnosed with hepatitis before the end of 2018. Utilizing one-to-one closest neighbor propensity score matching, a control group from among the dialysis patients with no diagnosed hepatitis was derived with sufficient bias reduction based on age, gender, education, region and ethnicity. Crude survival analysis was conducted using Kaplan–Meier method to compare the survivability of dialysis patients based on the presence of hepatitis and relative time of hepatitis diagnosis. Hepatitis diagnoses that took place in the 120 days since dialysis initiation were classified as prior hepatitis. Any later hepatitis diagnoses were considered as infection developed after the start of dialysis. All statistical analyses were conducted using STATA 15 MP/IC Version (STATA Corporation, College Station, TX). The study was approved by the Institutional Review Ethics Committee (NU-IREC 203/29 112 019), with exemption from informed consent. RESULTS Among the dialysis patients, 500 were diagnosed with hepatitis in 2014–8 or earlier. Propensity score matching resulted in a loss of two cases due to lack of appropriate controls, resulting in a final cohort of 996 patients with 498 cases and 498 controls. Within this cohort, survival analysis was conducted. Figure 1 illustrates the Kaplan–Meier survival probability curves, where a consistently and significantly lower survivability is apparent among dialysis patients without hepatitis, as compared with those with hepatitis. Figure 2 shows the comparison of survival probabilities of patients diagnosed with prior or consequent hepatitis infection, relative to the time of dialysis initiation. A significantly lower survivability is visible among patients with prior hepatitis infection, as compared with those with consequent hepatitis infection. Both graphs are limited to 5 years of follow-up, with dates of patients’ dialysis initiation as the start points of individual follow-up periods. Both graphs contain the P-values of log-rank significance tests of the difference between the survival curves. CONCLUSION Viral hepatitis continues to be a serious complication in patients with HD, with HCV being the most common. Internationally, HCV infection is almost never treated in patients on HD. Our data inform in incident (<120 days) patients undergoing HD, HCV prevalence was around 5.4%. Patients with HBV and HCV on HD survival rate is higher than in patients without hepatitis receiving HD. The key to reducing the incidence of viral hepatitis in patients with HD is the development of an infection control system and interaction between the dialysis center and the hepatology center.

Sero-prevalence of HBsAg and anti-HCV Co-infection among Pregnant Women Accessing Primary Health Care (PHC) Maternity of Lamurde, Mubi-South, Adamawa State, Nigeria

The epidemiology of viral hepatitis among pregnant women is of paramount significance in policy and decision making and the provision of effective and adequate antenatal care, especially in the grassroots health care facilities like that of our study area. This study is cross-sectional hospital-based research aimed at investigating the seroprevalence of HBsAg and anti-HCV among pregnant women accessing PHC maternity in Lamurde, Mubi for antenatal care. Blood samples from all the 100 consenting pregnant women were screened for HBsAg and anti-HCV antibodies using rapid diagnostic kits. A total of 11(11.0%) of the pregnant women tested were seropositive for HBsAg and none 0.0(0.0%) of the participants tested were seropositive for anti-HCV. Hepatitis B surface antigen (HBsAg) seropositivity was highest in the age group 26-30yrs (17.4%) and least in the age group 16-20yrs (3.4%). However, no single case of HBsAg and or anti-HCV was recorded in the age groups 31-35. Most of the participants (55.0%) in this study were those without formal education. The highest (18.5%) prevalence rate of HBsAg was reported among pregnant women with secondary education, closely followed by pregnant women with primary education (18.2%). The association between educational status and infection with hepatitis B virus (OR =3.75, 95% CI = 0.931-15.08) showed that the odds were 3.75 times higher that pregnant women with formal education will be infected with HBV when compare with pregnant women with no formal education, but with no statistical difference. In view of the above result and the likelihood of mother-to-child transmission of hepatitis viruses, there is a need to institute compulsory routine screening for these viruses for all pregnant women attending antenatal care in Mubi

Epidemiology of HCV and HBV in a High Endemic Area of Southern Italy: Opportunities from the COVID-19 Pandemic-Standardized National Screening or One Tailored to Local Epidemiology?

Simple SummaryEpidemiological data on viral hepatitis are essential to optimize screening programs. For HCV, the Italian Health Ministry planned a cohort screening for those born in 1969–1989. In order to update the epidemiological data of viral hepatitis in a highly endemic area of Southern Italy and assess whether the screening programs currently planned by the Italian government for those born between 1969–1989 will be effective, a retrospective multicenter study was carried out enrolling all COVID-19 hospitalized patients screened for markers of HCV and HBV infection. Indeed, the COVID-19 pandemic has resulted in access to the national health system of an unselected population similar to the general one. Among the 2126 patients evaluated, HBsAg and HCV-Ab prevalence was 1.6% and 5.1%, respectively. For HCV infection, a bimodal distribution was observed, with peaks in the birth cohorts 1930–1939 and 1960–1969 (11.6% and 5.6%, respectively). An analysis of the screening period imposed (born: 1969–1989) demonstrates that only 17% of HCV infection could be captured. Thus, an alignment of the screening period (i.e., birth cohort 1960–1984) would capture 40% of cases. Data show a high endemicity of hepatitis virus in our geographic area and the need for a tailored regional screening program.The COVID-19 pandemic led to the hospitalization of an unselected population with the possibility to evaluate the epidemiology of viral hepatitis. Thus, a retrospective multicenter study was conducted in an area of Southern Italy with the aim of assessing the prevalence of HCV and HBV markers and the ability of current screening program to capture cases. We evaluated 2126 hospitalized patients in seven COVID Centers of Naples and Caserta area in which 70% of the Campania population lives. HBsAg and HCV-Ab prevalence was 1.6% and 5.1%, respectively, with no differences between gender. Decade distribution for birth year shows a bimodal trend of HCV prevalence, with a peak (11.6%) in the decade 1930–1939 and a second peak (5.6%) for those born in 1960–1969. An analysis of the screening period imposed by the Italian government for those born between 1969 and 1989 shows that only 17% of cases of HCV infection could be captured. A small alignment of the screening period, i.e., those born from 1960 to 1984, would capture 40% of cases. The data confirm the high endemicity of our geographical area for hepatitis virus infections and underline the need for a tailored screening program according to the regional epidemiology.

Epidemiology of viral hepatitis C: Road to elimination in Japan.

Although HCV infection was the main cause of HCC in Japan contributing 70% over two decades after its first cloning in 1989, it was markedly decreased to 49% in 2013 and expected to decrease continuously. Based on blood donor national database, the new incident cases were 0.4/100,000 person-years, the prevalence was 0.13% and the total number was 890,902-1,302,179 in 2015. Establishment of blood donor screening with anti-HCV measurement and nucleic acid test introduced by Japanese Red Cross as pioneer, high-level medical and surgical care, and the government's policy under the Basic Act on Hepatitis Control have changed its epidemiology and outbreak trend and also enforced the disruption of potential transmission cascades. HCV prevalence among the younger generation was extremely low in all regions, and the predominant age for HCC has shifted to over 60 years old population. Considering such changes, HCV induced HCC occurrence is supposed to be ultimately suppressed in the near future. However, taking into account society changes, regulating intravenous drugs users and monitoring high-risk groups such as tattoos, and men who have sex with men are indeed required in Japan. Understanding the epidemiological changes in HCV is important in assigning, modifying, and designating effective response systems. Selective or national action plans, strategic approaches, and cooperation between government sectors have a positive impact on HCV prevention and control. A dramatic decrease in total number of HCV carriers, increase in number of people treated with highly effective DAA, and subsequent high SVR indicates Japan might achieve WHO's target of HCV elimination by 2030.

Prevalence and associated risk factors for hepatitis B and C viruses among refugee populations living in Mahama, Rwanda: A cross-sectional study.

As part of the integration of refugees into Rwanda's national hepatitis C elimination agenda, a mass screening campaign for hepatitis B (HBV) and hepatitis C (HCV) was conducted among Burundian refugees living in Mahama Camp, Eastern Rwanda. This cross-sectional survey used data from the screening campaign to report on the epidemiology of viral hepatitis in this setting. Rapid diagnostic tests (RDTs) were used to screen for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV) among people of ≥15years old. We calculated seroprevalence for HBsAg and anti-HCV by age and sex and also calculated age-and-sex adjusted risk ratios (ARR) for other possible risk factors. Of the 26,498 screened refugees, 1,006 (3.8%) and 297 (1.1%) tested positive for HBsAg and Anti-HCV, respectively. HBsAg was more prevalent among men than women and most common among people 25-54 years old. Anti-HCV prevalence increased with age group with no difference between sexes. After adjusting for age and sex, having a household contact with HBsAg was associated with 1.59 times higher risk of having HBsAg (95% CI: 1.27, 1.99) and having a household contact with anti-HCV was associated with 3.66 times higher risk of Anti-HCV (95% CI: 2.26, 5.93). Self-reporting having HBV, HCV, liver disease, or previously screened for HBV and HCV were significantly associated with both HBsAg and anti-HCV, but RDT-confirmed HBsAg and anti-HCV statuses were not associated with each other. Other risk factors for HBsAg included diabetes (ARR = 1.97, 95% CI: 1.08, 3.59) and family history of hepatitis B (ARR = 1.32, 95% CI: 1.11, 1.56) and for anti-HCV included heart disease (ARR = 1.91, 95% CI: 1.30, 2.80) and history of surgery (ARR = 1.70, 95% CI: 1.24, 2.32). Sero-prevalence and risks factors for hepatitis B and C among Burundian were comparable to that in the Rwandan general population. Contact tracing among household members of identified HBsAg and anti-HCV infected case may be an effective approach to targeted hepatitis screening given the high risk among self-reported cases. Expanded access to voluntary testing may be needed to improve access to hepatitis treatment and care in other refugee settings.

Chronic Viral Hepatitis in the Italian Prison Setting: Prevalence, Outcomes, Literature Needs and Perspectives

Compared with the general population, incarcerated people have a higher prevalence of several communicable diseases, including viral hepatitis. Nevertheless, there is still a lack of literature in field. Our review aims to shed the actual knowledge on viral hepatitis among incarcerated people in Italy. We performed a comprehensive literature search, through key electronic databases (Scopus, Pubmed–MEDLINE) and search engines (Google Scholar), of peer-reviewed publications (articles and reviews), grey literature on viral hepatitis prevalence, and models proposed for active case finding and control strategies in prison settings. We found that viral hepatitis epidemiology drastically changed in the last five years, particularly on hepatitis C virus (HCV), reporting an HCV antibody (HCV-Ab) prevalence decrease from up to 38% to ˂20% in penitentiary institutes, as well as an even more important reduction in active infections. Probably, the availability of direct-acting antivirals is contributing to this scenario. However, there is a lack of data available regarding incarcerated women. For this reason, more tailored interventions are needed for this sub-population. Judiciary and regulatory bodies should be prompted to discuss and define specific regulations to optimize case active finding strategies, guarantee wide access to effective preventive and treatment options for viral hepatitis and enhance treatment management.

Epidemiological characteristics of viral hepatitis in the Varna region for 2014-2019. Part two

Viral hepatitis is identified as a major global public health problem affecting several hundred million people. The severity of the hepatitis infection is not evenly distributed worldwide. Every year, 1.4 million people die from viral cirrhosis and hepatitis-related liver cancer. However, the majority of the infected population is unaware of their status. Therefore, prevention remains the best strategy to reduce viral hepatitis. Aim To study the epidemiology of viral hepatitis in Varna for the period 2014-2019. Materials Quick notifications, registration documents, reports, analyzes of laboratory tests of the Regional Center for Transfusion Hematology (RCTH) Varna and Virology Laboratory of RHI Varna, NCIPD Sofia, health education materials. Methods Documentary, statistical, laboratory, partial epidemiological analysis, graphic presentation of results. Results Viral hepatitis by settlement have a high relative share of 86.12% in cities as opposed to 11.55% in villages. A total of 1557 people were contacted, and 99.2% of them were examined according to the normative requirements. Mainly adult men with small fluctuations in age are ill. Morbidity in men between 30-34 years of age is (37.97%ооо) in 2014, for 2015 the leading age is 45-49 years with morbidity (33.47%ооо) in 2017, > 65-year-olds with morbidity (13.20% ооо) in 2016 and 2019. Conclusions The comparative shares of ill people when divided into groups are: for students - (5.11%), for Kindergarteners - (1.37%), for workers in a food establishment - (0.37%). Age-related morbidity shows that there are no diseases up to 1 year, while there are single cases for the age group of 1-4 year-olds. A prophylactic study in RHI and RCTH in blood donation revealed a total of 857 positive samples for HBsAg and HCV.

The Mutational and Transcriptional Landscapes of Hepatocarcinogenesis in a Rat Model.

SummaryHepatocellular carcinoma (HCC) initiation is characterized by stepwise accumulation of molecular alterations, during which the early events are largely unknown. Here, we presented a comprehensive genomic and transcriptomic landscape at stages of hepatitis, cirrhosis, and HCC by using a diethylnitrosamine-induced rat HCC model. We observed the early occurrence of gene instability and aberrant cancer associated signaling pathways in liver hepatitis. We further characterized the progressive molecular changes during hepatocarcinogenesis, wherein the intense rivalry between tumor-suppressive and oncogenic strengths occurred in cirrhosis stage. Despite the significant pathological difference, mutation signatures and expression landscape are highly similar between hepatitis and cirrhosis stages. Furthermore, we identified PI3K-Akt signaling pathway as a key pathway in the process of hepatocarcinogenesis through integrative analysis, and PIK3CD is a potential biomarker indicating HCC recurrence. The dynamic immune response during hepatocarcinogenesis, such as continuous decline of monocytes, suggests an immunological intervention strategy beyond chemoprevention for liver cancer.

Viral hepatitis in patients on hemodialysis

Hepatitis B and hepatitis C (HCV) prevalence are higher in people on hemodialysis (HD) than the general population. Through implementation of prevention interventions including vaccines, serologic screening, and post-exposure management, transmissions linked to HD have decreased dramatically. In this manuscript, we review epidemiology of viral hepatitis, summarize current screening and vaccine recommendations, and appraise the available data about efforts to decrease incidence within HD facilities, including isolation of people with viral hepatitis within HD units. Also included is a discussion of the highly effective all-oral HCV treatment options and treatment for HCV in people awaiting kidney transplant.

Revisiting the Epidemiology of Viral Hepatitis C in Rural Areas in Egypt: Results from a Screening Campaign

Abstract Background: Egypt has the highest known prevalence of HCV in the world, a problem which represents a major chal-lenge to healthcare policymakers in the country. Aim of Study: This study aimed to highlight on the prev-alence of HCV infection in rural areas of this country and to clarify the association between different risk factors and the prevalence of HCV infection. Material and Methods: A screening campaign was con-ducted in five villages present in rural Menoufia Governorate. Blood samples from consented participants were tested for HCV antibodies. For assessment of the contribution of different risk factors with hepatitis C infection, we interviewed partic-ipants to complete the study questionnaire. Results were tabulated and analyzed by suitable statistical tests to assess the prevalence of HCV infection in these areas and possible risk factors that are significantly associated with infection. Results: Out of 14000 participants, 14.8% (n=2071) of the screened sample tested positive for HCV antibodies. Various risk factors were significantly associated with higher risk for acquiring HCV including parenteral anti-schistosomaiasis therapy, invasive medical procedures and other important risk factors. Conclusion: One of each six in the population of rural Menoufia is seropositive for HCV. Our results thus confirm the severity of the current disease burden in the Nile Delta of Egypt. There are significant risk factors associated with HCV infection, suggesting the need for more strict infection control measures specially upon using invasive medical procedures.

Hepatotropic viruses (hepatitis A, B, C, D and E) in a rural Brazilian population: prevalence, genotypes, risk factors and vaccination.

People living in settlement projects represent an emergent rural population in Brazil. Data on their health is scarce and there are no data on viral hepatitis in this population. This study investigated the epidemiology of viral hepatitis A-E in residents of settlement projects in central Brazil. During 2011 and 2012, 923 people living in rural settlements in central Brazil were interviewed and tested to estimate the prevalence of exposure to viral hepatitis A-E, to identify the circulating hepatitis B virus (HBV)/hepatitis C virus (HCV) genotypes and risk factors for HBV exposure and to evaluate adherence to the hepatitis B vaccination series. Overall, 85.9, 3.9, 0.4 and 17.3% of individuals showed evidence of exposure to hepatitis A virus (HAV), hepatitis E virus, HCV and HBV, respectively. Among HBV-DNA positive samples (n=8), subgenotypes A1 (n=3) and A2 (n=1) and genotype D/subgenotype D3 (n=4) were identified. Hepatitis D virus superinfection was detected in 0/16 HBsAg-positive participants. A total of 229 individuals showed serological evidence of HBV vaccination. In total, 442 settlers were eligible for vaccination, but only 150 individuals completed the vaccine series. All anti-HCV-positive samples (n=4) were also HCV-RNA positive and identified as subtype 1a. The intermediate endemicity of HAV, the higher prevalence of HBV exposure compared with urban areas and the low compliance with HBV vaccination requires preventive measures focused on rural populations, emphasizing the need for HAV and HBV vaccination.

Epidemiology of Viral Hepatitis in Men Who Have Sex with Men in Mediterranean Europe: A Region-Wide Sero-Surveillance in Rome (Italy)

BACKGROUND: Viral hepatitis caused by HAV, HBV and HCV are a major public health problem worldwide. Men who have sex with men (MSM) are at increased risk of viral hepatitis. In 2017, a voluntary screening and prevention campaign for viral hepatitis was started in Lazio, a Region of central Italy, following a vast epidemic of HAV mainly affecting young MSM. Here we present the results of the sero-surveillance study carried out as a component of the campaign. METHODS: The study enrolled 1,100 MSM people aged 18-45 years participating to the campaign. Eighteen exposure variables were assessed for potential association with outcomes (i.e. serology for HAV, HBV, and HCV). FINDINGS: We found a very low prevalence of immunity against HAV and a significant exposure to high-risk behaviours, suggesting that gay community of Lazio is an ideal setting for HAV outbreaks. Prevalence of different serology profiles for HBV suggests that waning immunity and escape to mandatory vaccination still represent a significant issue in patients older than 35 years. Moreover, waning immunity suggests that patients who were vaccinated at birth may show low antibody levels. Consistently with other studies, prevalence of HCV infection was very low among young MSM. INTERPRETATION: Tailored vaccine programme aimed at immunizing MSM are critical to improve control of HAV in our setting. Findings on HBV epidemiology suggest that there is a need to define a clear strategy to recover patients who escaped vaccination and inform clinicians on the need to booster subjects with low immunity and high risk of exposure, such as MSM. Finally, MSM in Lazio do not represent a special group for HCV neither in terms of risk of infection nor in terms of potential issues for therapy access. FUNDING STATEMENT: The study was funded by Lazio Region Health Authority and Italian ministry of Health “Ricerca Corrente” INMI-Spallanzani. CONFLICT OF INTERESTS: All authors declared no conflict of interest. ETHICS APPROVAL STATEMENT: INMI Spallanzani ethical board approved the study (ethical clearance N.1 of January 24th 2017). Patients were required to sign an informed consent.

Ecological study of viral hepatitis in Brazil: A geographical and temporal analysis

Introduction : Viral hepatitis is a group of diseases that present high hepatotropism and are related to liver dysfunctions, having either an acute or a chronic course. Their worldwide epidemiology is diverse, with several endemic places, such as South America. The objective of this study was to analyze the epidemiology of viral hepatitis in Brazil, in order to better understand its pattern of distribution and evolution. Method: A temporal aggregation study was conducted using the Viral Hepatitis Database of the Brazilian Ministry of Health. The serological markers used were HBsAg and anti-HCV for hepatitis B and C, respectively. Mortality data were collected from the Mortality Information System for deaths attributed to viral hepatitis. The period analyzed was from 2007 to 2016/17. Results: The incidence was 7.88 (95% CI, 7.30-8.45) for hepatitis B and 11.9 (95% CI, 11.15-12.65) for hepatitis C. Mortality attributed to viral hepatitis was 1.61 (95% CI, 1.35-1.87) deaths per 100,000 people. An analysis of municipal distribution data showed several endemic areas. The Brazilian regions most affected by hepatitis B virus were the northern and southern borders, Santa Catarina coast and Espirito Santo state, while hepatitis C virus was mostly present in metropolitan areas such as Porto Alegre and Sao Paulo. Conclusion: Viral hepatitis has a diverse geographic distribution in the Brazilian territory, with highly endemic areas. The distribution differs between hepatitis B and hepatitis C viruses. Keywords: Hepatitis; epidemiology; mortality; Brazil

Epidemiology of hepatitis B, C and D in Malawi: systematic review

BackgroundViral hepatitis is an important public health issue in sub-Saharan Africa. Due to rising mortality from cirrhosis and hepatocellular carcinoma and limited implementation of screening and treatment programmes, it has been characterised as a neglected tropical disease. Synthesis of the existing evidence on the epidemiology of viral hepatitis B, C and D in Malawi is required to inform policy and identify research gaps.MethodsWe searched Pubmed, EMBASE and Scopus for studies reporting the epidemiology of viral hepatitis B, C and D in Malawi from 1990 to 2018. Articles reporting prevalence estimates were included provided they described details of participant selection, inclusion criteria and laboratory methods (detection of HBsAg, anti-HCV or anti-HDV antibody, HCV antigen or HCV RNA or HDV RNA). We assessed study quality using a prevalence assessment tool. Where appropriate, a pooled prevalence was calculated using a DerSimonian Laird random effects model.ResultsSearches identified 199 studies, 95 full text articles were reviewed and 19 articles were included. Hepatitis B surface antigen (HBsAg) seroprevalence was assessed in 14 general population cohorts. The pooled prevalence among adults was 8.1% (95% CI 6.1, 10.3). In 3 studies where HBsAg was stratified by HIV status, no effect of HIV on HBsAg prevalence was observed (OR 1.2 (95% CI: 0.8, 1.6, p = 0.80)). In a single study of HIV/HBV infected individuals, anti-hepatitis D antibody (anti-HDV) prevalence was low (1.5%). HCV antibody prevalence (anti-HCV) ranged from 0.7 to 18.0% among 12 cohorts in general populations. Among three studies which used PCR to confirm current infection, the pooled rate of HCV RNA confirmation among anti-HCV positive individuals was only 7.3% (95% CI: 0.0, 24.3).ConclusionsHepatitis B is highly prevalent in Malawi. There is a paucity of epidemiological data from rural areas where 85% of the population reside, and the Northern region. Priority research needs include large-scale representative community studies of HBV, HDV and HCV seroprevalence, assessment of children following introduction of the HBV vaccine in 2002, prevalence estimates of viral hepatitis among individuals with cirrhosis and HCC and data on HCV prevalence using PCR confirmation, to support a viral hepatitis strategy for Malawi.

Aiming for the elimination of viral hepatitis in Australia, New Zealand, and the Pacific Islands and Territories: Where are we now and barriers to meeting World Health Organization targets by 2030.

Viral hepatitis affects more than 320 million people globally, leading to significant morbidity and mortality due to liver failure and hepatocellular carcinoma (HCC). More than 248 million people (3.2% globally) are chronically infected with hepatitis B virus (HBV), and an estimated 80 million people (1.1% globally) are chronically infected with hepatitis C virus (HCV). In 2015, more than 700000 deaths were directly attributable to HBV, and nearly 500000 deaths were attributable to HCV infection; 2-5% of HBV-infected people develop HCC per annum irrespective of the presence of cirrhosis, whereas 1-5% HCV-infected people with advanced fibrosis develop HCC per annum. The rapidly escalating global mortality related to HBV and HCV related viral hepatitis to be the 7th leading cause of death worldwide in 2013, from 10th leading cause in 1990. Australia, New Zealand, and Pacific Island Countries and Territories fall within the World Health Organization Western Pacific Region, which has a high prevalence of viral hepatitis and related morbidity, particularly HBV. Remarkably, in this region, HBV-related mortality is greater than for tuberculosis, HIV infection, and malaria combined. The region provides a unique contrast in viral hepatitis prevalence, health system resources, and approaches taken to achieve World Health Organization global elimination targets for HBV and HCV infection. This review highlights the latest evidence in viral hepatitis epidemiology and explores the health resources available to combat viral hepatitis, focusing on the major challenges and critical needs to achieve elimination in Australia, New Zealand, and Pacific Island Countries and Territories.

Epidemiology of viral hepatitis in Somalia: Systematic review and meta-analysis study.

AIMTo provide a clear understanding of viral hepatitis epidemiology and their clinical burdens in Somalia.METHODSA systematic review and meta-analysis was conducted as Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search of published studies on viral hepatitis was performed from 1977-2016 in PubMed, Google Scholar, Science Direct, World Health Organization African Index Medicus and the Africa Journals Online databases, as well as on the Ministry of Health website. We also captured unpublished articles that were not available on online systems.RESULTSTwenty-nine studies from Somalia and Somali immigrants (United Kingdom, United States, Italy, Libya) with a combined sample size for each type of viral hepatitis [hepatitis A virus (HAV): 1564, hepatitis B virus (HBV): 8756, hepatitis C virus (HCV): 6257, hepatitis D virus (HDV): 375 and hepatitis E virus (HEV): 278] were analyzed. The overall pooled prevalence rate of HAV was 90.2% (95%CI: 77.8% to 96%). The HAV prevalence among different age groups was as follows: < 1 year old, 61.54% (95%CI: 40.14% to 79.24%); 1-10 years old, 91.91% (95%CI: 87.76% to 94.73%); 11-19 years old, 96.31% (95%CI: 92.84% to 98.14%); 20-39 years old, 91.3% (95%CI: 83.07% to 95.73%); and > 40 years old, 86.96% (95%CI: 75.68% to 93.47%). The overall pooled prevalence of HBV was 18.9% (95%CI: 14% to 29%). The overall pooled prevalence among subgroups of HBV was 20.5% (95%CI: 5.1% to 55.4%) in pregnant women; 5.7% (95%CI: 2.7% to 11.5%) in children; 39.2% (95%CI: 33.4% to 45.4%) in patients with chronic liver disease, including hepatocellular carcinoma (HCC); 7.7% (95%CI: 4.2% to 13.6%), 12.4% (95%CI: 6.3% to 23.0%) and 11.8% (95%CI: 5.3% to 24.5%) in age groups < 20 years old, 20-39 years old and > 40 years old, respectively. The HBV prevalence among risk groups was 20% (95%CI: 7.19% to 44.64%) in female prostitutes, 21.28% (95%CI: 7.15% to 48.69%) in hospitalized adults, 5.56% (95%CI: 0.99% to 25.62%) in hospitalized children, 60% (95%CI: 31.66% to 82.92%) in patients with acute hepatitis, 33.55% (95%CI: 14.44% to 60.16%) in patients with ancylostomiasis, 12.34% (95%CI: 7.24% to 20.26%) in patients with leprosy and 20.19% (95%CI: 11.28% to 33.49%) in schistosomiasis patients. The overall pooled prevalence of HCV was estimated as 4.84% (95%CI: 3.02% to 7.67%). The prevalence rates among blood donors, risk groups, children and patients chronic liver disease (including HCC) was 0.87% (95%CI: 0.33% to 2.30%), 2.43% (95%CI: 1.21% to 4.8%), 1.37% (95%CI: 0.76% to 2.46%) and 29.82% (95%CI: 15.84% to 48.98%), respectively. The prevalence among genotypes of HCV was 21.9% (95%CI: 15.36% to 30.23%) in genotype 1, 0.87% (95%CI: 0.12% to 5.9%) in genotype 2, 25.21% (95%CI: 18.23% to 33.77%) in genotype 3, 46.24% (95%CI: 37.48% to 55.25%) in genotype 4, 2.52% (95%CI: 0.82% to 7.53%) in genotype 5, and 1.19% (95%CI: 0.07% to 16.38%) in genotype 6. The overall pooled prevalence of HDV was 28.99% (95%CI: 16.38% to 45.96%). The HDV prevalence rate among patients with chronic liver disease, including HCC, was 43.77% (95%CI: 35.09% to 52.84%). The overall pooled prevalence of HEV was 46.86% (95%CI: 5.31% to 93.28%).CONCLUSIONOur study demonstrates a high prevalence of all forms of viral hepatitis in Somalia and it also indicates that chronic HBV was the commonest cause of chronic liver disease. This highlights needs for urgent public health interventions and strategic policy directions to controlling the burden of the disease.

HEPATITIS B AND C IN PREGNANT WOMEN ATTENDED BY A PRENATAL PROGRAM IN AN UNIVERSITARY HOSPITAL IN RIO DE JANEIRO, BRAZIL: RETROSPECTIVE STUDY OF SEROPREVALENCE SCREENING.

Hepatitis B and C are diseases with high morbimortality and constitute a global public health problem. In Brazil, the prevalence is not homogeneous, oscillating among different regions, but it is estimated that currently about 1% of the population present chronic disease related to the B virus and that there are 1.5 million infected with the C virus. Despite the development of hepatitis B vaccine, improvement in diagnostic methods and therapeutic advances in the field of viral hepatitis, there is still a large number of people who continues to be infected by these viruses, especially in populations at risk and also due to several factors, including vaccination and migration policies. Vertical and perinatal transmissions are of great importance in the epidemiology of viral hepatitis and the blood tests performed during prenatal care constitute a great opportunity for screening and identifying these viruses. To evaluate the seroprevalence of markers for B and C viruses in women who underwent prenatal care at the Hospital Universitário Antônio Pedro (Antonio Pedro University Hospital) from 2006 to 2013 and to compare the results found with regional data and those described in the specific literature. A descriptive, cross-sectional, quantitative study with retrospective data collected from 635 records of pregnant women attended at the Prenatal Service of the Hospital Universitário Antônio Pedro, Niterói, state of Rio de Janeiro, from March 2006 until December 2013. The database was built in the Microsoft Office Access program and was later exported to Microsoft Office Excel. For the processing and analysis of the data, it was used the SPSS (Statistical Package for Social Science, IBM) version 22.0, for Windows. Twelve cases with positive HBsAg (1.9%), 189 cases with positive anti-HBs (35.9%) and seven positive anti-HCV patients (1.3%) were observed. There was no significant association between age and positivity for HBsAg, anti-HBs and anti-HCV (P =0.205, 0.872 and 0.676, respectively). There was a direct relationship between the anti-HBs positivity and the last four years of the study (P<0.0001). A high prevalence of HBsAg was observed, higher than the expected for the evaluated region; there was a prevalence of anti-HCV, consistent with the current Brazilian reality; and a likely low rate of hepatitis B immunization, with a relatively high rate of susceptibility to this infection and no case of co-infection between B and C viruses and HIV. It is emphasized not only the need to trace hepatitis B and C, without exceptions, during prenatal care, since even though the current advances in therapy may not cure, at least they may allow a better quality of life for patients with chronic disease and the mandatory completion of immunoprophylaxis in all newborns. Special attention should be given to those patients susceptible to HBV, with prompt diagnosis and referral for specific vaccination.