High Prevalence Of Hepatitis B Virus Infection Research Articles

533 Infection with hepatitis B, C, and HIV in children with cancer in turkey

Turkey is considered to be an area of endemic hepatitis B virus (HBV) infection. Prevalence of HBV infection in the pediatric age group is 9.8%. Pediatric cancer patients are at an increased risk for hepatitis B, C and HTV infection because of repeated blood transfusions and immunosuppressive chemotherapy. Serological markers for hepatitis B, C and HIV were studied in 102 newly diagnosed pediatric oncology patients at the beginning of therapy between July 1993–December 1994. The age ranged between 7 months and 17 years with a mean of 10 years. 24 patients had Hodgkin's disease, 15 had Ewing's sarcoma, 11 had non-Hodgkin's lymphoma, 10 had osteosarcoma, 8 had Wilms' tumor, 7 had rhabdomyosarcoma, 6 had neuroblastoma, 4 had soft tissue sarcoma, 3 had germ cell tumour, 3 had primitive neuroectodermal tumour, 3 had brain tumour, 2 had hepatoblastoma, 2 had nasopharynx carcinoma, 1 had Langerhans cell histiocytosis, 1 had optic glioma, 1 had tyroid carcinoma and 1 had unclassified tumour. Four patients (4%) had contact with HBV, 15 (14%) developed immunity against HBV and had anti HBs antibodies. One patient had a previous infection with positive anti HBc. Hepatitis C virus (HCV) antibodies were positive in only 1 patient (0.9%). HIV serology was negative in all patients. These results show high prevalence of HBV infection in pediatric oncology patients. In HBV endemic countries, strict HBV screening of blood donors, usage of disposable equipment and vaccination of patients is recommended.

Prevalence of Antibody to Hepatitis C Virus in Saudi Blood Donors

The prevalence of antibodies to hepatitis C virus (anti-HCV) was retrospectively determined using a second generation enzyme immunoassay in 3868 blood donors from the southern part of Saudi Arabia in an area with high prevalence of hepatitis B virus (HBV) infection. Of 3354 Saudis, 48 (1.43%) were seropositive for anti-HCV. A high prevalence (43 of 204, 21.08%) of anti-HCV was observed among Egyptian donors compared with Saudis (1.43%) and other nationalities (eight of 310, 2.58%). Furthermore, the prevalence of anti-HCV antibodies was observed to increase with age, peaking in the 25 to 34 year age group. From this and other studies conducted in different regions of Saudi Arabia, the prevalence of anti-HCV among Egyptian donors appears to range from 19.2 to 24.5%, and among Saudi donors appears to range from 1.00 to 1.7%, a rate similar to that reported from western countries; this latter rate does not seem to be influenced by the high prevalence of HBV infection in this region.

Protracted Outbreak of Severe Delta Hepatitis: Experience in an Isolated Amerindian Population of the Upper Orinoco Basin

In an investigation of a 21-year-old epidemic of severe hepatitis, 80 serum samples were studied from two isolated Yanomami Amerindian populations of the Upper Orinoco basin in Venezuela. Of the assayed samples, 30.6% were positive for hepatitis B surface antigen (HBsAg), 53.7% were considered to reflect immunity to infection with hepatitis B virus (HBV), and only 16.2% were believed to reflect susceptibility to HBV infection; 82.5% of the samples tested positive for any marker of HBV infection. Thirty-one (39.7%) of 78 samples were also positive for antibody to delta antigen, including 91.6% of those positive for HBsAg and 20.9% of those immune to HBV. Our findings provide evidence of a high prevalence of HBV infection in this population. Furthermore, the high prevalence of antibody to delta antigen strongly suggests that coinfections with HBV or superinfections with hepatitis delta virus (HDV) in HBV carriers may be an important factor in the occurrence of an unusually high number of cases of fulminant hepatitis and of chronic liver disease. Serum samples obtained at the beginning of the outbreak 13 years earlier from 36 selected cases in the same population revealed a high rate of HBV infection (96.5%). All six HBsAg carriers from whom enough serum remained to be assayed were positive for antibody to delta antigen. Our findings indicate that the outbreak coincided with the introduction of HDV into a population with an already-high prevalence of HBV infection.

Perinatal transmission of hepatitis B virus in highincidence countries

Hepatitis B is a serious public health problem throughout the world. Hepatitis B virus (HBV) induces acute hepatitis with a case-fatality rate of about 1%. Even more important, 5–10% of patients infected with HBV become chronic carriers and about 25% of these will die due to cirrhosis and hepatocellular carcinoma. The reservoir of HBV chronic carriers in the world is estimated at more than 200 million people and 80% of them reside in Asia and the western Pacific. In high-incidence areas, such as south-east Asia, perinatal transmission of HBV from carrier mothers to newborns appears to be the most important factor for the high prevalence of HBV infection and 70–90% of infants born to HBsAg/HBeAg-positive mothers become chronic carriers. Three possibilities of transmission of HBV from carrier mothers to newborns are suggested: (a) transplacental transmission in utero — it was estimated that such transmission occurred in 5–15% of newborns; (b) transmission during delivery, which is considered the main mode of perinatal transmission; (c) postnatal transmission from mother to newborn, which is not common. HBeAg is the main maternal factor in determining whether infection of newborns will occur; the expression of this antigen seems to be determined genetically. Recently it has been shown that immunoprophylaxis is highly effective in preventing the development of the carrier state in infants born to HBsAg/HBeAg-positive mothers. Only 5–10% of high-risk infants are not protected by vaccination. If it becomes possible to immunize the entire world population including all babies born to carrier mothers at birth, and if our knowledge of the mechanisms of perinatal transmission of HBV is accurate, the carriers and acute cases of HB ought to disappear in two to three generations.

Fulminant Hepatitis in Asymptomatic Hepatitis B Surface Antigen Carriers in Greece

Eleven male fulminant hepatitis (FH) patients (mean age: 47.7 +/- 16 years) positive for hepatitis B surface antigen (HBsAg) but negative for IgM antibody to hepatitis B core antigen (IgM anti-HBc) were admitted consecutively to the Athens Hospital for Infectious Diseases between May 1981 and November 1983. Because of the absence of IgM anti-HBc, determined by an enzyme immunoassay, these patients were considered to be HBsAg carriers with a superimposed acute hepatitis. Three of the 11 patients received immunosuppressive chemotherapy during the six months before the onset of the acute hepatitis. None of the patients was homosexual or a drug addict. Infection with hepatitis A virus (HAV), hepatitis B virus (HBV), or hepatitis delta virus (HDV) was detected with serologic markers and/or molecular hybridization techniques. Fulminant hepatitis was attributed to spontaneous reactivation of chronic hepatitis B in four patients, chemotherapy-induced reactivation of chronic hepatitis B in three patients, HDV superinfection in one patient and possible superinfection by non-A, non-B agent(s), HDV, or HDV-like agents in three patients. Reactivation of chronic hepatitis B was an important cause of apparent acute hepatitis in heterosexual male HBsAg carriers from an area with a high prevalence of HBV infection.

Double infections with hepatitis A and B viruses.

Ten (2.8%) asymptomatic carriers of HBsAg and four (1.1%) patients with acute hepatitis B virus (HBV) infection were detected among 356 adults with acute viral hepatitis A (HAV) consecutively admitted to the Athens Hospital for Infectious Diseases from May 1981 to March 1984. These patients did not differ in clinical, epidemiologic (except in age), biochemical or serologic characteristics from patients acutely infected with HAV alone. Transient suppression of the HBV replication and disappearance of the HBV DNA accompanied by seroconversion from HBeAg positive to anti-HBe positive were detected in one and two carriers respectively. The titer of non-class-specific anti-HBc was low (less than or equal to 10(-2)) in all cases. These data suggest that superinfection of HBsAg carriers with HAV does not cause more severe disease or influence adversely the course of chronic hepatitis B disease. However, accurate diagnosis of double infections is necessary for prognosis of the liver disease and appropriate management of the patient's environment. This is quite important in areas with a high prevalence of HBV infections, like Greece, where double infections are relatively common.

Hepatocellular carcinoma in the U.S.A., etiologic considerations: Localization of hepatitis B antigens

The serologic and tissue markers of hepatitis B virus (HBV) were studied in 50 patients in whom hepatocellular carcinoma (HCC) was confirmed at autopsy. Serologic and tissue markers included serum hepatitis B surface antigen (HBsAg), tissue HBsAg, tissue hepatitis core antigen (HBcAg), and serum antibody to HBcAg (anti-HBc). Twenty-two patients had HCC arising in alcoholic cirrhosis; 2 of the 22 (9.1%) had one or more of the HBV tissue and serologic markers. This infection rate is similar to the rate of 7.9% observed in 63 control alcoholic cirrhotic patients without HCC. In contrast, 15 of 20 (75.0%) patients with HCC in nonalcoholic chronic active liver disease showed evidence of active HBV infection. One of 8 patients with HCC in normal liver had serum HBV markers. This result indicates that there is an extremely high prevalence of HBV infection among HCC patients with nonalcoholic chronic liver disease in the U.S.A. The prevalence of HBV infection in these patients is as high as that observed in Asia and Africa. Thus, it can be concluded that the lower prevalence rate of active HBV infection in HCC patients in the U.S.A. is the result of statistical dilution of HCC-B-viral disease by the large numbers of the alcoholic cirrhotic patients with HCC, and that if chronic active hepatitis type B were as common in the United States as it is in Africa and Asia, the frequency of occurrence of HCC might also be as high.