Hepatitis virus non-A, non-B: the cause of a major public health problem in India

Serological studies of hepatitis viruses A and B were carried out on 362 patients with acute viral hepatitis, 130 with fulminant hepatitis, and 56 with subacute hepatitis, and on samples of serum from 230 subjects during epidemics of viral hepatitis. A diagnosis of non-A, non-B viral hepatitis was made when serological tests showed that anti-HAV IgM and anti-HBc IgM were absent. Hepatitis virus non-A, non-B was the causative agent responsible for 58% of cases with acute viral hepatitis, 58% with fulminant hepatitis, 87% with subacute hepatitis, and 66% with epidemic hepatitis. A considerable proportion of patients (6-32%) were infected with both hepatitis virus non-A, non-B and hepatitis virus B. Viral hepatitis non-A, non-B is probably transmitted by infection of drinking-water and is the principal cause of hepatitis in India.     

Acute sporadic non-A, non-B hepatitis in India

A total of 293 sporadic cases of acute viral hepatitis were identified in Kashmir, India, from April 1979 to December 1981; 44 (15%) were found serologically to be hepatitis A, 94 (32%) hepatitis B, and 155 (53%) non-A, non-B type. The non-A, non-B hepatitis observed was a disease of young adults (29.8 +/- 15 years) with slight male predominance (1.4:1). Six of the 155 non-A, non-B cases had history of prior parenteral exposure, while 51 (33%) had a recent contact with another case of jaundice, suggesting that this form of hepatitis was spread by person-to-person contact. Fulminant hepatic failure occurred in 19 cases, and six (31.5%) of the 19 cases occurred in pregnant women. None of 90 non-A, non-B cases followed up six months later had developed chronic hepatitis. The acute sporadic non-A, non-B hepatitis described in Kashmir resembles epidemic non-A, non-B hepatitis epidemiologically and seems to be distinct from the non-A, non-B hepatitis described in the West.     

Social determinants and risk of acute viral hepatitis

The authors examined the relationship between viral hepatitis risk and social determinants in Piedmont region population surveyed by SEIEVA (sistema epidemiologico integrato dell'epatite virale acuta). The education and the working position showed different correlation with incidence rates of different types of viral hepatitis A, B, non-A non-B. The hepatitis A risk is proportional to education and the probability of hepatitis B and non-A non-B is higher in low social classes. This situation is only apparently a balanced risk: the clinical seriousness and the strong probability of complications of hepatitis B and non-A non-B make the risks deeply unequal.     

The effect of underreporting on the apparent incidence and epidemiology of acute viral hepatitis

To determine if passively reported cases of acute viral hepatitis are representative of the affected population, an active surveillance system was set up that identified all persons in Pierce County, Washington, who had been diagnosed by a physician as having acute viral hepatitis in the period March 1 through August 31, 1984. In this county, this was part of an ongoing epidemiologic study of viral hepatitis that had previously included some stimulation of reporting. The active surveillance system covered all primary sources of medical care, including all private physicians who were most likely to see persons with hepatitis. Secondary sources, those that did not provide direct medical care but might be aware of new cases, were also surveyed. The results of active surveillance showed that passive reporting was about 65% complete in Pierce County. No change occurred in the number of hepatitis A cases reported, but hepatitis B cases increased by 50%, and non-A, non-B hepatitis cases increased by 138%. Most of the increase was a result of enhanced reporting from private physicians. The two risk groups most affected by underreporting were homosexual men with hepatitis B and blood transfusion recipients with non-A, non-B hepatitis. During active surveillance, the proportion of persons with hepatitis B who reported homosexual activity was 52% compared with 20% from passive surveillance. Transfusion recipients represented 24% of the non-A, non-B hepatitis reported from active surveillance compared with 9% reported from passive surveillance. Although Pierce County may not be representative of all counties in the United States, persons responsible for public health prevention programs should recognize that data acquired through passive surveillance may not accurately reflect the magnitude of the risk for specific populations or the amount of disease that can be prevented.     

Indirect immunoperoxidase method using a monoclonal antibody and clinico-pathological examination of non-A, non-B hepatitis

For the purpose of diagnosing non-A, non-B hepatitis, an indirect immunoperoxidase method using the monoclonal antibody 48-1 was carried out. Human liver biopsy specimens of 74 cases with various hepatic diseases containing non-A, non-B hepatitis were investigated by using optical microscopy. Moreover, cases with non-A, non-B hepatitis were clinico-pathologically examined. Peroxidase-positive hepatocytes were found in 13 cases of the 74 cases. The thirteen cases were as follows; 8 cases with acute hepatitis (non-A, non-B type), 2 cases with chronic hepatitis (non-A, non-B type), 2 cases with acute hepatitis (B type), 1 case with chronic hepatitis (B type). The frequency of positive peroxidase staining was high (80%) in acute hepatitis (non-A, non-B type), but it was not significant statistically. On histological examination, acidophilic condensation was frequently seen in liver specimens of cases with acute hepatitis (non-A, non-B type). Furthermore, the correlation between acidophilic condensation and peroxidase positive staining was statistically seen. It is suggested that the peroxidase staining by using monoclonal antibody 48-1 is useful for diagnosis of acute hepatitis (non-A, non-B type).     

Trends of hepatitis B and hepatitis C mortality in Canada, 1979-1997

Mortality data from Statistics Canada were analyzed to measure the temporal trends and burden of illness attributed to viral hepatitis in Canada. Analysis of age-standardized mortality rates from 1979 to 1997 showed an increasing trend in mortality for both hepatitis B and non-A, non-B hepatitis (NANBH), most of which are attributed to hepatitis C infections. Hepatitis B and NANBH age-standardized mortality rates increased respectively, from 0.03 and 0.12 deaths per 100,000 population in 1979 to 0.26 and 0.41 deaths per 100,000 in 1997. Male mortality rates were consistently higher than female for both diseases. Among deaths from chronic liver disease, over 1,000 deaths were estimated to have been caused by hepatitis B and hepatitis C annually. Although the hepatitis B or NANBH recorded deaths largely underestimate the true burden of HBV and HCV in Canada, the temporal trends are useful as they reflect changes in the impact of both diseases.     

Viral hepatitis in the US Navy, 1975-1984

The epidemiology of viral hepatitis in US Navy enlisted personnel was reviewed for the years 1975-1984. Hospital discharge summaries of all active duty enlisted personnel admitted to a US Navy treatment facility were used for the study. From 1975 to 1984, total first hospitalizations for viral hepatitis declined from 128 per 100,000 personnel (95% confidence interval (Cl) 118-139) to 56 per 100,000 personnel (95% Cl 50-63). The highest incidence of acute viral hepatitis (115 per 100,000 personnel) was found in the youngest age groups aged 24 years and less. Risk factors for acute hepatitis included a previous hospitalization with either drug abuse (relative risk = 363) or a sexually transmitted disease (relative risk = 25) listed among the discharge diagnoses. Having a medical job classification was also associated with an increased risk of acute hepatitis. The steep decline in the incidence of viral hepatitis during this 10-year period may have been due to decreasing drug abuse in the US Navy. Immunization of high-risk groups in the US Navy with hepatitis B vaccine could be an effective policy for the prevention of acute viral hepatitis.     

Fréquence de l'hépatite sporadique E en C?te d'Ivoire,vue au travers d'une sérologie encore problématique.

The first well-documented outbreak of viral hepatitis E in Africa was described in 1986 in Côte d''lvoire. Subsequently, no other outbreaks have been observed in the country. Côte d''lvoire therefore offers an excellent opportunity to evaluate the prevalence of sporadic viral hepatitis E in a country where the frequency of non-A, non-B, non-C viral hepatitis appears to be high. The study was carried out in Abidjan, the most populous city, and involved 111 hospitalized patients suffering from non-A, non-B and presumed non-C acute viral hepatitis. Screening for leptospirosis or a toxic etiology was carried out and the risk of including such patients eliminated. Diagnosis of viral hepatitis A was excluded from the absence of IgM anti-HAV antibodies. Patients with HBsAg and anti-HCV antibodies were not included in the study, although co-infection in asymptomatic HBV carriers or subsequent infection in patients who had recovered from a past HCV infection remained possible. There was a risk that some patients with late appearance of anti-HCV antibodies were included since PCR tests could not be performed. Cytomegalovirus or Epstein-Barr virus was not involved, since no specific IgMs against these viruses were detectable. Large discrepancies between the two commercial enzyme-linked immunosorbent assays (ELISAs) available for serological diagnosis of hepatitis E (Abbott and Genelabs) were observed. Among the 53 sera screened using both tests, only 20 gave positive results in both, and all such sera were confirmed using a domestic immunological test involving inhibition of labelled, well-documented anti-HEV-specific human IgG. Immunological confirmation was obtained for only half of the sera with discordant results in the commercial ELISAs. Full agreement between both commercial tests was observed for only 59% of the sera studied. The minimal incidence of sporadic viral hepatitis E among hospitalized patients in Abidjan with an acute hepatitis was estimated to be 27%.     

Viral hepatitis and pregnancy in Kuwait

The frequency and severity of viral hepatitis among pregnant and non-pregnant women in Kuwait was studied from 1980 to 1984. 542 female hepatitis patients were investigated, of whom 52 (9.6%) were pregnant. 35 of the 52 (67.3%) cases of viral hepatitis in pregnancy were due to hepatitis B virus while 11 of 52 (21.2%) and 6 of 52 (11.5%) had acute hepatitis non-A, non-B (NANB) and hepatitis A virus infections, respectively. The frequency and severity of viral hepatitis among the pregnant women was similar to that among non-pregnant women. Hepatitis did not have a deleterious effect on pregnancy and no death was recorded. Fulminant acute NANB hepatitis was seen in only one patient, who recovered completely.     

1997至2006年卢湾区乙型肝炎流行病学分析

目的分析卢湾区近10年急性乙型肝炎流行特征。方法由本区各社区卫生服务中心防保人员对在1997年至2006年间接报的常住户籍人口急性乙肝病例开展流行因素调查。结果近10年间累计报告急性乙肝病例442例，年均报告发病率12．76／10万，占急肝发病总数的23．62％。1997至2001年间20～29岁年龄组的急性乙肝发病率最高，为30．44／10万，后5年发病高峰退至30～39岁年龄组，平均发病率较前5年下降50．89％。其中，工人乙肝发病数占乙肝发病总数的26．70％。男女发病比为2．65：1。结论在重点人群中开展预防乙肝、提高自身防护意识的健康教育，对重点人群实施免疫接种、提高肝炎病毒分型能力是预防控制乙肝的重要措施。     

Immunization programme against hepatitis B virus infection in Italy: cost-effectiveness

In Italy in the 1980s the extent of viral hepatitis B infection was on average about 11,000 symptomatic cases of acute viral hepatitis (AVH) per year (19/100,000 inhabitants). The prevalence of HBsAg carriers in the general population was about 3% and in pregnant women 2.4%. 64,000 people were affected by chronic viral hepatitis (CVH) or cirrhosis (prevalence rate 112/100,000) and 3400 by hepatocellular carcinoma (HCC) (prevalence rate 5.9/100,000). To reduce these HBV related pathologies in the Italian population, universal vaccination of newborn babies, 12-year old adolescents and high risk groups was implemented in 1991. The annual cost of this immunization is about 57 million 544 thousand USD: direct costs: 41 million 34 thousand USD; indirect costs: 16 million 510 thousand USD. Concerning the vaccination impact on HBV endemicity in Italy, we found a significant reduction of acute viral hepatitis incidence (4.2/100,000 in 1996 versus 19/100,000 in the '80s) and HBsAg carrier prevalence (0.9% in 1997 versus 3% in the '80s). As for the assistance and social cost of acute viral hepatitis occurring from 1991 to 1996 (17,608 cases) it was 238 million 908 thousand USD, while the cost for the same pathology in the years from 1985 to 1990 (35,614 cases) was 483 million 216 thousand USD. Thus, the saving during the years of the vaccination was evaluated in 244 million 308 thousand USD. At the moment, we have no information about the reduction in chronic sequelae of HBV pathology as an effect of the vaccination, because the incidence of this pathology generally starts to appear after 15 years (in our case in 2006).     

Non-A,Non-B hepatitis; Factors involved in progression to chronicity

A cross-sectional, longitudinal study was undertaken on a group of acute non-A, non-B hepatitis patients, as well as on a control group of hepatitis B patients, in order to assess both the prevalence of the most important factors favoring infection, and the relevance of these factors in promoting evolution towards chronic liver disease. Exposures to unknown risk factors were present in 47.4% of acute non-A, non-B infections, followed by blood transfusions (17.9%), sporadic exposures (17.9%) and drug addiction (16.6%). Unknown as well as sporadic exposures showed a greater prevalence in control population if compared to non-A, non-B cases, while drug addiction was equally represented in the two groups, and blood transfusion nearly absent from control group. The risk of evolution to chronic liver disease was about 13 times greater in non-A, non-B group than in controls, with the greatest risk for drug addicts and the lowest for patients with unknown exposures. Among patients with known exposures, the lowest risk of chronic hepatitis was observed in post-transfusion and in sporadic cases, while the greatest was observed in drug addicts.Corresponding author.     

宁波市1991～2000年甲、乙型病毒性肝炎流行特征

目的 了解宁波市自1991年对病毒性肝炎进行分型报告以来，甲，乙型病毒性肝炎流行特征。方法 对1991-2000年甲，乙型肝炎疫情资料进行综合分析。结果 宁波市1991-2000年甲型肝炎平均报告发病率为52.63/10万，死亡率为0.03/10万，病死率为0.05%；甲型肝炎发病呈缓慢下降趋势，乙型肝炎平均报告发病率为42.55/10万，死亡率为0.17/10万，病死率为0.40%;10年间发病率相对平稳。结论 病毒性肝炎发病呈明显下降趋势，影响宁波市病毒性肝炎的发病高峰主要是甲型肝炎。     

Reactivity of 48-1 antibody with human liver tissue

Reactivity of monoclonal antibody (48-1), produced by the Epstein-Barr Virus (EBV) transformation method using lymphocytes from a chimpanzee infected with non-A, non-B hepatitis, on human liver biopsy specimens from 240 cases was studied. By means of indirect immunoperoxidase study (Secondary Antibody: Horseradish peroxidase labeled anti-human IgM.F(ab')2), the cases with non-A, non-B acute hepatitis showed a high positive reaction (15/24), while those cases with A-type and B-type hepatitis showed almost no reaction, suggesting that this 48-1 antibody strongly related to human non-A, non-B hepatitis. As for staining pattern, cytoplasms of some hepatocytes and large-size histiocytes were stained diffusely in pellet form, and were found scattered in each lobule. In addition, an EM study was made on positive cases using an immunoperoxidase method. However, a definite finding on peroxidase-reactive products was not obtained. We believe that this antibody (48-1) obtained by the EBV method would be useful in investigations of antigen-antibody systems related to non-A, non-B hepatitis.     

浙江省2001—2007年甲乙类肠道传染病疫情分析

目的：了解浙江省甲乙类肠道传染病的流行特征．为制定防控措施提供科学依据。方法：对浙江省2001—2007年甲乙类肠道传染病疫情年报资料进行描述性流行病学分析。结果：7年来浙江省共报告甲乙类肠道传染病4种,共计报告发病数260212例,年报告发病率波动于（56．32～97．13）／10万;其中以痢疾最高,年均报告发病率达43．67／10万。其余依次为病毒性肝炎（已明确分型为乙肝、丙肝者除外）、伤寒副伤寒、霍乱。结论：浙江省甲乙类肠道传染病疫情总体上呈下降趋势,但部分年份有所回升,仍应继续加强防控工作。     

上海市徐汇区2000～2010年病毒性肝炎疫情分析

目的 分析上海市徐汇区急性病毒性肝炎(急性肝炎)的流行特征,为完善肝炎防治策略和措施提供依据.方法 对2000～2010年户籍人口急性肝炎疫情和病原学分型年报进行分析.结果 2000～2010年徐汇区急性肝炎年均发病率为26.88/10万,青壮年高发,男女发病比例为1.70:1,城乡结合地区发病率(32.32...     

Epidemiology of endemic viral hepatitis in an urban area of India: a retrospective community study in Alwar.

In a community study during a reference period of 1 year, 192 cases of jaundice were detected in an urban population of 69,440 in Alwar, Rajasthan. Detected by paramedics and confirmed by physicians, these cases gave an annual incidence of 2.76 (95% CI: 2.37-3.15) per 1000 population. At least one of these patients died, giving a case fatality ratio of 0.6%. The jaundice cases occurred in all areas investigated, and affected all socioeconomic strata. About 94% of the affected families had only single cases. Although cases occurred throughout the year, more than 59% occurred during June-September, which are the summer and monsoon months. The incidence was highest (5.23 per 1000) among under-5-year-olds and declined progressively and significantly thereafter. Males had a higher incidence than females at all ages; the differences were not significant. Blood samples from 56 cases who had jaundice in the last 3 months of the reference period were tested for markers of viral hepatitis. Of these, 18 (32.1%), 1 (1.8%), 0, 2 (3.6%), and 4 (7.1%) were found to have hepatitis A, B, C, D and E, respectively. The etiology of the remaining 31 cases (55%) could not be established; previously, they would have been included in the NANB (non-A, non-B) category, inflating its proportion. Hepatitis A (HA) was the predominant type; being comparatively mild, it is perhaps underrepresented in hospital-based data. Many HA cases were in adults, which may be the beginning of an age shift of HA to the right owing to improvements in living standards of the study population. Five cases were carriers of hepatitis B virus (HBV), indicating the importance of HBV infection in India as well. Finally, the study found the annual incidence of laboratory-supported cases of viral hepatitis to be 1.24 (95% CI: 0.98-1.5) per 1000 population, which suggests that it is a major public health problem in India.     

2005-2014年抚州市法定传染病疫情分析

目的 分析2005-2014年抚州市法定传染病的发病与流行变化趋势,为控制法定传染病疫情提供科学依据。方法 采用Excel和SPSS22.0对2005-2014年抚州市法定传染病疫情资料进行描述性流行病学分析。结果 2005-2014年抚州市报告法定传染病31种,发病105 719例,年均发病率270.80/10万,年均死亡率0.37/10万,病死率0.14％,发病率为223.19/10万~328.09/10万,2005-2010年呈下降趋势,而2010-2014年呈上升趋势;肠道传染病、血源及性传播传染病呈上升趋势,呼吸道传染病发呈下降趋势。年均发病率前5位的法定传染病依次为肺结核、病毒性肝炎、手足口病、感染性腹泻病、痢疾,占总发病数的87.30%。结论 抚州市重要传染病病种为肺结核、病毒性肝炎(乙肝)、手足口病、其他感染性腹泻、痢疾、流行性腮腺炎、梅毒、淋病、麻疹等,法定传染病防治工作重点为肺结核、乙型肝炎、手足口病、感染性腹泻病、痢疾,应加强梅毒、艾滋病等性传播传染病管理与监测。     

Viral hepatitis

Three forms of viral hepatitis can be recognized: hepatitis A, hepatitis B, and hepatitis non-A, non-B. Hepatitis A is caused by a picornavirus, is transmitted by the faceal—oral route, does not become chronic, and no chronic virus carriers exist. The virus can be grown in cell cultures, and killed as well as live attenuated virus vaccines are under development. Hepatitis B is caused by an enveloped virus containing a circular, double-stranded form of DNA. The disease is transmitted parenterally through inoculation of blood or blood products containing virus or through close personal contact with a virus-positive person. Hepatitis B becomes chronic in a certain number of cases and can lead to cirrhosis and primary liver cell carcinoma. The blood and certain body secretions of individuals with a persistent or chronic infection may remain infectious for many years. The hepatitis B virus cannot be grown in cell cultures but the entire genome has been sequenced and cloned in bacterial and eukaryotic cells. An inactivated virus vaccine has been prepared from hepatitis B surface antigen present in the plasma of hepatitis B virus carriers and further vaccines are under development. The agents of hepatitis non-A, non-B have not been identified. It is possible to distinguish between a predominantly parenterally transmitted and an orally transmitted form of hepatitis non-A, non-B. The latter is reported to be caused by a picornavirus that does not, however, have any antigenic relationship with hepatitis A virus.