Epidemiological study of hepatitis B virus infection in Manitoba, Canada, 1992–2003

In comparison with other Canadian provinces and most Western countries, the province of Manitoba maintains a different vaccination policy for hepatitis B. This policy provides selective antenatal screening for hepatitis B in women and an inoculation program for hepatitis B vaccination for fourth-grade pupils. There has been increasing concern for this policy with regard to its influence on secular trends of acute hepatitis B incidence in Manitoba. This created a need to summarise the epidemiological characteristics of hepatitis B virus (HBV) infection in Manitoba and to allocate finances and human resources for future prevention programs. The Cadham Provincial Laboratory in Winnipeg, a Canadian Public Health Laboratory, is responsible for testing all specimens for diagnosis of various common infectious diseases in Manitoba. During the period from 1 January 1992 to 31 December 2003, a total of 285,946 clinical specimens were submitted to this laboratory, which confirmed 310 cases of acute HBV and 7,556 cases of chronic HBV infection. A total of 18,168 individuals were identified as having vaccine-induced immune status. The incidence rate of acute HBV infection has significantly decreased from 6.52/100,000 person-years in 1996 to 0.86/100,000 person-years in 2003. Annual prevalence rates of chronic HBV infection in Manitoba increased slightly from 42.96 cases/100,000 population in 1992 to 71.47 cases/100,000 population in 2003. Incidence rates were generally higher in men than in women at all age groups, with values of 2.65 and 1.65 per 100,000 population, respectively (chi-square=15.768, p value <0.001). The highest incidence rate for both males and females was observed in the age group 30–34 years. The North Eastman and Winnipeg Regional Health Authorities showed significantly higher incidence rates of acute hepatitis B compared with the other nine Regional Health Authorities. Selective hepatitis B vaccination programs for children in Manitoba had achieved the greatest success in the prevention of vertical and horizontal transmission. There is an urgent need to develop cost-effective harm-reduction strategies for hepatitis B prevention among adults (aged 30–34) and groups at risk in Manitoba.     

Validity of administrative database detection of previously resolved hepatitis B virus in Japan

The risk of hepatitis B virus (HBV) reactivation has increased owing to advances in the immunosuppressive therapy field. However, the HBV reactivation incidence among patients with previously resolved HBV (prHBV) infection during immunosuppressive therapy for rheumatoid arthritis (RA) remains unclear. The objective of this work is to describe the validity of detecting prHBV infection from administrative data through comparisons with chart abstraction and determine the incidence of HBV reactivation during immunosuppressive therapy for RA in Japan. In this retrospective cohort study, data on selected patients were extracted from administrative claims data. To identify patients with prHBV infection and de novo hepatitis, and HBsAg carriers, we conducted chart abstraction. The incidence rate of de novo hepatitis was 1.23 of 100 person-years. The positive predictive value (PPV) and its 95% confidence interval (CI) of administrative data for the identification of suspected prHBV infections was 85.8% (95% CI: 81.7%-89.3%). This study evaluated the PPV of the algorithm of HBV-DNA testing with immunosuppressive therapy performed four times or more per year for the detection of prHBV infection from administrative data. Additionally, we determined the incidence rate of HBV reactivation among preHBV infections during immunosuppressive therapy for RA to be 1.23 of 100 person-years.     

Hepatitis B vaccination in children: The Taiwan experience

The world's first nationwide hepatitis B virus (HBV) universal vaccination program for infants was launched in Taiwan in July, 1984. All infants received three to four doses plasma or recombinant HBV vaccines. In addition, infants of HBeAg-positive mothers received 0.5 ml of hepatitis B immunoglobulin within 24 hours after birth. The vaccination coverage rate is as high as 97%. Seroprevalence of hepatitis B surface antigen (HBsAg) declined from 9.8% (prevaccination period) to 0.6% in children in Taipei City after 20 years of mass vaccination. The seropositive rates for HBsAg, antibody to HBsAg, and antibody to hepatitis B core antigen were 1.2%, 50.5%, and 3.7%, respectively, in those born after the vaccination program (< 20 years old) in 2004. In line with the decrease of chronic HBV infection, the incidence of hepatocellular carcinoma (HCC) also decreased in children in Taiwan. From 1981 to 1994, the incidence of HCC in 6- to 9-year-olds declined from 0.52/100,000 for those born between 1974 and 1984 to 0.13 for those born between 1984 and 1986 (p < 0.001). We extended the observation to 2000, the incidence of HCC per 100,000 children declined from 0.54 to 0.20. The prevalence of a determinant mutants (amino acids 121–149 of HBsAg) in Taiwanese carrier children was 7.8% (eight out of 103) in 1984, increased to 19.6% (10 out of 51) in 1989, peaked at 28.1% (nince out of 32) in 1994, and remained stationary at 23.1% (three out of 13) and about 25% in 1999 and 2004, respectively; it was higher in those fully vaccinated compared with those not vaccinated. The other group of subjects who are susceptible to vaccine failure is the immunocompromized hosts. We observed some de novo HBV infection in children after liver transplantation. Despite of the success of hepatitis B immunization, childhood chronic HBV infection and HCC were not eliminated by the universal vaccination program. Among those HBsAg carriers born after the vaccination program, 89% of their mothers were found to be positive for HBsAg, indicating the importance of maternal transmission. This was also true in the mothers of children with HCC, of them 96% were HBsAg positive. After two decades of universal infant HBV vaccination, we found this program provides long-term protection for up to more than 20 years, and a universal booster is not required for the primary HBV vaccinees before adulthood. Mother-to-child transmission, although largely diminished, is still the main cause for immunoprophylaxis failure. The emergence of escape mutant did not impose increased risk of chronic infection at present. Nevertheless, development of new vaccines may overcome the vaccine failure.     

Natural history of compensated viral cirrhosis in a cohort of patients with HIV infection

BACKGROUND: The natural history of initially compensated cirrhosis in patients with HIV and concurrent hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection is poorly defined. This study was designed to investigate the incidence and type of liver-related complications and mortality in coinfected cirrhotic patients. METHODS: We retrospectively identified a cohort of patients coinfected with HIV and HCV or HBV and initially compensated viral cirrhosis. Time to decompensation and mortality from liver-related causes were recorded. RESULTS: Between 1999 and 2004, 392 HIV-infected patients underwent a follow-up of > or =6 months. Sixty-nine patients (17.6%) with initially compensated cirrhosis were identified (7 HBV positive, 59 HCV positive, and 3 positive for both HBV and HCV). The most frequent complication was ascites. The mortality was 71.3 per 1000 person-years (95% confidence interval [CI], 47 to 108) in HIV-infected patients with HBV and/or HCV compensated cirrhosis, 8 (95% CI, 4 to 16) in HIV/HCV-coinfected patients without cirrhosis, and 6.5 (95% CI, 2.7 to 15.5) in HIV-monoinfected patients. After the first event of decompensation, the survival rate was 48% at 1 year and 18.1% at 3 years. Treatment with HAART after the first event of decompensation was associated with an increased survival rate (61.1% and 26.2% at 1 and 3 years, respectively, vs. 26.7% and 0%; P < 0.0001). CONCLUSIONS: These results indicate significant morbidity and mortality during the 6 years after the diagnosis of compensated cirrhosis due to HBV and/or HCV in HIV-infected patients, identifying ascites as the most frequent complication.     

Hepatitis A in Korea from 2011 to 2013: Current Epidemiologic Status and Regional Distribution

The hepatitis A virus (HAV) has been the leading cause of viral hepatitis in Korea since the 2000s. We aimed to describe the current status and regional differences in hepatitis A incidence. We studied the total number of hepatitis A cases reported to the Korea Centers for Disease Control and Prevention through the National Infectious Diseases Surveillance System between 2011 and 2013. Additionally, National Health Insurance Review and Assessment Service data and national population data from Statistics Korea were used. In total, 7,585 hepatitis A cases were reported; 5,521 (10.9 cases per 100,000 populations), 1,197 (2.3 cases per 100,000 populations), and 867 (1.7 cases per 100,000 populations) in 2011, 2012, and 2013, respectively. Fifty-eight patients were infected outside of the country and 7,527 patients represented autochthonous HAV infection cases. Autochthonous HAV infection occurred more frequently among men than women (4,619 cases, 6.1 cases per 100,000 population vs. 2,908 cases, 3.9 cases per 100,000 population). The incidence rate was higher in the 20-29 yr-old group (2,309 cases, 11.6 cases per 100,000 populations) and 30-39 yr-old group (3,306 cases, 13.6 cases per 100,000 populations). The majority of cases were reported from March to June (53.6%, 4,038/7,527). Geographic analyses revealed a consistently high relative risk (RR) of HAV infection in mid-western regions (2011, RR, 1.25, P=0.019; 2012, RR, 2.53, P<0.001; 2013, RR, 1.86, P<0.001). In summary, we report that hepatitis A incidence has been decreasing gradually from 2011 to 2013 and that some regions show the highest prevalence rates of HAV infection in Korea.     

Preimmunization epidemiology of hepatitis B virus infection in South African children.

The prevalence of hepatitis B surface antigen (HBsAg) was determined in a community-based, cross-sectional, age-stratified sample of children from 0 to 6 years of age (n = 2,299) from the Eastern Cape Province of South Africa. The purpose of the study was to investigate the epidemiology and the age of acquisition of hepatitis B virus (HBV) infection in children, thus providing a preimmunization baseline measure of this infection in the population targeted for HBV immunization in South Africa. Overall, 10.4% (95% CI, 9.2-11.7) of the children tested were HBsAg-positive. There was a high rate of positivity in the 0-6- and 7-12-month age groups at 8.1% (95% CI, 5.5-11.7) and 8.9% (95% CI, 6.1-12.7), respectively, suggesting a higher rate of early acquisition of this infection than previously reported in South Africa. The proportion of HBsAg-positive children increased significantly with increasing age (chi2trend = 5.9, df = 1, P = 0.02), reaching 15.7% in the 61-72-month age group. This is the highest rate of HBV infection reported in community-based children from South Africa, indicating a significant burden of this infection. The difference in HBsAg prevalence between urban and rural children was not statistically significant (chi2 = 0.32, df = 1, P = 0.57). There was also no difference in positivity between males (10.5%; 95% CI, 8.7-12.5) and females (9.8%; 95% CI, 8.1-11.7), (chi2 = 0.006, df = 1, P = 0.94). This study provides the most recent preimmunization, community-based baseline investigation of the epidemiology of HBV infection in children targeted for universal immunization in South Africa.     

Update on diagnosis, management, and prevention of hepatitis B virus infection

Acute and chronic hepatitis B virus (HBV) infection is a leading cause of liver disease worldwide. It is estimated that approximately 350 million people worldwide have chronic HBV infection and that 1 million persons die each year from HBV-related chronic liver disease. In the past decade, significant progress in the understanding of the molecular virology and pathogenesis of HBV infection has been made. In addition, effective treatment modalities have been developed for persons with chronic infection. Worldwide, prevention of HBV transmission has become a high priority. In 1992, the Global Advisory Group to the World Health Organization recommended that all countries integrate hepatitis B vaccine into national immunization programs by 1997. Currently, 80 countries have done so and several others are planning to. Many countries have reported dramatic reductions in the prevalence of chronic HBV infection among children born since the hepatitis B vaccine was introduced into infant immunization schedules. Recent reports from Taiwan indicate a reduction in the incidence of liver cancer among children as a result of widespread hepatitis B vaccination programs.     

Evaluation of residual infectious risk among blood donors in National Center of Blood Transfusion in Conakry]

To estimate the risk of transmitting human immunodeficiency virus (HIV) and hepatitis B virus (HBV) by blood transfusion. Residual risks for each of infections have been calculated from incidence cases number, rate incidence for 100,000 person-years has been estimated and multiplied by the period of mute serological window for each agent (22 days for HIV and 56 for HBV) in order to estimate the residual risk. This study shows that risk residual is 1/121 blood donations for HBV and 1/8562 blood donations for HIV. The obtained results show that the HIV and HBV transmission risk due to blood transfusion according to the present practice at the NCBT of Conakry is important.     

Factors associated with intrafamilial transmission of hepatitis B virus infection in Korea.

Epidemiologic and serologic data on 137 household contacts of 51 chronic carriers of HBsAg and 111 household contacts of 38 controls who were negative for serologic markers of hepatitis B virus (HBV) were obtained from March 1990 to August 1991. Using this data, possible routes of intrafamilial transmission of hepatitis B virus among household contacts of chronic carriers of hepatitis B surface antigen (HBsAg) were evaluated and analyzed. The HBsAg prevalence among the household contacts of carriers was 14. 1% (95% CI 7.8-24.0) compared to 0.0% (95% CI 0.0-7.0) among those of controls (P < 0.01). The offspring of carriers showed significantly higher risk of HBV infection(relative risk; 6.6). Sharing of towels and handkerchieves, and drinking vessels was associated with an increased risk of HBV infection via intrafamilial transmission in Korea (relative risk 11.5 for towel and handkerchief, 12.1 for drinking vessels).     

Hepatitis B virus infection in isolated Afro-Brazilian communities

The prevalence and genotypes of hepatitis B virus (HBV) have distinct geographical distribution. In Brazil, some African-descendants have been maintained as small isolated communities since the slavery period. In this study, HBV infection among these communities of African origin was examined. Individuals (1,058) living in 12 communities were interviewed and serum samples screened for the presence of HBV markers. HBsAg-positive sera were tested for HBV DNA by PCR and positive samples were genotyped by restriction fragment length polymorphism (RFLP). The overall prevalence of HBV infection was 19.8% (95% CI: 17.5-22.3), ranging from 5.5% to 42.4%, depending on the communities studied. Multivariate analysis of risk factors showed that increasing age, family history of hepatitis, and sexual activity were associated significantly with this infection. HBsAg was detected in 23/1,058 (2.2%) individuals. HBV DNA was present in 2/2 of HBeAg-positive serum samples and in 18/21 (85.7%) anti-HBe-positive samples. All HBV isolates belonged to genotype A, subtype Aa. Three RFLP patterns were identified: AI (17 isolates), AIV (1 isolate), and AVI (2 isolates). These findings suggest a common introduction of HBV during the slave trade from Africa to Brazil.     

HLA-DQA1基因多态性和HBV感染结局的关联

目的 探讨人类白细胞抗原(HLA)DQA1基因多态性与乙型肝炎病毒(HBV)感染临床结局的关联.方法 临床收集慢性乙型肝炎(120例)、慢性HBV携带者(60例)、自限性HBV感染者(60例)三组病例,前两组诊断均经肝活检证实.聚合酶链反应序列特异性引物(PCR-SSP)法检测HLA-DQA1基因型,比较组间基因频率的差异.结果 (1)HLA-DQA1*0201在慢性乙型肝炎组的分布频率显著高于自限性HBV感染组(38.3% vs 5.8%,P<0.001,A=10.04,95% CI:4.48～22.48);HLA-DQA1*0102的分布频率显著低于自限性HBV感染组(9.6% vs 36.7%,P<0.001,A=0.183,95%CI:0.10～0.32).(2)HLA-DQA1*0201在慢性乙型肝炎组的分布频率显著高于慢性HBV携带者组(38.3% vs 7.5%,P<0.01,A=7.667,95% CI:3.7～15.87);HLA-DQA1*0102的分布频率显著低于慢性HBV携带者(20% vs 9.6%.P<0.01,A=0.424,95% CI:0.23～0.79).结论 HLA-DQAI基因多态性影响HBV感染临床结局,其中DQA1*0102呈保护作用,DQA1*0201可能促进HBV感染的慢性化和肝炎的发生.     

Seroepidemiology of the human herpesvirus 8 infection among people living with HIV in Taiwan, 2014–2018

BackgroundHuman herpesvirus type 8 (HHV-8) can be transmitted through unprotected sex as HIV. We aimed to investigate the seroincidence of HHV-8 and associated factors among people living with HIV (PLWH).MethodsFrom 2014 to 2018, blood samples of PLWH on the first date of HIV care were determined for antibodies against HHV-8. Individuals testing HHV-8-seronegative at baseline were followed for at least four months to estimate the annual seroconversion rate. To identify the factors associated with HHV-8 seroconversion, we compared the clinical characteristics between seroconverters and non-seroconverters who were matched for observation duration.ResultsThe HHV-8 seroprevalence increased from 8.1% in 2014 to 20.0% in 2018. HHV-8 seroconversion occurred in 154 (14.7%) PLWH after a total of 2652.16 person-years of follow-up (PYFU), resulting in an overall incidence rate of 5.62 per 100 PYFU, which increased from 3.20 to 6.84 per 100 PYFU during the study period. HHV-8 seroconverters were less likely to have chronic hepatitis B virus (HBV) infection (1.9% vs 10.6%) and more likely to be antiretroviral-naïve on entry into care (87.7% vs 75.4%) (both p < 0.05). In multivariate logistic analysis, men who have sex with men (MSM) (adjusted odds ratio [aOR], 2.22; 95% CI, 1.01–4.86), being antiretroviral-naïve (aOR, 2.91; 95% CI, 1.27–6.67), and chronic HBV infection (aOR, 0.13; 95% CI, 0.03–0.61) at baseline were associated with HHV-8 seroconversion.ConclusionsAn increasing trend of HHV-8 infection was observed among PLWH in Taiwan between 2014 and 2018. MSM and being antiretroviral-naïve were associated with higher risk for HHV-8 seroconversion.     

A mathematical model to study the effect of hepatitis B virus vaccine and antivirus treatment among the Canadian Inuit population

The prevalence of hepatitis B among the Canadian Inuit population is 4%. This study will use a mathematical model to compare the roles of vaccination and therapy to predict future prevalence and incidence among the Canadian Inuit population for the next 50 years. We applied a mathematical model developed by Medley et al. (Nat Med 7(5):619–624, 2001), combined with data on hepatitis B incidence, prevalence, and vaccination coverage, to predict trends of hepatitis B virus (HBV) among the Inuit population over the next 50 years. The current estimated prevalence of HBV is 6.04% and the incidence is 3.4/100,000 persons among Canadian Inuit. If HBV vaccination coverage levels of 47.2% remain unchanged, the prevalence of HBV will decrease to 1.91% and the incidence will decrease to 0.81/100,000 persons by 2058. If vaccination coverage levels are increased to 57.2%, the prevalence and incidence of HBV will decrease to 1.74% and 0.63/100,000 persons, respectively. If we increase both immunization and therapy by 10%, this will produce the greatest reduction in prevalence and incidence, to 1.56% and 0.54/100,000 persons, respectively. The combination of immunization and treatment programs seems to have the best result in decreasing the prevalence and incidence of HBV among the Inuit population.     

Risk factors for and incidence of acute hepatitis C after the achievement of blood supply safety in Italy: Results from the national surveillance system

Surveillance systems for acute hepatitis C allow monitoring of disease incidence trends and transmission patterns. This study aimed to describe the epidemiological profile of reported cases of symptomatic acute hepatitis C in Italy after the achievement of blood supply safety. The incidence of symptomatic acute hepatitis C since 1991 was estimated. Risk factors for acute hepatitis C were analyzed for the period 2003–2010 through a case–control study within a population‐based surveillance for acute viral hepatitis. From 1991 to 2010, the incidence decreased from 2 to 0.2 per 100,000, with a more evident decrease among persons aged 15–24 years. During 2003–2010, 1,053 cases were reported. Intravenous drug use (adjusted odds ratio [_adjOR], 30.5; 95% confidence interval [CI], 18.9–49.1), cohabitation or sexual partnership with an hepatitis C virus (HCV) carrier (_adjOR, 11.2; 95% CI, 6.6–19.2), nosocomial exposure (_adjOR, 6.6; 95% CI, 4.6–9.4); unsafe sexual practices (_adjOR, 3.1; 95% CI, 1.9–5.2), and cosmetic treatments with percutaneous exposure (_adjOR, 1.7; 95% CI, 1.2–2.4) were independently associated with acute hepatitis C. Population attributable risk estimates indicated nosocomial exposure (39.6%) and intravenous drug use (30.5%) as responsible for most cases. In conclusion, the incidence of symptomatic acute hepatitis C is declining in Italy. Currently, the most important risk factors are: having an HCV‐positive household or sexual partner, unsafe sexual practices, cosmetic percutaneous treatments, intravenous drug use, and nosocomial exposure; the latter two factors are responsible for most cases. Effective prevention programs for intravenous drug users and strict adherence to universal precautions in healthcare settings are needed. J. Med. Virol. 85:433–440, 2013. © 2012 Wiley Periodicals, Inc.     

Clinical and virological characteristics associated with severe acute hepatitis B

To identify early predictors of a severe or fulminant course in patients with acute viral hepatitis B (AVH-B). One hundred and thirty-eight patients with symptomatic acute hepatitis B observed from 1999 to 2012 were enrolled. For each patient, the demographics, risk factors for the acquisition of hepatitis B virus (HBV) infection, clinical, biochemical and virological data (HBV DNA, HBV DNA sequences) were recorded and analysed. The HBV mutants in the polymerase region were sought in 110 (87%) patients by direct sequencing, and the rtM204V/I mutations also by an allele-specific PCR. AVH-B was severe in 13 (9.4%) of the 138 patients enrolled, fulminant in 6 (4.3%) and with a normal clinical course in 119. The 19 patients with severe or fulminant AVH-B more frequently than the 119 with a normal course stated intravenous drug use (63.2% versus 36.1%, p 0.04) and were HBV-DNA negative (31.6% versus 11.8%, p 0.03) and anti-hepatitis C virus (HCV) positive (57.9% versus 19.3%, p 0.0008); the prevalences of different HBV genotypes and of the rtM204V/I mutant were similar in these three forms of AVH-B. A multivariate logistic regression analysis identified a pre-existing HCV chronic infection as the only factor independently associated with a severe or fulminant clinical course of AVH-B (OR 4.89, 95% CI 1.5–15.94, p 0.01). A pre-existing HCV chronic infection was identified as the only factor independently associated with a severe clinical presentation of acute hepatitis B, an association most probably due to the combination of the liver lesions caused by acute hepatitis B and the pre-existing histological abnormalities related to HCV chronic infection.     

Molecular epidemiology of hepatitis B, C, D and E viruses among children in Moscow, Russia.

BACKGROUND: It is known that the prevalence of HBV and HCV infections vary according to geographical areas. However, in Russia, an adequate level of information on the molecular epidemiology of hepatitis viruses has not been available so far. OBJECTIVES: To investigate the characterization of various hepatitis viruses in Russia, we conducted molecular-based epidemiological survey of hepatitis viruses including hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HEV) among children in Moscow, Russia. STUDY DESIGN: The study population of 374 subjects (ranging in age from 1 to 14 years old) consisted of 195 patients with liver diseases and 179 patients without liver diseases. Viral DNA/RNA was determined by nested PCR. Genotyping of HBV and HCV were examined by PCR using type-specific primers. Anti-HEV antibody was assayed by ELISA. RESULTS: The infection rate of each virus among patients with liver diseases including acute hepatitis, chronic hepatitis or cirrhosis was 65.6% for HBV and 15.9% for HCV. In contrast, among non-liver disease patients, the infection rates were 14.4% for HBV and 0.6% for HCV, respectively. The most common viral genotypes were type D (85%) of HBV and type 1b (79.3%) of HCV. HDV RNA was detected in 7 of 149 (4.7%) HBV DNA-positive children tested. Moreover, testing for HEV among 341 subjects resulted in the detection of anti-HEV IgG in 62 cases (18.2%). CONCLUSIONS: Our results suggest that HBV infection is widespread in Moscow and have led to a high incidence of acute and chronic liver diseases among children in this region.     

Retrospective analysis of non-A-E hepatitis: possible role of hepatitis B and C virus infection

In an effort to determine the cause of non-A-E hepatitis, a retrospective study was undertaken on a group of patients with hepatitis but without serological infection markers of hepatitis viruses A-E. A total of 60 patients admitted to Beijing Ditan Hospital during the period of September 1997 and September 1999 were chosen for this study. These patients were diagnosed as either acute or chronic hepatitis, but no serological markers of hepatitis viruses A-E were detected. Since TT virus (TTV), human parvovirus B19 (B19), SEN virus (SENV), and GB virus C/HGV were reported to be associated with hepatitis, attempts were made to detect the presence of these viruses in the sera of patients with non-A-E hepatitis by a nested polymerase chain reaction (nPCR) method. Also, more sensitive nPCR and RT-nPCR methods were used to determine HBV DNA and HCV RNA in these patients. Results derived from these analyses demonstrate that HBV DNA was detected in most of these patients (47/60, 78.3%), suggesting that HBV infection played a major role in occult non-A-E hepatitis and detection of HBV DNA by more sensitive PCR methods such as nPCR should be considered for diagnosis of HBV infection. In addition, HCV RNA was detected in three (5%) of these patients. However, GBV-C (HGV) RNA was not detected, and TTV, B19, and SENV appear not to be associated with non-A-E hepatitis, as the prevalence rates of these viruses in patients with non-A-E hepatitis were similar to those in patients with viral hepatitis A-E. The results from this study indicate that co-infection of TTV or B19 with HBV did not increase the severity of the disease.     

Prevalence of human herpesvirus 8 and hepatitis C virus in a rural community with a high risk for blood-borne infections in central China

Illegal blood donation in the past decade has caused human immunodeficiency virus (HIV) outbreaks in some rural areas in China. Other HIV-associated virus infections, such as those caused by human herpesvirus 8 (HHV8), in such areas are still not well defined. In order to explore HHV8 and hepatitis C virus (HCV) seroprevalence and potential risk factors in such areas, a cross-sectional study with 305 HIV-positive and 315 HIV-negative subjects recruited from a rural county in Shanxi province was conducted, in which illegal blood collection was reported. Interview questionnaires and serum testing were carried out with these participants. HCV and HHV8 seroprevalence were found to be higher in the HIV-positive than in the HIV-negative group (76.4% vs. 2.5% and 15.4% vs. 4.8%, respectively), whereas the difference in HBV seroprevalence was not significant. Co-infection with HCV and HHV8 was also more prevalent in the HIV-positive group. HIV status (OR 2.71; 95% CI 1.16–6.30) and HBV status (OR 2.56; 95% CI 1.14–5.75) were independently associated with HHV8 infection. HIV status (OR 23.03; 95% CI 9.95–53.27) and blood/plasma selling history (OR 14.57; 95% CI 7.49–28.23) were strongly associated with HCV infection. These findings demonstrate that both HHV8 and HCV infections are prevalent in this community. HIV infection is an important risk factor for both HHV8 and HCV infection. HBV infection is associated with HHV8 infection but not with HCV infection. It is possible that HHV8 and hepatitis B virus, but not HCV, have similar modes of transmission in this population.     

Prevalence of hepatitis B virus infection in a highly endemic area of southern China after catch-up immunization

The Chinese national goals for control of hepatitis B virus (HBV) infection were to achieve a prevalence of HBsAg below 7% for the entire population, and 1% for children under 5-year old, by 2010. To determine whether Guangxi, a multi-minority province with a low socio-economic status and a very high prevalence of HBV, achieved this goal, a seroepidemiological survey of HBV infection was carried out using stratified, random cluster sampling. The results show that the overall prevalence of HBsAg is 9.16% [95% confidence interval (CI) = 8.32-10%]. The prevalence in males (10.96%, 95% CI = 9.64-12.28%) is significantly higher than in females (7.71%, 95% CI = 6.64-8.78%; χ(2) = 10.5923, P < 0.05). The prevalence in children under 5-year old is 3.62% (95% CI = 0.60-6.64%) and increases with age. The prevalence of HBsAg in non-immunized individuals is significantly higher than in those immunized completely, although not within 24 hr of birth (χ(2) = 31.426, P < 0.05); a significant difference was found in those below the age of 20 years but not in older persons. Gender, age, immunization history, and familial HBsAg carriers are risk factors for infection. In conclusion, this study indicates that Guangxi has not reached the goal for the control of HBV infection. Catch-up HBV immunization may not protect adults effectively against infection in highly endemic regions.     

Outbreak of hepatitis B virus in recent arrivals to the Brazilian Amazon

An outbreak of acute hepatitis cases in a small community took place 6 months after the community's arrival to the Brazilian Amazon. An epidemiological investigation was performed and included residents aged more than two years. Study subjects were interviewed and bled to test for hepatitis markers by enzyme immunoassays. Around 80% of the village population was surveyed. The overall prevalence of hepatitis B virus (HBV) markers was 75.1% (281/374). The surface antigen of HBV (HBsAg) and the IgM class antibody against hepatitis B core antigen (IgM anti-HBc) were present in 10.4% and 9.6%, respectively. Evidence of HBV–HDV (Delta virus) coinfection or hepatitis C infection was not found. IgM class antibody against hepatitis A virus was uncommon (3.7%). Follow-up evaluation 6 and 12 months later were carried out to identify new HBV infections. An incidence rate of 7.2 new infections per 100 exposed subjects per month was found. Average individual risk for HBV infection among susceptible inhabitants of the village between June 1995 and June 1996 can be estimated at 57.6%. The predominant HBsAg subtype found (ayw3) suggests that immigrants may have carried HBV from the original area. Time living in the study region was significantly associated with HBV markers in analysis for linear trend and logistic regression analysis. Environmentally related factors may have facilitated HBV transmission. J. Med. Virol. 56:4–9, 1998. © 1998 Wiley-Liss, Inc.