Hepatitis B virus infections among Danish surgeons

Acute viral hepatitis B is considered to be an occupational risk to health-care workers worldwide. At the 1977 annual meeting of the Danish Society of Surgeons, 224 participants were examined for the presence of hepatitis B surface antigen (HGsAg) and antibody to HBsAg (anti-HBs) with use of a radioimmunoassay. None of the surgeons was HBsAg-positive, but 23% had anti-HBs. The prevalence of anti-HBs was five times higher among these surgeons than that in an age-matched control population. Hepatitis acquired during occupation as a surgeon was predominantly of type B, in contrast to hepatitis acquired before entering the surgical profession. Danish surgeons must be regarded as a group at high risk of hepatitis B infection.     

Hepatitis B virus and hepatitis C virus infections in children

PURPOSE OF REVIEW: To analyse the most relevant recent information on efficacy, duration and coverage of anti-hepatitis B virus vaccination; correlates of mother-to-child hepatitis C virus transmission; the natural history and outcomes of hepatitis B and C virus infections in children; the efficacy and safety of specific therapies. RECENT FINDINGS: Insufficient hepatitis B virus vaccine coverage and incomplete or delayed vaccine cycles need improvement in many countries. Hepatitis B virus mutants may explain some fulminant hepatitis in perinatally infected infants and vaccine failures. No interventions to prevent vertical hepatitis C virus transmission have been identified. Spontaneous clearance of hepatitis B is lower in children than in adults, while the rates appear to be similar for hepatitis C. The disease progression is slower for both infections in childhood. Several studies support the efficacy and safety of interferons and lamivudine in chronic hepatitis B or of interferons and ribavirin in chronic hepatitis C in children, but the optimal therapy remains unclear. SUMMARY: There are doubts as to the long-term persistence of anti-hepatitis B immunization in low-endemicity areas. Routine hepatitis C virus testing in pregnancy is not recommended as there are no available prophylactic measures. Although hepatitis B and C virus infections are usually asymptomatic or with mild manifestations in childhood, concerns around their long-term clinical impact suggest the need for early treatment. Children should preferably be treated in the context of targeted trials for a better understanding of the efficacy and tolerance of drugs currently used in adults.     

Hepatitis B and C virus infections in the immune compromised

PURPOSE OF REVIEW: This review compares and contrasts the natural history and treatment of hepatitis B and C virus infections in three principal populations of immune compromised individuals: (1) patients co-infected with HIV; (2) patients with liver failure secondary to hepatitis B or C virus infection who undergo liver transplantation, and (3) patients with hepatitis B or C virus infection who undergo anticancer chemotherapy. RECENT FINDINGS: Chronic liver disease resulting from hepatitis B or C virus infection progresses more rapidly in patients co-infected with HIV than in HIV negative patients. Treatment protocols for antiviral therapy are, however, similar to those used in immunocompetent individuals and although few long-term results are available, the efficacy of interferon and ribavirin therapy in hepatitis C virus/HIV infection and lamivudine in HIV/hepatitis B virus infection has been proven in the short-term. Perhaps the most important consideration is the timing of administering treatments to co-infected patients. For patients with well preserved CD4 counts and hepatitis C virus/HIV co-infection, the hepatitis infection should be treated as early as possible to avoid drug interactions of hepatitis C virus antivirals with antiretroviral therapy. Also, response to hepatitis C virus treatment appears better when treatment is administered in the context of preserved immune function. Conversely, in hepatitis B virus/HIV co-infection, hepatitis B virus antivirals are best administered with anti-retroviral therapy, thus preventing the selection of HIV viral species which may be resistant to the drugs used for hepatitis B virus. Improved graft and patient survival after liver transplant and with anticancer chemotherapy in hepatitis B virus infected patients has been proven using lamivudine prophylaxis. However, although therapy for hepatitis C virus recurrence after liver transplantation would seem rational, limited success with current treatment protocols has been achieved. SUMMARY: Although the prognosis of hepatitis B and C virus infections in the immune compromised may be inferior to that of immunocompetent individuals, such patients should have full evaluation of their viral hepatitis, and antiviral therapy should be considered.     

Hepatitis B virus

Recent developments in molecular biology have advanced our understanding of the pathogenesis of HBV-induced disease. New data derived from the molecular analysis of clinical material have begun to bridge the gap between bench research and the clinical arena. In this review, we consider topics that have relevance to clinical management and that have not been summarized in the recent literature. The recent advances that have been made in the areas of HBV variants,in vitro cell culture systems, and extrahepatic infection are discussed in greater detail.Supported by grants from the American College of Gastroenterology (B.Y.), Gulf Coast Regional Blood Center (C.N., B.Y.), and Schering Corporation (B.Y.).     

乙型肝炎病毒基因型

乙型肝炎病毒(hepatitis B virus,HBV)是嗜肝DNA病毒家族的重要成员,所引起的慢性乙型病毒性肝炎及肝衰竭、肝硬化、肝癌等是严重危害人民健康的疾病.据统计,目前我国有慢性乙型肝炎患者2000万人,是我国现阶段最为突出的公共卫生问题之一.HBV遗传变异率很高,有8个基因型,由于独特的流行病学特性,多数又可以分为不同的基因亚型.另外DNA基因型的高度异质性使重组基因型也增加了.有研究证实HBV基因型与疾病进展关系密切.不同基因型HBV的流行病学特征不同,同时其临床感染特点和致病性也有差异.本文综述了本领域研究进展,包括HBV生物学特性、基因型与基因亚型、重组基因型、HBV基因型的流行病学特点以及HBV基因型与临床等方面.     

Hepatitis B virus genotypes and clinical manifestation among hepatitis B carriers in Thailand

BACKGROUND: Hepatitis B virus (HBV) genotypes have distinct geographic distributions. The aim of the present study was to evaluate the distribution of HBV genotypes and their clinical relevance in Thailand. METHODS: Hepatitis B virus genotypes among 107 hepatitis B carriers residing in Thailand were evaluated using serologic and genetic methods. They were clinically classified into asymptomatic carriers with normal serum alanine transaminase (ALT) levels and patients with chronic liver disease, such as those with chronic hepatitis (CH), liver cirrhosis (LC) and hepatocellular carcinoma (HCC). RESULTS: Hepatitis B virus genotype distribution among the 107 patients was 25.2% for genotype B, 72.0% for genotype C and 2.8% for genotype D. The serum ALT levels, HBV-DNA and hepatitis B e antigen positivity were significantly higher in carriers infected with genotype C HBV than in those infected with genotype B (P < 0.05). The proportion of genotype B HBV was higher in asymptomatic carriers than in patients with CH and those who developed liver disease, such as LC and HCC (45.5, 16.9 and 25.0%, respectively; P < 0.05). In contrast, the proportion of genotype C HBV was higher in patients who developed liver disease and CH than in asymptomatic carriers (68.7, 83.0 and 50.0%, respectively; P < 0.05). Phylogenetic analysis based on entire genome sequences revealed three HBV isolates, which were classified into a subgroup of genotype C in isolates from South-East Asian countries. CONCLUSIONS: Genotypes B and C are the predominant types among hepatitis B carriers residing in Thailand and those genotypes influence the clinical manifestation in carriers with chronic hepatitis B infection.     

Hepatitis G virus infections in Iceland

This study describes the prevalence of hepatitisG virus (HGV) in Iceland, in blood donors and in persons with parenteral risk factors. Among 370 randomly selected Icelandic blood donors, the prevalence of HGV viraemia was 3.8%, whereas the prevalence of HGV antibodies in the same donor group was found to be 13.2%, thus indicating that at least 17% of blood donors in Iceland had previously been exposed to HGV. Previous exposure was seen in all age groups and also in older blood donors. Among intravenous drug users (IVDUs), the prevalence of HGV was much higher. Among 109 hepatitisC virus (HCV) antibody-positive serum samples collected in the years 1992–1997, 33.9% were polymerase chain reaction (PCR)-positive for HGV and 48.6% had HGV antibodies. Thus, the pattern of HGV in IVDUs was similar to findings among IVDUs in other western countries. HGV viraemia was detected neither in 10 patients with haemophilia nor in five dialysis patients. However, six of the 10 haemophilic patients and one of the five dialysis patients had HGV antibody. In conclusion, unlike hepatitisC, which seems to have been introduced into Iceland relatively recently and has remained virtually confined to IVDUs, exposure to HGV is common among all age groups in the general population, suggesting that the virus has been prevalent in Iceland for much longer, making additional routes of transmission probable.     

Hepatitis B virus among saudi children in Gizan,Saudi Arabia

Summary Using the enzyme-linked immunosorbent assay (ELISA), the prevalence rates for hepatitis B virus surface antigen (HBsAg), antibody to core antigen (anti-HBc), and antibody to surface antigen (anti-HBs) were studied among 325 school children and those seeking treatment for minor ailments in Gizan City, Saudi Arabia. Tests for hepatitis B virus e antigen (HBeAg), antibody to HBeAg (anti-HBe), IgM antibody to HBV core antigen (IgM anti-HBc) and antibody to delta-virus were made in HBsAg carriers. There was a serological evidence of HBV infection in 91 (28%) Saudis of which 11.1% were HBsAg carriers, 9.5% positive for anti-HBs and 7.4% positive only for anti-HBc. There was no intersex difference for positivity for HBsAg, anti-HBs and anti-HBc. The evidence of existing or earlier infection was higher in females. Among HBsAg carriers, none of the 24 was positive for IgM anti-HBc, 12% were positive for HBeAg or anti-HBe. Anti-delta antibody was present in one of the nine carriers tested. HBV infection in Gizan City is acquired fairly early during childhood with little clinical evidence suggestive of an acute hepatitis. Immunization against HBV should be considered in the neonatal period to prevent the long term sequelae of HBV, like cirrhosis and primary hepatocellular carcinoma.

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Hepatitis B-Virus-Marker bei Kindern in Gizan, Saudi-Arabien

Zusammenfassung Bei 325 Schulkindern und Kindern, die wegen geringfügiger Beschwerden in Gizan, Saudi-Arabien, zur Behandlung kamen, wurden Untersuchungen zur Prävalenz des Hepatitis B-Virus-Oberflächenantigens (HBsAg), des Antikörpers gegen core-Antigen (anti-HBc) und des Antikörpers gegen Oberflächenantigen (anti-HBs) unter Verwendung des enzymgebundenen Immunsorbent-Tests (ELISA) vorgenommen. Bei Trägern von HBsAg wurden auch Tests zur Bestimmung des Hepatitis B Virus e-Antigen (HBeAg), des Antikörpers gegen HBeAg (anti-HBe), des IgM-Antikörpers gegen HBV core-Antigen (IgM anti-HBc) und des Antikörpers gegen delta-Virus durchgeführt. Bei 91 Saudis (28%) ergab sich ein serologischer Beweis für eine HBV-Infektion, 11,1% davon waren HBsAg-Träger, 9,5% anti-HBs-positiv und 7,4% nur anti-HBc-positiv. Es zeigten sich keine Geschlechtsunterschiede in der Positivität für HBsAg, anti-HBs und anti-HBc. Anhalt für eine vorliegende oder früher durchgemachte Infektion bestand bei Mädchen häufiger als bei Knaben. Von den 24 HBsAg-Trägern war keiner anti-HBc-IgM-positiv, bei 12% wurden sowohl HBeAg wie anti-HBe nachgewiesen. Bei einem der neun untersuchten Träger fanden sich Anti-delta-Antikörper. Die HBV-Infektion in der Stadt Gizan wird relativ früh in der Kindheit erworben, wobei nur geringfügige klinische Zeichen für eine akute Hepatitis auftreten. Es sollte eine Immunisierung gegen HBV in der Neonatalperiode erwogen werden, um die Langzeitfolgen der HBV-Infektion wie Leberzirrhose und hepatozelluläres Karzinom zu verhüten.

     

Hepatitis A infection and vaccination among Danish blood donors

When testing 466 Danish blood donors, of whom 60 reported to be vaccinated against hepatitis A, 55 (11.8%, 95% CI: 9.0-15.1) had detectable levels of anti-hepatitis A virus IgG (> 10 m IU/ml). Among unvaccinated donors, the prevalence rate was 23/376 (6.1%, 95% CI: 3.9-9.0) with age above 50 y and use of private water supply being independently associated with seropositivity.     

Hepatitis B virus taxonomy and hepatitis B virus genotypes

Hepatitis B virus (HBV) is a member of the hepadnavirus family. Hepadnaviruses can be found in both mammals (orthohepadnaviruses) and birds (avihepadnaviruses).The genetic variability of HBV is very high. There are eight genotypes of HBV and three clades of HBV isolates from apes that appear to be additional genotypes of HBV. Most genotypes are now divided into subgenotypes with distinct virological and epidemiological properties. In addition, recombination among HBV genotypes increases the variability of HBV. This review summarises current knowledge of the epidemiology of genetic variability in hepadnaviruses and, due to rapid progress in the field,updates several recent reviews on HBV genotypes and subgenotypes.     

Hepatitis A virus infections in Belgian children

Summary In childhood HAV infection most often passes subclinically. In this study we evaluate the percentages of clinically and subclinically developing HAV infections and the age distribution of the prevalence of immunity to HAV. The study population (n=1,008) included newborns, children and teenagers up to 20 years of age from the Brussels area. Sera were randomly collected at a general hospital. Subjects were stratified into six age groups. Among children and teenagers, the overall prevalence of anti-HAV (IgG) was 13.4%; this prevalence increased from 4.8% among children in the first group (1–2-year-olds) to 33.9% in the group of teenagers (16–20-year-olds). Among children and teenagers, 10% HAV infections on average is clinically recognized. For the different age groups, these figures are 3.5%, 18.7%, 12.3% and 5.5%, respectively. It can be concluded that, relative to the overall population of each age group, 0.3%, 1.8%, 1.6% and 0.3%, respectively, will have a clinically recognized HAV infection as members of that specific age group.

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Hepatitis-A Virus-Infektion bei belgischen Kindern

Zusammenfassung In der Kindheit nimmt die HAV-Infektion meist einen subklinischen Verlauf. In der vorliegenden Studie werden der prozentuale Anteil klinisch und subklinisch verlaufender HAV-Infektionen und die altersbezogene Prävalenz der Immunität gegen HAV untersucht. Die Studie umfaßte insgesamt 1008 Serumproben von Kindern und Jugendlichen aus der Region Brüssel, darunter Neugeborene, Kinder und Teenager bis zum Alter von 20 Jahren. Die Proben wurden zufallsgemäß in einem Allgemeinen Krankenhaus gewonnen. Die Unterteilung der Studienpopulation erfolgte in sechs Altersgruppen. Die Prävalenz an anti-HAV (IgG) lag bei Kindern und Jugendlichen insgesamt bei 13,4%. Sie nahm von 4,8% bei Kindern der ersten Gruppe (Alter 1–2 Jahre) zu auf 33,9% bei Jugendlichen (16–20 Jahre). Nur etwa 10% der HAV Infektionen bei Kindern und Jugendlichen werden klinisch erkannt. In den verschiedenen Altersgruppen liegen die Anteile klinisch manifester Fälle bei 3,5%, 18,7%, 12,3% und 5,5%. Bezogen auf die Gesamtpopulation der jeweiligen Altersgruppen kann man davon ausgehen, daß 0,3%, 1,8%, 1,6% und 0.3% eine klinisch erkennbare HAV-Infektion durchmachen.

     

乙型肝炎病毒相关肾炎

自 1971年Combes首先报告HBV感染相关的肾病以来 ,陆续发现一些肾小球疾病如肾小球肾炎、IgA肾病 ( 1gAN )、狼疮肾炎 (LN)等的发病与HBV感染相关 ,但对HBV感染相关的肾损害 ,名称一直比较混乱 ,曾称为乙型肝炎 肾炎或乙型肝炎肾炎、乙型肝炎免疫复合物肾炎或乙型肝炎病毒抗原相关性肾炎等 ,1990年中华内科杂志组织的乙型肝炎肾炎座谈会建议采用乙型肝炎病毒相关肾炎名称 (hepatitisBvirusrelatedglomerulonephritis) ,简称HBV相关肾炎 (HBV GN) [1] 。一、病理改变研究发现 ,HBV GN肾损害的病理类型较多 ,如膜性肾病(MGN )…