Adriano Nori Rodrigues Taniguchi

Immunogenicity and safety of hepatitis A vaccine in children with chronic liver disease.

Background Acute hepatitis A superimposed on chronic liver disease has been associated with a more severe course of disease and development of fulminant hepatitis. The aim of this study was to evaluate the immunogenicity and safety of an inactivated hepatitis A virus vaccine in children with chronic liver disease. Patients and Methods This was an open, prospective, and controlled trial with 89 anti-HAV negative children between 1 and 16 years of age studied at a pediatric liver disease and transplantation referral center. Inactivated HAV vaccine (Havrix), from GlaxoSmithKline Biologicals containing 720 Elisa units of alum-adsorbed hepatitis A antigen per 0.5 ml dose was used. Thirty-four pediatric patients with chronic liver disease (mean age: 7.0 ± 4.86 years) and 55 healthy controls (mean age: 4.8 ± 2.7 years) received two doses of Havrix vaccine in months zero and six. Seroconversion and anti-HAV titers expressed as geometric mean titers (GMT) in mIU/ml were measured at months one and seven, by a modified Hepatitis A virus andibodies (HAVAB) assay. Results Seroconversion rates at four weeks after primary immunization were 76% and 94% and the GMT 107.77 and 160.77 mIU/ml in the patient and control groups, respectively. One month after second dose the seroconversion rates were 97% and 100% in the groups with GMT of 812.40 and 2344.90 mIU/ml. Both doses were well tolerated with no significant adverse events observed. Local injection-site symptoms were the most common reactions reported in both groups. Conclusion Although GMTs were significantly lower in children with chronic liver disease compared to healthy controls, the overall seroconversion rates were not different. Hepatitis A virus vaccine was safe, well-tolerated, and immunogenic in children with chronic liver disease.

Amplification of bacterial DNA does not distinguish patients with ascitic fluid infection from those colonized by bacteria.

Objective: To evaluate 16S ribosomal RNA (rRNA) gene amplification to diagnose spontaneous bacterial peritonitis (SBP). Patients and Methods: According to a retrospective protocol, 31 patients with portal hypertensive ascites (serum to ascites albumin gradient ≥1.1 g/dL) were studied. Ascitic fluid was analyzed as follows: Gram stain, aerobic and anaerobic cultures, polymorphonuclear cell count, and biochemical tests. Bacterial DNA was detected by polymerase chain reaction. Results: There were 8 episodes of SBP and 4 episodes of bacterascites (BA). Culture was positive in 4 of 8 cases of SBP and bacterial DNA was positive in 7 of 8 cases of SBP. Bacterial DNA was positive in 3 of 4 cases of BA and in 8 of 28 cases of culture-negative non-neutrocytic ascites (CNNNA). The PELD score, serum to albumin ascites gradient, and mortality showed no statistical difference between patients with CNNNA and the result of the bacterial DNA analysis. Conclusions: Although the 16S rRNA gene amplification was better than culture to diagnose SBP, bacterial DNA does not seem to allow a distinction between ascites infection and ascites colonization.

Prevalence of hepatitis A antibody in children and adolescents with chronic liver disease

Objetivo: avaliar a prevalencia de hepatite viral A (HVA) em criancas e adolescentes portadores de doencas cronicas do figado, em um servico de hepatologia pediatrica. Metodos: entre maio de 1999 e fevereiro de 2001, foi estudada a prevalencia de anticorpos anti-HVA total em 60 criancas e adolescentes, entre 1 e 16 anos de idade, portadoras de hepatopatias cronicas, provenientes da unidade de gastroenterologia pediatrica e programa de transplante hepatico infantil do servico de pediatria do Hospital de Clinicas de Porto Alegre. O anti-HVA, realizado atraves de um teste laboratorial comercialmente disponivel em nosso meio (Abbott - MEIA HAVAB - sistema AXSYM), foi determinado e relacionado com a idade, com o sexo, com a cor, com o diagnostico etiologico da hepatopatia e com a renda familiar dos pacientes. Resultados: apenas uma crianca de 1 ano, portadora de atresia biliar, foi excluida do estudo por apresentar anti-HVA indeterminado, em duas ocasioes. Das 59 criancas restantes, 14 (24%) apresentavam resultados positivos para o anti-HVA total. As idades dos pacientes com anti-HVA positivos variaram de 1 a 16 anos (x= 7,7 anos e mediana 8,5 anos). Nao houve diferenca significante entre idade, sexo e cor entre os grupos positivo e negativo. A renda familiar foi menor no grupo dos pacientes anti-HVA positivo, mas nao mostrou diferenca estatistica significante. A diferenca de prevalencia de anti-HVA entre as etiologias das hepatopatias esta, provavelmente, relacionada a idade mais do que ao diagnostico. Conclusoes: na populacao estudada, a maioria (76%) das criancas e adolescentes portadoras de hepatopatias cronicas e suscetivel a infeccao pelo virus A, podendo apresentar, portanto, um curso mais grave e complicacoes, se adquirirem HVA. Sugerimos, entao, que esses pacientes devam receber a vacina inativada contra HVA.