José Carlos Ferraz da Fonseca

Methodology of a nationwide cross-sectional survey of prevalence and epidemiological patterns of hepatitis A, B and C infection in Brazil

A population-based survey to provide information on the prevalence of hepatitis viral infection and the pattern of risk factors was carried out in the urban population of all Brazilian state capitals and the Federal District, between 2005 and 2009. This paper describes the design and methodology of the study which involved a population aged 5 to 19 for hepatitis A and 10 to 69 for hepatitis B and C. Interviews and blood samples were obtained through household visits. The sample was selected using stratified multi-stage cluster sampling and was drawn with equal probability from each domain of study (region and age-group). Nationwide, 19,280 households and ~31,000 residents were selected. The study is large enough to detect prevalence of viral infection around 0.1% and risk factor assessments within each region. The methodology seems to be a viable way of differentiating between distinct epidemiological patterns of hepatitis A, B and C. These data will be of value for the evaluation of vaccination policies and for the design of control program strategies.

Prevalência de marcadores para o vírus da hepatite B em contatos domiciliares no Estado do Amazonas

The aim of our investigation was to evaluate, with a prevalence study, the modes of transmission of Hepatitis B virus (HBV), within infected subjects and their household contacts in the state of Amazon, western Brazilian Amazon. We studied 97 index cases and 258 household contacts. Out of the 258 household contacts of HBV, 51.6% had serological markers of a past infection, 12.0% signs of active infection, suggesting that the virus circulates within household members. The high prevalence among siblings (23.6%) demonstrates the importance of personal contact in the transmission of this virus. Another indirect indicator of intra-familial transmission was the high prevalence of HBV markers within contacts of a fulminant hepatitis. The vertical transmission of HBV in our region may or may not occur, but if it does it as a rare event. Our results demonstrate the importance of the presence of HBV, and demand other investigations to clarify the inter-familial transmission of these viruses in our region.

História natural da hepatite crônica B

An estimated 350 million people worldwide are chronically infected with hepatitis B virus (HBV). Three phases of chronic hepatitis B virus infection is are recognized: the immune tolerant phase (HBeAg-positive, high levels of serum HBV-DNA, normal ALT, and no evidence of active liver diseases), the immune clearance phase or chronic hepatitis phase (HBeAg-positive, high levels of serum HBV-DNA, elevated ALT, and active liver disease ), and the inactive carrier state or asymptomatic phase (HBsAg-positive in serum without HBeAg, HBV-DNA levels than < 105 copies/mL, and normal ALT levels). Chronic hepatitis B is classified into 2 major forms: HBeAg-positive disease (wild-type HBV) and HBeAg negative disease (pre-core/core promoter HBV variant). Both forms can lead to liver cirrhosis, hepatic decompensation and liver cancer. The purpose of this article is to review the principal aspects of natural history of chronic hepatitis B.

Infecção pelo vírus da hepatite C na região Amazônica brasileira

The article evaluates available scientific information concerning the prevalence and clinical characteristics of hepatitis C virus infection in the Brazilian Amazon, a know endemic area for hepatitis A, B and D viruses infection. All the information was obtained through extensive analysis of original and review articles and abstracts published in distinguished journals or in scientific meetings. In the Amazon Region, HCV infection prevalence rate in the general population varies from 1.1 to 2.4%. Among blood donators the prevalence rate varies from 0.8 to 5.9%. Pard (Eastern Amazon) and Acre (Western Amazon) State present the highest rates, 2% and 5.9%, respectively. In respect to the HCV infection prevalence rate in the risk groups, one observates high prevalence. In the Brazilian Amazon, infection by HCV seems to cope in the same way of infection in other parts of the world among the hemodialized (48.1 - 51.9%), health professionals (3.2%), HCV carriers contactants (10%) and lichen plannus patients (7.5%). There is a significant predominance of genotype 1, being sub-type 1b the most frequent. The HCV infection is similar in men and women and most of the infected are above 39 years of age. The major route of infection is parenteral and the major risk factors are blood transfusion and surgical procedures. HCV is rarely responsable for acute severe hepatitis in this region. On the other hand, of all chronic hepatitis, 22.6% are attributed to HCV in the Western Amazon and 25% in the Eastern Amazon. In the Brazilian Amazon, infection by HCV seems to cope in the same way of infection in other parts of the world.

Hepatite fulminante e febre negra de Lábrea: estudo de 5 casos procedentes de Codajás, Amazonas, Brasil

We have described the clinical and laboratory manifestations and evolutiortal aspects of five patients from Codajas, state of Amazonas, Brasil. These patients were treated at the Instituto de Medicina Tropical de Manaus with a picture of acute liver failure with an average period of evolution of 4 days. Of these patients, four died, within an average time of five days since the prodromal phase. Serology for hepatitis B showed that HBAg was present in four, and the HBc antigen in all patients. An autopsy was perfomed on the four patients who died, and the liver histopathology revealed a picture of fulminant hepatitis in two, and Labrea fever (febre negra), in the other two.

Prevalência da infecção pelos vírus da hepatite B (VHB) e da hepatite Delta (VHD) em Lábrea, Rio Purus, Estado do Amazonas

Summary This study estimates the prevalence of hepatitis B virus (HBV) and hepatitis Delta virus (HDV) infections in the city of Labrea, Western Amazon, Brazil, 11 years after the introduction of the HBV vaccination program in this region. The prevalence rates of HBV infection and HBV surface antigen (HbsAg) carriage were 49,9% and 3,3% respectively. HBV infection shows a medium endemicity pattern, low potential of infectivity and subclinical course of infection. Transmission may be more intense in children between 6 and 12 years of age, and among young adults, probably by perinatal or horizontal transmission within households or by sexual transmission, with a moderate risk for the development of chronic liver disorders. Interfamilial dissemination may be of great importance. HDV was found in 30% of HBsAg carriers, occurred with a history of acute hepatitis, and in HBV carriers was associated with biochemical signs of liver damage, demonstrating the importance of these two viruses as agents of liver disease in this population. We identified a significant reduction in the prevalence rates of HBV infection compared to those reported before the

History of viral hepatitis

INTRODUCTION The history of viral hepatitis goes back thousands of years and is a fascinating one. When humans were first infected by such agents, a natural repetitive cycle began, with the capacity to infect billions of humans, thus decimating the population and causing sequelae in thousands of lives. METHODS This article reviews the available scientific information on the history of viral hepatitis. All the information was obtained through extensive bibliographic review, including original and review articles and consultations on the internet. RESULTS There are reports on outbreaks of jaundice epidemics in China 5,000 years ago and in Babylon more than 2,500 years ago. The catastrophic history of great jaundice epidemics and pandemics is well known and generally associated with major wars. In the American Civil War, 40,000 cases occurred among Union troops. In 1885, an outbreak of catarrhal jaundice affected 191 workers at the Bremen shipyard (Germany) after vaccination against smallpox. In 1942, 28,585 soldiers became infected with hepatitis after inoculation with the yellow fever vaccine. The number of cases of hepatitis during the Second World War was estimated to be 16 million. Only in the twentieth century were the main agents causing viral hepatitis identified. The hepatitis B virus was the first to be discovered. CONCLUSIONS In this paper, through reviewing the history of major epidemics caused by hepatitis viruses and the history of discovery of these agents, singular peculiarities were revealed. Examples of this include the accidental or chance discovery of the hepatitis B and D viruses.

Co-infecção humana pelo plasmódio e o vírus da hepatite B: aspectos clínicos, sorológicos e imunológicos

The Amazon region is known for a high prevalence of hepatitis B infection, and accounts for more than 90% of malaria cases in Brazil. It has been suggested that the occurrence of coinfections may be important, and may influence the natural history of both diseases. This study evaluated 545 patients with acute malaria, in Coari, Western Brazilian Amazon. 333 (61.1%) presented Plasmodium vivax malaria, 193 (35.4%) Plasmodium falciparumand 19 (3.5%) mixed infections. The HBsAg prevalence was 4.2% and total anti-HBc 49.7%. Patients with HBV serological markers presented no clinical differences than those with malaria only, nor showed any association with classic signs of hepatic disorder. Although showing no statistical significance, HBsAg reactive subjects presented lower parasitic load and higher antibody titers, suggesting the possibility that the immune response in a coinfected individual is differentiated and leads to a variation in the parasite load and antibody production.

Hepatite fulminante na Amazônia brasileira

The author makes a revision and an update on the results of the researches involving the Labrea hepatitis and others fulminant hepatitis in western Brazilian Amazon, with emphasis in the clinical, epidemiologic, histopatologic characteristics and viral etiology as hepatitis B and D viruses. Potential etiologic role of same anothers hepatotropic virus is considered.

Fulminant hepatic failure in children and adolescents in Northern Brazil

The histological findings of fulminant hepatic failure were correlated to the demographic, clinical, biochemical and virological features in children and adolescents, native to the Amazonas State in Northern Brazil. 96.2% had evidence of infection by primary hepatotrophic viruses. Histological analysis revealed three distinct patterns of fulminant hepatic failure.