Rosangela Gaze

Soroprevalência das infecções pelos vírus das hepatites A e B em Macaé, Rio de Janeiro, Brasil

Total HAV and HBc seroprevalence rates in two socioeconomic groups in Macaé, Rio de Janeiro State, Brazil, were estimated in 1,100 surplus serum samples from routine laboratory tests identified by sex, age, neighborhood, and category of medical care, i.e., the public health system or National Unified Health System (SUS) as compared to private health services (NSUS). Seroprevalence rates by age, 95% confidence intervals, and statistical significance tests for differences between SUS and NSUS are presented. Distribution of seroprevalence rates (P) for total HAV (P = 88.8%; 95% CI = 86.8-90.6) and total HBc (P = 15.3%; 13.2-17.6) by age showed an ascending curve. Prevalence rates in the SUS group were significantly higher that in the NSUS group, for both HAV (chi2 = 31.15; p < 0.0001) and HBV (chi2 = 15.41; p < 0.0001). The high prevalence rates reflect the epidemiological pattern of HAV infection in developing countries and the relevance of the social and environmental context. The proportion of susceptible individuals in the < 5 and > 20 year groups highlights the need to vaccinate for hepatitis A and the potential increase in severe cases. High HVB prevalence among adolescents underscores the importance of vaccinating this group. The results serve as a reminder to health professionals concerning biosafety norms.

Reflexões éticas acerca dos estudos de soroprevelência de hepatites virais

INTRODUCAO: A aplicacao de novas tecnologias em pesquisas epidemiologicas sobre hepatites virais (HV) exige discussoes eticas sobre inqueritos domiciliares de soroprevalencia (IDS), estudos sentinelas (ES) e de registros de bancos de sangue (ERBS) e amostras de sorotecas (EAS). METODOS: Discutem-se fatores de forca (FF) e fragilidade (FR) destas abordagens, argumentos/justificativas para sua utilizacao e alternativas, segundo os principios eticos da Resolucao CNS no 196/96. RESULTADOS E DISCUSSAO: As pesquisas sobre HV justificam-se por sua magnitude, gravidade, vulnerabilidade e necessidade de subsidiar protocolos diagnosticos/terapeuticos e estrategias de prevencao/controle. Em relacao aos IDS, discutimos quanto a FF: autonomia do sujeito; representatividade amostral adequada; e FR: custo maior que beneficios; possibilidade de obter a informacao por outros meios. Para os ES, FF: monitoramento das HV com custo operacional inferior ao dos IDS; ausencia de danos adicionais ao sujeito; e FR: limitacao relativa de representatividade. Para os ERBS, FF: monitoramento do VHB/VHC em doadores de sangue com baixo custo, sem risco adicional; e FR: limitacao de representatividade. Quanto aos EAS, FF: preponderância de beneficios sobre riscos/custos; possibilidade de desvendar agravos desconhecidos e de oferecer diagnostico precoce e tratamento; FR: material biologico e dados de uma pesquisa podem ser utilizados em outras. CONCLUSAO: Estas discussoes contribuem para embasar processos eticos, orientar a escolha do tipo de estudo epidemiologico e construir novos conceitos sobre estes temas.

From hepatic diseases and jaundice to viral hepatitis: the configuration of a kaleidoscope

As hepatites virais A, B, C, D e E - viroses sistemicas hepatotropicas - produzem quadros de hepatite aguda. Dependendo do agente etiologico, da carga viral e de condicoes do hospedeiro, podem evoluir para hepatite cronica, cirrose, câncer de figado e formas agudas fulminantes. A versatilidade ecologica desses virus configura uma natureza espectral e cambiante de transmissao no tempo e no espaco; potencializada pelo curso subclinico por vezes prolongado de grande parte das infeccoes, constitui-se em desafio epidemiologico. Com base no curso historico dessas infeccoes foram descritos cenarios e tendencias relativas ao seu comportamento socioepidemiologico, apontando para a necessidade de superar modelos, padroes, protocolos e retornar a investigacao de cada situacao de saude/doenca. Ou seja, assinala para a imprescindivel exploracao das singularidades no sentido de desenvolver acoes gerais modeladas pelas especificidades locais.Viral hepatitis A, B, C, D and E--systemic hepatotropic viral infections--present as acute hepatitis that, depending on the etiological agent, viral load and host conditions, may evolve into chronic hepatitis, cirrhosis, liver cancer and acute fulminant disease. The ecological versatility of these viruses, their spectrum of transmission in time and space, potentialized by the sub-clinical course of a large proportion of infections, comprise an epidemiological challenge. This essay describes scenarios and tendencies in the socioepidemiologic profile, based on the history of these infections, and indicates the need to overcome patterns, models, and protocols and instead investigate each particular situation. In other words, it highlights the need to explore singularities in order to be able to develop new proposals for general actions tailored to local specificities.

Teses sobre hepatites na Faculdade de Medicina da Universidade Federal do Rio de Janeiro, 1837-2000

An inventory of the theses on hepatitis of the Faculdade de Medicina of the Universidade Federal do Rio de Janeiro between 1837 and 2000 is presented. The analysis indicates the potential and limits for discussion of the evolutionary framework of scientific knowledge on these health problems in Brazil. The theories are also discussed in light of their scientific reference points and the technological and social changes that influenced them. The landmarks in medical education and knowledge about hepatitis are identified and categorized, considering that the theses reveal at the very least the state of the art on the subject. The study makes it possible to explore the foundations upon which the scientific knowledge on hepatitis were built and indicate possibilities for research in the reconstruction of scientific knowledge of other health problems.

Das hepatopatias e icterícias às hepatites virais: configuração de um caleidoscópio

As hepatites virais A, B, C, D e E - viroses sistemicas hepatotropicas - produzem quadros de hepatite aguda. Dependendo do agente etiologico, da carga viral e de condicoes do hospedeiro, podem evoluir para hepatite cronica, cirrose, câncer de figado e formas agudas fulminantes. A versatilidade ecologica desses virus configura uma natureza espectral e cambiante de transmissao no tempo e no espaco; potencializada pelo curso subclinico por vezes prolongado de grande parte das infeccoes, constitui-se em desafio epidemiologico. Com base no curso historico dessas infeccoes foram descritos cenarios e tendencias relativas ao seu comportamento socioepidemiologico, apontando para a necessidade de superar modelos, padroes, protocolos e retornar a investigacao de cada situacao de saude/doenca. Ou seja, assinala para a imprescindivel exploracao das singularidades no sentido de desenvolver acoes gerais modeladas pelas especificidades locais.Viral hepatitis A, B, C, D and E--systemic hepatotropic viral infections--present as acute hepatitis that, depending on the etiological agent, viral load and host conditions, may evolve into chronic hepatitis, cirrhosis, liver cancer and acute fulminant disease. The ecological versatility of these viruses, their spectrum of transmission in time and space, potentialized by the sub-clinical course of a large proportion of infections, comprise an epidemiological challenge. This essay describes scenarios and tendencies in the socioepidemiologic profile, based on the history of these infections, and indicates the need to overcome patterns, models, and protocols and instead investigate each particular situation. In other words, it highlights the need to explore singularities in order to be able to develop new proposals for general actions tailored to local specificities.

Ethical issues on experiments in anima nobile on hepatitis

, other agents of viral hepatitis (VH) have been identi-fied. Transaminases and hepatic biopsy in the 1950s, and serological diagnosis, gave additional visibility to the VH and contributed to the growing efforts on research of pas-sive and active immunization of the 1970/1980s. From 1990 on, the hepatitis C pandemic helped to focus scientific and economic interests in the production of drugs. Research methods and goals changed but phase three experiments – clinical trials – still require interventions in people. The history of diseases provides many examples of re-search in human beings, volunteers or not. In the case of hepatitis, resistance of the scientific community to accept its infective etiology