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Abdel-Gawad M, Abd-Elsalam S, Abdel-Gawad I, Tag-Adeen M, El-Sayed M, Abdel-Malek D. Seroprevalence of hepatitis C virus infection in children: A systematic review and meta-analysis. Liver Int 2022; 42:1241-1249. [PMID: 35220648 DOI: 10.1111/liv.15212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/02/2022] [Accepted: 02/16/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS Estimates of paediatric hepatitis C virus (HCV) seroprevalence are needed to aid treatment scaling-up, screening and detection approach in this age range, with the ultimate goal of global HCV eradication. The aim of this study was to gather all of the available information on HCV seroprevalence in children all around the world. METHODS We searched PubMed, Scopus, Web of Science (WOS), Wiley and EBSCO databases for all studies evaluating HCV seroprevalence in children; however, studies examining seroprevalence in high-risk children or specific groups were excluded. RESULTS Only 20 articles with 48 963 people met our inclusion criteria, with an overall prevalence of 0.904% and a 95% confidence interval (CI) of 0.543 to 1.355. Seroprevalence was higher in research published prior to 2010 than in those published after 2010 (0.77% vs. 0.53%). CONCLUSION Few studies were conducted to assess the seroprevalence of HCV in children worldwide. However, the worldwide pooled seroprevalence of HCV in children in these studies is low (less than 1%).
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Affiliation(s)
- Muhammad Abdel-Gawad
- Hepatology, Gastroenterology, and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Mohammed Tag-Adeen
- Internal Medicine, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Marwa El-Sayed
- Microbiology and Immunology, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Dalia Abdel-Malek
- Clinical Pharmacy, Egyptian Ministry of Health and Population, Assiut, Egypt
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Melikoki V, Kourlaba G, Kanavaki I, Fessatou S, Papaevangelou V. Seroprevalence of Hepatitis C in Children Without Identifiable Risk-Factors: A Systematic Review and Meta-Analysis. J Pediatr Gastroenterol Nutr 2021; 72:e140-e148. [PMID: 33633077 DOI: 10.1097/mpg.0000000000003099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Hepatitis C virus (HCV) remains a major public health burden for >30 years since its discovery. It is estimated that >80 million people have been already infected. Direct-acting antiviral (DAA) treatment is now approved for young children over the age of 3 years. Treating children before the development of high-risk behaviors is optimal. Thus, assessing the current epidemiology of HCV in children becomes important and may promote awareness. METHODS Articles describing the prevalence of hepatitis C in children, were systematically reviewed. To assess HCV infection prevalence in the general population, studies discussing high-risk groups alone were excluded. RESULTS Data from 58 studies were analyzed. National data was scarce. An overall prevalence of HCV in children of 0.87% was found, ranging from 0.34% in Europe to 3.02% in Africa. Prevalence of viremic infection is important and data synthesis from available data indicated that HCV viremia was detected in 56.8% of children. The prevalence of HCV according to sex was described in 25 studies but no difference between sexes was detected. HCV prevalence was significantly higher in children older than 10 years (0.97%) when compared to those ages under 10 years old (0.75%, P < 0.001). CONCLUSIONS Considering probable underdiagnosis of HCV infection in children, this information reveals that prevalence is substantial. One may argue that future strategies aiming towards HCV elimination, may need to include antiviral treatment of pre-adolescent children as well.
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Affiliation(s)
| | - Georgia Kourlaba
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens
| | - Ino Kanavaki
- Third Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, Greece
| | - Smaragdi Fessatou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, Greece
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Al Humayed SM, El-Mekki AA, Mahfouz AA. Hepatitis C virus infection in southwestern Saudi Arabia: Are we still in the plateau phase? J Med Virol 2016; 89:867-871. [PMID: 27735998 DOI: 10.1002/jmv.24712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 12/15/2022]
Abstract
The aim was to study the seroprevalence of Hepatitis C virus (HCV) infection and related risk factors in Aseer region in southwestern Saudi Arabia, the region known to be of the highest endemicity of viral hepatitis. In a cross-sectional study, all participants were interviewed using structured questionnaire. HCV infection was diagnosed using fourth-generation ELISA. All positive and equivocal HCV serology results were further confirmed by using a qualitative confirmatory RT-PCR. The study enrolled 10,234 participants. A seroprevalence of 2.2% (95%CI: 1.9-2.5%) was found. In multivariate logistic regression analysis, the study showed that males had significantly more risk to become seropositive for HCV (aOR = 1.437, 95%CI: 1.071-1.927) compared to females. Similarly, participants having history of blood transfusion had more than two times the risk of becoming seropositive for HCV (aOR = 2.079, 95%CI: 1.037-4.149). HCV infection in the study area is still high in the plateau phase. It is recommended to have an active educational and media campaign about the risks of HCV infections. Workshops and training of qualified laboratory staff related to blood banking seem mandatory. J. Med. Virol. 89:867-871, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Suliman M Al Humayed
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Awad A El-Mekki
- Department of Clinical Microbiology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ahmed A Mahfouz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Mohamoud YA, Riome S, Abu-Raddad LJ. Epidemiology of hepatitis C virus in the Arabian Gulf countries: Systematic review and meta-analysis of prevalence. Int J Infect Dis 2016; 46:116-25. [PMID: 26996460 DOI: 10.1016/j.ijid.2016.03.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/16/2016] [Accepted: 03/13/2016] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aims of this study were to perform a systematic review and synthesize epidemiological data on hepatitis C virus (HCV) in the Arabian Gulf countries, and to assess the country-specific prevalence among nationals and expatriate populations. METHODS A systematic review of HCV antibody prevalence and incidence in the Arabian Gulf countries was conducted, based on the items outlined in the PRISMA statement. Meta-analyses were performed incorporating inverse variance weighting and using a random-effects model to pool summary estimates of HCV prevalence among general population groups, for nationals and the entire resident population. RESULTS A total of 557 prevalence measures and one incidence measure were identified for the Arabian Gulf countries. HCV prevalence among nationals was 0.24% (95% confidence interval (CI) 0.02-0.63) in the United Arab Emirates (UAE), 0.44% (95% CI 0.29-0.62) in Kuwait, 0.51% (95% CI 0.43-0.59) in Qatar, and 1.65% (95% CI 1.40-1.91) in Saudi Arabia. No data were available for Bahrain or Oman. Among the entire resident populations, HCV prevalence was 0.30% (95% CI 0.23-0.38) in Bahrain, 0.41% (95% CI 0.35-0.46) in Oman, 1.06% (95% CI 0.51-1.81) in Qatar, 1.45% (95% CI 0.75-2.34) in Kuwait, 1.63% (95% CI 1.42-1.84) in Saudi Arabia, and 1.64% (95% CI 0.96-2.49) in UAE. A higher prevalence was observed among expatriate populations such as Egyptians. Among the high-risk populations, HCV prevalence was as high as 78.6% in the multi-transfused and 74.6% in people who inject drugs. CONCLUSIONS National-level HCV prevalence in the Arabian Gulf region is comparable to global levels. A higher prevalence is found in specific expatriate populations, reflecting the prevalence in their countries of origin. Most exposures appear to occur in high-risk groups and these are often linked to medical care.
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Affiliation(s)
- Yousra A Mohamoud
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation, Education City, PO Box 24144, Doha, Qatar
| | - Suzanne Riome
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation, Education City, PO Box 24144, Doha, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation, Education City, PO Box 24144, Doha, Qatar; Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, USA; College of Public Health, Hamad bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar.
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Mohamoud YA, Miller FD, Abu-Raddad LJ. Potential for human immunodeficiency virus parenteral transmission in the Middle East and North Africa: An analysis using hepatitis C virus as a proxy biomarker. World J Gastroenterol 2014; 20:12734-12752. [PMID: 25278675 PMCID: PMC4177460 DOI: 10.3748/wjg.v20.i36.12734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/20/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
The Middle East and North Africa (MENA) region has endured several major events of infection parenteral transmission. Recent work has established the utility of using hepatitis C virus (HCV) as a proxy biomarker for assessing the epidemic potential for human immunodeficiency virus (HIV) parenteral transmission. In this review, we use data on the prevalence of HCV infection antibody (seroprevalence) among general population and high risk population groups to assess the potential for HIV parenteral transmission in MENA. Relatively low prevalence of HCV infection in the general population groups was reported in most MENA countries indicating that parenteral HIV transmission at endemic levels does not appear to be a cause for concern. Nonetheless, there could be opportunities for localized HIV outbreaks and transmission of other blood-borne infections in some settings such as healthcare facilities. Though there have been steady improvements in safety measures related to parenteral modes of transmission in the region, these improvements have not been uniform across all countries. More precautions, including infection control training programs, surveillance systems for nosocomial infections and wider coverage and evaluation of hepatitis B virus immunization programs need to be implemented to avoid the unnecessary spread of HIV, HCV, and other blood-borne pathogens along the parenteral modes of transmission.
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Alfaleh FZ, Alswat K, Helmy A, Al-hamoudi W, El-sharkawy M, Omar M, Shalaby A, Bedewi MA, Hadad Q, Ali SM, Alfaleh A, Abdo AA. The natural history and long-term outcomes in patients with chronic hepatitis C genotype 4 after interferon-based therapy. Liver Int 2013; 33:871-83. [PMID: 23490034 DOI: 10.1111/liv.12127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 01/16/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) genotype 4 (G4) infection is common in the Middle East. Post-treatment long-term outcomes have not been reported in these patients. This study evaluates these outcomes in patients after interferon-based therapy. PATIENTS AND METHODS A total of 157 patients were followed from June 2001 to February 2012. Descriptive and analytical statistics, cumulative outcomes and the independent predictors of disease progression were calculated. RESULTS The overall age was 48.0 ± 11.8 years, 75 (47.8%) were males and 53 (70.7%) of 75 who were genotyped had G4. The follow-up period was 63.8 ± 32.8 months. Sustained virological response (SVR) was achieved in 62 (39.5%) and 24 (45.3%) patients in the whole group and the G4 subgroup respectively. Among the whole cohort and the G4 subgroup, disease progressed in 59 (37.6%) and 21 (39.6%), respectively, with less progression in the SVR groups; 15/62 (24.2%) and 3/24 (12.5%) compared with non-responders; 44 (46.3%) and 18 (62.1%) with P = 0.01 and 0.001 respectively. Multivariate logistic regression analysis showed that having diabetes mellitus (P = 0.03), higher baseline APRI score (P = 0.00) and non-SVR (P = 0.00) were independent predictors of disease progression. G4 patients showed similar results, but 'non-SVR' (P = 0.00) was the only independent predictor of progression. Eight patients died and four developed HCC all among the non-SVR group only. CONCLUSIONS This study describes, for the first time, the natural history and demonstrates the beneficial long-term effects of interferon-based therapy in HCV G4 patients.
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Affiliation(s)
- Faleh Z Alfaleh
- Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Alswat KA, Sanai FM, Altuwaijri M, Albenmousa A, Almadi M, Al-Hamoudi WK, Abdo AA. Clinical characteristics of patients with hepatocellular carcinoma in a middle eastern population. HEPATITIS MONTHLY 2013; 13:e7612. [PMID: 23922558 PMCID: PMC3732662 DOI: 10.5812/hepatmon.7612] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/02/2012] [Accepted: 01/19/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the leading causes of death in Saudi male patients. Local clinical and demographic data of this disease are scarce. OBJECTIVES We sought to describe the clinical characteristics and outcomes of patients from two tertiary care centers in Saudi Arabia. PATIENTS AND METHODS Data were collected for all patients diagnosed to have hepatocellular carcinoma between June 2003 and July 2008 who had been registered in a special research database (the Saudi Observatory Liver Disease Registry (SOLID)). Data were extracted from SOLID for clinical, biochemical, radiologic parameters and outcome. RESULTS Data was available for 363 patients, the mean age of diagnosis was 66 years, 74% of patients were males, and Hepatitis C was the underlying cause of liver disease in 48%, while Hepatitis B in 29%. Most of the patients were diagnosed at an advanced stage, 53 % of patients had a CLIP score of 4 to 6 (advanced stage), 55% had large multi-nodular tumors and 16% had vascular invasion or extra-hepatic spread at the time of diagnosis. Most of the patients had decompensated cirrhosis; with child-pogh score B in 44% and C in 26% with presence of portal hypertension in 55%. Forty eight percent died during the study period. Predictors of poor survival in the univariate analysis were; presence of portal vein thrombosis (P = 0.03), portal hypertension (P < 0.0001), presence of ascites (P = 0.022), hepatic encephalopathy (P < 0.0001), advanced child-pough score (P < 0.0001), bilirubin > 22 (P < 0.0001) and INR > 1.2 (P = 0.02). On multivariate analysis, only the presence of portal hypertension, bilirubin > 22 and severe hepatic encephalopathy were significant with adjusted hazard ratio of 1.6 (95% CI; 1.04-2.47), 1.76 (95% CI; 1.12-2.8), and 3.18 (95% CI; 1.42-7.14) respectively. CONCLUSIONS The data from this cohort indicates that most of patients diagnosed with HCC present at late tumor and liver disease stages, when prognosis is usually dismal. Regular cancer surveillance in cirrhotic patients might change the outcomes. Further studies with results of treatment outcomes in this community are needed.
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Affiliation(s)
- Khalid A. Alswat
- Department of Medicine, Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
- Corresponding author: Khalid A. Alswat, Department of Medicine, Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia. Tel: +966-14679167, Fax: +966-14671217, E-mail:
| | - Faisal M. Sanai
- Department of Hepatobiliary Science and Liver Transplantation, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mansour Altuwaijri
- Department of Medicine, Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
| | - Ali Albenmousa
- Department of Gastroenterology, Riyadh Military Hospital, Riyadh, Saudi Arabia
| | - Majid Almadi
- Department of Medicine, Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
| | - Waleed K. Al-Hamoudi
- Department of Medicine, Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
| | - Ayman A. Abdo
- Department of Medicine, Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
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Shakeri MT, Nomani H, Ghayour Mobarhan M, Sima HR, Gerayli S, Shahbazi S, Rostami S, Meshkat Z. The prevalence of hepatitis C virus in mashhad, iran: a population-based study. HEPATITIS MONTHLY 2013; 13:e7723. [PMID: 23745128 PMCID: PMC3669679 DOI: 10.5812/hepatmon.7723] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 11/10/2012] [Accepted: 12/09/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a significant health problem throughout the world. Chronic form of the disease is found in about 75% to 85% of the newly infected individuals. The chronic infection may lead to severe forms including chronic liver disease, cirrhosis and with a higher mortality rate, hepatocellular carcinoma. Since no vaccine has yet been developed against HCV, there is an increasing need to take measures to control the spread of the infection. Therefore, epidemiologic study of the virus is important to manage and monitor the spread of the virus in the community. OBJECTIVES The aim of this study was to determine the prevalence of hepatitis C seropositivity in the general population of Mashhad, northeast of Iran. PATIENTS AND METHODS Three thousand, eight hundred and seventy (3870) individuals living in the city of Mashhad were recruited using cluster sampling method. HCV seropositivity was determined with HCV antibody detection ELISA kit and was confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) method. RESULTS In this study the overall seroprevalence of hepatitis C was founded to be 0.2% by using ELISA method. However, the overall Hepatitis C virus infection prevalence was found to be 0.13% with RT-PCR method. CONCLUSIONS Our study suggested that the prevalence rate of Hepatitis C virus is below 1% in the general population of Mashhad.
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Affiliation(s)
- Mohammad Taghi Shakeri
- Department of Biostatistics, Public Health School, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Hosein Nomani
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Majid Ghayour Mobarhan
- Biochemistry of Nutritional Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Hamid Reza Sima
- Department of Internal Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Sina Gerayli
- Department of Biology, Faculty of Sciences, Ferdowsi University of Mashhad, Mashhad, IR Iran
| | - Shirin Shahbazi
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Sina Rostami
- Department of Biology, Faculty of Sciences, Ferdowsi University of Mashhad, Mashhad, IR Iran
| | - Zahra Meshkat
- Women’s Health Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Zahra Meshkat, Women’s Health Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel.: +98-5118012453, Fax: +98-5118002960, E-mail:
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Wirth S. Current treatment options and response rates in children with chronic hepatitis C. World J Gastroenterol 2012; 18:99-104. [PMID: 22253515 PMCID: PMC3257449 DOI: 10.3748/wjg.v18.i2.99] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 06/16/2011] [Accepted: 06/23/2011] [Indexed: 02/06/2023] Open
Abstract
Vertical transmission has become the most common mode of transmission of hepatitis C virus (HCV) in children. The rate of perinatal transmission from an HCV-infected mother to her child ranges from 2% to 5% and the prevalence of HCV in children in developed countries ranges between 0.1% and 0.4%. Spontaneous viral clearance seems to be dependent on the genotype and has been reported between 2.4%-25%. For chronically infected patients, treatment with recombinant polyethylene glycol (PEG)-interferon α-2b and daily ribavirin has now been approved as standard treatment for children 2-17 years of age. In five large prospective studies, a total of 318 children and adolescents aged 3-17 years were treated either with subcutaneous PEG-interferon α-2b at a dose of 1-1.5 μg/kg or 60 μg/m² once a week in combination with oral ribavirin (15 mg/kg per day) or PEG-interferon α-2a with ribavirin. Subjects with genotype 1 and 4 received the medication for 48 wk and individuals with genotype 2 and 3 mainly for 24 wk. Overall sustained viral response (SVR) was achieved in 193/318 (60.7%) of treated patients. Stratified for genotype; 120/234 (51%) with genotype 1, 68/73 (93%) with genotype 2/3, and 6/11 (55%) with genotype 4 showed SVR. Relapse rate was between 7.7% and 17%. Overall, treatment was well tolerated; however, notable side effects were present in approximately 20%. According to recent experiences in the treatment of chronic hepatitis C in children and adolescents, a combination of PEG-interferon α with ribavirin has been found to be well tolerated and highly efficacious, particularly in individuals with genotype 2/3. Thus, this treatment can be recommended as standard of care until more effective treatment options will become available for genotype 1 patients.
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Abstract
In industrialized countries, hepatitis C virus (HCV) is the most common cause of chronic liver disease in children. Perinatal transmission is the leading cause of infection. Perinatal transmission is confined almost always to women with detectable HCV ribonucleic acid (RNA) in the peripheral blood by the polymerase chain reaction but all children born to women with anti-HCV antibodies should be tested for HCV. Some but not all studies found that a high concentration of serum HCV RNA is associated with a higher risk of transmission. Maternal peripheral blood mononuclear cell infection by HCV, membrane rupture of longer than 6 hr before delivery, and procedures exposing the infant to maternal blood infected with HCV during vaginal delivery are associated with an increased risk of transmission. Maternal coinfection with HCV and human immunodeficiency virus, maternal history of intravenous drug use and of HCV infection of the sexual partner of the mother predict the risk of perinatal transmission and are dependent on the peripheral blood mononuclear cell infection by HCV. Delivery by Cesarean section is not recommended in pregnant women infected with HCV. Infected mothers can breast feed safely their infants if the nipples are not damaged. A previous delivery of a child infected perinatally with HCV does not increase the risk of transmission in subsequent pregnancies. Immunogenetic factors and HCV genotypes are not related to HCV perinatal transmission. Despite an increased understanding of the risk factors involved in perinatal transmission of HCV, to date little is known about the transmission mechanisms and timing.
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Affiliation(s)
- Giuseppe Indolfi
- Department of Paediatrics, University of Florence, Anna Meyer Children's Hospital, Florence, Italy.
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Al Ashgar H, Helmy A, Khan MQ, Al Kahtani K, Al Quaiz M, Rezeig M, Kagevi I, Alshehri A, Al Kalbani A, Al Swat K, Dahab S, Elkum N, Al Fadda M. Predictors of sustained virological response to a 48-week course of pegylated interferon alfa-2a and ribavirin in patients infected with hepatitis C virus genotype 4. Ann Saudi Med 2009; 29:4-14. [PMID: 19139619 PMCID: PMC2813618 DOI: 10.4103/0256-4947.51816] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Knowledge of the predictors of sustained viral response (SVR) to pegylated interferon (PEG-INF) alfa-2a and ribavirin (RBV) therapy in patients with hepatitis C genotype-4 (HCV-4) is crucial for selecting patients who would benefit most from therapy. We assessed the predictors of SVR to this combination therapy in Saudi patients with chronic HCV-4 infection. PATIENTS AND METHODS This retrospective study included 148 patients with HCV-4 infection who underwent clinical, biochemical and virological assessments before treatment and at 12, 24, 48 and 72 weeks post-treatment. RESULTS Of the 148 patients, 90 (60.8%) were males. Mean (SD) for age was 48.5 (12.7) years and BMI was 27.9 (7.5) kg/m(2). Seventy-nine of 148 (60.1%) patients were treatment naïve and 110 (74.3%) underwent pre-treatment liver biopsy. Eighteen (12.2%) patients did not complete therapy because of side effects or they were lost to follow up. Early virological response was achieved in 84 of 91 (92.3%) patients. In the 130 (87.8%) patients who completed therapy, 34 (26.2%) were non-responders and 96 (63.8%) achieved end-of-treatment virological response (ETVR). SVR and virological relapse (24 weeks after ETVR) occurred in 66/130 (50.7%) and 30/130 (31.2%) patients, respectively. Compared to relapsers, sustained responders were significantly younger (P=.005), non-diabetic (P=.005), had higher serum albumin (P=.028), lower alpha-fetoprotein level (P=.026), lower aspartate aminotransferase (AST) (P=.04) levels, and were treatment-naïve (P=.008). In a multivariate regression analysis, the independent predictors of SVR were younger age (P=.016), lower serum AST (P=.012), and being treatment naïve (P=.021). CONCLUSION Approximately half of HCV-4 patients who complete the course of combination therapy achieve an SVR, especially if they are young, treatment naA ve and have lower AST levels.
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Affiliation(s)
- Hamad Al Ashgar
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Hassan ZM, Wahsheh MA, Shishani KR, Pryor ER. Hepatitis needs assessment among Jordanian healthcare workers. Int Nurs Rev 2008; 55:142-7. [PMID: 18477097 DOI: 10.1111/j.1466-7657.2007.00583.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hepatitis infections caused by hepatitis A, B and C virus are considered to be an important health problem worldwide. Based on the available data from the Jordanian Ministry of Health, the incidence rates of hepatitis A and B in the Jordanian population in 2003 were 10.2 and 0.8 per 100,000 per year, respectively; however, data on the incidence of hepatitis C are not currently available. RESEARCH OBJECTIVE To assess Jordanian healthcare workers' hepatitis training needs. METHODS A total of 339 healthcare workers from private and public Jordanian healthcare settings participated in this descriptive study. The Minnesota Primary Care Practitioners Viral Hepatitis Survey was utilized for data collection. RESULTS Two-thirds of the participants expressed that they did not have adequate and current training in issues related to hepatitis infections. Healthcare workers indicated an interest in receiving information and training about hepatitis A, B and C (83%, 71% and 80%, respectively). CONCLUSION The results of this study showed that the majority of Jordanian healthcare workers reported a need for hepatitis training. IMPLICATION TO PRACTICE: Standardized training should be provided to healthcare workers who are working in high-risk settings.
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Affiliation(s)
- Z M Hassan
- School of Nursing, Hashemite University, Zarqa, Jordan.
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Rezvan H, Abolghassemi H, Kafiabad SA. Transfusion-transmitted infections among multitransfused patients in Iran: a review. Transfus Med 2008; 17:425-33. [PMID: 18067646 DOI: 10.1111/j.1365-3148.2007.00794.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Transfusion-transmitted infections (TTI) continue to be a major challenge for Blood transfusion organizations across the world. The problem is more serious in the developing countries with lower economic means. Multitransfused patients (MTPs) in these countries are at higher risk of infection, and studies of infection in these patients can be a useful index for examining the blood safety filters in place. The present article reviews the situation in Iran, where prevalence of the major viruses of concern, namely, hepatitis B virus, hepatitis C virus (HCV) and human immunodeficiency virus, studied in these patients is reported over a 9-year period. It is demonstrated that HCV is the most prevalent TTI and remains a major health problem for these patients.
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Affiliation(s)
- H Rezvan
- IBTO Research Center, Hemmat highway, Tehran, Iran.
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Abstract
The prevalence of chronic hepatitis C infection in the general paediatric population varies between 0.1 and 15% around the world, with the highest numbers noted in endemic areas of Africa. The risk of viral transmission from an infected mother to her child is approximately 5% and there are currently no effective preventative measures to lower it. All children born to infected mothers should be tested for hepatitis C. The progression to liver damage in infected children is slow. However, in the perspective of 15-20 years of infection or in the presence of other risk factors, such as concomitant chronic disease, a progression to more severe liver damage can be seen. Thus, the use of antiviral treatment may be of importance. Treatment combinations of interferon and ribavirin seem to be at least as effective in children as in adults. However, the negative effect on growth of interferon requires specific attention by paediatricians.
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Affiliation(s)
- Björn Fischler
- Department of Pediatrics, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden.
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Park HS, Han JH, Choi KM, Kim SM. Relation between elevated serum alanine aminotransferase and metabolic syndrome in Korean adolescents. Am J Clin Nutr 2005; 82:1046-51. [PMID: 16280437 DOI: 10.1093/ajcn/82.5.1046] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Concern is growing about nonalcoholic fatty liver disease, not only because it is a common liver disorder but also because it is one of the leading causes of chronic liver disease. Unexplained elevations in aminotransferase concentrations have been strongly associated with adiposity and thus may represent nonalcoholic fatty liver disease. OBJECTIVE We investigated the relation between nonviral or nonalcoholic elevations in alanine aminotransferase (ALT) and the metabolic syndrome in Korean adolescents. DESIGN Data were obtained from 1594 subjects aged 10-19 y from the Korean National Health and Nutrition Examination Survey 1998, a cross-sectional health survey of a nationally representative sample of noninstitutionalized civilian South Koreans. Body mass index, waist circumference, blood pressure, fasting glucose, lipid profiles, and serum ALT were measured. RESULTS The prevalence of elevated ALT (> 40 U/L) was 3.6% in boys and 2.8% in girls. The prevalence of metabolic syndrome was 3.3% in both boys and girls. The components of the metabolic syndrome were significantly worse in the group with elevated ALT concentrations than in the group with normal ALT concentrations. The odds ratios (95% CIs) for elevated ALT were 6.6 (3.7, 11.8), 2.3 (1.2, 4.6), and 3.0 (1.6, 5.8) in the adolescents with abdominal obesity, high triacylglycerol concentrations, and low HDL-cholesterol concentrations, respectively. The odds ratios for elevated ALT were 1.5 (0.7, 3.1), 2.6 (1.1, 6.2), and 6.2 (2.3, 16.8) in the adolescents with 1, 2, and > or = 3 risk factors (metabolic syndrome), respectively. CONCLUSION The metabolic syndrome was strongly associated with elevated ALT concentrations in Korean adolescents, and this association existed in a graded fashion across the number of metabolic components.
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Affiliation(s)
- Hye Soon Park
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Monteiro MRDCC, do Nascimento MMP, Passos ADC, Figueiredo JFDC. Hepatite C: prevalência e fatores de risco entre portadores do VIH/SIDA em Belém, Pará, na Amazônia brasileira. Rev Soc Bras Med Trop 2004; 37 Suppl 2:40-6. [PMID: 15586895 DOI: 10.1590/s0037-86822004000700006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este trabalho objetivou investigar a prevalência de infecção pelo vírus da hepatite C e identificar possíveis fatores de risco para sua transmissão, em 406 indivíduos portadores do vírus da imunodeficiência humana, maiores de dezoito anos de idade, atendidos na rede pública de saúde da cidade de Belém, Pará, situada na Amazônia brasileira. Os exames referentes ao anti-VHC foram realizados pelo método de Elisa e a pesquisa do VHC RNA através da reação de polimerase em cadeia. A prevalência de infecção, atual ou pregressa, pelo vírus da hepatite C foi de 16% (IC: 12,4 - 19,6). A análise multivariada mostrou associação do vírus C com as variáveis idade, cujo risco significante recaiu no grupo com cinqüenta ou mais anos (OR=9,75), antecedente de transfusão de sangue (OR=4,74) e uso de droga ilícita injetável (OR=149,28). A prevalência do vírus da hepatite C entre os usuários de drogas injetáveis foi de 83,7% e de 22,1% na população de transfundidos. Estes resultados indicam a efetiva transmissão do vírus C através da exposição percutânea e reafirmam o grande potencial de risco para hepatite C contido no uso injetável de drogas ilícitas.
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17
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Al-Faleh FZ. Changing pattern of hepatitis viral infection in Saudi Arabia in the last two decades. Ann Saudi Med 2003; 23:367-71. [PMID: 16868370 DOI: 10.5144/0256-4947.2003.367] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Information on the epidemiology of viral hepatitis B, C and A in the Kingdom of Saudi Arabia (KSA) has accumulated over the last two decades. We review the changing epidemiology of these infections and suggest possible strategies for eradication. METHODS We screened Saudi medical journals and Medline for reports dealing with hepatitis B, C and A, and analyzed official of blood donor screening data from the Ministry of Health (MOH) Central Blood Bank and the King Khalid University Hospital (KKUH) Blood Bank. RESULTS Several studies from the 1980s found a high endemicity for HBV, with 5% to 10% of the population infected and prevalence varying from one region to another. In children (age 1 to 12 years), the prevalence was almost 7% in 1989, just before the addition of the HBV vaccine to the Extended Program of Immunization (EPI). By 1997, the prevalence of HBV infection in children had declined to 0.3%. Blood donor results have also shown a steady decrease in HBV infection. At KKUH, prevalence declined from 3.7% in 1987 to 1.7% in 2000. Hepatitis C infection has also shown a marked decline among Saudi blood donors at KKUH, HAV infection among children has declined from 50% in 1989 to 25% in 1997, but the infection rate is still high, reaching 50% in a few regions. CONCLUSIONS Hepatitis B, C, and A infection has declined in KSA in the last two decades by more than 50%. The reasons for this marked decline are multifactorial. An important reason is the adoption in the last two decades of the MOH strategy for prevention of viral hepatitis infection, which needs to continue. Improvements in the economic status of the population and the decline in illiteracy have also contributed to the decline in viral hepatitis infection.
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18
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Abstract
An estimated 240,000 children in the United States have antibody to hepatitis C virus (HCV) and 68,000 to 100,000 are chronically infected with HCV. Acute HCV infection is rarely recognized in children outside of special circumstances such as a known exposure from an HCV-infected mother or after blood transfusion. Most chronically infected children are asymptomatic and have normal or only mildly abnormal alanine aminotransferase levels. Although the natural history of HCV infection acquired in childhood seems benign in the majority of instances, the infection takes an aggressive course in a proportion of cases leading to cirrhosis and end-stage liver disease during childhood; the factors responsible for a more aggressive course are unidentified. An optimal approach to management of hepatitis C in children would be prevention, particularly of perinatal transmission, which is now the major cause of new cases of hepatitis C in children. Obstetrical factors may be important determinants of transmission, which, if confirmed, should lead to changes in the care of infected women. Therapy of HCV infection in children is also not well defined. There have been no large randomized, controlled trials of therapy in children with chronic hepatitis C. Small heterogeneous studies of interferon monotherapy have reported sustained virological response rates of 35% to 40%. There are few data regarding the use of combination therapy with interferon and ribavirin in children and no information on the use of peginterferon. Clearly, there are important needs for future epidemiologic and clinical research on hepatitis C in childhood.
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Affiliation(s)
- Maureen M Jonas
- Division of Gastroenterology, Children's Hospital Boston, MA 02115, USA.
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19
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Abstract
An estimated 240,000 children in the United States have antibody to hepatitis C virus (HCV) and 68,000 to 100,000 are chronically infected with HCV. Acute HCV infection is rarely recognized in children outside of special circumstances such as a known exposure from an HCV-infected mother or after blood transfusion. Most chronically infected children are asymptomatic and have normal or only mildly abnormal alanine aminotransferase levels. Although the natural history of HCV infection acquired in childhood seems benign in the majority of instances, the infection takes an aggressive course in a proportion of cases leading to cirrhosis and end-stage liver disease during childhood; the factors responsible for a more aggressive course are unidentified. An optimal approach to management of hepatitis C in children would be prevention, particularly of perinatal transmission, which is now the major cause of new cases of hepatitis C in children. Obstetrical factors may be important determinants of transmission, which, if confirmed, should lead to changes in the care of infected women. Therapy of HCV infection in children is also not well defined. There have been no large randomized, controlled trials of therapy in children with chronic hepatitis C. Small heterogeneous studies of interferon monotherapy have reported sustained virological response rates of 35% to 40%. There are few data regarding the use of combination therapy with interferon and ribavirin in children and no information on the use of peginterferon. Clearly, there are important needs for future epidemiologic and clinical research on hepatitis C in childhood.
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Affiliation(s)
- Maureen M Jonas
- Division of Gastroenterology, Children's Hospital Boston, MA 02115, USA.
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20
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Solà R, Cruz De Castro E, Hombrados M, Planas R, Coll S, Jardí R, Sunyer J, Covas MI, Marrugat J. [Prevalence of hepatitis B and hepatitis C viruses in different counties of Catalonia, Spain: cross-sectional study]. Med Clin (Barc) 2002; 119:90-5. [PMID: 12106536 DOI: 10.1016/s0025-7753(02)73328-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND There are few data available in our community regarding the prevalence of hepatitis B (HBV) and hepatitis C (HCV) virus infection in the general population. MATERIAL AND METHOD The aim of this study was to determine the prevalence and serologic characteristics of HBV and HCV in Catalonia. For this purpose, HBsAg and anti-HCV were assessed in serum aliquots obtained from a sample of 2194 individuals, who were chosen at random out from different Catalonian counties. In those cases in which any of the markers were positive, the following analyses were performed afterwards: serum transaminases, HBV-DNA detection by PCR (in HBsAg positives) and HCV-RNA detection by PCR and genotypes (in antiHCV positives). All subjects yielding positive results were interviewed in order to determine possible risk factors. RESULTS HBV prevalence was 1.69% (95% CI, 1.62-1.76) and that of HCV was 2.64% (95% CI, 2.53-2.75). HCV prevalence increased with age (1.7% in younger than 50 years and 3.6% in older than 50 years, p < 0.01), but not that of HBV. Only a small proportion (12.1%) of HBV carriers had detectable HBV-DNA levels. On the contrary, quite an important proportion of HCV carriers (68.6%) had detectable HCV-RNA levels. Predominant HCV genotype was 1 (79.3%). Transaminases levels were within normal limits in many HBV and HCV carriers (70.9 and 60%, respectively). CONCLUSIONS Prevalence of HBV and HCV in Catalonia was 1.69% and 2.64%, respectively. Most HCV carriers had positive serum HCV-RNA, whereas serum HBV-DNA was negative in most HBV carriers
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Affiliation(s)
- Ricard Solà
- Societat Catalana de Digestologia, Acadèmia de Ciències Mèdiques de Catalunya i Balears, Barcelona, Spain.
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21
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Abstract
The aim of the study was to analyse the current literature regarding the mode of transmission of HCV and its global prevalence in different groups of people. A systematic review of the literature on the epidemiology of hepatitis C from 1991 to 2000 using computerized bibliographic databases which include Medline, Current Content and Embase. The prevalence of hepatitis C virus (HCV) varies tremendously in different parts of the world, with the highest incidence in the Eastern parts of the globe compared with the Western parts. Furthermore, certain groups of individuals such as intravenous drug users are at increased risk of acquiring this disease irrespective of the geographical location. Although the main route of transmission is via contaminated blood, curiously enough in up to 50% of the cases no recognizable transmission factor/route could be identified. Therefore, a number of other routes of transmission such as sexual or household exposure to infected contacts have been investigated with conflicting results. Hepatitis C infection is an important public health issue globally. Better understanding of routes of transmission will help to combat the spread of disease. In order to prevent a world wide epidemic of this disease, urgent measures are required to (i) develop a strategy to inform and educate the public regarding this disease and (ii) expedite the efforts to develop a vaccine.
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Affiliation(s)
- M I Memon
- Department of Community Health, Guild NHS Trust, Lancashire Post Graduate Medical School, Preston, UK.
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22
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Ayoola EA, Want MA, Gadour MOEH, Al-Hazmi MH, Hamza MKM. Hepatitis E virus infection in haemodialysis patients: a case-control study in Saudi Arabia. J Med Virol 2002; 66:329-34. [PMID: 11793384 DOI: 10.1002/jmv.2149] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To determine the prevalence of antibody to hepatitis E virus (IgM anti-HEV) among haemodialysis patients and evaluate whether there was an increased risk of infection and exposure to HEV in an area of endemic viral hepatitis, serum samples obtained from 83 Saudi patients on chronic haemodialysis (group 1), 400 sex- and age-matched healthy subjects (group 2) and hospital patients (group 3) were tested for the IgM anti-HEV and IgG anti-HEV. The prevalence of anti-HEV among the patients (group 1) and the healthy controls were 4.8% and 0.3%, respectively. The difference (4.5%) was statistically significant, with a calculated odds ratio (OR) of 20.2 (95% CI = 2.1-481.0; P = 0.0002). In contrast, there was no significant difference in the prevalence rates of IgG anti-HEV (7.2% vs 10.8%) in both groups. In nonhaemodialysis patients with various diseases, 1.6% (1 of 64) of outpatients (group 3) and none (0 of 113) of the ward patients (group 4) was positive for IgM anti-HEV. Thus, the prevalence (4 of 83) of IgM anti-HEV in the haemodialysis patients was significantly higher than the rate (1 of 177) in the combined groups of nonhaemodialysis hospital patients. The calculated OR was 8.9 (95% CI = 0.92, 212.8; P = 0.037). IgM antibody to hepatitis A virus (IgM anti-HAV) was not detected in any subjects, and the prevalence rates of IgG anti-HAV were similar in the patients and controls (72.3% and 74.3% in groups 1 and 2, respectively, and 75.7% combined groups 3 and 4). The study indicated a significantly higher risk of acute HEV infection among patients on chronic haemodialysis. It is possible that these were nosocomial infections acquired by person-to-person transmission in the haemodialysis unit. However, it is more probable that the infections were community acquired, a conclusion supported albeit indirectly by the lack of a significant difference between the prevalence in haemodialysis patients (4.8%) and outpatients (1.6%). In areas of endemic HEV, appropriate strategies should be adopted to prevent the risk of HEV among haemodialysis patients.
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Affiliation(s)
- E A Ayoola
- Department of Gastroenterology, King Fahd Central Hospital Gizan, Saudi Arabia.
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23
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Abstract
BACKGROUND Hepatitis C viral (HCV) infection is common in the general population and can cause disease in the nervous system. This article reviews the neurologic complications associated with this virus. REVIEW SUMMARY A vasculitic neuropathy is the most firmly linked neurologic illness associated with HCV infection. This type of neuropathy occurs frequently in the presence of cryoglobulinemia. HCV is considered the most common cause of cryoglobulinemia. Other types of neuropathy have been rarely reported with HCV infection and this association is less firm. In the central nervous system, vasculitis causing stroke appears to complicate HCV infection, usually in the setting of cryoglobulinemia. Several reports of myelitis, encephalitis,lymphoma are reviewed. HCV may be the etiologic virus of progressive encephalomyelitis with rigidity; a rare disorder similar to stiff-man syndrome although different because it is progressive and fatal. Treatment of the neurologic complications associated with HCV infection is summarized. CONCLUSIONS HCV infection is being increasingly recognized as a probable cause of a variety of neurologic disorders. Systematic study of the various therapeutic options remains unexplored.
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Affiliation(s)
- Sami L Khella
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
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Aslam M, Aslam J. Seroprevalence of the antibody to hepatitis C in select groups in the Punjab region of Pakistan. J Clin Gastroenterol 2001; 33:407-11. [PMID: 11606859 DOI: 10.1097/00004836-200111000-00013] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
GOALS Hepatitis C is on the rise in clinics in Pakistan. To estimate the occurrence of hepatitis C in the region and to create awareness about the disease in the general public, two studies were conducted in Punjab, Pakistan. Before this, no such effort has been made in Pakistan. BACKGROUND Two studies were held in Lahore and Gujranwala of Punjab, Pakistan. These studies were advertised throughout the city, and people who participated were screened for anti-hepatitis C virus (anti-HCV)-positive serology at a concession rate and were surveyed through a questionnaire. In Lahore, there were 488 participants (mean age, 28 years; male-to-female ratio, 1.4 to 1). In Gujranwala, there were 1,922 participants (mean age, 27 years; male-to-female ratio, 1.5 to 1). The patients' blood was tested using an immuno-chromatography to identify the antibody to hepatitis C using Instatest HCV, with very high sensitivity. RESULTS In Lahore, the occurrence of anti-HCV-positive serology was 15.9%. In Gujranwala, the occurrence of anti-HCV-positive serology was 23.8%. In Lahore, the occurrence was 1.2% in participants 20 years of age and younger and was 23.5% in those who were more than 20 years of age. In Gujranwala, the occurrence of anti-HCV-positive serology was 5.4% in participants 20 years of age and younger and was 34% in those who were more than 20 years of age. CONCLUSION It can be seen that in those younger than 20 years of age, the occurrence of hepatitis C is almost at par with the rest of the world (0.5-2%). However, those more than 20 years of age had a very high occurrence, as high as 50% in certain age groups. The time-frame of contraction of the HCV for those individuals more than 20 years of age (approximately 20 to 35 years ago) corresponds with that of the smallpox eradication program conducted in Pakistan from 1964 to 1982. This may indicate the likelihood of a relationship between the high rate of hepatitis C and the administration of the smallpox vaccine in Pakistan.
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Affiliation(s)
- M Aslam
- Punjab Hepatitis Research Center, Lahore, Pakistan
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25
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Meir H, Balawi I, Nayel H, El Karaksy H, El Haddad A. Hepatic dysfunction in children with acute lymphoblastic leukemia in remission: relation to hepatitis infection. MEDICAL AND PEDIATRIC ONCOLOGY 2001; 36:469-473. [PMID: 11260570 DOI: 10.1002/mpo.1111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Viral hepatitis is a cause of hepatic dysfunction in children with ALL in remission during maintenance therapy is debated. The aims of the current study were (1) to explore the incidence of hepatic dysfunction in a group of children (Egyptian and Saudi) with ALL under maintenance therapy, (2) to study the prevalence of hepatitis B (HBV) and/or C (HCV) infection and their contributions to chronic liver disease that might be induced by maintenance therapy. PROCEDURE The current study included 105 children with ALL (54 Egyptian and 51 Saudi). All eligible patients had been on maintenance therapy for at least 12 months and all had serial assessments of liver function. These included determination of total bilirubin, AST, ALT, and alkaline phosphatase. Markers for HBV and HCV including HBsAg, anti-HBC, and anti-HCV and for some patients HCV RNA by PCR were studied. Percutaneous liver biopsy was performed for a group of children. RESULTS The prevalence of hepatitis infection (HBV and/or HCV) among Egyptian children was found to be high (43/54-80%). Only five Saudi children had evidence of exposure to HBV (5/51-9.8%), P<0.0001. During the period of study, 22 Egyptian patients vs. four Saudi patients (41 vs. 7.8%, P<0.0001) experienced at least one episode of elevation of liver enzymes, three times the upper limit of normal or more. Twenty-six of the 48 patients (54%) with HBV and/or HCV infection had episodes of elevated liver enzymes, while there was no occurrence among the patients negative for HBV and HCV. In patients with HBV infection, the presence of HBsAg was strongly associated (100%) with elevated liver enzymes. Histopathologic examination of liver biopsies obtained from 35 patients revealed that all five patients negative for HBV and HCV had normal liver biopsies in spite of being under maintenance therapy. CONCLUSION In children undergoing treatment for ALL, elevations in liver enzymes may be primarily due to hepatitis viruses. However, maintenance therapy using known hepatotoxic drugs, may have additive deleterious effects. Liver enzymes are normalized in affected patients when maintenance therapy is temporarily suspended.
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Affiliation(s)
- H Meir
- King Abdul Aziz Hospital and Oncology Center, Jeddah, Saudi Arabia
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26
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Bellentani S, Miglioli L, Masutti F, Saccoccio G, Tiribelli C. Epidemiology of hepatitis C virus infection in Italy: the slowly unraveling mystery. Microbes Infect 2000; 2:1757-63. [PMID: 11137048 DOI: 10.1016/s1286-4579(00)01332-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In spite of the large diffusion of hepatitis C virus (HCV) infection and its high association with liver disease, the epidemiology of HCV in Italy is still unclear. This review collects all the data available on the prevalence and incidence of HCV infection in Italy and compares them with those reported in other countries.
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Affiliation(s)
- S Bellentani
- Fondo per lo Studio delle Malattie del Fegato- Sezione di Modena - Via R.Wagner, 12 - 41100, Modena, Italy.
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27
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Al-Faleh FZ, Aljumah A, Rezeig M, Al-Otaibi M, Alahdal M, Al-Humayed S, Mayet I, Al-Juhani M, Al-Karawi M, George K, Sbeih F. Treatment of chronic hepatitis C genotype IV with interferon-ribavirin combination in Saudi Arabia: a multicentre study. J Viral Hepat 2000; 7:287-91. [PMID: 10886538 DOI: 10.1046/j.1365-2893.2000.00213.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Between 1996 and 1997, we conducted a multicentre study to assess the effect of combination therapy of interferon (IFN) + ribavirin on chronic hepatitis C genotype 4. Ninety-seven patients were enrolled. Sixty-eight patients (47 male and 21 female) were non-responders to previous therapy with IFN (Group I). Twenty-nine patients (19 male and 10 female) were new (Group II). Following treatment with IFN, 23% in Group I and 9% in Group II had a sustained biochemical response. Only 12% in Group I and 5% in Group II achieved a sustained virological response. Virus load was found to be the major factor determining response, followed by histology grading and staging. Like HCV genotype 1, HCV genotype 4 seems to have a poor response to therapy.
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Affiliation(s)
- F Z Al-Faleh
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Aach RD, Yomtovian RA, Hack M. Neonatal and pediatric posttransfusion hepatitis C: a look back and a look forward. Pediatrics 2000; 105:836-42. [PMID: 10742329 DOI: 10.1542/peds.105.4.836] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- R D Aach
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
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Lee CM, Lu SN, Changchien CS, Yeh CT, Hsu TT, Tang JH, Wang JH, Lin DY, Chen CL, Chen WJ. Age, gender, and local geographic variations of viral etiology of hepatocellular carcinoma in a hyperendemic area for hepatitis B virus infection. Cancer 1999; 86:1143-50. [PMID: 10506697 DOI: 10.1002/(sici)1097-0142(19991001)86:7<1143::aid-cncr7>3.0.co;2-z] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND There are etiologic variations of hepatocellular carcinoma (HCC) in different geographic areas. Taiwan is a hyperendemic area for hepatitis B virus (HBV) infection. Hepatitis C virus (HCV) infection also plays an important role in HCC development in Taiwan. Identification of local HCV-endemic areas is important to keep HCV from spreading. This study investigated the etiologic variations of HCC in different geographic areas of Taiwan. METHODS The authors evaluated the hepatitis B surface antigen (HBsAg) and antibodies to HCV (anti-HCV) status of 284 patients (232 male, 52 female) with HCC. They also evaluated the gender ratio and mean age of these patients. RESULTS The mean age of HBsAg positive patients was significantly lower than the mean age of HBsAg negative patients (52.6 +/- 12.3 vs. 61.3 +/- 11.2 years) (P < 0.05). The male-to-female ratio was 4.5:1 for all HCC patients, 7:1 for HBsAg positive HCC patients, and 2.8:1 for anti-HCV positive HCC patients. In Chaiyi County in southern Taiwan, the prevalence of anti-HCV in male HCC patients was 52%, significantly greater than that of Taiwan as a whole (27.6%) (P = 0.07). However, the prevalence of anti-HCV in male HCC patients in Taipei County in northern Taiwan was 8.7%, significantly less than that of Taiwan as a whole (P = 0.043). Of a total of 65 Chiayi-based HCC patients, 55.4% were anti-HCV positive and 46.2% were HBsAg positive. In the Chiayi area, results of multiple logistic regression showed that the HCC patients who were age 60 years or older or who were living in the city area both had highly HCV-related disease. CONCLUSIONS The mean age of patients with HBV-related HCC was significantly lower than that of patients with non-HBV-related HCC. The male-to-female ratio for patients with HBV-related HCC was significantly higher than that of patients with HCV-related HCC. The authors identified an area of Taiwan in which HCV-related HCC was prevalent.
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Affiliation(s)
- C M Lee
- Liver Unit, Kaohsiung Medical Center, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Al-Faleh FZ, Al-Jeffri M, Ramia S, Al-Rashed R, Arif M, Rezeig M, Al-Toraif I, Bakhsh M, Mishkkhas A, Makki O, Al-Freihi H, Mirdad S, AlJuma A, Yasin T, Al-Swailem A, Ayoola A. Seroepidemiology of hepatitis B virus infection in Saudi children 8 years after a mass hepatitis B vaccination programme. J Infect 1999; 38:167-70. [PMID: 10424796 DOI: 10.1016/s0163-4453(99)90245-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES On October 1 1989, a programme was begun in Saudi Arabia in which the HBV vaccine was added as the 'seventh' primary immunogen of the Extended Programme of Immunization (EPI). In 1990, another programme was launched by the Ministry of Health to vaccinate all school children. Eight years after this mass vaccination programme, the efficacy of HBV vaccine was evaluated in a community-based study. METHODS A community-based study was carried out in Saudi children in urban and rural areas, covering all the regions of Saudi Arabia. After informed consent, blood samples were obtained and tested for HBV markers. RESULTS Among 4791 vaccinated Saudi children aged 1-12 years, only 15 were found to be HbsAg-positive (0.31%). HbsAg-positivity was 0.16% in children vaccinated at birth compared with 0.7% in those vaccinated at school entry. The overall HbsAg carrier rate dropped from 6.7% in 1989 to 0.3% in 1997 (P<0.00001). Similarly, there was a significant reduction in the prevalence of anti-HBc from 4.2% in 1989 to 0.46% in 1997 (P<0.00001). The overall seroconversion rate to HB vaccine among 4087 Saudi children up to 12 years of age was about 77%. Seroconversion rate in those vaccinated at birth was 77% compared with 71% in those vaccinated at school entry. After 8 years of receiving the third vaccine dose, close to 65% of the children had an anti-HBs titre of more than 10 IU/l compared with about 28% who had an anti-HBs titre of more than 100 IU/l after the same period. CONCLUSION The result of this study demonstrates the tremendous impact of the mass HB vaccination programme on the seroepidemiology of HBV infection in Saudi Arabia. The ultimate goal of preventing HBV-related chronic liver disease and hepatocellular carcinoma in Saudi Arabia is foreseeable in the near future.
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Affiliation(s)
- F Z Al-Faleh
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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McDiarmid SV, Conrad A, Ament ME, Vargas J, Martin MG, Goss JA, Busuttil RW. De novo hepatitis C in children after liver transplantation. Transplantation 1998; 66:311-8. [PMID: 9721798 DOI: 10.1097/00007890-199808150-00006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND We describe the incidence, results of interferon therapy, and outcome of hepatitis C virus (HCV) hepatitis occurring de novo after pediatric orthotopic liver transplantation (OLT). METHODS AND RESULTS Of children undergoing OLT between 1984 and September 1996, 321 children survived for more than 1 year. Of these, 13 (4.0%) developed previously undiagnosed HCV disease, as suggested by HCV antibody testing and HCV polymerase chain reaction and confirmed by liver biopsy. Of the 117 children who received transplants before HCV screening of blood products or donors, 10.2% developed de novo HCV disease. The mean age at diagnosis of HCV hepatitis was 13.2+/-5.0 years, and the mean time to diagnosis after OLT was 8.1 years (range, 4-11 years). The mean alanine aminotransferase (ALT) level at diagnosis was 108 IU/ml, and the liver biopsy specimen showed chronic active or chronic persistent hepatitis in 11 children, cirrhosis in 1 child, and nonspecific changes in 1 child. Twelve children were treated with interferon-2alpha; children who weighed > or =20 kg received 3 x 10(6) units every other day, and those who weighed <20 kg received 1.5 x 10(6) units every other day. Four patients developed rapidly progressive liver failure while receiving interferon therapy and required urgent re-transplantation. Three of the four children again developed histologic evidence of recurrent HCV 4-6 months after the second OLT, and all three subsequently died of HCV-induced liver failure. One patient remains alive and well with no evidence of HCV recurrence and a negative HCV RNA. Of the remaining eight children treated with interferon, only two have had a sustained response (normal ALT) and one is now HCV RNA negative. HCV RNA levels did not correlate with outcome or disease severity. HCV antibody levels were unreliable, with two patients having negative HCV antibody but a positive HCV RNA at diagnosis. Six patients were able to be genotyped: four were la and two were 1b. CONCLUSION Overall mortality for de novo HCV hepatitis was 23%. Seventy-five percent of children who received a second transplant for HCV hepatitis had early histologic recurrence that led to liver failure and death. Interferon therapy resulted in a sustained improvement in ALT in only 15% of children. The time to onset and progression of clinical disease both in the original graft and the retransplant graft were accelerated compared with nonimmunosuppressed individuals.
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Affiliation(s)
- S V McDiarmid
- Division of Pediatrics, Gastroenterology and Nutrition, UCLA Medical Center, Los Angeles, California 90095-1752, USA
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Abstract
Hepatitis C virus (HCV) infection afflicts millions of people in the United States and worldwide. We examine the epidemiology of HCV infection, the molecular biology of the virus, the pathophysiology of infection, the clinical diagnosis and manifestations of infection, and the treatment of HCV infection.
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Affiliation(s)
- T A Morton
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287-2080, USA
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35
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Abstract
In contrast to our understanding of hepatitis C virus infection in adults, relatively little is known about the evolution and treatment of HCV infection in pediatric patients. Children at risk for HCV infection include recipients of multiple blood-product transfusions, organ transplantation and infants born to HCV-infected mothers. A proportion of HCV-infected pediatric patients do not have an identifiable risk factor. HCV infection is commonly detected in children previously presumed to have non-A, non-B hepatitis and cryptogenic liver disease. HCV infection usually leads to mild chronic liver disease in children but is also associated with chronic active hepatitis and cirrhosis. Interferon therapy is effective in a proportion of patients with chronic hepatitis C.
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Affiliation(s)
- R P González-Peralta
- Division of Gastroenterology and Hepatology, Department of Pediatrics and Section of Hepatobiliary Diseases, University of Florida College of Medicine, Gainesville, Florida 32610-0296, USA
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Abstract
We tested 869 subjects attending either an urban adolescent medicine clinic or a school-based clinic for antibody to hepatitis C virus. Demographic data indicated a representative study sample, and behaviors associated with hepatitis C virus transmission. One subject (0.1%) was seropositive for antibody to hepatitis C virus, indicating a very low prevalence of hepatitis C virus exposure in adolescents.
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Affiliation(s)
- M M Jonas
- Department of Medicine, Children's Hospital, Boston, Massachusetts 02115, USA
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37
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Osella AR, Misciagna G, Leone A, Di Leo A, Fiore G. Epidemiology of hepatitis C virus infection in an area of Southern Italy. J Hepatol 1997; 27:30-5. [PMID: 9252070 DOI: 10.1016/s0168-8278(97)80276-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND/AIMS Hepatitis C virus (HCV) has been recognized as a major cause of liver disease, but little is known about its diffusion at population level. To estimate the prevalence and incidence of HCV infection and to explore potential risk factors at population level, an epidemiologic study was carried out. METHODS A cohort was built up in 1985, on a random sample of the population of Castellana, a small town in southern Italy (Bari province), and followed up until 1993. HCV ELISA II and RIBA HCV 2.0 were used as screening and confirmatory tests, respectively. RESULTS The overall anti-HCV prevalence was 26.0% (511/1969) at enrollment. The HCV infection incidence rate was 34.2x100,000 person-years (3 cases/8766 persons-years). A secular trend (referent born before 1930; born 1930-39 Odds Ratio (OR) 0.72, 95% Confidence Interval (95% CI) 0.56-0.94; born 1940-49, OR 0.33, 95% CI 0.25-0.44; born 1950 or after, OR 0.15, 95% CI 0.09-0.23) and geographical pattern (referent born outside Bari province; born in Bari province, OR 1.71, 95% CI 0.93-3.16; born in Castellana G, OR 2.29, 95% CI 1.29-4.05) were found by logistic regression analysis after controlling for several confounding factors. CONCLUSIONS The high prevalence, moderate incidence, and marked decrease in HCV infection in the cohort of birth in a population without known risk factors suggest that an epidemiological transition has been operating at population level since the 1950's.
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Affiliation(s)
- A R Osella
- Laboratory of Epidemiology and Biostatistics, Medical Research Institute Saverio De Bellis, Castellana Grotte, Italy
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38
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Al-Ahdal MN, Kessie G. Serological diagnosis of hepatitis C virus in patients with liver disease in Saudi Arabia. Evaluation of antibody determination by recombinant immunoblot assays in relation to RNA detection by polymerase chain reaction. Diagn Microbiol Infect Dis 1997; 27:69-73. [PMID: 9147007 DOI: 10.1016/s0732-8893(97)00001-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Sera from 164 Saudi Arabian patients with non-A, non-B hepatitis liver disease were examined for antibodies to hepatitis C virus (HCV) by second- and third-generation recombinant immunoblot assay (RIBA-2 and RIBA-3) and for HCV RNA by polymerase chain reaction (PCR). By using RIBA-2, 92 (56.1%) were reactive, 64 (39%) were nonreactive, and 8 (4.9%) were indeterminate. By using RIBA-3, 98 (59.7%) were reactive 60 (36.6%) were nonreactive, and 6 (3.7%) were indeterminate. By using PCR, 108 (65.9%) were positive. Of the eight RIBA-2 indeterminate samples, seven became RIBA-3 reactive but PCR-positive, and one became RIBA-3 nonreactive but PCR-negative. Of the six RIBA-3 indeterminate samples, five were RIBA-2 nonreactive but PCR-positive, and one was RIBA-2 reactive but PCR-negative. From our study on Saudi patients, we conclude that RIBA-3 has slightly but not significantly improved the results of anti-HCV antibody detection, and is probably of more value to resolve those indeterminate samples by RIBA-2. Although expensive, PCR remains the most reliable HCV diagnostic method until an HCV antigen detection test is available.
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Affiliation(s)
- M N Al-Ahdal
- Department of Biological and Medical Research, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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39
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Al Rashed RS. Prevalence of hepatitis A virus among Saudi Arabian children: A community-based study. Ann Saudi Med 1997; 17:200-3. [PMID: 17377430 DOI: 10.5144/0256-4947.1997.200] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
HAV is endemic in Saudi Arabia, with about 90% of the adult population having positive anti-HAV. A population-based survey of hepatitis B virus markers provided an opportunity to determine the age-related prevalence of anti-HAV among Saudi children and examine some of the factors that influence its transmission in the community. The overall prevalence of anti-HAV is 52.4% of 4375 children tested. There was no significant difference in HAV prevalence between males and females (51.3% vs 53.5%). The age-specific rates, which were similar in both sexes, indicated the lowest rate in infants with a steady increase in the older age group. There was a marked regional variation in anti-HAV prevalence, the Eastern region showing the lowest prevalence (38.4%), while the Northwestern region showed the highest prevalence (67%). In nearly all the regions, rural inhabitants had a higher prevalence than urban residents. Socioeconomic factors had a significant correlation with the prevalence of anti-HAV, with the level of education of parents having the strongest influence on HAV prevalence. The high overall HAV prevalence in children confirms that Saudi Arabia is endemic for HAV infection, despite the recent improvement in the socioeconomic standards of its population. The pattern of HAV may be changing in Saudi Arabia as the prevalence has dropped in the Central province compared to previous reports. The need for the introduction of hepatitis A vaccination will be determined in the future definition of HAV epidemiology in Saudi Arabia.
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Affiliation(s)
- R S Al Rashed
- Department of Medicine, College of Medicine and KKUH, King Saud University, Riyadh, Saudi Arabia
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Affiliation(s)
- F Z Al-Faleh
- Departments of Medicine, and Pathology, College of Medicine an d King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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al-Mugeiren M, al-Rasheed S, al-Salloum A, el-Zouki A, al-Sohaibani M, al-Fawaz I, Ramia S. Hepatitis C virus infection in two groups of paediatric patients: one maintained on haemodialysis and the other on continuous ambulatory peritoneal dialysis. ANNALS OF TROPICAL PAEDIATRICS 1996; 16:335-9. [PMID: 8985531 DOI: 10.1080/02724936.1996.11747846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Seropositivity to hepatitis C virus (HCV) was evaluated in three groups of Saudi children. One group (n = 18) was maintained on haemodialysis and another group (n = 21) on continuous ambulatory peritoneal dialysis (CAPD). The third group were community-based normal controls. The prevalence of antibody to HCV (anti-HCV) in children on haemodialysis (11.2%) was significantly higher than that in the control group (n = 220) (1.4%; p = 0.056). There was no significant difference in the prevalence of anti-HCV between children on CAPD (4.8%) and the control group (1.4%; p = 0.244). Among ten children on haemodialysis who were anti-HCV-negative 4 years earlier, two seroconverted and the seroconversion was not due to transfused blood but was most likely due to environmental contamination. This is the first report on the prevalence of anti-HCV in children maintained on CAPD. The results of the study emphasize the need for separate dialysis machines for anti-HCV-positive patients. It seems that CAPD therapy might reduce transmission of HCV but a large number of CAPD patients will need to be studied to confirm superiority to haemodialysis in this respect.
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Affiliation(s)
- M al-Mugeiren
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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42
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Abstract
In endemic areas infection with hepatitis B virus is a common cause of chronic liver disease in childhood. High levels of viral replication and mild ALT abnormalities are the rule in children infected perinatally and many of them are likely to maintain viral replication through their youth. Conversely about 90% of children infected later in life clear HBeAg and achieve sustained remission of liver disease before reaching adulthood. The eventual outcome of infection and disease in these patients remains unpredictable as reactivation of liver damage and viral replication may occur after several years of sustained remission. Cirrhosis is a rare and early complication of chronic HBV infection in children, and a risk factor for hepatocellular carcinoma. IFN therapy can accelerate HBV DNA clearance, improving the spontaneous anti-HBe seroconversion rate in Caucasian children by two to three times. Hepatitis delta is the most severe form of chronic viral hepatitis in childhood. Cirrhosis can be diagnosed in up to 26% of patients at presentation, and few cases respond to IFN therapy. Hepatitis C is relatively rare in children. Before the discovery of HCV, blood transfusions were the most common source of infection. Hepatitis C is usually a mild, asymptomatic disease in otherwise healthy children, but has a poor propensity to spontaneous remission over the years. For this reason, and based on the experience in adults, IFN treatment is now being evaluated.
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43
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Abstract
Among hepatitis A to E viruses, hepatitis B, C, and D viruses can cause chronic hepatitis, in both children and adults. Hepatitis B virus (HBV) infection is the most prevalent and important one. Perinatal transmission accounts for about 40-45% of chronic HBV infection in hyperendemic areas. Horizontal transmission through intramuscular injection using non-sterile needles and intrafamilial spread accounts for the other half of carriers. During the natural course of HBV infection, the host gradually clears HBV and hepatitis B e antigen (HBeAg), liver damage and elevation of aminotransferases occur during the process of HBV clearance. The most effective way to eliminate HBV infection is immunoprophylaxis starting since birth. It can prevent both HBV and hepatitis D virus (HDV) infections. Hepatitis C virus (HCV) infection in children occurs mainly in high risk children, such as those who received blood product or injection using non-sterile needles, or infants of HCV viremic mothers, etc. Screening of blood product reduced markedly the prevalence of post-transfusion HCV infection, but the prevention of sporadic cases requires HCV vaccination which is still under investigation.
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Affiliation(s)
- M H Chang
- Department of Pediatrics, College of Medicine, National Taiwan University, Taipei
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44
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Ozen H, Koçak N, Yüce A, Gürakan F. Low prevalence of hepatitis C virus antibody in Turkish children with chronic hepatitis B infection. J Hepatol 1995; 23:480. [PMID: 8655968 DOI: 10.1016/0168-8278(95)80209-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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al-Sohaibani MO, al-Sheikh EH, al-Ballal SJ, Mirghani MA, Ramia S. Occupational risk of hepatitis B and C infections in Saudi medical staff. J Hosp Infect 1995; 31:143-7. [PMID: 8551020 DOI: 10.1016/0195-6701(95)90169-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The prevalence of markers for hepatitis B virus (HBV) and hepatitis C virus (HCV) was studied among final year medical students and the medical staff at two university teaching hospitals in Saudi Arabia. At King Khalid University Hospital (KKUH) in Riyadh, evidence of exposure to HBV in the male medical staff (42.9%) was significantly greater than among medical students (25.3% males, 19.3% females; P = 0.0041) or the controls (28.6% males, 17.1% females; P = 0.0095). At King Fahad University Hospital (KFUH) in Al-Khobar, although the prevalence of exposure in the medical staff (28.3%) was higher than that in the controls (18.5%) the difference was not statistically significant (P > 0.05) and this could be due to the small numbers tested (46 physicians, 54 controls). Regarding exposure to HCV there was no significant difference in markers of the virus among the three categories investigated (1.7% in the controls, 2.6% in medical students and 1.9% in the medical staff). The low risk of transmission in the medical staff could be due to the small amount of the virus in the blood of HCV carriers. It can be concluded from the study that, in contrast to HCV, the occupational risk of HBV infection is high among Saudi physicians and hence HBV vaccination to unexposed medical staff is the only way for effective prevention of infection.
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Affiliation(s)
- M O al-Sohaibani
- Department of Pathology, King Saud University, Riyadh, Saudi Arabia
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46
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Bortolotti F. Hepatitis C in childhood. Indian J Pediatr 1995; 62:507-18. [PMID: 10829917 DOI: 10.1007/bf02761868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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47
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al-Faleh FZ, Ramia S, Arif M, Ayoola EA, al-Rashed RS, al-Jeffry M, Hossain A, el-Hazmi M. Profile of hepatitis C virus and the possible modes of transmission of the virus in the Gizan area of Saudi Arabia: a community-based study. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1995; 89:431-7. [PMID: 7487230 DOI: 10.1080/00034983.1995.11812972] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The seroprevalence of antibody to hepatitis C virus (anti-HCV) and the possible modes of transmission of HCV were investigated in Gizan, southern Saudi Arabia. The sample size chosen to give an adequate estimate of the seroprevalence, about 1500, was based on the assumption that 5% of the population in Gizan were anti-HCV-positive. Sera from 1482 subjects (705 males, 777 females; aged > or = 10 years) were initially screened for anti-HCV using a commercial, ubiquitin-based enzyme immunoassay. Repeatedly reactive sera were confirmed positive using second-generation immunoassays. Serum samples were also tested by ELISA for hepatitis B surface antigen (HbsAg) and antibodies to this antigen and to the hepatitis B core antigen. Of the subjects tested, 27 (1.8%) were anti-HCV-positive. Exposure to HCV was generally similar in both sexes, age-prevalence curves for anti-HCV peaking in males aged > 49 years (6.2%) and in females aged 40-49 years (5.0%). In the youngest subjects, those aged 10-19 years, the HbsAg carrier rate was significantly higher in males (10.4%) than in females (3.6%). Exposure to the hepatitis B virus was similar in both sexes (31.0% in males v. 28.6% in females). Some 7.4% and 14.8% of the 27 anti-HCV-positive cases had histories of schistosomiasis and blood transfusion, respectively. The corresponding values for the 1455 anti-HCV-negative cases investigated, 1.1% for schistosomiasis and 3.5% for blood transfusion, were much lower. The spouses and other family members of eight anti-HCV-positive index cases were investigated but none was anti-HCV-positive.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F Z al-Faleh
- Department of Medicine, College of Medicine and King Khalid University Hospital, Riyadh, Saudi Arabia
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Tandon P, Pathak VP, Zaheer A, Chatterjee A, Walford N. Cancer in the Gizan province of Saudi Arabia: An eleven year study. Ann Saudi Med 1995; 15:14-20. [PMID: 17587892 DOI: 10.5144/0256-4947.1995.14] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The occurrence of histologically diagnosed primary malignant tumors in Saudi and Yemeni patients in Gizan Province over the 11 years from 1982 to 1992 was analyzed. During the study period, 1398 malignancies of known primary site were seen in males and 972 in females. In common with other parts of Saudi Arabia, the overall incidence of malignant disease was low by Western standards with lymphoreticular malignancies relatively common and tumors of lung, bowel, breast and the female genital system relatively uncommon. Some malignancies are more common in Gizan Province as compared to elsewhere in Saudi Arabia. Oral cancer was the most common malignancy in females and the most common overall, probably due to widespread use of oral tobacco preparations. Liver cancer was the most common malignancy in males, reflecting the endemic nature of hepatitis B in the area. The incidence of bladder cancer, and particularly of squamous carcinoma of the bladder, was also more, probably due to the high incidence of schistosomiasis in the area. No significant trends in incidence of specific malignancies were noted over the 11-year study period, even though the period has been marked by dramatic and unprecedented changes in lifestyle and public health.
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49
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Abstract
Specific and sensitive diagnostic tests are now available to identify type A, B, C, D and E hepatitis. Hepatitis A and E which cause only acute, very rarely fulminant, hepatitis are spread largely by the faecal-oral route, having a brief viraemic phase. Hepatitis B, C and D which are transmitted parenterally and via secretions are often associated with chronic viraemia. Patients with chronic renal disease are at particular risk. Impaired immunity due to disease or drugs increases the propensity to develop a chronic carrier state which may progress to cirrhosis and hepatocellular carcinoma. Limited reports indicate that hepatitis C infection may cause cirrhosis more rapidly than hepatitis B. The emergence of mutants to both hepatitis B and C is a cause for concern. Treatment with interferon is of limited efficacy. Screening of blood products for viral markers and prudent handling of potentially infected materials to avoid contamination of damaged skin or mucous membrane are the best strategies to prevent infection. Hepatitis B vaccination of all newborns, young adolescents and those at risk is the most effective means of reducing the carrier frequency.
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Affiliation(s)
- G V Gregorio
- King's College Hospital, Department of Child Health, Denmark Hill, London, UK
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50
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Nowicki MJ, Ahmad N, Heubi JE, Kuramoto IK, Baroudy BM, Balistreri WF. The prevalence of hepatitis C virus (HCV) in infants and children after liver transplantation. Dig Dis Sci 1994; 39:2250-4. [PMID: 7924751 DOI: 10.1007/bf02090380] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Hepatitis C virus (HCV) is an important cause of liver injury following liver transplantation in adults. We hypothesized that the prevalence of HCV infection in children following liver transplantation would be lower than the prevalence in adults after liver transplantation because HCV-related liver disease leading to liver transplantation in children is low and children require less blood products than adults during transplantation. We therefore performed a cross-sectional study to determine the prevalence of HCV infection in children who had undergone liver transplantation. Serum samples were obtained from 62 of 65 (95.4%) consecutive patients surviving for more than six months after transplantation. Using a second-generation enzyme-linked, immunosorbent assay (ELISA-2) and a second-generation recombinant immunoblot assay (RIBA-II), antibodies to HCV were detected in 5.1% (3 of 59) of the subjects. Using a single-step, polymerase chain reaction (PCR), HCV RNA was detected in 6.2% (4 of 62). All HCV-positive children had undergone liver transplantation before the initiation of routine screening for HCV in blood donors; overall 30 patients were transplanted prior to routine screening of blood products for HCV. The prevalence of HCV in infants and children after liver transplantation in our study is substantially less than the rates reported in adults. This difference may be due, in part, to the lower volume of blood product exposure and to the fact that children, as opposed to adults, rarely have chronic HCV infection as a cause of end-stage liver disease.
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Affiliation(s)
- M J Nowicki
- Division of Pediatric Gastroenterology and Nutrition, Children's Hospital Medical Center, Cincinnati, Ohio 45229
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