The territorial and age-related characteristics of the distribution of patients with non-A, non-B viral hepatitis infected via the fecal-oral mechanism in foci of elevated viral hepatitis morbidity in the Uzbek SSR

The study of patients from 10 foci of acute viral hepatitides for the presence of HBsAg (in the passive reverse hemagglutination test) and anti-hepatitis A virus IgM (in the radioimmunoassay) has shown high frequency and variability in the spread of hepatitis non-A, non-B, the prevalence of adults aged 20-29 years and children aged 2-4 years among persons involved into the epidemic process and the tendency towards an increase in the proportion of hepatitis non-A, non-B in the total number of cases of viral hepatitides in the republic.     

Characteristics of the distribution of the markers of hepatitis B vir us infection among the healthy population of the Tadzhik SSR and Azerbaijan SSR

A total of 708 healthy persons in Tajikistan and 576 healthy persons in Azerbaijan, these groups comprising persons of both sexes and different age groups, were examined by the method of double gel immunodiffusion (the gel precipitation test) and by the passive hemagglutination test for the presence of the markers of hepatitis B virus (HBV) infection (HBsAg and HBeAg) and antibodies to them. This investigation showed that, in accordance with the level of hepatitis B morbidity, HBsAg was significantly more often detected among the population in Tajikistan (7.2%) than in Azerbaijan (2.8%). In both republics HBV carriers occurred most frequently among children aged 1-4 years (4.0% in Azerbaijan and 13.9% in Tajikistan), and among men more frequently than among women. In accordance with different intensity of the spread of HBV infection in the territories under comparison, differences in the age structure of the immune population were noted: in Tajikistan the formation of the immune layer occurred most frequently among younger age groups and in Azerbaijan, among senior adult age groups. The presence of a considerable percentage of persons with HBe-antigenemia (14.3-14.9% as determined by the gel precipitation test) among HBV carriers, observed in Tajikistan and in Azerbaijan, indicates that some of them have undetected chronic hepatitis B.     

Seroepidemiological characterization of virus hepatitis in the Republic of Armenia

The survey of the population immunological structure with respect to parenteral hepatitis showed awide circulation of hepatitis B (HB) and hepatitis C (HC) viruses among the adult population of Armenia. During the 5 year period of observation the number of persons having antibodies to HC virus increased 2.7-fold. High occurrence of antibodies to HBsAg of HB virus among the healthy population in 2002 (12.0%) in comparison with 1997 (5.4%) reflected a decreased infection rate with HB virus as well. Antibodies to hepatitis A (HA) virus were isolated, on the average, in 64 % of persons. Simultaneously with a decrease in the proportion of HA cases an increased number of HC patients was registered. No circulation of hepatitis E virus was detected. A high percentage of hepatitis cases of mixed etiology was established, as well as an increased number of combined parenteral hepatitis cases was registered (57.1%).     

Family incidence of type B hepatitis

Family incidence of HBsAg-positive viral hepatitis was confirmed to be high. In 499 families with a type B viral hepatitis patient, type B viral hepatitis morbidity among 1116 contacts amounted to 2.24% within 6 months of the primary patients' hospitalization (being 188.2 times higher than semiannual morbidity of the population of the Czech Socialist Republic, CSR) and the prevalence of HBsAg amounted to 8.96% (being 22.4 times higher than among the population of CSR). On deducting positive findings at first blood samplings, which at least partially eliminated individuals who could themselves have been the source of infection for the first patient in each family, the rate for contact cases equalled 0.70% (58.8 times higher morbidity than among the population) and the rate for HBsAg prevalence equalled 2.50% (6.25 times higher than among the population). Among 917 members of 335 families where a case of HBsAg-negative viral hepatitis occured, 0.32% developed HBsAg-positive viral hepatitis within 6 months (26.8 times higher morbidity than population morbidity) and the HBsAg prevalence was 2.94% (7.35 greater than among the population). On deducting the first positive findings no clinical illness remained and HBsAg prevalence equalle 0.98% (2.45 times higher than among the population). The highest HBsAg prevalence was found among contacts aged 0-5 years (17.09% for the whole period, 3.41% after deducting first positive findings) and 40 years and over (10.82% and 3.39%, respectively). Type B viral hepatitis morbidity was again highest in the age groups of 0-5 years (5.12%) and 40 years and over (2.54%) for the whole period. On deducting first positive findings, the 40+ years group displayed the highest morbidity (1.27%), whereas the 0-5 years group displayed zero morbidity. Disclosure of the mechanisms of nonparenteral or inapparently parenteral transmission specific for family environments would be important for the prospect of introducing adequate measures to limit or prevent the spread of type B viral hepatitis.     

The rate of detection of hepatitis B markers in persons with chronic alcoholism

A total of 707 males suffering from chronic alcoholism and 447 male donors not abusing alcohol have been surveyed in different regions of the USSR. The presence of HBsAg, as well as anti-HBs and anti-HBc antibodies, has been determined by the enzyme immunoassay. The survey has revealed a high rate of hepatitis B virus infection in chronic alcoholics in comparison with the control group, which gives grounds for including such persons into a high risk group with respect to viral hepatitis B infection.     

The epidemiological aspects of viral hepatitides in Estonia]

The etiological structure of viral hepatitides among the adult population of Tallinn and the occurrence of markers of hepatitis B and hepatitis C virus infections in medical workers, addict introducing drugs intravenously and hemodialysis patients were studied. Changes in the etiological structure of viral hepatitides were established: they took the form of a decrease in the level of hepatitis A morbidity and the considerable growth of the role of hepatitides B and C, as well as the newly detected circulation hepatitis D virus. About one-third in the structure of morbidity in viral hepatitides were hepatitis cases without markers of hepatitis A, B or C viruses (non-A, non-B, non-C). The highest rates of hepatitis B virus infection (78.9%) and hepatitis C virus infection (82.5%) were detected among drug addicts. Their level of HBsAg was 8.8%. In the group of medical workers, 25% of the examinees, i.e. every fourth person, had markers of hepatitis B virus, while antibodies to hepatitis C virus were detected in 5% of cases. Among hemodialysis patients these rates were 21.4% and 10.7% respectively.     

Results of the examination of patients with viral hepatitis for HBsAg in Kashka-Darya Province, Uzbek SSR

The practical use of the reverse passive hemagglutination test for the examination of viral hepatitis patients revealed the presence of HBsAg, on the average, in 28.4 +/- 0.95% of cases. This antigen occurred most frequently among the patients aged up to 1 year (42.8 +/- 4.18%), as well as in the second quarter of the year (33.3 +/- 2.3%). The proportion of patients with hepatitis B in the total number of patients with viral hepatitis was 20%.     

甘肃省1～59岁人群乙型肝炎病毒感染的血清流行病学调查

为了解甘肃省现阶段乙型肝炎病毒感染的现状,分析乙肝病毒感染血清学指标的变化,采用多阶段整群抽样的方法,抽取5个县区1~59岁人群共2200人进行调查。以ELISA方法对血清标本统一检测乙肝病毒表面抗原(HBsAg)、乙肝病毒表面抗体(抗-HBs)、乙肝病毒核心抗体(抗-HBc)。结果显示,甘肃省1~59岁调查人群HBsAg阳性率为3.59%,抗-HBs和抗-HBc阳性率分别为49.45%、16.33%;HBV总感染率为27.50%。比1992年HBV总感染率下降了36.48%,HBsAg阳性率下降了45.94%;1~4岁儿童HBsAg阳性率仅为1.13%,比1992年(5.34%)下降78.84%。甘肃省1~59岁人群乙肝病毒感染率下降,抗-HBs阳性率升高,尤其在1~4岁儿童变化更为明显;甘肃省乙肝感染逐步呈现由中高流行转向低流行区的趋势;乙肝疫苗免疫取得显著效果。     

The prevalence of helicobacteriosis in regions of Siberia based on serological study data

687 adults in 5 regions of Siberia and 79 children and young persons in Novosibirsk were examined. IgG antibodies to H. pylori in their blood sera were determined with the use the enzyme immunoassay. The detection rate of antibodies among the adult population varied within 70-87%, depending on the region, being somewhat lower among the population north of latitude 60 degrees (75%) in comparison with the population residing south of this latitude (86%, p < 0.001). In Novosibirsk the number of seropositive persons was found to be unrelated to sex, age and clinical manifestations of digestive tract diseases. A high detection rate of antibodies to H. pylori was registered in persons aged 25-34 years with a minor increase in older age groups. In children the detection rate increased with age: 29% in children of 5-10 years old and 56% in children 11-14 years old. By the age of 15 more than a half of the children had antibodies.     

Immune structure of the population in some regions of the USSR with respect to Legionella pneumophila

For the first time in the USSR the structure of the immunity of different population groups to L. pneumophila was studied. Antibodies to L. pneumophila were detected in the passive hemagglutination test with the use of erythrocyte diagnosticum prepared at the Gamaleya Research Institute of Epidemiology and Microbiology (Moscow). The survey covered the total number of 2,902 persons in differ nt regions of the USSR, among them 2,430 adults and 472 children. Among the healthy adult population antibodies to L. pneumophila were detected, on the average, in 5.9% of persons. The highest number of persons with antibodies in diagnostic titers was detected among the population of the Baltic Republics (15.9%) and Kazakhstan (10.2%). The survey revealed an essential difference in the number of children aged 3-7 years, found to have antibodies to L. pneumophila, in the Brest region of the Byelorussian SSR (31.4%) and in the Turkmen SSR (1.3%). The high risk groups exposed to L. pneumophila infection were found to include narcological patients with the changed reactivity of the body and healthy adults professionally employed in earth-moving works.     

Evidence for hepatitis C viral infection in patients with primary hepatocellular carcinoma.

In testing for antibodies to the hepatitis C virus (anti-HCV) in 112 patients with primary hepatocellular carcinoma, 10 of 33 white patients (30%) and 15 of 79 Asian patients (19%) had a positive response to the antibody. The antibody profile to individual hepatitis C viral antigens and the presence of circulating hepatitis C viral RNA were determined in the 25 patients. The anti-HCV antibodies most frequently detected were toward the antigens from the core (C22) and NS3 regions. Serum hepatitis C viral RNA was present in 17 of the 25 patients (68%), and these patients tended to have serum levels of alanine and aspartate aminotransferases higher than those patients without viremia (136 +/- 22 U per liter versus 64 +/- 11 U per liter and 161 +/- 26 U per liter versus 79 +/- 14 U per liter, respectively, both P < .05). Of the 15 Asian patients with hepatocellular carcinoma and anti-HCV, 4 (27%) had coexisting hepatitis B surface antigen (HBsAg) and 13 (87%) had antibodies to either hepatitis B core or surface antigen. Of the 10 white patients with anti-HCV, however, only 1 (10%) had hepatitis B virus antibodies (P < .01). Among 4 Asian patients with coexisting anti-HCV and HBsAg, 1 was found to have serum hepatitis B viral DNA and the other 3 had hepatitis C viral RNA. A history of blood transfusion was obtained from 12 of the 25 patients with anti-HCV (48%); 20 (80%) had coexisting cirrhosis. Our findings support the hypothesis that hepatitis C virus is an important etiologic agent in the development of primary hepatocellular carcinoma in both white and Asian patients in the United States.     

Morbidity and mortality in acute viral hepatitides in a hyperendemic region. The role of viral hepatitis E

Official annual statistical data on morbidity in acute viral hepatitides (AVH), including the number of lethal cases, for 1985-1995 were analyzed. Mortality rates per 100,000 of the population at the period of 11 years were calculated for different age groups, sex and the place of residence. 396 and 99 patients were examined for the presence of serological markers of hepatitides A, B and E, respectively, at the periods of epidemic rises in morbidity and satisfactory epidemic situation. In the course of 11 years AVH caused the death of 22,405 persons. In 1985-1987 the average mortality level (ML) reached 12.3-17.8 per 100,000 of the population (with morbidity being 1,200-1,400 and was essentially higher among the rural population in comparison with the urban population. During these years the highest ML, was registered among children aged 0-2 years (190-50 per 100,000) and, among adults, mainly among women aged 20-29 years (21.4-19.6 per 100,000). During the years when the epidemic of AVH was absent, ML among these groups was essentially lower: 40-20 among children aged 0-2 years and 4-5 among women aged 20-29 years. In 1987 in the Fergana Valley hepatitis E was detected in 72.2% of all examined patients, and in the southern areas of the country in 68.7%. A sharp rise on mortality among women of the productive age at the period of the epidemic rise of AVH morbidity in the endemic region indicated that this epidemic was linked with hepatitis E. High ML among young children may be indicative of a highly unfavorable course of hepatitis E in the group of infants, which had never been registered before. This newly established regularity may be used for the retrospective diagnostics of the outbreak of hepatitis E.     

Clinical aspects of delta infection.

The clinical features of delta infection were analysed retrospectively in 191 hepatitis B surface antigen (HBsAg) carriers and 592 cases of acute hepatitis B seen over 11 years in the Swedish town of Malmö (population 250 000). With a few exceptions delta infections occurred exclusively in drug addicts. In the chronic HBsAg-carriers the most common clinical manifestation was an episode of acute hepatitis, which in some individuals became severe with a pronounced rise in serum alanine aminotransferase activity for many months. During the period of delta infection the HBsAg titre was lowered and in three out of 26 cases the patient lost HBsAg altogether and developed hepatitis B surface antibodies (anti-HBs). In one patient the acute hepatitis due to delta infection was fulminant and fatal. In patients with acute hepatitis B the clinical picture did not distinguish between those with and without simultaneous delta infection. The frequency with which acute hepatitis B was succeeded by a chronic carrier state was the same whether or not the patient was infected simultaneously with the delta agent. The discovery of the delta agent has improved understanding of the natural history of chronic hepatitis B infection in drug addicts. Thus, instances of acute hepatitis in a chronic carrier, previously termed hepatitis non-A, non-B, may actually be episodes of delta infection.     

Humoral immunity indices of chronic alcoholism patients

Sera obtained from 642 patients with chronic alcoholism and 400 sera from healthy donors, collected in different regions of the USSR (Moscow, the Kirghiz SSR, Transcarpathian Province, the northern Caucasus), were studied. Out of all patients with chronic alcoholism whose blood sera were examined, persons aged 20-30 years constituted 22%, 31-40 years, 41.8%, 41-50 years, 27.5%, above 50 years, 8.7%. The results of the study of the immune structure of these patients with respect to the causative agents of respiratory diseases revealed a large proportion of persons seropositive to influenza virus B Leningrad/369/75 (92-93%) and coronavirus OC-43 (78-93%). Patients with chronic alcoholism were shown to belong to a high risk group with respect to Legionella pneumophila infection. The proportion of persons with antibodies to L. pneumophila among such patients (up to 21.1%) was considerably higher than among healthy donors (not more than 6%). In different regions of the USSR large risk groups with respect to diphtheria (42-56%) and tetanus (12-45%) were detected among patients with chronic alcoholism. These patients also showed considerably higher levels of anti-tissue antibodies in comparison with the healthy population.     

Hepatitis A in Estonia (1990-1999)

During recent 10 years (1990-1999) essential changes occurred the epidemiology of viral hepatitis A (VHA) in Estonia: simultaneously with a decreased level of morbidity (morbidity rate per 100,000 of the population was 78.4 in 1990 and 7.7 in 1996, or 1,241 and 112 cases, respectively), a shift in the age structure of patients from children of preschool age to older age groups took place. Everyday contacts were the main established route of VHA transmission in recent years, but in more than 80% of cases the risk factors of the virus transmission remained obscure. During the regional outbreak of VHA in North Estonia in 1998 (937 out of 989 cases registered in the country) a rise in morbidity was observed among young people aged 15-29 years, when a wide spread of parenteral viral hepatitides B and C and drug addiction were registered in this region. During this outbreak VHA was transmitted mainly through everyday contacts. Still the considerable prevalence of injection drug users who practiced the group use of syringes and needles and took drugs from common containers, a sufficiently high level of the mixed forms of the disease (more than 18% of all registered cases of VHA), detected for the first time, make it possible to suggest that the parenteral transmission route could appear among persons belonging to the above mentioned group. Vaccination is regarded as the most effective measure for the prophylaxis of VHA.     

Etiological structure of viral hepatitis in the area about one of the cities in Gorki Province

The etiological structure of viral hepatitides (VH) in one of the towns of the Gorky region was studied with the use of specific methods for diagnosing hepatitis A (detection of IgM to hepatitis A virus) and hepatitis B (detection of HBsAg in the passive hemagglutination test). The study revealed that hepatitis A was the major nosological from in the structure of VH among children and adults in the area under survey, which was documented by the detection of IgM to hepatitis A virus. The form, second in importance among VH cases, was hepatitis B. The ratio of these two forms of VH was determined by the epidemiological situation in the area. The proportion of hepatitis B cases increased at the period between epidemics. Nondifferentiated hepatitis constituted 6.8% of all cases of sporadic hepatitis among adults. In 90% of cases clinical diagnosis coincided with the serological one.     

Comparative information value of humoral immunity characteristics in some bacterial and viral infections

Serological examination of 144 patients with different bacterial and viral infections was carried out. Antibodies to Brucella were detected in blood serum in 42 patients (85.7%) with the average titer of 1:996 and in saliva in 41 patients (83.7%) with the average titer of 1:567 by passive hemagglutination test with brucella erythrocyte diagnosticum. Out of 26 dysentery patients, antibodies in blood serum were detected in the diagnostic titer in 17 patients (65.4%) with the average titer of 1:282 and in saliva in 21 patients (80.8%) in the titer of 1:100 and higher. Anti-HAV and anti-HBc IgM were detected in specimens of saliva from patients with serologically confirmed viral hepatitis A and B in 100% of cases. The presence of HBsAg in saliva from hepatitis B patients was established in 95.4% of cases. In blood serum and in specimens of saliva anti-HCV IgM were detected in 100% and 85.7% of cases respectively. Out of 25 women with aggravated obstetric history, IgG antibodies to CMV were detected in blood serum in 23 women (88.5%) and in saliva in 22 women (84.6%). The results of these investigations revealed that the detection rate of antibodies in blood serum and saliva in cases of infections, both bacterial (brucellosis, shigellosis) and viral (hepatitis A, B, C and CMV infection), was not essentially different. The simplicity of obtaining material for analysis make it possible to recommend the use of saliva for diagnosing bacterial and viral infections, especially in mass epidemiological surveys.     

An epidemiological assessment of the chronic carriage of the hepatitis B virus surface antigen and other markers of this infection

On the basis of prolonged (up to 10 years) observations of chronic HBsAg carriers (87 persons) slowly progressing chronic hepatitis B virus infection was detected in most of them (57.5%). In these persons up to 6 negative results of the analysis for the presence of HBsAg were periodically obtained, with the subsequent renewal of HBs-antigenemia. More profound examination of 192 persons with chronic lesions of the liver and other digestive organs helped diagnose chronic persistent hepatitis and chronic active hepatitis, accompanied by HBs-antigenemia and the circulation of other markers of this infection, in 63.5% of the examinees.     

Antibodies to the hepatitis A virus in the healthy population of Moscow

Serum specimens collected from 1002 persons in Moscow were tested for the presence of antibodies to hepatitis A virus (anti-HAV antibodies) by solid-phase enzyme immunoassay. The prevalence of these antibodies increased progressively with age from 10% in children aged 5-9 years to over 90% in the age groups of 40-49 years and over, the 50% immunity level being established at the age of 18 years. 79% of infants under 1 year were found to be immune, which was obviously due to the placental transfer of antibodies from mother to child. In a considerable part of seropositive persons over 30 years high or medium antibody titers were detected. These age groups showed a stable proportion of the low, medium and high level of anti-HAV antibodies. The prevalence of such antibodies was not related to sex. The presence of an ample amount of anti-HAV antibodies was determined in all of 18 tested lots of commercial serum immunoglobulin obtained from 3 different manufacturers.     

Detection of HBsAg in the familial environment of children with viral hepatitis B

A total of 231 persons from the families of 62 children hospitalized in connection with viral hepatitis B were examined for the presence of HBsAg in their blood over a period of 3 years. Simultaneously with countercurrent electrophoresis (CIE) and the gel precipitation (GP) test, the passive hemagglutination (PHA) test and the GP test with sandwich treatment were used in this work. The presence of HBs-antigenemia in the members of the families of children with viral hepatitis confirmed by laboratory methods were found to occur 6.7 times more frequently than in the families of children with HBsAg-negative hepatitis. The use of the PHA test and the GP test with sandwich treatment increased the frequency of the detection of HBsAg 2.5 times in comparison with CIE and the GP test. The data indicating the possibility of children being infected through everyday contacts in families with cases of HBs-antigenemia among their members are presented, but further studies are necessary to make the final decision on this problem.