Etiologic structure of viral hepatitis in children based on data from an comprehensive serologic study of hospitalized patients

During a year an overall serological examination of 1,200 children hospitalized with the diagnosis of viral hepatitis was carried out with a view to establish the presence of hepatitis A and hepatitis B markers (anti-HAV IgM, HBsAg, anti-HBs, anti-HBc and anti-HBe IgM) by means of the enzyme immunoassay and radioimmunoassay. The average annual proportion of cases of hepatitis A (61.4%), hepatitis B (20.4%), hepatitis non A, non B (11.2%) and mixed infection (7.0%) among children, as well as seasonal and age-group fluctuations of this proportion, were established. The etiological structure of viral hepatitides, based on commonly accepted clinico-epidemiological diagnostic criteria, was shown to differ from their true etiological structure as determined in accordance with specific serological markers detected in this investigation.     

The characteristics of an outbreak of non-A, non-B hepatitis with a fecal-oral mechanism of the transmission of the causative agent in Osh Province, the Kirghiz SSR

The results of epidemiological, clinical and laboratory studies revealed that the sharp rise of morbidity in viral hepatitides in Osh Province, the Kirghiz SSR in autumn 1987 was caused by hepatitis non A, non B virus with fecal-oral transmission. At this period the results of the enzyme immunoassay showed the absence of the markers of hepatitides A, B and Delta in 72.2% of viral hepatitis patients. Hepatitis non A, non B occurred only in 2.4% of viral hepatitis patients of preschool age (of these, 83.3% had hepatitis A) and was diagnosed in autumn 1987 in 50% of the patients aged 7-14 years and in 97.4% of the patients aged 15-29 years (in the latter age group 95-98% of the patients had IgG to hepatitis A virus in their blood). The appearance of the outbreak of the above-mentioned infection in Kirghizia is linked with the water route of the transmission of the infective agent. The epidemiological and clinical signs, characteristic of fecal-oral hepatitis non A, non B in Kirghizia, were not different from those registered earlier in other republics of the Central Asia and could be used for the identification of this infection.     

Results of Russian multicenter trial of immunogenicity, reactogenicity and safety of new combination vaccine against hepatitis A and B (Twinrix)

Results of registration trial of combination vaccine for prevention of hepatitis A and B are presented. The trial was conducted in 5 centers of Russia in 2004-2005 with full accordance to good clinical practice requirements and standards for multicenter open randomized trials. Immunogenicity of studied combination vaccine Twinrix was evaluated in comparison with two simultaneously administered monovalent vaccines against hepatitis A and B (Havrix and Engerix-B) in 200 healthy subjects aged 18-40, which were seronegative to hepatitis A and B. Reactogenicity based on interviewed and non-interviewed symptoms ranged on intensity was assessed also. 1 month after completion of primary vaccination all subjects in both groups were seropositive to hepatitis A. Sero-protection level of antibodies to hepatitis B virus was detected in 98.9% of participants vaccinated with Twinrix and in 95.6% of participants vaccinated with Engerix-B and Havrix. Overall, reactogenicity of vaccines was minor, marked adverse events caused by vaccination were rare (approximately 1%). Study shows that combination vaccine against hepatitis A and B (Twinrix) at least non inferior in terms of immunogenicity, safety and tolerability to monovalent vaccines (Havrix and Engerix-B), were registered in Russia.     

Detection of Epstein-Barr viral antibodies in patients with acute viral hepatitis

Serum samples obtained from 44 patients with virus A hepatitis, 23 patients with virus B hepatitis, 65 patients with virus non A, non B hepatitis and 100 healthy adults were studied for the presence of Epstein-Barr (EB) virus in the indirect immunofluorescence test. In this work lymphoblastoid cell lines PH3-J-1 and CN37 were used. Among patients with different forms of hepatitis, the statistically significant elevation of the titers of antibodies to EB virus was detected only in the group of patients with virus non A, non B hepatitis, and in 6 cases the etiological role of EB virus was confirmed by serological and hematological methods.     

Viral hepatitis with clinical and epidemiological manifestations similar to hepatitis A but of a different etiology

A case of viral hepatitis in man, appearing as the result of infection caused by pooled concentrated suspensions of fecal samples collected from patients having had repeated hepatitis infection during the period of 1-2 years, is described. Though this infection was similar to hepatitis A in many clinical and epidemiological signs, the possibility of its etiologic relationship with hepatitis virus A was positively excluded; there was also no evidence of the participation of hepatitis virus B in the process. Immunoelectron microscopy of excretions collected at the acute stage of the disease revealed the presence of spherical viral particles 27-30 nm in diameter. Antibodies capable of reacting with these particles were detected in the sera of patients having had 2 kinds of hepatitis and in the sera of patients having the 1 kind of hepatitis in the focus of infection where repeated cases of hepatitis had been observed. No such antibodies were found in the sera of patients with hepatitis A alone and in the set of standard sera specific to viruses causing hepatitis A and hepatitis non A, non B. The authors believe that 2 kinds of hepatitis with the fecal-oral mechanism of transmission exist and propose to name their causative agents hepatitis viruses A, type 1 and type 2.     

Condition of morbidity of viral hepatitis and ways of improving prevention of these infections among the populace of the USSR

In this article the state of morbidity in hepatitis A and B in the USSR as a whole and in individual republics is analyzed, the causes of the preservation of high morbidity levels in some regions of the USSR are shown, the specific epidemiological features of fecal-oral hepatitis non A, non B in the republics of Central Asia are pointed out and the ways for improving separately the prophylaxis of hepatitis A and hepatitis B are considered.     

Retrospective epidemiologic diagnosis of viral non-A, non-B hepatitis with a fecal-oral mechanism of transmission of the causative agent

The possibility of the retrospective epidemiological diagnosis of viral hepatitis non A, non B with the fecal-oral mechanism of the transfer of infection in three cities of Central Asia on the basis of the analysis of the dynamics of registered hepatitis A morbidity is shown. With the irregularity of morbidity levels among the total population being characteristic of all three cities, in Andizhan one rise in morbidity within a period of 3 years (1975-1978) and in Tashauz one rise within a period of 5 years (1975-1980) were registered. The analysis of the dynamics of morbidity observed in individual age and social groups showed that these rises, especially those registered in 1976 in Andizhan and in 1977 in Tashauz, were determined by morbidity levels among school children and adults. This is also true for a rise in morbidity rate registered in Tashauz in 1985. In Andizhan the highest morbidity rates among adults were registered in districts insufficiently equipped with modern amenities. Cases of infection registered as hepatitis A (HA) among persons immune to HA at territories with high intensity of the epidemic process of HA at the above-mentioned periods seem to be due to viral hepatitis non A, non B with the fecal-oral mechanism of the transmission of the infective agent.     

Viral hepatitis E: its epidemiological characteristics in the Republic of Tajikistan

The characteristic feature of the Republic of Tajikistan, as well as other republics of Central Asia, is the wide spread of virus hepatitis E. The epidemiology of this grave disease, recently known as virus hepatitis non A, non B with the fecal-oral mechanism of transmission of this infection, has been yet insufficiently studied. The article points out to the specific character of this infection which essentially differs, both epidemiologically and clinically, from other enteric hepatitis (hepatitis A), also hyperendemic for the republic. The results of the study of the immunostructure of the population with respect to both hepatitis E and hepatitis A are presented.     

社区居民乙肝防控知识知晓情况调查及乙肝歧视的影响因素分析

目的:了解社区居民乙肝防控知识知晓情况并分析乙肝歧视的影响因素。方法:采用分层整群随机抽样方法选取天津市鸿顺里社区1276名居民进行问卷调查,每人发放一份问卷,回收后统计居民乙肝防控知识的知晓情况及乙肝歧视现状,并通过多因素Logistic回归分析乙肝歧视的影响因素。结果:共回收1214份有效问卷,回收率为95.14%(1214/1276),乙肝5条主要传播途径中知晓经血液传播最高为70.18%(852/1214),知晓经共用牙刷及剃须刀传播为48.76%(592/1214),知晓经母婴传播为37.73%(458/1214),知晓经性生活传播为34.68%(421/1214),知晓经污染的医疗器械传播为34.18%(415/1214),5条传播途径均知晓为27.92%(339/1214);90.77%(1102/1214)的调查者知晓"乙肝是否具有传染性",乙肝知识的总体知晓率为21.91%(266/1 214)。79.90%(970/1214)的调查对象不愿意和乙肝患者恋爱/结婚,60.96%(740/1214)的调查对象不愿意和乙肝患者共同进餐;无歧视、中轻度歧视及重度歧视的比例分别为24.87%(302/1214)、50.91%(618/1214)及24.22%(294/1214);不同年龄、职业、文化程度、月收入人群之间乙肝歧视程度的差异具有统计学意义(P<0.05)。Logistic回归分析显示年龄、职业、文化程度、月收入均是造成乙肝歧视的影响因素。结论:天津市鸿顺里社区居民的乙肝防控知识知晓率较低且歧视现象严重,应加强对乙肝知识的宣传教育,纠正对乙肝的歧视心态。     

Prospects for new viral vaccines

Animal virology has made outstanding contributions to preventive medicine by the development of vaccines for the control of infectious disease in man and animals. Cost-benefit analysis indicates substantial savings in health care costs from the control of diseases such as smallpox, poliomyelitis, yellow fever and measels. Areas for further development include vaccines for influenza (living, attenuated virus), the herpes group (varicella: cytomegalovirus), respiratory syncytial virus, rotavirus and hepatitis A, B, and non A/non B. The general options for vaccine formulation are discussed with particular emphasis on approaches with the use of viral genetics to 'tailor make' vaccine viruses with defined growth potential in laboratory systems, low pathogenicity, and defined antigens. Current progress with the development of an inactivated hepatitis B vaccine is reviewed as a case study in vaccine development. The impact of recent experiments in cloning hepatitis B virus DNA in E. coli on the production of a purified viral polypeptide vaccine is assessed.     

The structure of the population morbidity with specific intestinal infections in areas with different intensities in the development of the epidemic process and an evaluation of its manifestations]

The authors analyze the morbidity structure in five enteric infections (typhoid fever, dysentery caused by Shigella flexneri and Shigella sonnei, hepatitis A, and hepatitis E (non A, non B) with the fecal/oral mechanism of the agent transmission) in three towns of Turkmenia and in the town of Novomoskovsk, Tula Province. The incidence of S. sonnei dysentery was found higher in Novomoskovsk and that of the rest enteric infections under study in Turkmenia. The incidence of typhoid fever and hepatitis E was the highest among schoolchildren and adults, whereas preschool children suffered mostly from hepatitis A and S. sonnei dysentery. The authors discuss the specific features of the epidemic process manifestation in enteric infections.     

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.     

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.     

TNFa-308基因启动子多态性与新疆维吾尔族人乙型肝炎易感性的相关性研究

目的：研究TNF-α基因单核苷酸多态性（SNP）308G—A位点与新疆地区维吾尔族人乙型肝炎之间的关系。方法：以聚合酶链式反应－限制性内切酶长度多态性（PCR-RFLP）技术,对120例乙肝患者和120例正常对照者TNF—α基因SNP308多态性位点进行基因分型。结果：SNP308多态性位点G／G基因型和G／A基因型频率在病例组为77％和23％,正常对照组为88％和12％,2组基因型和等位基因频率分布差异有显著性（p〈0．05）。结论：TNF—α基因启动子308多态性位点与新疆维吾尔族人乙肝有明显相关性。     

Hepatitis A and B: serologic survey of human and nonhuman primate sera

Sera of humans and seven species of nonhuman primates were tested by radioimmunoassay and enzyme immunoassay for the presence of hepatitis A antibody, hepatitis B surface antigen and antibody to hepatitis B surface antigen. The outcome of testing a total of 276 serum or plasma specimens was as follows: with the exception of squirrel monkeys (0%) and cotton-top marmosets (0%), a considerable percentage of all other species tested had detectable antibodies to hepatitis A virus: humans 45.9%, chimpanzees 36.6%, baboons 38.2%, vervets 57.9%, cebus monkeys 40.0% and common marmosets 50.0%. Only one human and two chimpanzees were carriers of hepatitis B surface antigen. Antibodies to hepatitis B surface antigen were detected in human (11.3%), chimpanzees (29.9%), baboons (36.2%) and squirrel monkeys (5%). Chimpanzees showed an increasing prevalence of antibodies to hepatitis A virus and hepatitis B surface antigen with age.     

Frequency of finding hepatitis B viral markers in young children born of mothers carrying the HBs-antigen

The present communication deals with the results of investigations on the frequency of HBsAg-carriership among expectant mothers in Fergana (the Uzbek SSR) and on the risk for their children to be infected with hepatitis B virus. To detect the markers of hepatitis B virus, the passive hemagglutination test, the enzyme immunoassay, and the radioimmunoassay were used. The incidence rate of HBsAg-carriership among expectant mothers was rather high (5.1 +/- 0.52%) in comparison with the control group (3.5 +/- 0.70%). The detection of HBsAg in children 3 months after their birth, i.e. at the term corresponding to the possible incubation period of hepatitis B, suggested that the children were infected at birth. As noted in the course of this investigation, the risk for a newborn to be infected was directly related to the titer of HBsAg, as well as to the presence of HBeAg, in the blood of the carrier mother. A high detection rate of HBsAg was registered among children born to HBsAg-carrier mothers, which makes it possible to consider these children as a high risk group with respect to hepatitis B virus infection and necessitates the development of the system of antiepidemic and prophylactic measures for preventing newborns to be infected with hepatitis B.     

乙型肝炎病毒X蛋白的优势氨基酸序列与热点突变位点的生物信息学分析

乙型肝炎病毒X蛋白(hepatitis B virus X protein,HBx)全长154个氨基酸,与肝癌发生密切相关.为确定HBx的优势氨基酸序列和热点突变位点,在GenBank中下载所有HBx的氨基酸序列13950条,剔除插入突变、缺失突变和起始密码子非甲硫氨酸的序列,最后保留7126条.通过分析这7126条序列,计算出HBx每个位点的氨基酸分布情况,出现频率最高的氨基酸为该位点的优势氨基酸,其他氨基酸为突变氨基酸.154个位点的优势氨基酸组成HBx优势氨基酸序列.突变率>10.0%的热点突变位点有32个.其中第36、42、44、87、88和127位氨基酸有4种(突变率>1.0%)以上突变形式,具有较高的多态性.与肝癌密切相关的K130M/V131I双突变率为34.7%.通过7126条HBx序列与优势序列的同源性比较,随机选出其中50条序列(2条与优势序列同源性<75%,48条同源性为76%~99%),与23条参考序列及优势序列共同构建系统发生树.结果显示,HBx优势氨基酸序列属于基因型C,这与基因型C为全球主要流行型一致.本研究首次系统性分析了GenBank中HBx的优势序列,确定了32个HBx热点突变位点和6个多态性较高的位点,为基于HBx突变的基础和应用研究奠定了基础.     

Constitutive heterochromatin polymorphism and chromosome damage in viral hepatitis

The frequencies of chromosomal aberrations and sister-chromatid exchanges (SCEs) were scored in relation to constitutive heterochromatin in 100 patients with viral hepatitis B, 100 patients with viral hepatitis A and 100 age- and sex-matched normal controls. 23.4%, 15% and 4% of the cells showed chromosomal aberrations in patients with hepatitis B, hepatitis A and normal controls respectively. Non-random involvement of chromosomal aberrations were also noted in chromosome 1 of patients with hepatitis B and A as compared to normal controls. The frequencies of SCEs (mean +/- S.D.) were found to be 10.40 +/- 2.83 in hepatitis B and 8.70 +/- 2.34 in hepatitis A. These values were significantly higher than the SCE frequency (mean +/- S.D.) of 5.88 +/- 2.25 observed in normal controls (P less than 0.001). The intra-chromosomal distribution of SCEs revealed a relatively increased incidence of SCEs in chromosome 1 of patients with hepatitis B and A as compared to normal controls. Analysis of constitutive heterochromatin polymorphism showed chromosome 1 qh+ to be the most frequent variant in patients with hepatitis B and A as compared to normal controls. The increased involvement of C-band variant 1 qh+ in patients with hepatitis B and A as compared to normal controls may indicate that extra heterochromatin offers additional sites for viral integration.     

Anti-pre-S2 antibody response in subjects vaccinated against hepatitis B and in naturally immunized subjects

Serum samples from individuals immunized with a pepsinized or non-pepsinized vaccine and from patients who had recovered from acute hepatitis B or who developed a chronic form of the disease, were analysed for the presence of antibody against the pre-S2 epitope of the hepatitis B virus.Anti-pre-S2 antibody was absent in all but one individual immunized with the pepsinized vaccine. Thirty-eight percent of the subjects who responded by anti-HBs production to the non-pepsinized preparation showed anti-pre-S2 antibody one year after complete vaccination. Among subjects who did not produce anti-HBs after immunization with this vaccine, 1 single individual produced anti-pre-S2 antibody. Anti-preS2 antibody was detectable after one year in 38% of the patients who recovered from acute hepatitis B, but in none of those with chronic hepatitis B. The kinetics of anti-pre-S2 antibody response to a booster injection was also analysed 1 month and 1 year after the 3rd injection and 1 month after the 4th injection of the non-pepsinized vaccine.     

Treatment of chronic hepatitis C

Chronic hepatitis C entails a life-long risk of developing cirrhosis and hepatocellular carcinoma and eradication of the hepatitis C virus (HCV) is the only realistic approach for lowering the risk of disease progression. Treatment is indicated for patients with high transaminases and histologic signs of chronic hepatitis: 6-12 month therapy with 3-6MU interferon alfa thrice weekly combined with 1-1.2 grams ribavirin yielded up to 30% sustained virological responses (SVR). SVR raised up to 50% with pegylated interferons combined with ribavirin. Favourable predictors of response to the former treatment are genotype 2 or 3, less than 2 million copies of HCV, no or portal fibrosis at biopsy, age less than 40 yr and female gender. The same was true for the latter treatment, however, with body weight less than 82 kg replacing female gender. Six month treatment is enough for treating genotype 2 or 3 patients whereas 12-month therapy is indicated for the more resistant patients with genotype 1 or 4.98% cure of community-acquired acute hepatitis C was achieved with early treatment with daily doses of 5MU interferon, compared to a calculated 30% virus clearance occurring in untreated patients. Cost-effective stopping rules based upon early clearance of serum HCV-RNA, are under investigation. A cut-off equal or more than 2 log decrease in serum HCV-RNA at week 12, has 97% negative predictive value and 60% positive predictive value. Treatment could be optimized also by retreatment with combination therapy of relapsers and non-responders to monotherapy, with SVR rates of 50% and 25%, respectively. Difficult-to-treat patients include patients who have high genotype 1 and 4 viremia or coinfection with HIV or hepatitis B virus as well as patients who carry an organ graft. Extended treatment of virological non responders with pegylated interferons might slow down progression of hepatic fibrosis and prevent hepatocellular carcinoma.